Formulación diagnóstica integrativa y multidimensional en psiquiatría de niños y adolescentes: presentación de un caso / Case formulation comprehensive model in child and adolescent psychiatry: a case example

Resumen En la clínica psiquiátrica infanto juvenil se aconseja realizar evaluaciones en contexto del funcionamiento individual, familiar, escolar y relacional. Es así que, una formulación de diagnósticos clínicos que cuente con un método integrativo y de múltiples perspectivas de análisis, organizada además por medio de marcos de referencias, aportará a un mejor conocimiento del estado de salud del paciente y de la multifactorialidad causal habitual de los problemas mentales. Un modelo de formulación diagnóstica (FD) se puede constituir como un componente esencial en una evaluación psiquiátrica integral guiando al psiquiatra y al residente en formación en el análisis clínico inicial de su caso, conduciéndolos desde la obtención de la información clínica y el planteamiento diagnóstico global hasta la confección de un plan de intervención. El presente articulo da cuenta del análisis clínico de un caso de una adolescente consultante a un centro de salud mental cuyo equipo de atención está constituido por residentes de un programa de psiquiatría de niños adolescentes de primer año y sus supervisores. El equipo utiliza en el análisis del caso un modelo integrativo y multidimensional de formulación diagnóstica, basado en un análisis clínico de factores de riesgo ordenado temporalmente (modelo 7P), complementado con una perspectiva de modelos psicopatológicos y un modelo de funcionamiento individual. El conocimiento de cómo realizar una FD puede estimular el pensamiento reflexivo de los residentes de psiquiatría en su práctica clínica y puede constituirse como una herramienta útil para que los supervisores clínicos guíen su enseñanza.

In psychiatric clinical practice it is recommended to assess children and adolescents in the context of their individual, familial, academic and interpersonal functioning. Therefore, the formulation of clinical diagnoses using an integrative method with multiple analytical perspectives organized by frames of reference, will contribute to a better understanding of the patient's health status and the common multifactorial causation of mental health problems. A diagnostic formulation model can constitute an essential component of the integrative psychiatric assessment, guiding the psychiatrist and resident in training in the initial clinical analysis of their case, leading them from the gathering of clinical information and global diagnostic approach to the construction of an intervention plan. The present article demonstrates the clinical analysis of a case of an adolescent who presents to a mental health center, whose care team is composed of first year residents in a child and adolescent psychiatry program and their supervisors. In the analysis of the case, the team uses an integrative and multidimensional model of diagnostic formulation based on a clinical analysis of chronologically ordered risk factors (7P model), which is complemented from the perspective of psychopathological models and an individual functioning grid. Knowing how to conduct a diagnostic formulation can stimulate psychiatry residents to think reflexively in their clinical practice and can serve as a useful tool to guide clinical supervisors in their teaching.

Vigilancia epidemiológica del virus Occidental del Nilo en las llanuras orientales de Colombia / Epidemiological surveillance of West Nile virus in the Eastern Plains of Colombia

RESUMEN Objetivo. Identificar la presencia del virus del Oeste del Nilo en equinos y mosquitos en ocho municipios del departamento del Meta. Materiales y métodos. La investigación contó con el aval del Comité de bioética de la Universidad de los Llanos. Se analizaron mediante pruebas serológicas y moleculares 613 muestras de equinos criollos y de raza cuarto de milla, destinados a actividades deportivas y de trabajo, con un rango de edad de 2 a 15 años, en los transectos: Villavicencio-Restrepo-Cumaral, San Martín - Castilla la Nueva-Granada y Puerto López-Puerto Gaitán, analizados en 62 pool y 213 mosquitos. Los pool de sueros de equinos y mosquitos fueron analizados por ELISA y PCR. Resultados. No se encontraron animales seropositivos mediante la prueba de ELISA y las pruebas moleculares también fueron negativas. Conclusiones. Aunque en este estudio no se evidenció la presencia de anticuerpos IgM por la técnica de Elisa y las pruebas moleculares (RT-PCR) también fueron negativas para circulación viral, en los municipios objeto de estudio, es importante indicar que la detección molecular en sueros, requiere unos niveles de viremia representativos y que el animal se encuentre en la fase aguda de la enfermedad. Aunque es posible que la población equina se mantenga libre de contacto con el virus, se debe mantener la vigilancia epidemiológica frente a este importante patógeno para la salud humana, especialmente por la presentación de brotes de otros virus zoonóticos como la Encefalitis Equina del Este y Encefalitis Equina Venezolana en los departamentos del Meta y Casanare, contiguo a este.

ABSTRACT Objective. Identify the presence of West Nile virus in horses and mosquitoes in eight municipalities of the department of Meta. Materials and methods. The research was supported by the Bioethics Committee of the University of Los Llanos. 613 samples of Creole and quarter-mile equine horses, intended for sports and work activities, with an age range of 2 to 15 years, were analyzed using serological and molecular tests in the transects: Villavicencio-Restrepo-Cumaral, San Martín- Castilla la Nueva-Granada and Puerto López-Puerto Gaitán, analyzed in 62 pools and 213 mosquitoes. The pool of sera of horses and mosquitoes were analyzed by ELISA and PCR. Results. No seropositive animals were found by the ELISA test and molecular tests were also negative. Conclusions. Although in this study the presence of IgM antibodies was not evidenced by the Elisa technique, and molecular tests (RT-PCR) were also negative for viral circulation, in the municipalities under study, it is important to indicate that the molecular detection in sera, it requires representative levels of viremia and that the animal is in the acute phase of the disease. Although it is possible that the equine population remains free of contact with the virus, epidemiological surveillance should be maintained against this important pathogen for human health, especially due to the outbreak of other zoonotic viruses such as Eastern Equine Encephalitis and Encephalitis Venezuelan Equine in the departments of Meta and Casanare, adjacent to this.

Carcaça e componentes não carcaça de cordeiros terminados em confinamento com caroço de algodão na dieta / Carcass and non carcass components of lambs finished in feedlot with cottonseed on the diet

O objetivo deste estudo foi avaliar as características de carcaça e dos componentes não carcaça de cordeiros terminados em confinamento, com diferentes proporções de caroço de algodão na dieta. Foram utilizados 45 cordeiros, machos, não castrados, da raça Ile de France. Os tratamentos foram constituídos por níveis de inclusão de caroço de algodão na matéria seca (MS) da dieta total (0%; 10%; 20%; 30% ou 40%), sendo a dieta composta por silagem de milho (Zea mays L.), grão de milho triturado (Zea mays L.), farelo de soja (Glycine max L.), caroço de algodão (Gossypium hirsutum L.), calcário calcítico e sal mineral, em proporção de volumoso:concentrado de 40:60. Os animais foram abatidos com peso de abate preestabelecido. O peso de carcaça quente e o peso de carcaça fria, bem como o índice de quebra ao resfriamento, o índice de compacidade, a conformação e o estado de engorduramento da carcaça, não foram influenciados (P>0,05) pelo nível de inclusão de caroço de algodão na dieta. As características de rendimento de carcaça quente e rendimento de carcaça fria diminuíram linearmente (P≤0,05) à medida que se incluiu caroço de algodão na dieta. Com relação à medida de espessura de gordura de cobertura, pode-se observar que houve comportamento quadrático crescente e, em relação à variável área de olho de lombo, o comportamento observado foi o linear decrescente. Quanto às proporções dos cortes comerciais da carcaça, o peso de perna diminuiu linearmente (P≤0,05) enquanto a porcentagem de perna foi influenciada de forma quadrática (P≤0,05) pela inclusão de caroço de algodão nas dietas. O trato gastrointestinal cheio e o conteúdo do trato gastrointestinal aumentam linearmente (P≤0,05) com o incremento do nível de inclusão de caroço de algodão na dieta. Algumas das características de carcaça e dos componentes não carcaça tiveram influência negativa da elevação do teor de fibra e de lipídios da dieta à medida que se incluiu caroço de algodão na dieta total.(AU)

The objective of this study was to evaluate the carcass and non carcass components characteristics of lambs finished in feedlot with different proportions of cottonseed on the diet. Forty five lambs, non castrated males, from Ile de France race. The treatments were constituted by levels of inclusion of cottonseed on dry matter (DM) of the total diet (0%; 10%; 20%; 30% or 40%), being the diet composed by corn silage (Zea mays L.), ground corn grain (Zea mays L.), soybean meal (Glycine max L.), cottonseed (Gossypiumhirsutum L.), limestone and mineral salt in a roughage: concentrate proportion of 40:60. The animals were slaughtered with a pre- established slaughter weight. The hot and cold carcass weight, as well as the carcass chilling index, the compactness index, the conformation and the fattening state of the carcass were not influenced (P> 0.05) by the level of inclusion of cottonseed on the diet. The hot and cold carcass yield decreased linearly (P≤ 0.05) as the cottonseed was included on the diet. Regarding the subcutaneous fat thickness it is possible to observe that there was a crescent quadratic behavior and in relation to the rib eye area variable, the behavior observed was linear decrescent. Regarding the proportions of the commercial cuts of the carcass, the leg weight decreased linearly (P≤ 0.05) while the percentage of leg was quadratic influenced (P≤ 0.05) by the inclusion of cottonseed on the diets. The full gastrointestinal tract and the gastrointestinal tract content increased linearly (P≤ 0.05) with the increase on the level of inclusion of cottonseed on the diet. Some of the carcass and non carcass components characteristics had negative influence of level fiber content and dietary lipids as it included cottonseed in the total diet.(AU)

Análise conjunta de indicadores na viabilidade econômica do confinamento de novilhos recebendo dietas com diferentes níveis de concentrado / Joint analysis of economic viability indicators of feedlot steers fed diets with different concentrate levels

O objetivo deste estudo foi avaliar a viabilidade econômica, por meio da análise conjunta de indicadores financeiros expressos por animal, da terminação em confinamento de novilhos Aberdeen Angus recebendo dietas com diferentes níveis de concentrado (NC): 25, 40, 55 ou 70% (base na matéria seca). Foram consideradas cotações históricas consecutivas dos anos de 2003 a 2014. A análise univariada caracterizou-se por delineamento inteiramente ao acaso, com quatro tratamentos e quatro repetições, procedendo-se à análise de regressão. A análise multivariada consistiu de agrupamento (cluster). Pela análise univariada, houve similaridade para os indicadores financeiros, com médias para margem bruta de R$ 173,21; margem líquida de R$ 163,73; lucro de R$ 110,61; valor presente líquido de R$ 93,31; índice benefício: custo de 1,048; retorno adicional sobre o investimento de 1,17% a.m.; taxa interna de retorno de 2,04% a.m. e payback descontado de 1,36 mês. Pela análise de cluster, o NC de 55% apresentou maior discrepância em relação aos demais níveis, enquanto 40 e 70% foram os mais próximos. A análise conjunta dos indicadores financeiros indicou viabilidade do confinamento de novilhos, independentemente do nível de concentrado.

The objective of this study was to evaluate the economic viability, through the joint analysis of financial indicators expressed by animal, of the Aberdeen Angus steers feedlot finished fed diets with different levels of concentrate (CL): 25, 40, 55 or 70% (on dry matter basis). Consecutive historical quotes of years 2003 to 2014 were considered. Univariate analysis was characterized by a completely randomized design with four treatments and four replications, proceeding regression analysis. Multivariate analysis consisted of grouping (cluster). The univariate analysis showed similarity to the financial indicators with averages to gross margin of R$ 173.21; net margin of R$ 163.73; income of R$ 110.61; net present value of R$ 93.31; benefit: cost ratio of 1.048; additional return on investment of 1.17% per month; internal rate of return of 2.04% per month and discounted payback of 1.36 months. By cluster analysis, 55% CL presented greater discrepancy in relation to other levels, while 40 and 70% were the nearest. The analysis of the financial indicators indicated feasibility of feedlot steers, regardless of the concentrate level.

Análise conjunta de indicadores na viabilidade econômica do confinamento de novilhos recebendo dietas com diferentes níveis de concentrado / Joint analysis of economic viability indicators of feedlot steers fed diets with different concentrate levels

O objetivo deste estudo foi avaliar a viabilidade econômica, por meio da análise conjunta de indicadores financeiros expressos por animal, da terminação em confinamento de novilhos Aberdeen Angus recebendo dietas com diferentes níveis de concentrado (NC): 25, 40, 55 ou 70% (base na matéria seca). Foram consideradas cotações históricas consecutivas dos anos de 2003 a 2014. A análise univariada caracterizou-se por delineamento inteiramente ao acaso, com quatro tratamentos e quatro repetições, procedendo-se à análise de regressão. A análise multivariada consistiu de agrupamento (cluster). Pela análise univariada, houve similaridade para os indicadores financeiros, com médias para margem bruta de R$ 173,21; margem líquida de R$ 163,73; lucro de R$ 110,61; valor presente líquido de R$ 93,31; índice benefício: custo de 1,048; retorno adicional sobre o investimento de 1,17% a.m.; taxa interna de retorno de 2,04% a.m. e payback descontado de 1,36 mês. Pela análise de cluster, o NC de 55% apresentou maior discrepância em relação aos demais níveis, enquanto 40 e 70% foram os mais próximos. A análise conjunta dos indicadores financeiros indicou viabilidade do confinamento de novilhos, independentemente do nível de concentrado.(AU)

The objective of this study was to evaluate the economic viability, through the joint analysis of financial indicators expressed by animal, of the Aberdeen Angus steers feedlot finished fed diets with different levels of concentrate (CL): 25, 40, 55 or 70% (on dry matter basis). Consecutive historical quotes of years 2003 to 2014 were considered. Univariate analysis was characterized by a completely randomized design with four treatments and four replications, proceeding regression analysis. Multivariate analysis consisted of grouping (cluster). The univariate analysis showed similarity to the financial indicators with averages to gross margin of R$ 173.21; net margin of R$ 163.73; income of R$ 110.61; net present value of R$ 93.31; benefit: cost ratio of 1.048; additional return on investment of 1.17% per month; internal rate of return of 2.04% per month and discounted payback of 1.36 months. By cluster analysis, 55% CL presented greater discrepancy in relation to other levels, while 40 and 70% were the nearest. The analysis of the financial indicators indicated feasibility of feedlot steers, regardless of the concentrate level.(AU)

Farmacoterapéutica de la anticoagulación. Revisión de la literatura / Pharmacotherapeutic of anticoagulation: review of literature / Farmacoterapia da anticoagulação. Revisão da literatura

La terapia anticoagulante tiene múltiples indicaciones en diversos contextos; va más allá de la prevención de la formación de \r\ntrombos o su propagación y tiene como objetivo final mejorar la calidad de vida de los pacientes. En efecto, la anticoagula\r\n-\r\nción se hace relevante en diversas situaciones clínicas que abarcan desde enfermedades crónicas hasta patologías quirúrgicas \r\ny situaciones especiales (obesidad, enfermedad renal crónica, trauma, cáncer) para evitar desenlaces adversos, tales como el \r\ntromboembolismo venoso, los estados hipercoagulables, el síndrome coronario agudo, la fibrilación y el aleteo (\r\nflutter\r\n) auricular, \r\nentre otros. En este sentido, la comprensión adecuada y la formulación de dosis óptimas de anticoagulantes recobran especial \r\nimportancia. El objetivo de este trabajo fue revisar la evidencia proveniente de estudios clínicos sobre el papel de los principales \r\nanticoagulantes orales y parenterales en el contexto de los pacientes con indicación de anticoagulación por antecedentes pato\r\n-\r\nlógicos, quirúrgicos y en situaciones especiales como las mencionadas. Existen diversos conceptos y recomendaciones sobre la profilaxis y el tratamiento anticoagulante en indicaciones habituales; sin embargo, se debe establecer un consenso de anticoagu\r\n-\r\nlación en situaciones especiales que se presentan en la práctica clínica diaria.

Anticoagulant therapy has multiple indications in diverse contexts; it \r\ngoes beyond preventing the formation and propagation of thrombi \r\nand has as its final objective improving the quality of life of patients. \r\nIn effect, anticoagulation becomes relevant in diverse clinical situ\r\n-\r\nations, ranging from chronic diseases to surgical pathologies and \r\nspecial situations (obesity, chronic kidney disease, trauma, cancer), \r\nin order to avoid adverse outcomes such as venous thromboem\r\n-\r\nbolism, hypercoagulable states, acute coronary syndrome, atrial \r\nflutter and fibrillation, among others. In this sense, adequate under\r\n-\r\nstanding and formulation of optimum doses of anticoagulants gain \r\nparticular importance.\r\nThe objective of this work was to review the evidence from \r\nclinical studies on the role of the main oral and parenteral \r\nanticoagulants in the context of patients with indication for \r\nanticoagulation for pathological, surgical and special situations \r\nlike the aforementioned. Although there are several concepts \r\nand recommendations in prophylaxis and anticoagulant \r\ntreatment in habitual indications, in special situations that are \r\npresented in daily clinical practice with patients, and for which \r\nthere is still no consensus about medications and dosages \r\noptimal, indications of anticoagulation should be established

A terapia anticoagulante tem múltiplas indicações em diversos \r\ncontextos. Além da prevenção da formação de trombos \r\nou sua propagação, ela tem como objetivo final melhorar a \r\nqualidade de vida dos pacientes. De fato, a anticoagulação é \r\nrelevante em diversas situações clínicas que abrangem desde \r\ndoenças crônicas até patologias cirúrgicas e situações especiais \r\n(obesidade, doença renal crônica, trauma, câncer) para evitar \r\nresultados adversos, tais como tromboembolismo venoso, \r\nestados hipercoaguláveis, síndrome coronária aguda, fibri\r\n-\r\nlação e flutter atrial, entre outros. Deste modo, a compreensão \r\nadequada e a formulação de doses ótimas de anticoagulantes \r\nsão particularmente importantes. O objetivo deste trabalho \r\nfoi revisar a evidência proveniente de estudos clínicos sobre \r\no papel dos principais anticoagulantes orais e parentais no \r\ncontexto dos pacientes com indicação de anticoagulação por \r\nantecedentes patológicos, cirúrgicos e em situações especiais, \r\ncomo as mencionadas. Existem diversos conceitos e reco\r\n-\r\nmendações sobre a profilaxia e o tratamento anticoagulante \r\nem indicações habituais. Entretanto, deve-se estabelecer um \r\nconsenso de anticoagulação em situações especiais que são \r\napresentadas na prática clínica diária

Estudio voltamétrico de la inmovilización de anticuerpos anti-escherichia coli atcc 25922 en electrodos de oro desnudos y modificados con tiourea / Voltammetric study of antibody immobilization anti-escherichia coli atcc 25922 on naked gold electrodes and modified with thiourea

Se realizó el estudio voltamétrico de la inmovilización de anticuerpos anti-Escherichia coli ATCC 25922 en electrodos de oro desnudos y electrodos de oro modificados con tiourea. Las cepas de Escherichia coli fueron cultivadas durante 24 horas en medio tripticasa de soya, provenientes del Laboratorio de Microbiología del Agua de la Facultad de Farmacia y Bioanálisis de la Universidad de Los Andes en Mérida-Venezuela. Los resultados obtenidos muestran que ocurre la inmovilización de los anticuerpos anti-E. coli tanto en la superficie de los electrodos de oro desnudos, así como en los modificados con tiourea, ya que en ambos casos ocurre la detección de Escherichia coli. Al comparar ambos resultados, podemos decir que en oro desnudo el potencial de pico anódico es menor que en oro modificado con tiourea, +0,158V y +0,251V respectivamente; igual comportamiento ocurre con las corrientes de pico anódicas, 0,127x10-4A y 0,156x10-4A respectivamente. Un mayor potencial implica que la presencia de la monocapa de tiourea en el electrodo, hace que se dificulte la transferencia de electrones desde el anticuerpo al electrodo. Así mismo, los resultados obtenidos permiten sugerir un método para la inmovilización de moléculas biológicas en superficies de oro modificadas. De igual forma, el método utilizado permitió demostrar la especificidad de la unión anticuerpo-antígeno (anticuerpo-E.coli), al agregar volúmenes de Klebsiella pneumoneae, demostrando que el inmunosensor tiene la capacidad de reconocer la presencia o ausencia de E. coli en un medio, así como conocer si un anticuerpo es específico o no para un determinado antígeno

The voltammetric study of immobilization of anti-Escherichia coli antibodies ATCC 25922 was carried out on naked gold electrodes and gold electrodes modified with thiourea. The strains of Escherichia coli were cultivated for 24 hours in trypticase soybean medium, from the Laboratory of Microbiology of Water of the Faculty of Pharmacy and Bioanalysis of the University of Los Andes in Merida-Venezuela. The results obtained show that the immobilization of the anti-E. coli antibodies occurs on both the surface of the naked gold electrodes as well as those modified with thiourea, since in both cases the detection of Escherichia coli occurs. When comparing both results, we can say that in naked gold the anodic peak potential is lower than in gold modified with thiourea, +0.158V and +0.251V respectively; similar behavior occurs with the anodic peak currents, 0.127x10-4A and 0.156x10-4A respectively. Higher potential implies that the presence of the thiourea monolayer in the electrode makes it difficult to transfer electrons from the antibody to the electrode. Likewise, the results obtained suggest a method for the immobilization of biological molecules on modified gold surfaces. Likewise, the method used demonstrated the specificity of antibody-antigen (antibody-E.coli) binding, by adding volumes of Klebsiella pneumoneae, demonstrating that the immunosensor has the ability to recognize the presence or absence of E. coli in a medium, as well as to know if an antibody is specific or not for a certain antigen

Consumo e desempenho de cordeiros e borregos alimentados com dietas de alto concentrado de milho ou sorgo / Intake and performance of lambs and hoggets fed high concentrate corn or sorghum diets

Objetivou-se avaliar os consumos de matéria seca, nutrientes e desempenho na terminação de cordeiros e borregos submetidos a dietas de alto concentrado de grão de milho ou sorgo. Foram utilizados 32 animais, sendo 16 cordeiros (dente de leite) e 16 borregos (dois dentes) da raça Corriedale. As dietas eram constituídas de feno de aveia- branca (Avena sativa), grão de milho (Zea mays) ou de sorgo (Sorghum bicolor (L.) Moench), farelo de soja (Glycine Max), calcário calcítico, bicarbonato de sódio e monensina. Os cordeiros apresentaram superioridade (P≤0,05) quanto ao CMS (% do PV e g/kg PV0,75), ao CPB (kg/dia, % do PV e g/kg PV0,75), ao CEE (% do PV), ao CFDN e ao CFDA (% do PV e g/kg PV0,75), ao CNDT (% do PV), ao ganho de peso médio diário, à conformação in vivo e à conversão alimentar. Por outro lado, o CEE, o CCHT e o CCNE (kg/dia), o peso vivo inicial, o peso vivo final e o peso vivo ao abate foram superiores (P≤0,05) na categoria dos borregos. Em relação aos grãos avaliados, verificou-se maior (P≤0,05) CEE (kg/dia, % do PV e g/kg PV0,75) e menor (P≤0,05) CFDN (% do PV) e CFDA (kg/dia, % do PV e g/kg PV0,75) para os animais alimentados com dieta de alto concentrado à base de grão de milho em relação àqueles alimentados com grão de sorgo. Os cordeiros apresentam consumos relativos superiores aos borregos, porém sua resposta zootécnica é maior. O uso de dietas de alto concentrado de sorgo ou de milho proporcionou resultados semelhantes.(AU)

This study aimed to evaluate the dry matter, nutrient intake, and performance on feedlot of lambs and hoggets submitted to corn or sorghum high concentrate diets. Thirty-two Corriedale animals, being 16 lambs (milk teeth) and 16 hoggets (two teeth) were used. The diets were composed of white oat hay (Avena sativa), corn (Zea mays) or sorghum grain (Sorghum bicolor (L.) Moench), soybean meal (Glycine Max), limestone, sodium bicarbonate, and monensin. The lambs presented a superiority (P≤0.05) regarding the DMI (% of LW and g/kg LW0.75), CPI (kg/day, % of LW and g/kg LW0.75), EEI (% of LW), NDFI and ADFI (% of LW and g/kg LW0.75), TDNI (% of LW), daily average weight gain, conformation in vivo and feed conversion. On the other hand, the EEI, TCI, and NSCI (kg/day), the initial live weight, final live weight and the live weight at slaughter were superior (P≤0.05) in the hoggets category. In relation to the evaluated grains, a higher (P≤0.05) EEI (kg/day, % of LW and g/kg LW0.75) and a lower (P≤0.05) NDFI (% of LW) and ADFI (kg/day, % of LW and g/kg LW0.75) were verified for the animals fed with high concentrate diets based on corn grain in relation to those fed with sorghum grain. The lambs presented an intake relatively superior to the hoggets, however their zootechnical response is higher. The use of high concentrate diets of sorghum or corn provides similar results.

Características clínicas de la niñez menor de cinco años con desnutrición aguda complicada hospitalizados en 36 hospitales de la red de servicios de Salud Pública, año 2014 / Clinical features of children under five years with complicated acute malnutrition hospitalized in 36 hospitals of the public health service network- year 2014

La desnutrición aguda es un problema grave de salud. Actualmente afecta a 52 millones de niños menores de cinco años con prevalencia de 8% a nivel mundial. el riesgo de muerte para niños con desnutrición aguda moderada y severa es de 3 y 9 veces más que los niños con un estado nutricional normal.

Prevalencia de conducta ortoréxica en estudiantes de educación media de Temuco / Prevalence of orthorexic behaviour in high school students of Temuco

This research aims to determine the prevalence of orthorexic behavior in high school students from private and municipal schools located in Temuco, city Chile. The study had a non-experimental, descriptive, cross-sectional design with a quantitative approach. A non-probabilistic approach was used for selecting the sample, which included 205 students divided into 94 females and 111 males ranging from 16 to 18 years of age. The instrument used is called "ORTHO-15". The results indicate that 30.7% of students presented orthorexic behavior, and its prevalence was higher in the municipal school (35.3%) and men (35.1%). Finally the instrument should be applied in wider populations to confirm the presence of this behavior and eventually report its effects.

La presente investigación, tiene por objetivo medir la prevalencia de conducta ortoréxica en estudiantes de Educación Media de un colegio particular pagado y un establecimiento municipal de la ciudad de Temuco, Chile. El tipo de Investigación contempla un diseño no experimental, descriptivo, transversal, con un enfoque cuantitativo. La muestra fue seleccionada bajo un criterio no probabilístico, que incluyó a 205 estudiantes, distribuidos en 94 mujeres y 111 varones, que se encontraran en el rango de los 16 a 18 años de edad. El instrumento utilizado se denomina "ORTHO-15". Los resultados indican que 30,7% de los sujetos presentaba conducta ortoréxica, el establecimiento con mayor prevalencia corresponde al municipal (35,3%), y los varones obtienen valores más altos (35,1%) respecto a las mujeres (25,5%). Finalmente se sugiere aplicar el instrumento en otras poblaciones más cuantiosas con la intención de confirmar la presencia de esta conducta y eventualmente informar sobre sus efectos.

La conducta suicida en la adolescencia y sus condiciones de riesgo / Suicidal behavior in adolescence and its risk conditions

Introducción: La conducta suicida es una gran preocupación para los clínicos que trabajan con adolescentes, siendo el suicidio una de las primeras 5 causas de muerte en adolescentes entre 15 y 19 años. La conducta suicida es una emergencia médica cuya evaluación debe ser acuciosa, sin embargo, la determinación precisa del riesgo suicida es difícil de realizar en la práctica clínica. En esta revisión, los autores analizan de la literatura tanto nacional como extranjera las características de la conducta suicida con énfasis en los factores de riesgo, las estrategias de evaluación de estos y los aspectos del manejo clínico del riesgo. Objetivo: Revisar los diferentes factores asociados con el riesgo de conducta suicida en adolescentes de manera de encontrar predictores precoces de suicidio. Método: La revisión de la literatura fue realizada usando la base de datos Medline con las siguientes palabras clave: suicide attempt, suicidal behavior, adolescents, children, suicide risk factors. Los estudios relevantes y con impacto en la práctica clínica con niños y adolescentes fueron seleccionados y revisados según criterio de los autores. Discusión: La conducta suicida se asocia a variados factores de riesgo; diversas condiciones epidemiológicas, psiquiátricas y médicas, además de eventos vitales estresantes actúan como precipitantes. El intento suicida previo y los trastornos del ánimo destacan como potentes factores de riesgo individual. Los servicios de urgencia constituyen un importante contexto de evaluación y manejo de conductas suicidas particularmente graves, por lo que debe potenciarse el desarrollo de intervenciones a este nivel y protocolizar la atención.(AU)

Introduction: Suicidal behavior is a great concern for clinicians who deal with mental health problems in adolescent. Worldwide, suicide is one of the top five causes of adolescent death between 15 and 19 years old, making of this a serious public health problem. It is a medical emergency and its evaluation must be accurate, however the exact determination of suicidal risk is difficult in the clinical practice. In this paper, the authors review the national and foreign literature to describe and analyze the characteristics of suicidal behavior, with emphasis on risk factors, strategies for evaluation and clinical management of suicidal risk. Objective: To review among different risk factors associated with suicidal behavior in adolescents, in order to find early predictors of suicide. Method: This review was systematically done using the Medline database with the following keywords: attempted suicide, suicide, adolescents, children, risks factors suicide. Relevant studies with potential impact on clinical practice were selected and reviewed. Conclusion: The suicide behavior is not associated with a single risk predictor, but to different epidemiological, psychiatric and known medical conditions and stressful vital events acting as precipitants. Prior suicide attempt stands out as the most powerful risk factor to retry. Emergency services are an important setting for evaluation and management of particularly serious suicidal behavior and should be enhanced the development of interventions at this level.(AU)

Proceso de atención de Enfermería, a una adolescente con dependencia en la necesidad de oxigenación por ventrículo único / Nursing Assisting Process to a single ventricle heart teenager with an oxygen deficit

Las personas con ventrículo único, enfrentan diversas limitaciones que requieren cuidados especializados de Enfermería; esta patología se caracteriza por la presencia de una sola cámara ventricular lo que conlleva a un cortocircuito de la circulación sanguínea de derecha a izquierda a nivel cardiaco, con la consiguiente hipoxemia. Ante estos casos, se exige una particular competencia profesional para otorgar cuidados de calidad, cualquier intervención de Enfermería se rige por criterios éticos que pueden resumirse en trabajar con sentido de responsabilidad y lealtad hacia el paciente, familia y comunidad. El propósito de este artículo es dar a conocer el Proceso de Atención de Enfermería a una adolescente con alteración en la necesidad de Oxigenación, basado en el modelo teórico de las 14 necesidades de Virginia Henderson; en la valoración se utilizó un instrumento especifico, se identificó la necesidad de oxigenación, como la de mayor dependencia, de los datos obtenidos se formularon 2 diagnósticos, para los cuales se planearon intervenciones y cuidados específicos, y se evaluaron consecutivamente a su ejecución los resultados obtenidos, la persona no presentó datos de descompensación hemodinámica, sin embargo debido a la complejidad de la patología no fue posible disminuir el nivel de dependencia.

Persons with a single ventricle face several limitations and require specialized nursing care. This problem is characterized by a right left cardiac blood flux shortcut which leads to hypoxia. In these cases, a special professional competence is required in order to provide quality of care. Any nursing intervention should be ethically oriented towards the patient, family, and community. The objective of this article is to show the Nursing Assisting Process in a teenager with oxygen-needs alterations. The theoretical model was based on the 14 needs proposed by Virginia Henderson. A specific instrument was used. From the obtained data, two major diagnoses were established, and specific care interventions were planned and assessed. The patient did not show major signs of hemodynamic unbalances however, due to the complexity of the pathology, it was not possible to reduce the patient's level of oxygen dependence.

Maternal protein restriction affects gene expression and enzyme activity of intestinal disaccharidases in adult rat offspring

This study investigated the consequences of intrauterine protein restriction on the gastrointestinal tract and particularly on the gene expression and activity of intestinal disaccharidases in the adult offspring. Wistar rat dams were fed isocaloric diets containing 6% protein (restricted, n = 8) or 17% protein (control, n = 8) throughout gestation. Male offspring (n = 5-8 in each group) were evaluated at 3 or 16 weeks of age. Maternal protein restriction during pregnancy produced offspring with growth restriction from birth (5.7 ± 0.1 vs 6.3 ± 0.1 g; mean ± SE) to weaning (42.4 ± 1.3 vs 49.1 ± 1.6 g), although at 16 weeks of age their body weight was similar to control (421.7 ± 8.9 and 428.5 ± 8.5 g). Maternal protein restriction also increased lactase activity in the proximal (0.23 ± 0.02 vs 0.15 ± 0.02), medial (0.30 ± 0.06 vs 0.14 ± 0.01) and distal (0.43 ± 0.07 vs 0.07 ± 0.02 U·g-1·min-1) small intestine, and mRNA lactase abundance in the proximal intestine (7.96 ± 1.11 vs 2.38 ± 0.47 relative units) of 3-week-old offspring rats. In addition, maternal protein restriction increased sucrase activity (1.20 ± 0.02 vs 0.91 ± 0.02 U·g-1·min-1) and sucrase mRNA abundance (4.48 ± 0.51 vs 1.95 ± 0.17 relative units) in the duodenum of 16-week-old rats. In conclusion, the present study shows for the first time that intrauterine protein restriction affects gene expression of intestinal enzymes in offspring.

Características da carcaça e do corpo vazio de bovinos Charolês de diferentes categorias abatidos com similar grau de acabamento / Carcass characteristics and empty body of Charolais cattle of different categories slaughtered at similar degree of fatness

Avaliaram-se as características de carcaça e do corpo vazio de novilhos (NO), novilhas (NA) e vacas de descarte (VA) Charolês n= 9, 10 e 10, respectivamente, terminados em confinamento e abatidos com similar grau de acabamento. O peso de abate e o peso de corpo vazio (PCVZ) foram similares entre NO, 480,2 e 417,4kg, e VA, 516,2 e 405,8kg, e maiores do que os das NA, 368,3 e 306,1kg. O rendimento de carcaça quente diferiu entre as categorias, sendo 57,2, 53,3 e 50,5%, respectivamente, para NO, NA e VA. Com o rendimento de carcaça quente expresso em relação ao PCVZ, as diferenças entre categorias diminuíram, sendo significativas apenas entre NO e NA. O conteúdo do trato digestivo das VA foi 34 e 45% maior que o dos NO e NA, respectivamente, sendo correlacionado (P<0,05) com peso de abate (r=0,66) e rendimento de carcaça quente (r=-0,41). O peso de carcaça quente foi similar entre NO, 274,9kg, e VA, 260,8kg, e maior que o NA, 196,4kg. O comprimento de carcaça foi maior nas VA, intermediário nos NO e menor nas NA. A área do músculo Longissimus dorsi foi menor nas NA. Novilhos apresentaram melhor conformação de carcaça que as fêmeas, as quais não diferiram entre si.

The carcass characteristics and empty body of Charolais steers n=9, cull heifers n= 10, and cull cows n=10, feedlot finished with similar subcutaneous fat thickness were evaluated. The slaughter weight and empty body weight (EBW) were similar between steers (480.2 and 417.4kg) and cows (516.2 and 405.8kg), which were higher than for heifers (368.3 and 306.1kg). Hot carcass dressing was significantly different among categories, being 57.2, 53.3 and 50.5%, respectively, for steers, heifers and cows. When carcass dressing was expressed in relation to EBW the differences became smaller among categories, being significant only between steers and heifers. The digestive tract content of cows was 34 and 45% higher than for steers and heifers, respectively, being correlated (P<0.05) with slaughter weight (r=0.66) and hot carcass dressing (r=-0.41). Hot carcass weight was similar for steers (274.9kg) and cows (260.8kg), both superior to heifers (196.4kg). Carcass length was higher for cows, intermediate for steers and lower for heifers. The Longissimus dorsi area was smaller for heifers. Steers showed better carcass conformation score than females, which did not differ between themselves.

Efecto de la concentración alginato-calcio sobre las propiedades físicas y sensoriales de extensores grasos / Effect of alginate/calcium concentrationon physical and sensory properties of fat extenders

The fat extenders are fat replacer that can be used to provide some or all of the functions of fat in the meat products, yielding fewer calories than fat. The influence of several sodium alginate (0.69% - 2.81%) and calcium carbonate (0.21% - 0.84%) concentrations on the texture, melting point, and sensory properties of fat extenders made from pork back fat, and a mixture of the above two variables have been studied using a varying central composite design and response surfaces. Sodium alginate and calcium carbonate concentration revealed a significant effect (p ≤ 0.05) on the texture parameters. In melting properties, there were not significant effects (p ≤ 0.05) on the established limit for variables, except for melting peak temperature. In sensory attributes, they had significant differences (p ≤ 0.05) between fat extenders and the standard, in regard to shine, color and hardness. Therefore, fat extenders made with the addition of 1.0% sodium alginate and 0.79% calcium carbonate displayed textural and melting point properties with higher values in comparison with other treatments, along with sensory characteristics closer to the standard.

Cosmovisión ancestral y comprensión de los conceptos salud, cuidado y enfermería en habitantes del resguardo muisca de Chía, 2010 / Ancestral worldview and understanding of the concepts of health, care and nursing in the population of a muisca reservation in Chía, 2010

El reconocimiento, fortalecimiento y recuperación de prácticas de cuidado en culturas diversas favorece la calidad de las acciones de enfermería; el Enfoque Biopsicosocial, cultural y espiritual y la teoría Transcultural aportan a este objetivo y sirven de soporte al diseño de estrategias orientadas a preservar, adaptar y reestructurar los cuidados culturales; acciones que desde la comprensión de la salud en este grupo, se propone sean lideradas por el profesional de enfermería. La investigación descriptiva cualitativa contó con la participación voluntaria de familias y líderes muiscas reconocidos como cuidadores por la comunidad; se presenta como abordaje metodológico que posibilita reconocer la comprensión actual de los conceptos salud, cuidado y enfermería. La información recolectada mediante la observación, encuestas y entrevistas, en las categorías enunciadas, se analizó por triangulación de fuentes y de investigadores. Se identificó un marcado proceso de aculturación en las tres categorías analizadas: el concepto “cuidado” guarda mayor proximidad con la cosmovisión ancestral; la comprensión de la salud no incorpora dimensiones reconocidas ancestralmente; y, la enfermería se identifica como un “quehacer” propio del género femenino que articula las dimensiones comunicacional, afectiva y de protección próximas a lo descrito como cuidado por los líderes en salud ancestrales.

Factores relacionados a la adherencia a tratamiento en adolescentes con depresión / Factors associated with treatment adherence in adolescents with depression

Introduction: Mood disorders prevalence during adolescence has increased. Unfortunately, the greatest number of diagnosis is not a synonym of treatment success because this depends, among others factors, on the treatment adherence. In fact, mental health research has shown consistently high rates of treatment non-adherence. Nevertheless, the literature has been focused mainly on adult populations, and only a few articles describe adolescent adherence. Objectives: To review the different factors associated with treatment adherence in adolescents with depression and to describe theoretical models that can help improving adherence in this population. Method: Review of current research and adherence theories related to adherence in adolescents with different pathologies, adults with mood disorders and especially in adolescent depression. Conclusion: Cognitive factors related to personal and family beliefs and attitudes towards mental health disorders and medication, biological and psychological factors related to the developmental stage like emotional regulation, self-esteem, self-efficacy and adolescent-parent relationship are very important factors associated to medication adherence in adolescents. The therapeutic relationship might help to improve adherence by shaping these factors, building trust, cooperation, patient and family commitment to behavior change and giving information.

Desafortunadamente la prevalência de los trastornos depresivos en la adolescencia se ha visto incrementada en los últimos años. Un mayor diagnóstico no conlleva necesariamente a un tratamiento exitoso, debido, entre otros factores, a la pobre adherencia al tratamiento con medicamentos en la adolescencia. De hecho, los estudios en salud mental demuestran que un importante número de pacientes no adhieren a los tratamientos farmacológicos. Sin embargo, estos estudios se centran principalmente en pacientes adultos y pocos en la población infanto juvenil. Nuestro artículo tiene por objetivo conocer de un modo general los factores que están en juego en la adherencia a tratamiento medicamentosos antidepresivo en adolescentes con trastorno del ánimo, y describir un modelo que pueda ayudar a intervenir clínicamente en favor de una mayor adherencia terapéutica.

Diferencias clínicas entre adolescentes hospitalizados por intento suicida y adolescentes hospitalizados por otra causa psiquiátrica / Clinical differences between suicide and non suicide attempter hospitalized adolescents

Background: Suicide is the third cause of death among adolescents in United States and between 5 to 12 percent of teenagers have a history of suicide attempt. Therefore, suicide is a public health problem in this age group. Aim: To compare the clinical characteristics of hospitalized adolescents who attempted suicide with those without a history of suicide attempt. Material and Methods: The clinical records of adolescents aged less than 18years, hospitalized in a psychiatric clinic, were analyzed. Forty six patients aged 15 ±2years (72 percent females) had a history of suicide attempt and were considered cases and 81 patients aged 15 ±2 years (52 percent females) did not have a history of suicide attempt and were considered controls. Demographical and clinical characteristics of both groups were compared. Psychiatric diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV). Results: No significant differences were found between groups in the length of hospital stay. The most common psychiatric diagnosis was depressive disorder, found in 71 and 35 percent of suicide and non-suicide attempters, respectively (p < 0.01). Personality diagnosis was deferred in most studied cases. Conclusions: Depression is more common among hospitalized adolescents who attempt suicide.

Trastorno de ansiedad por separación / Separation anxiety disorder and developmental separation anxiety

Anxiety disorders constitute the most common psychiatric diseases in children. These disorders predict an increase in the risk of later anxiety disorders, mayor depression and hospitalization for psychiatric pathology. The primary feature of Separation Anxiety Disorder is developmentally inappropriate anxiety sufficient to cause clinically significant distress or impairment when faced with separation from home or major attachment figures. Drugs that selectively inhibit serotonin reuptake, psychotherapy and parent education constitute effective treatments for children and adolescents with anxiety disorders. Pediatricians and other health care professionals are in a unique position to assist families in understanding the etiology, prevention and treatment of separation anxiety disorder. Early identification in pediatric primary care and effective management may help improve outcome. The objective of our review is to analyze clinical and therapeutic aspects of the Separation Anxiety Disorder and its differences with Separation Anxiety as an expression of the evolutionary emotional development in children.

Los trastornos por ansiedad son cuadros clínicos psiquiátricos frecuentes y predicen un riesgo aumentado de presentar posteriormente trastornos ansiosos y depresivos, además de hospitalizaciones por causa psiquiátrica. El trastorno por ansiedad de separación tiene como característica principal ansiedad excesiva e inapropiada para el desarrollo del niño, concerniente a su separación respecto de las personas con quienes está vinculado. El uso de fármacos, psicoterapia y apoyo parental son medidas terapéuticas eficaces. Los pediatras pueden ser los primeros profesionales que tomen contacto clínico con los niños y realicen la primera aproximación diagnóstica y terapéutica. El propósito de nuestra revisión es analizar aspectos clínicos y terapéuticos del trastorno de ansiedad por separación y sus diferencias con la ansiedad de separación propia del desarrollo emocional del niño.

Silagem de milho e grão de sorgo como suplementos para vacas de descarte terminadas em pastagem cultivada de estação fria / Corn silage and sorghum grain supplementation to cull cows finished on cultivated winter pasture

Avaliou-se o efeito da suplementação com silagem de milho ou grão de sorgo no desempenho e características da carcaça e da carne de vacas de descarte, submetidas ao pastejo restrito em pastagem de aveia (Avena strigosa) + azevém (Lolium multiflorum). Foram utilizadas 30 vacas mestiças Charolês-Nelore, com idade média de oito anos, distribuídas em igual número e ao acaso em três tratamentos: silagem de milho (TSI) ou grão de sorgo moído (TSO) como suplemento, e não suplementação (TPH). A suplementação com silagem de milho proporcionou aos animais maior escore corporal ao final do experimento (4,35 pontos contra 4,15 do TPH e 4,22 pontos para o TSO). Não houve efeito do volumoso ou concentrado suplementar sobre o peso corporal, ganho de peso diário e ganho em escore corporal. Não houve efeito de tratamento (P>0,05) sobre pesos e rendimentos quentes e frios da carcaça, espessura de gordura subcutânea, conformação, espessura de coxão, área de Longissimus dorsi e percentagem de cortes comerciais. A suplementação resultou em maior percentagem de gordura na carcaça e influenciou a cor e o marmoreio da carne. A silagem de milho e o grão de sorgo servem como alternativa para a suplementação de vacas de descarte em pastagem de aveia e azevém, uma vez que melhora as características da carcaça, embora sem efeito sobre o desempenho quando comparado à pastagem exclusiva.

The effect of supplementation with corn silage or sorghum grain on the performance and characteristics of carcass and meat of cull cows, under temporary grazing on oats (Avena strigosa) + ryegrass (Lolium multiflorum) pasture was evaluated. Thirty crossbred Charolais-Nellore cull cows, with averaging eight-yearold,were randomly distributed in three treatments. The animals received corn silage (TSI) or sorghum grain (TSO) as supplement, while another lot did not receive supplementation (TPH). Animals supplemented with corn silage showed higher final body condition score (4.35 points versus 4.15 for TPH and 4.22 for TSO). No effect of supplementation on body weight, average daily weight gain; and body condition score gain were verified. Differences were not observed concerning carcasses weight, hot and cold yield of carcasses, fat thickness, conformation, cushion thickness, Longissimus dorsi area, and commercial cuts percentages. Supplemented animals showed better color and higher marbling of meat. Corn silage and sorghum grain are alternative for the supplementation of cull cows in oats and ryegrass pasture, since they showed better carcass characteristics, although no effect on the performance in relation to exclusive pasture was detected.