Pseudotumor inflamatorioocular asociado a IgG4. Reporte de un caso / IgG4-Associated Ocular Inflammatory Pseudotumor. A Case Report

Resumen Introducción: El pseudotumor inflamatorio ocular asociado a IgG4 es un proceso inflamatorio no neoplásico y poco frecuente con una incidencia de 0.28-1.08 por cada 100,000 personas. El diagnóstico de esta patología es de exclusión debiendo cumplir criterios histopatológicos, agrandamiento de un órgano en específico y concentraciones serias de IgG4. El tratamiento tiene como objetivo evitar las complicaciones secundarias. Caso clínico: Mujer de 54 años de edad sin patologías previas referidas, acude refiriendo que 6 meses previos presenta de forma súbita y sin causa aparente prurito a nivel de globo ocular y párpado izquierdo, además de disminución de la agudeza visual y dolor retroocular, motivo por el que acude a valoración. Al examen físico presentó movimientos oculares normales, proptosis izquierda, dolor a la palpación, hiperemia subconjuntival, opacidad corneal, ausencia de reflejo rojo y más renitente a la presión el ojo izquierdo en relación con el contralateral. Tomografía cráneo-toraco-abdominal reporta a nivel ocular izquierdo imágenes sugestivas de melanoma coroideo sin hallazgos de actividad metastásica. Se realiza enucleación de ojo izquierdo. Se envía pieza a patología la cual reporta infiltrado difuso linfoplasmocítico positivas para IgG4. Conclusión: La enfermedad por IgG4 ocular es una patología muy infrecuente de clínica inespecífica y diagnóstico complejo. Sin embargo, un abordaje rápido y correcto es fundamental para evitar complicaciones.

Abstract Introduction: IgG4-associated ocular inflammatory pseudotumor is a rare, non-neoplastic inflammatory process with an incidence of 0.28-1.08 per 100,000 people. The diagnosis of this pathology is one of exclusion, having to meet histopathological criteria, enlargement of a specific organ, and serious concentrations of IgG4. Treatment aims to avoid secondary complications. Clinical case: A 54-year-old woman with no previous reported pathologies, reports that for the past 6 months she has itching at the level of the eyeball and the left eyelid, suddenly and without apparent cause, in addition to decreased visual acuity and retro-ocular pain; this is why she asked for the evaluation. The physical examination revealed normal eye movements, left proptosis, pain on palpation, subconjunctival hyperemia, corneal opacity, absence of red reflex, and the left eye being more resistant to pressure in relation to the contralateral eye. The cranio-thoraco-abdominal tomography reported images at the left ocular level that were suggestive of choroidal melanoma without findings of metastatic activity. Enucleation of the left eye was performed. The specimen was sent to pathology which reported diffuse lymphoplasmacytic infiltrate positive for IgG4. Conclusion: Ocular IgG4 disease is a very rare pathology with non-specific symptoms and complex diagnosis. However, a quick and correct approach is essential to avoid complications.

Trombosis venosa mesentérica y portal como causa infrecuente de obstrucción e isquemia intestinal en paciente joven. Reporte de caso / Mesenteric and Portal Venous Thrombosis as an infrequent cause of intestinal Obstruction and Ischemia in young patients. A case report

Resumen La isquemia mesentérica aguda se asocia a una mortalidad de entre el 50 y el 100%, la causa más rara de esta es la trombosis venosa de los vasos mesentéricos (5%) y portal (1%). Las manifestaciones clínicas son diversas, siendo el dolor abdominal el principal síntoma. La tomografía computarizada con contraste intravenoso en fase portal es la imagen más precisa para el diagnóstico. El tratamiento en fase aguda se basa en anticoagulación, fluidos intravenosos, antibióticos profilácticos, descanso intestinal y descompresión. La laparotomía de control de daños, incluida la resección intestinal y el abdomen abierto, pueden estar justificados en última instancia para pacientes con necrosis intestinal y sepsis. Caso clínico: Hombre de 35 años, sin antecedentes de importancia, solo tabaquismo desde hace 15 años. Refirió que 5 días previos comenzó a presentar dolor en el epigastrio tipo cólico, de intensidad moderada, posteriormente refirió que el dolor se generalizó y aumentó de intensidad, acompañado de náusea, vómito, intolerancia a la vía oral y alza térmica. Al examen físico tuvo datos de respuesta inflamatoria sistémica, estaba consciente y orientado, con abdomen doloroso a la palpación superficial y profunda a nivel generalizado, pero acentuado en el flanco derecho, rebote positivo con resistencia, timpanismo generalizado, peristalsis ausente. Se ingresó a quirófano a laparotomía exploradora, encontrando lesión a intestinal isquémica-necrótica a 190-240 cm del ángulo de Treitz, y 400 cc de líquido hemático; se realizó resección de la parte intestinal afectada, con entero-enteroanastomosis término-terminal manual. Se envió pieza a patología, y se reportó un proceso inflamatorio agudo con necrosis transmural y congestión vascular. Ante estos hallazgos se realizó angiotomografía abdominal que reportó defecto de llenado en la vena mesentérica superior, secundario a trombosis que se extendía hasta la confluencia y la vena porta. Conclusión: La trombosis venosa mesentérica y portal es una patología muy infrecuente en pacientes jóvenes sin factores de riesgo en los que se presenta dolor abdominal. El diagnóstico es complejo debido a que los datos clínicos y de laboratorio son poco específicos. Sin embargo, debemos tenerla en cuenta en el diagnóstico diferencial de etiologías de dolor abdominal.

Abstract Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis. Clinical case: 35-year-old man, with no significant history, only smoking for 15 years. For 5 days before, he reported crampy epigastric pain of moderate intensity. He subsequently reported that the pain became generalized and increased in intensity, accompanied by nausea, vomiting, oral intolerance, and temperature rise. The physical examination showed signs of a systemic inflammatory response, conscious and oriented, abdomen painful on superficial and deep palpation at a generalized level but accentuated on the right flank, positive rebound with resistance, generalized tympanism, absent peristalsis. The operating room was entered for exploratory laparotomy, finding an ischemic-necrotic intestinal lesion at 190 - 240 cm from the angle of Treitz, and 400cc of blood fluid. Resection of the affected intestinal part is performed, with entire manual terminal end anastomosis. The specimen was sent to pathology, reporting an acute inflammatory process with transmural necrosis and vascular congestion. Given these findings, abdominal CT angiography was performed, which reported a filling defect in the superior mesenteric vein, secondary to thrombosis that extended to the confluence and the portal vein. Conclusion: Mesenteric and portal venous thrombosis is a very rare pathology in young patients without risk factors in whom abdominal pain occurs. The diagnosis is complex because the clinical and laboratory data are not very specific. However, we must take it into account in the differential diagnosis of abdominal pain etiologies.

Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

Abstract Background: Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades. Objectives: To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events. Methods: This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests. Results: The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001). Conclusions: A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Abstract Background: It is estimated that more than 30% of the Brazilian population has systemic arterial hypertension (SAH), and mostly as an uncontrolled disease. The most recent Brazilian Guideline of Hypertension recommends the practice of self-measurement of blood pressure (BP) as one of the strategies for a better control of SAH, but there is no consensus about the efficiency of this tool. Objective: To assess the control of SAH and the practice of non-targeted self-measured BP (SMBP) among hypertensive users of the Unified Health System (SUS) and the Supplementary Network (SN). Methods: This is a cross-sectional, observational, analytical study, with a stratified probability sample. One thousand volunteers were investigated, being 500 from SUS and 500 from the SN. Uni and multivariate analyses were performed considering a 5% significance level. Results: Patients from SUS presented inferior sociodemographic data (schooling, social status) in relation to those of the SN (p < 0.001), and showed lower control of SAH (p = 0.014), as well as more visits to the emergency room in the past year due to hypertension (p = 0.002), and fewer regular appointments with the cardiologist (p = 0.004). SMBP was equally present in both assessed groups (p = 0.567), even though users of the SN have been more advised to not conduct such a practice (p = 0.002). SMBP (p < 0.001) was an independent factor for uncontrolled SAH both in SUS (OR = 3.424) and in the SN (OR = 3.474). Conclusion: Patients in SUS presented lower SAH control. The practice of SMBP, mostly practiced with an uncalibrated digital device, was equally present in both groups and became an independent factor of uncontrolled SAH.

Influencia de la enfermedad periodontal en la aterosclerosis

Introducción: La enfermedad periodontal ha sido identificada como un factor de riesgo para enfermedades del corazón. La falta de hábitos de higiene bucal asociados a factores de riesgo puede conducir al desarrollo de periodontitis, lo que conducirá a un aumento de mediadores inflamatorios en la sangre, lo que es un riesgo potencial para el desarrollo del proceso de aterosclerosis. Objetivo: Evaluar en la literatura la influencia de la enfermedad periodontal en las enfermedades cardiovasculares, especialmente en relación con la aterosclerosis. Método: Consistió en una búsqueda en libros y artículos científicos, con la utilización de palabras clave asociadas, así como artículos seleccionados en las bases de datos SciELO, PubMed, Scopus, de lo cual se obtuvieron alrededor de 40 bibliografías, que fueron decantadas a 35, de ellas el 50 % actualizadas. Resultados: estudios de metaanálisis apoyan una relación causal entre la enfermedad periodontal y la cardiopatía, lo que demuestra que el riesgo de desarrollar algunas complicaciones vasculares se encontró aumentado en pacientes con problemas periodontales. Conclusiones: Se hace relevante evaluar la relación de estas enfermedades y los mecanismos implicados, para poder elaborar medidas preventivas.

Introduction: Periodontal disease has been identified as a risk factor for heart disease. The lack of oral hygiene habits associated with risk factors can lead to the development of periodontitis, which will lead to an increase in inflammatory mediators in the blood, which is a potential risk for the development of the atherosclerosis process. Objective: To evaluate in the literature the influence of periodontal disease on cardiovascular diseases, especially in relation to atherosclerosis. Method: It consisted of a search in books and scientific articles, with the use of associated keywords, as well as selected articles in the SciELO, PubMed, Scopus databases, from which around 40 bibliographies were obtained, which were narrowed down to 35, of them 50% updated. Results: Meta-analysis studies support a causal relationship between periodontal disease and heart disease, demonstrating that the risk of developing some vascular complications was found to be increased in patients with periodontal problems. Final considerations: It is relevant to evaluate the relationship between these diseases and the mechanisms involved, in order to develop preventive measures.

Introdução: A doença periodontal tem sido apontada como fator de risco para doenças cardíacas. A falta de hábitos de higiene bucal associada a fatores de risco pode levar ao desenvolvimento de periodontite, o que levará ao aumento de mediadores inflamatórios no sangue, o que representa um risco potencial para o desenvolvimento do processo de aterosclerose. Objetivo: Avaliar na literatura a influência da doença periodontal nas doenças cardiovasculares, principalmente em relação à aterosclerose. Método: Consistiu na busca em livros e artigos científicos, com utilização de palavras-chave associadas, bem como em artigos selecionados nas bases de dados SciELO, PubMed, Scopus, dos quais foram obtidas cerca de 40 bibliografias, que foram reduzidas a 35, de eles 50% atualizados. Resultados: Estudos de meta-análise apoiam uma relação causal entre doença periodontal e doença cardíaca, demonstrando que o risco de desenvolver algumas complicações vasculares foi aumentado em pacientes com problemas periodontais. Considerações finais: É relevante avaliar a relação entre estas doenças e os mecanismos envolvidos, para desenvolver medidas preventivas.

Diferencia de niveles de dímero D ante la presencia de hipoxemia severa en pacientes con neumonía por SARS-CoV-2 ingresados a terapia intensiva / Difference in D-dimer levels in the presence of severe hypoxemia in patients with SARS-CoV-2 pneumonia admitted to therapy intensive / Diferença nos níveis de dímero D na presença de hipoxemia grave em pacientes com pneumonia por SARS-CoV-2 internados em terapia intensiva

Resumen Introducción: El SARS-CoV-2 se desconocía hasta el brote en Wuhan, China en diciembre de 2019, las características ultraestructurales de este virus con predisposición a receptores expresados en los neumocitos tipo II (CD209L y ECA2) resultan en daño alveolar difuso y un tercio de los pacientes con SARS-CoV-2 cumplen criterios de SIRA con hipoxemia severa. Tras el curso severo de la enfermedad y alta mortalidad se reportó en estudios la asociación del dímero D (DD) con casos graves y atribuyéndose al estado protrombótico de la enfermedad, contribuyendo directamente en ventilación mecánica prolongada y muerte. Objetivo principal: Determinar los diferentes niveles de dímero D ante la presencia de hipoxemia severa en pacientes con neumonía por SARS-CoV-2 ingresados en la terapia intensiva. Material y métodos: Estudio transversal comparativo retrospectivo unicéntrico, se revisaron expedientes de pacientes mayores de 18 años que ingresaron a la Unidad de Cuidados Intensivos con diagnóstico de neumonía por SARS-CoV-2; se tomaron en cuenta los valores de DD al ingreso, al séptimo día y la relación PaO2/FiO2 de gasometrías arteriales. Definimos hipoxemia severa PaO2/FiO2 menor de 150 mmHg y tras prueba U de Mann-Whitney se evaluaron niveles de DD, curva de ROC y AUC para punto de cohorte de DD y la asociación con terapia de aporte de oxígeno y su desenlace con OR e IC95%. Resultados: Se estudiaron expedientes de 82 pacientes, 81.7% presentó hipoxemia severa al ingreso, y 74.4% al séptimo día; se reportó una mediana de DD de 1,410 ng/mL con hipoxemia severa y al séptimo día 2,238 ng/mL (p = 0.001). Curva ROC encontró DD 1,500 ng/mL como punto de cohorte asociado a hipoxemia severa (AUC: 0.808, IC al 95% 0.706-0.910). En escalas pronósticas reportó mayor puntuación, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), y SAPS II (67 pts, p ≤ 0.0001); así como en defunciones (81.6%, p ≤ 0.0001, OR 16.50 IC al 95% 5.472-49.80). Conclusión: Dímero D mayor y/o igual a 1,500 ng/mL se asocia con hipoxemia severa y con mayor mortalidad al séptimo día de estancia en UCI, indicándonos que el DD es un potencial marcador temprano y útil para guiar la terapéutica y evaluar el pronóstico del paciente.

Abstract Introduction: SARS-CoV-2 was unknown until the outbreak in Wuhan, China in December 2019, the ultra-structural characteristics of this virus with predisposition to receptors expressed in type II pneumocytes (CD209L and ECA2), results in diffuse alveolar damage and a third of the patients with SARS-CoV-2 meet criteria for SIRA with severe hypoxemia. After the severe course of the disease and high mortality, the association of DD with severe cases was reported in studies and attributed to the prothrombotic state of the disease, directly contributing to prolonged mechanical ventilation and death. Main objective: To determine the different levels of DD in the presence of severe hypoxemia in patients with SARS-CoV-2 pneumonia admitted to intensive care. Material and methods: Cross-sectional retrospective single-center study, records of patients older than 18 years who were admitted to the intensive care unit with a diagnosis of SARS-CoV-2 pneumonia were reviewed; DD values on admission, on the seventh day and the PaO2/FiO2 ratio of arterial blood gases were considered. We defined severe hypoxemia PaO2/FiO2 less than 150 mmHg and after the Mann-Whitney U test, DD levels, ROC curve and AUC were evaluated for the DD cohort point and the association with oxygen supply therapy and its outcome with OR and HF 95%. Results: Records of 82 patients were studied, 81.7% presented severe hypoxemia on admission, and 74.4% on the seventh day; A median DD of 1,410 ng/mL was reported with severe hypoxemia and 2,238 ng/mL on the seventh day (p = 0.001). ROC curve found DD 1,500 ng/mL as a cohort point associated with severe hypoxemia (AUC: 0.808, 95% CI 0.706-0.910). On prognostic scales I report a higher score, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), and SAPS II (67 pts, p ≤ 0.0001); as well as in deaths (81.6%, p ≤ 0.0001, OR 16.50 95% CI 5.472-49.80). Conclusion: DD greater than and/or equal to 1,500 ng/mL is associated with severe hypoxemia and higher mortality on the seventh day of stay in the ICU, indicating that DD is a potential early and useful marker to guide the therapy and evaluate the prognosis of the patient.

Resumo Introdução: O SARS-CoV-2 era desconhecido até o surto em Wuhan, China, em dezembro de 2019, as características ultraestruturais desse vírus com predisposição a receptores expressos em pneumócitos tipo II (CD209L e ACE2), resultando em dano alveolar difuso e um terço dos pacientes com SARS-Cov-2 atendem aos critérios para SDRA com hipoxemia grave. Após o curso grave da doença e alta mortalidade, estudos relataram a associação do D-Di com casos graves e atribuindo-se ao estado pró-trombótico da doença, contribuindo diretamente para ventilação mecânica prolongada e óbito. Objetivo principal: Determinar os diferentes níveis de dímero-D na presença de hipoxemia grave em pacientes com pneumonia por SARS-CoV-2 internados em terapia intensiva. Material e métodos: Estudo transversal comparativo retrospectivo unicêntrico, foram revisados prontuários de pacientes maiores de 18 anos admitidos na unidade de terapia intensiva com diagnóstico de pneumonia por SARS-CoV-2; foram considerados os valores de D-Di na admissão, no sétimo dia e a relação PaO2/FiO2 da gasometria arterial. Definimos hipoxemia grave PaO2/FiO2 menor que 150 mmHg e após o teste U de Mann-Whitney, os níveis de D-Di, curva ROC e AUC foram avaliados para o ponto de coorte D-Di e a associação com oxigenoterapia e seu desfecho com OR e IC 95%. Resultados: Foram estudados prontuários de 82 pacientes, 81.7% com hipoxemia grave na admissão e 74.4% no sétimo dia; relatou-se um D-Di médio de 1,410 ng/mL com hipoxemia grave e 2,238 ng/mL no sétimo dia (p = 0.001). A curva ROC encontrou D-Di 1,500 ng/mL como um ponto de coorte associado à hipoxemia grave (AUC: 0.808, IC 95% 0.706-0.910). Em escalas de prognóstico, APACHE II (24 pontos, p = 0.036), SOFA (12 pts, p = 0.012) e SAPS II (67 pts, p ≤ 0.0001); bem como em óbitos (81.6%, p ≤ 0.0001, OR 16.50, IC 95% 5.472-49.80). Conclusão: O D-Di maior e/ou igual a 1,500 ng/ml está associada à hipoxemia grave e maior mortalidade no sétimo dia de internação na UTI, indicando que o D-Di é um potencial marcador precoce e útil para orientar a terapia e avaliar o prognóstico do paciente.

Infecção pelo sars-cov-2 e disfunção autonômica ­ labilidade pressórica na covid-19 / Sars-cov-2 infection and autonomic dysfunction - pressure liability at covid-19

Homem de 53 anos, hipertenso e portador de bronquite, admitido em um serviço de urgência no dia 15 de dezembro de 2020 devido sintomas gripais, febre e cefaleia iniciados há oito dias. Após constatação de acometimento pulmonar importante mediante tomografia computadorizada (TC) de tórax, sugestivo de infecção pelo vírus SARS-CoV2, o paciente foi internado em unidade de terapia intensiva. Foi intubado no décimo dia de internação, e, dois dias após, evoluiu com labilidade pressórica importante, recorrendo ao uso de noradrenalina e nitroprussiato, além de outros anti-hipertensivos, conforme a necessidade. O quadro predominante foi a hipertensão arterial sistêmica, manifestada principalmente com a mudança de decúbito, sendo o maior valor pressórico registrado de 240x90 mmHg. A disautonomia também se manifestou por ausência de dejeções, sudorese excessiva e espasmos musculares. A frequência cardíaca se manteve estável e dentro dos parâmetros de normalidade.A partir do trigésimo dia de internação, observou-se melhora progressiva do quadro e reestabelecimento da homeostase. Obteve alta após 59 dias de internação, sem sequelas significativas. A explicação mais razoável para o caso é o aumento da resistência vascular periférica, por ação da angiotensina II, associada à supressão do sistema parassimpático, o que explica, também, a incompetência do barorreflexo para compensação da frequência cardíaca. Adicionalmente, o paciente estava em uso de carvedilol. Este caso enfatiza o desafio diagnóstico precoce da disautonomia em pacientes críticos, devido a carência de ferramentas adequadas para uso na prática cotidiana. A estimulação vagal pode constituir opção terapêutica eficaz, mas carece de mais estudos

A 53-year-old male, hypertensive and with bronchitis, was admitted to the emergency department on December 15, 2020 due to flu-like symptoms, fever and headache that started eight days ago. After finding significant lung involvement by chest computed tomography (CT) suggestive of SARS-CoV2 virus infection, the patient was admitted to the intensive care unit. He was intubated on the tenth day of hospitalization, and, 2 days later, he evolved with significant pressure lability, using norepinephrine and nitroprusside, in addition to other antihypertensive drugs, as needed. The predominant state was hypertension, expressed mainly when there is interference from the patient's position in bed. The highest pressure value recorded was 240x90 mmHg. Dysautonomy was also manifested by the absence of stools, excessive sweating and muscle spasms. Heart rate remains stable and within normal limits. From the thirtieth day of hospitalization onwards, there was an evolution with progressive improvement and restoration of homeostasis. He was discharged after 59 days of hospitalization, without sequelae. The most reasonable explanation for the case is the increase in peripheral vascular resistance, due to the action of angiotensin II, associated with the suppression of the parasympathetic system, which also explains the incompetence of the baroreflex to compensate the heart rate. Additionally, the patient was using carvedilol. This case emphasizes the importance of tools that early identify dysautonomy, prepare the team. Vagal stimulation can be an effective therapeutic option, but further studies are needed

Uso do SAPS 3 no escore NUTrition RIsk in the Critically ill modificado tem precisão preditiva comparável ao uso do APACHE II como marcador de gravidade / SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker

RESUMO Objetivo: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. Métodos: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. Resultados: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). Conclusão: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

ABSTRACT Objective: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. Methods: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. Results: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). Conclusion: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

Doença crítica crônica: estamos salvando ou criando vítimas? / Chronic critical illness: are we saving patients or creating victims?

RESUMO Os avanços tecnológicos que permitem dar suporte às disfunções de órgãos levaram a um aumento nas taxas de sobrevivência para a maioria dos pacientes críticos. Alguns destes pacientes sobrevivem à condição crítica inicial, porém continuam a sofrer com disfunções de órgãos e permanecem em estado inflamatório por longos períodos. Este grupo de pacientes críticos foi descrito desde os anos 1980 e teve diferentes critérios diagnósticos ao longo dos anos. Sabe-se que estes pacientes têm longas permanências no hospital, sofrem importantes alterações do metabolismo muscular e ósseo, apresentam imunodeficiência, consomem quantias substanciais de recursos de saúde, têm reduzida capacidade funcional e cognitiva após a alta, demandam uma considerável carga de trabalho para seus cuidadores, e apresentam elevadas taxas de mortalidade em longo prazo. O objetivo desta revisão foi apresentar as evidências atuais, em termos de definição, fisiopatologia, manifestações clínicas, tratamento e prognóstico da doença crítica persistente.

ABSTRACT The technological advancements that allow support for organ dysfunction have led to an increase in survival rates for the most critically ill patients. Some of these patients survive the initial acute critical condition but continue to suffer from organ dysfunction and remain in an inflammatory state for long periods of time. This group of critically ill patients has been described since the 1980s and has had different diagnostic criteria over the years. These patients are known to have lengthy hospital stays, undergo significant alterations in muscle and bone metabolism, show immunodeficiency, consume substantial health resources, have reduced functional and cognitive capacity after discharge, create a sizable workload for caregivers, and present high long-term mortality rates. The aim of this review is to report on the most current evidence in terms of the definition, pathophysiology, clinical manifestations, treatment, and prognosis of persistent critical illness.

Nivel de intensidad de las principales actividades físicas de escolares chilenos: determinación por acelerometría / Intensity level of the main physical activities of Chilean school children: determination by accelerometry

The aim of this study was to determine the intensity level of different specific activities of chilean school children by accelerometric values. With this objective, 80 children aged 10 to 12 years (39 boys, 41 girls) filled a diary of their activities in a structured format and simultaneously weard an accelerometer for one to three days. The activities of every subject were expressed in counts per minute (cpm). The levels of physical activity (PA). Were classified as sedentary PA / light PA / moderate PA and vigorous PA. Results: 26 different activities were documented. In most of them the difference between boys and girls was weak and no significant. The only vigorous PA was to run. In category "moderate PA" the cpm of plays outdoor was significantly less than those of sports and school gymnastic (p 0,007)- These results can serve as guiding for establish a scale of values for global evaluation of PA in children schoolers.

El propósito del presente trabajo fue determinar por valores acelerométricos el nivel de intensidad de diferentes actividades específicas de niños escolares chilenos. Con este objetivo, 80 niños de 10 a 12 años (39 varones y 41 niñas) llevaron un diario de actividades en un formato estructurado y simultáneamente un acelerómetro por uno a tres días. En cada sujeto las actividades se expresaron en cuentas por minuto (cpm). Los niveles respectivos de actividad física (AF) fueron clasificados en: AF sedentaria/ AF leve / AF moderada / AF vigorosa. Resultados: 26 actividades diferentes fueron documentadas. En la mayoría de ellas la diferencia entre niños y niñas fue leve y no significativa. La única AF vigorosa fue correr. En la categoría “AF moderada” los cpm de los juegos al aire libre fueron significativamente más bajos que las de los deportes y educación física escolar (p 0,007). Estos resultados pueden servir de guía para establecer una escala de valores en la evaluación global de la AF de niños chilenos.

Parámetros de composición corporal en pacientes VIH mediante el análisis de la biompedancia eléctrica

Se han descrito cambios en la composición corporal en pacientes VIH mediante el análisis de la bioimpedancia eléctrica (ABE). Hay pocos estudios que describan estos cambios en la composición corporal en pacientes VIH en Venezuela. Objetivo: Conocer cuáles son las características de la composición corporal de los pacientes VIH (Hospitalizados y Ambulatorios), período enero - agosto 2015. Materiales y Métodos: Estudio descriptivo - transversal. Tres grupos: Hospitalizados: pacVIH-h (n=22), Ambulatorio: pacVIH-a (n=47) y No VIH: Control (n=28). Se registraron género, peso, talla y LCD4+. Mediante ABE se obtuvo: Masa grasa (MG), Tejido adiposo abdominal (TAA), Agua corporal total (ACT), Agua intracelular (AIC), Agua extracelular (AEC), Masa celular corporal (MCC), Masa libre de grasa (MLG), Potasio corporal total (KCT), Ángulo de Fase (AF). Resultados: Peso, IMC, LCD4+ fue menor en pacVIH-h. La MG y TAA fue menor en grupos de pacientes VIH con respecto al Control. No hubo diferencias en Agua Corporal. MMC fue menor en pacVIH-a. AF fue menor en pacVIH. Una correlación significativa entre MG y TAA, y LCD4+. Conclusión: Este estudio ha permitido exponer y reconocer los aspectos relacionados con los cambios en la composición corporal que ocurren en el paciente VIH adulto. La relación entre el compartimento graso y CD4+ permitiría explorar el papel del tejido adiposo en la reconstitución inmune.

Body composition in HIV patients have been assessed previously using bioelectrical impedance analysis (BIA). Lack of studies that describes changes in body composition in Venezuelan HIV patients. Objective: To assess body composition characteristic of HIV patients (hospitalized, ambulatory) , period January-August 2015. Methods: Descriptive-transversal study. Three groups: hospitalized: HIV-h (n=22), ambulatory: HIV-a (n=47) and Control (n=28). Gender, weight, height, CD4+ were measured. By BIA: Fat Mass (FM), Abdominal Adipose Tissue (AAT), Total body water (TBW), Intracellular water (ICW), Extracellular water (ECW), Body cell mass (BCM),Free Fat Mass (FFM), Total body potassium (TBK), Phase angle (PA). Results: Weight, BMI, CD4+ were lower in HIV-h. FM and AAT were lower in HIV patients. Water compartment showed no differences. BCM were lower in HIV-a. PA was lower in HIV patients. Significant relationship between FM, ATT and CD4+ was found. Conclusions: This study let us expose and recognize body composition changes that occur in HIV patients. Relationship between FAT, AAT and CD4+ can let us explore the possible role of adipose tissue in immune reconstitution.

Variability of susceptibility to deltamethrin in peridomestic Triatoma sordida from Triângulo Mineiro, State of Minas Gerais, Brazil

Despite chemical and physical vector control strategies, persistent infestations of Triatoma sordida have been reported in a large part of Minas Gerais, Brazil, and the cause for this is little investigated. We aimed to characterize the deltamethrin toxicological profile in peridomestic T. sordidapopulations from Triângulo Mineiro area of Minas Gerais.

Variabilidad de la actividad física en niños chilenos de 4 a 10 años: estudio por acelerometría / Variability of physical activity in 4 to 10-year-old children: a study by accelerometry

Introducción. Frente a los populares cuestionarios, la acelerometría entrega una información más confiable de la actividad física. Así, el objetivo ha sido documentar la variabilidad de la actividad física de niños chilenos en relación con edad, sexo, estado nutricional y días de la semana, y determinar cuántos de ellos cumplen con la recomendación de tener actividad física moderada y vigorosa por más de una hora diaria. Población y métodos. Ciento nueve (109) escolares de 4-10 años de edad (67 niños, 42 niñas) llevaron un acelerómetro durante 2, 3 o 4 días consecutivos. Treinta eran obesos (IMC>P95 por edad y sexo). En cada sujeto, los niveles de actividad física fueron expresados en cuentas por minuto (cpm) y promedios (DE) de cpm/hora. La actividad física moderada y vigorosa se definió por la suma diaria de cpm>900. Resultados. La actividad física diurna tuvo un promedio de 21 697 (662) cmp/hora con variabilidad considerable de un niño a otro, y de un momento a otro del día en un mismo niño. Las cpm/hora individuales estaban significativamente asociadas con actividad física moderada y vigorosa (R= 0,954). Se encontraron diferencias entre niñas y niños (p <0,01) y entre obesos y no obesos (p <0,01). No hubo diferencia entre 9 años (p= 0,12). Entre semana y fin de semana hubo una leve diferencia. Cincuenta y seis de 67 (83,6%) niños y 24 de 42 (57,1%) niñas cumplieron con la recomendación de realizar actividad física moderada y vigorosa por más de 60 minutos diarios. Conclusión. Existe déficit de actividad física en escolares chilenos menores de 10 años, particularmente en niñas y en obesos.

Introduction. When compared to popular questionnaires, accelerometry provides more reliable information regarding physical activity. Thus, the objective has been to document the variability of physical activity in Chilean children in relation to age, gender, nutritional status and days of the week, and to determine how many of them meet the recommendation for moderate to vigorous physical activity for more than an hour a day. Population and methods. One hundred and nine (109) school children aged 4-10 (67 boys, 42 girls) wore an accelerometer for 2, 3 or 4 consecutive days. Of them, 30 were obese (BMI>95th percentile by age and gender). In each subject, levels of physical activity were expressed in counts per minute (cpm) and means (SD) of cpm/hour. Moderate to vigorous physical activity was defined by the daily sum of cpm>900. Results. Daytime physical activity had a mean of 21,697 (662) cpm/hour with considerable variation from one child to another, and from one time of the day to another in the same child. Individual cpm/hour was significantly associated to moderate to vigorous physical activity (R = 0.954). Differences were found between girls and boys (p < 0.01) and between obese and non-obese children (p < 0.01). There were no differences between children 9 years (p = 0.12). There was a slight difference between weekdays and weekends. Fifty-six (56) of 67 boys (83.6%) and 24 of 42 girls (57.1%) met the recommendation for moderate to vigorous physical activity for more than 60 minutes a day. Conclusion. There is a physical activity defcit in Chilean school children under 10 years, particularly in girls and obese kids.

Estrategia de prevención de obesidad en escolares: Efecto de un programa aplicado a sus profesores (2007-2008) / Effect of counselling school teachers on healthy lifestyle on the impact of a program to reduce childhood obesity

Background: In 2007, a preventive strategy for childhood obesity, that included food education and an increase in physical activity, was implemented in seven public schools located in Santiago. In four of these schools, a counseling program about healthy lifestyles for teachers was also carried out. Aim: To test if counseling had an effect in the intervention for children. Material and Methods: Anthropometric measures were assessed in children at baseline and after two years of intervention. Teachers were also evaluated with anthropometry and a blood sample was obtained to measure blood glucose and serum lipids. Results: Four hundred twelve children from schools whose teachers had counseling and 237 children from schools whose teachers did not have it were evaluated. Twenty-eight teachers with and 19 with no counseling were assessed. In children, the overall prevalence of obesity decreased from 20.2 to 18.3 percent (p = 0.03). This reduction was only significant among females. BMIZ score decreased significantly in children of both genders. No effect of counseling was observed on weight reduction. Among teachers that received counseling, the prevalence of obesity decreased from 25 to 22.4 percent, with significant improvements in blood glucose and HDL cholesterol. Conclusions: Counseling directed at teachers did not improve the effect of a program to reduce obesity among schoolchildren.

Prevención de obesidad en preescolares y escolares de escuelas municipales de una comuna de Santiago de Chile: proyecto piloto 2006 / Obesity prevention in preschool and schoolchildren attending public schools from a district of Santiago, Chile: pilot project 2006

La obesidad infantil en Chile ha sido reconocida como un problema de salud pública prioritario. En el año 2006 desarrollamos un proyecto piloto de intervención de 5 meses para prevenir obesidad en preescolares y escolares de pre-kinder a 4º grado en 7 escuelas públicas de una comuna de clase media-baja de Santiago de Chile. El objetivo del proyecto fue evaluar la factibilidad de implementar una intervención de más largo plazo y darle sugerencias a las autoridades para poder hacerlo en mejor forma. En las 7 escuelas se implementaron actividades educativas dirigidas a los niños, en los ámbitos de alimentación saludable y fomento de la actividad física, pero además en 4 de éstas, se implementó un programa para los profesores. Este consistió en Consejería personalizada en hábitos de vida saludable, evaluaciones antropométricas y bioquímica. Las iniciativas se evaluaron en una muestra de 522 escolares (estado nutricional y aptitud física) y en 38 profesores intervenidos (IMC, circunferencia de cintura, glicemia, HDL, colesterol total y triglicéridos) y los 19 sin intervención (IMC y circunferencia de cintura). Se determinó además la calidad de las clases de educación física. Los resultados muestran una tendencia en los escolares de menor edad de disminuir el por ciento de obesidad, mejorando significativamente la aptitud física. En los profesores intervenidos se aprecia una tendencia a disminuir el IMC y circunferencia de cintura, mientras que los parámetros bioquímicos no variaron. Se muestra que es factible implementar un programa de más larga duración recomendando mejorar las clases de educación física y aumentar el tiempo disponible para Consejería y capacitación de profesores.

Childhood obesity in Chile has been recognized as a public health problem. In 2006, we developed a school-based obesity prevention pilot project to intervene during 5 months preschool and schoolchildren from 1st to 4th grades attending 7 public schools located in a district of Santiago, Chile of medium-low and low SES. The objective of this project was to evaluate the feasibility of implementing a longer intervention giving recommendations to the educational authorities to better implement it. We trained teachers to apply educational activities ( in nutrition and physical activity) for the children in the 7 schools, but additionally in 4 of these schools, teachers of those grades participated in a Counselling program on healthy lifestyle applied individually, anthropometric evaluation and blood tests. The initiatives were evaluated on a sample of 522 schoolchildren (nutritional status and physical fitness), 38 teachers with Counselling (BMI, waist circumference or WC, blood sugar, HDL, triglycerides, cholesterol) and 19 teachers with no Counselling (BMI and WC). Additionally, we evaluated the quality of PE classes. The results on the children show a trend on only the younger ones to decrease the percent obesity, improving significantly their physical fitness. In teachers with Counselling, a trend toward decreasing BMI and WC was observed, while biochemical parameters remained unchanged. We showed that it is feasible to implement a longer intervention recommending improving the quality of PE classes and allowing more time to train teachers and for individual Counselling.

Efecto de un programa de educación nutricional en el consumo de energía y macronutrientes de preescolares asistentes a jardines infantiles Junji de la zona oriente de Santiago Chile / Effect of educational nutrition program on the energy and macronutrients intake of preschoolers attending Junji day care centres in the eastern sector of Santiago Chile

El objetivo de este trabajo fue evaluar los cambios en el consumo de energía y macronutrientes de niños (as) obesos y eutróficos, asistentes a jardines infantiles JUNJI de la zona oriente de Santiago, como producto de una intervención educativa en alimentación, nutrición y actividad física, sustentada en la teoría del aprendizaje social cognitivo y el modelo de organización comunitaria. La muestra fue de 35 preescolares obesos y 85 eutróficos (4-5 años). El consumo se evaluó durante dos días de semana y uno de fin de semana; en el jardín infantil, se midió mediante pesaje de la ración y en el hogar, por registro de los alimentos y preparaciones ingeridas por el párvulo. Luego de la intervención, durante la jornada del jardín infantil, se redujo el consumo de energía, proteínas, lípidos y carbohidratos (p<0.05), en niñas obesas, así como el consumo de energía y carbohidratos en niños obesos (p<0.01), además de lípidos y carbohidratos en niñas y niños eutróficos (p<0.05). En el hogar, durante la semana, se redujo el consumo en el hogar de energía y lípidos en las niñas obesas y niños eutróficos (p<0.05), y lípidos en las niñas eutróficas (p<0.05). En fin de semana, los niños obesos redujeron el consumo de calorías (p<0.05) y lípidos (p<0.05); mientras que las niñas obesas calorías (p<0.05) y carbohidratos (p<0.05). En niñas y niños eutróficos, también se redujo el consumo de lípidos y se incrementó proteínas (p<0.01). En conclusión, esta intervención demostró ser efectiva en modular tempranamente la ingestión alimentaria infantil, uno de los factores de riesgo de obesidad y enfermedades crónicas no trasmisibles.

The objective of this study was to evaluate the change on the energy and macronutrients intake in obese and eutrophic preschoolers, attending National Board of Day Care Centres (JUNJI), in the eastern area of Santiago, as product of an educational intervention in intake, nutrition and physical activity, sustained in the theory of the social cognitive learning and the model of community organization. The sample comprised of thirty five obese children, plus eighty five eutrophic children (4-5 years olds). Energy intake was evaluated, measuring full two days a week plus one weekend day. At the day care centre, all ingested food was weighed, and when back at home, child food-intake was recalled. During the stay at the day care centres, the intervention produced a reduction in: energy, proteins, lipids and carbohydrates in obese girls (p<0.05), energy and carbohydrate in obese boys (p<0.01), lipids and carbohydrates, in eutrophic girls and boys (p<0.05). When at home, intake reduced in: energy and lipids in the obese girls and eutrophic boys (p<0.05), lipids in eutrophic girls (p<0.05). During the weekend, obese boys, reduced the intake of calories (p<0.05) and lipids (p<0.05). In obese girls the reduction was in calories (p<0.05) and carbohydrates (p<0.05). In eutrophic girls and boys, lipid intake was reduced as well as, protein intake was increased (p<0.01). In conclusion, this intervention demonstrated to be effective in early modulation of preschool children dietary intake, one of the important risk factors for obesity and chronic diseases.

Comparación entre la ingesta alimentaria de preescolares obesos y eutróficos asistentes a jardines infantiles de Junji de la zona oriente de Santiago / Comparison in the dietary intake of preschool children, attending national daycare centres (Junji), in the eastern area of Santiago Chile

El objetivo de este estudio fue evaluar la ingesta alimentaria de preescolares eutróficos y obesos de 4 a 5 años, asistentes a jardines infantiles del sector oriente de Santiago. La muestra fue de 85 niños eutróficos y 35 obesos, representativa de una población de 450 niños. La ingesta se realizó durante dos días de semana y uno de fin de semana. En el jardín infantil, se evaluó la ingesta alimentaria mediante el pesaje de la ración servida y de los residuos. La alimentación recibida en el hogar, se efectuó por registro de los alimentos y preparaciones consumidos por el menor. Para calcular las necesidades energéticas se utilizaron los requerimientos de energía FAO 2001. Los resultados mostraron una ingesta energética similar tanto en el jardín infantil como en el hogar, demostrando que el exceso energético consumido por los niños proviene del hogar, dado que en el establecimiento educacional se ofrecen tres tiempos de comida y en el hogar, el preescolar debiese sólo ingerir la cena. Respecto de los requerimientos energéticos de los preescolares, tanto los niños obesos como eutróficos están en balances energético durante la semana (90-110 por ciento), no así las niñas obesas y eutróficas, que exceden la adecuación energética entre 116 y 111 por ciento respectivamente. En conclusión, en el hogar, se ofrece la mayor oferta de alimentos y de menor calidad, lo que empeora durante el fin de semana, en todos los preescolares, independiente de su estado nutricional (adecuación energética mayor 114 por ciento).

Asociación entre la composición corporal de la embarazada y la composición corporal del recién nacido

Objetivo: estudiar la asociación entre la composición corporal de la madre al final del embarazo y la composición corporal del recién nacido. Sujetos: se estudiaron 224 embarazadas y sus recién nacidos atendidos en el servicio de salud sur-oriente de Santiago, Chile. Métodos: la composición corporal de la embarazada fue calculada a través de la técnica de dilución con deuterio descrita por Schoeller; la composición corporal del recién nacido se estimó con el método antropométrico de Dauncey. La asociación entre la composición corporal materna y del recién nacido fue estudiada por análisis de correlación y de regresión múltiple. Resultados: la masa magra y masa grasa materna (MMM y MGM, respectivamente), talla materna y la edad gestacional (EG) se correlacionaron significativamente con la MG del recién nacido (r=0,38, 0,24 , 0,15 y 0,14; p = 0,0001, 0,0002, 0,01 y 0,03, respectivamente), así como también con la MM del RN (r=0,34, 0,23, 0,25 y 0,27; p=0,0001, 0,0004, 0,0001 y 0,0001, respectivamente). El análisis de regresión mostró influencias significativas de MMM, MGM y EG sobre MG del RN (p=0,0001, 0,0008 y 0,03, respectivamente) y de MMM, MGM, EG y sexo femenino sobre la MM del RN (p=0,0001, 0,001, 0,0004 y 0,01, respectivamente); siendo la MMM mayor que la MGM en ambas regresiones lineales múltiples. Conclusión: la MMM influye más que la MGM en ambos compartimientos nutricionales del recién nacido (MM y MG del RN), lo que es compatible con observaciones recientes que asignan un importante rol en el crecimiento fetal al agua corporal total y a la expansión del volumen plasmático de la madre.

Objetivo: estudar a associação entre a correlação e a regressão múltiple. Resultados: a massa magra e massa graxa materna (MMM composição corporal da mãe ao final da gravidez e a composição corporal do recém-nascido. Sujeitos: estudaram-se 224 grávidas e seus recém-nascidos atendidos no serviço de saúde sul-oriente de Santiago, Chile. Métodos: a composição corporal da mulher grávida foi calculado através da técnica de "dilución com deuterio" descrita por Schoeller; a composição corporal do recém-nascido estimou-se com o método antropométrico de Dauncey. A associação entre a composição corporal materna e do recém-nascido foi estudada por análisise e, respectivamente, altura materna e idade gestacional (EG) correlacionaram-se MGM significativamente com a MG do recém-nascido (r= 0,38, 0,24 , 0,15 e 0,14; p = 0,0001, 0,0002, 0,01 e 0,03, respetivamente), assim como também com a MM do RN (r = 0,34, 0,23, 0,25 e 0,27; p = 0,0001, 0,0004, 0,0001 e 0,0001, respetivamente). A análise de regressão mostrou influências significativas de MMM, MGM e EG sobre MG do RN (p = 0,0001, 0,0008 e 0,03, respetivamente) e de MMM, MGM, EG e sexo feminino sobre a MM do RN (p= 0,0001, 0,001, 0,0004 e 0,01, respetivamente); sendo a MMM maior que a MGM em ambas regressões lineais múltiples. Conclusão: a MMM influi mais que a MGM em ambos compartimentos nutricionais do recém- nascido (MM e MG do RN), o que é compatível com observações recentes que indicam um importante rol no crescimento fetal à água corporal total e à expansão do volume plasmático da mãe.

Objective: to study the association between the body composition of women at the end of pregnancy and that of their respective newborn babies. Subjects: 224 pregnant women attending a public hospital in a poor urban area of Santiago, Chile. Methods: maternal body composition was determined using a deuterium dilution technique to measure total body water as described by Schoeller, fat free mass was calculated using the equations of van Raaji et al. Newborn body composition was estimated using the Dauncey anthropometric method. The association between maternal and newborn body compositions was studied using correlation and multiple regression analyses. Results: The multiple regression models showed that maternal fat free mass, maternal fat mass and gestational age influenced both newborn compartments (p<0,01), and fat free mass had a greater influence than the other variables. Conclusions: fat free maternal mass has a greater influence on newborn body composition than the fat mass. This observation is in accordance with other studies revealing an important tole in fetal growth of the maternal total body water and plasma volume expansion.