La sed ¿un mecanismo suficiente para lograr euhidratación?: una revisión narrativa / Is thirst sufficient as a mechanism for achieving euhydration? a narrative review

Capitán, C. y Aragón, L.F. (2023). La sed ¿un mecanismo suficiente para lograr euhidratación?: una revisión narrativa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. El papel de la percepción de sed para mantener el balance hídrico ha sido ampliamente estudiado, tanto durante el ejercicio como después de este. Sin embargo, la forma de evaluarla y la eficacia de los instrumentos existentes son aún áreas que necesitan más investigación. El objetivo de esta revisión fue integrar, de forma general, la información disponible en la literatura sobre el funcionamiento del mecanismo de la sed como respuesta a la deshidratación durante y después del ejercicio. Se explican los mecanismos fisiológicos y las respuestas de estos durante y posterior al ejercicio; además, se describen los instrumentos disponibles en la literatura científica, sus debilidades y fortalezas, y se plantea una serie de preguntas que aún no tienen respuesta en el área. En esta revisión se presenta el aspecto teórico de los mecanismos de la sed, además, se discuten los estudios científicos que respaldan o refutan el comportamiento de estos mecanismos en el ejercicio. Finalmente, se hace un resumen de las principales conclusiones extraídas de la literatura científica sobre la sed como un mecanismo suficiente para prevenir la deshidratación tanto durante como después del ejercicio.

Capitán, C. y Aragón, L.F. (2023). Is thirst sufficient as a mechanism for achieving euhydration? a narrative review. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. The role of thirst perception for keeping hydric balance, both during and after exercise, has been extensively studied. However, the way to assess it and the effectiveness of the existing instruments are areas that still require further research. The objective of this review is to integrate, in a general way, the information available in the literature on the functioning of the thirst mechanism as a response to dehydration during and after exercise. The physiological mechanisms and their responses during and after exercise are explained. In addition, a description of the instruments available in scientific literature is included, together with their weaknesses and strengths, and a series of as yet unanswered questions in this area are raised. This review presents the theoretical aspect of thirst mechanisms, and discusses the scientific studies that support or refute the behavior of these mechanisms in exercise. Finally, a summary is made of the major conclusions drawn from the scientific literature on thirst as a sufficient mechanism to prevent dehydration both during and after exercise.

Capitán, C. y Aragón, L.F. (2023). A sede é um mecanismo suficiente para alcançar a hidratação? uma revisão narrativa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. O papel da percepção da sede na manutenção do equilíbrio hídrico tem sido amplamente estudado, tanto durante quanto após o exercício. Entretanto, como avaliá-la e a eficácia dos instrumentos existentes ainda são áreas que necessitam de mais pesquisas. Esta revisão visou integrar, de forma geral, as informações disponíveis na literatura sobre o funcionamento do mecanismo da sede em resposta à desidratação durante e após o exercício. Ele explica os mecanismos fisiológicos e suas respostas durante e após o exercício, descreve os instrumentos disponíveis na literatura científica, seus pontos fracos e fortes, e levanta uma série de questões que permanecem sem resposta no campo. Esta revisão apresenta o aspecto teórico dos mecanismos da sede e discute os estudos científicos que respaldam ou refutam o comportamento desses mecanismos no exercício. Finalmente, é feito um resumo das principais conclusões extraídas da literatura científica sobre a sede como mecanismo suficiente para prevenir a desidratação tanto durante quanto após o exercício.

Ciencia básica y sus aplicaciones: tres hitos en el siglo XXCon especial referencia a la Hidratación Oral / Basic science and its applications: three milestones in the 20th century with special reference to Oral Rehydration

Resumen Tras el descubrimiento de que el transporte del sodio y el transporte de la glucosa están acoplados en el intestino delgado, de manera que la glucosa acelera la absorción de soluto y agua, destacó la hidratación oral junto con otros hitos del siglo XX como el desarrollo de la penicilina y los cultivos virales que anteceden la vacuna contra la poliomielitis; este artículo de opinión se refiere a la participación de Costa Rica en el exitoso desarrollo de un estudio de investigación aplicada sobre un problema prioritario de Salud: la hidratación oral en las diarreas provocadas por virus.

Abstract Following the discovery that sodium transport and glucose transport are coupled in the small intestine, such that glucose accelerates solute and water absorption, highlighted oral hydration), along with other 20th-century milestones like the development of penicillin and viral cultures that preceded the polio vaccine; this opinion article refers to the participation of Costa Rica in the successful development of an applied research study on a priority health problem: oral rehydration in diarrhea caused by viruses.

Effect of the Seasonal Adaptability on Carbohydrate-electrolyte Beverage Efforts on Post-exercise Rehydration in Healthy Young Men / 中国医学科学院学报

Objective To compare the effects of carbohydrate-electrolyte beverage on post-exercise rehydration of healthy young men in different seasons,and to explore the influence of seasonal adaptability on fluid and electrolyte balance.Methods Fifteen healthy men,aged(24.4±0.5)years,completed 2 trails in a random crossover design both in summer and winter.During recovery,they consumed a drink volume equivalent to 100% of their sweat loss with plain boiled water(the water group)or carbohydrate-electrolyte beverage(the beverage group).Recovery was monitored for further 180 minutes by the collection of blood and urine samples.Results The dehydration time in summer was significantly shorter by about 20 minutes than that in winter(

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.Results: The mean age was 19.49'14.41 months. The compliance to complete 14-day zinc therapy was 62.14%.' The mean number of days zinc was taken was 11.28'3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Studies on the mechanism of desiccation tolerance in the resurrection fern Adiantum raddianum

Desiccation-tolerance (DT) is the ability to lose virtually all free intracellular water and then recover normalphysiological functions. The phenomenon of DT is present in higher plants as well as few Pteridophytes whichwithstand drying up to 10%–20% of their dry weight and still resume metabolism following rehydration.The present investigation was carried to understand the biochemical adaptations against desiccation andalso subsequent rehydration in Adiantum raddianum (AR), an omnipresent fern in the Devarayanadurgaforest region of Tumakuru district of Karnataka, India. Detached fronds from healthy AR fern were fullyhydrated, subsequently desiccated, and rehydrated under in vitro conditions. During the desiccation process,the relative water content (RWC) of detached fronds decreased to as low as 16% after 4 hours with intenseinward curving. Upon rehydration, the RWC of the desiccated fronds regained 85% of the initial water contentwithin 4 hours. The rehydrated fronds almost showed the original morphology. Furthermore, physiologicalactivities of antioxidant enzymes such as superoxide dismutase, peroxidase, catalase, glutathione reductase,lipid peroxidation, and proline increased during desiccation but sucrose and starch content showed differentialresponse. The result obtained in this study reveals that AR has desiccation-tolerant properties.

Effect of relative humidity on drying characteristic and quality of Panacis Quinquefolii Radix / 中草药

Objective: Taking Panacis Quinquefolii Radix (PQR) as study object, the drying characteristic and quality was investigated under constant relative humidity (RH) and step-down RH drying method in order to provide foundation for improving drying efficient and quality of PQR. Methods: At drying temperature 55 ℃, the effect of constant RH (20%, 30%, and 40%), step-down RH, when RH 40% was kept for 1, 5, and 9 h and then decreased to 20%, and continuously dehumidification drying conditions on drying characteristic, moisture effective diffusion coefficient, rehydration ratio, shrinkage ratio, total ginsenoside content and microstructure were investigated. Results: With constant RH drying condition, the lower the RH was, the higher the drying rate was. When RH was 20%, the drying time was shortened by 6.8% compared with RH of 40%. With step-down RH drying condition, when RH 40% was held for 5 h and then decreased to 20%, the drying time was shortened by 3.4% compared with dehumidification drying method. Also, a transient increasing drying rate phase was appeared. Moisture effective diffusion coefficient ranged from 1.49 × 10-10 to 2.50 × 10-10 m2/s. Rehydration ratio mainly depended on the damage degree of the PQR cellular structure and the moisture content before rehydrating. Additionally, the rehydration ratio and shrinkage ratio increased with the increase of RH. High RH was benefit for reserving and transferring of ginsenoside content. The microstructure results showed that under continuous dehumidification drying process, the PQR surface was crusted so that the drying time was prolonged and rehydration ratio was decreased. On the other hand, step-down RH drying method was benefit for porous structure formation, which was helpful for shortening drying time and improving rehydration ratio. When RH 40% was kept for 5 h and then decreased to 20%, the comprehensive score of this drying condition achieved its maximum value as (0.61 ± 0.01). Such drying condition was regarded as the best drying process with the rehydration ratio, shrinkage ratio and total ginsenoside content of 2.23 ± 0.12, 0.26 ± 0.06, and (5.01 ± 0.04)%, respectively. Conclusion: Step-down RH drying method can improve PQR drying efficient and quality and such conclusion provided theoretical foundation and technical support for how to adjust RH during hot air drying of PQR.

Knowledge and practices among caregivers in cases of persisitent diarrhoea in children of age group 6 months-12 years

Background: Persistent diarrhoea has a variety of infectious and non-infectious etiology and it seriously affects the growth and development of children. The objective of the is to the identify the knowledge and practices prevalent amongst caregivers of children to understand environmental and behavioral risk factors and their interactions associated with the disease and its management.Methods: It is a hospital based cross-sectional study which included 70 children in the age group 6 months-12 years admitted in a tertiary care center at Bhopal over a period of one year with complaints of loose stools lasting for more than 14 days. A pre-tested questionnaire was used as a data collection tool for face-to-face interviews with the mothers or caretakers of the cases. Statistical analysis was done using Statistical Package of Social Science (SPSS Version 20; Chicago Inc., USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons.Results: Most of children's mother were Illiterate, 27.1% were educated till primary school and only 5.7% were graduate. Out of 70 cases, most of 51(72.8%) were have understanding that drinking untreated water is a risk factor, only 11(15.7%) understands the value of filtered water and 8(11.4%) know the importance of doing boiling. Most of 46(65.7%) were using open field for sanitation and only 11(15.7%) were using toilets at home. 42(60.0%) were having the habit of hand washing before taking meal.'Conclusions: Community education about the prevention and management of diarrhoea will reduce the mortality and morbidity associated with persistent diarrhoea.

Prognostic significance of initial management of childhood diarrhoea in rural areas: an observational study

Background: To identify current evidence in order to guide scaling up of initial management of diarrhoea among children of age group 2-60 months in rural areas of the country.Methods: This hospital based cross sectional study included all children 2 months to 60 months of age admitted with chief complains of loose stools in the last 7 days over a period of one year. A pre-tested questionnaire was used as the data collection tool and face to face interviews were conducted on mothers of children.' All the data were analyzed using IBM SPSS version 20 software. Chi-square/Fisher Exact/ Student t-test and ANOVA test has been used. Significance was assessed at 5%.Results: Data showed the use of antibiotic in 55.9% cases, IV fluids in 50.3%, ORS in 6.7%, zinc in 2.0% and blood transfusion in 13.8% cases as an initial management of diarrhoea in peripheral health care centers. Of these, 37.6% cases were severely dehydrated, and 8.14% cases were in shock at the time of admission. 10.1% mothers did not intervene in the first 3 days of the disease whereas 45.2% consulted some health care center only in the later part. 4.5% cases expired after admission of which 69% were malnourished.Conclusions: This study summarizes the importance of initial management of a child with diarrhoea in defining the further course of the disease and also the failure of effective promotion and propagation of the most appropriate and cost-effective therapy (ORS and Zinc) for diarrhoea in this part of the country. Pre-existing malnutrition further complicates the situation.

Knowledge, attitude and practices of childhood diarrhoea among mothers of children under five years of age: a cross sectional study

Background: Diarrhoea is an important communicable disease which can be prevented by proper hygiene and other simple practical measures. We assessed the knowledge, attitude and practices among mothers regarding childhood diarrhoea in a secondary care hospital in Dimapur, Nagaland.Methods: Cross-sectional observational study conducted over a period of one year including 449 mothers in the age group <45 years with atleast one child under 5 years of age using an interviewer administered, pilot tested, semi-structured questionnaire under the following as categories demography, knowledge, attitude and practices.Results: 97.8% had good knowledge regarding causes and prevention of diarrhoea, 65% had good knowledge regarding the management of diarrhoea while 31% mothers had moderate knowledge. 98% mothers had good attitude but only 17.8% had good practice scores. Multivariate regression analysis showed education > class 10 and residence in urban area were significantly associated with good knowledge and education >class 10, age of mothers ≥29 years, employed mothers, family income Rs. ≥28000 were significantly associated with good practice.Conclusions: Good knowledge and attitude regarding diarrhoea prevention and management among our study population did not translate to good practice. These could also be due to the lower knowledge about management of diarrhoea. Widespread prevalence of wrong practices in the community like irrational use of antibiotics could also have resulted in low practice scores. The gaps between knowledge and attitude and practices among the mothers need to be addressed.

Knowledge, attitude and practice regarding diarrhoea and its prevention and the use of oral rehydration therapy among mothers of children under the age of five visiting a tertiary care hospital in Mangalore, India

Background: Diarrheal diseases remain the second most leading cause of mortality and morbidity next to pneumonia among under-five mortality globally, contributing to 1/5th of child deaths.Methods: Cross sectional hospital based questionnaire study conducted among 200 mothers of children within the age group of 6-60 months with diarrhoea attending the paediatric outdoor or treated in the paediatric indoor (OPD) at YMCH hospital using personal interview method. Filled up questionnaires was collected and was attached along with the filled up proforma.Results: Of 200 mothers, 24.3% knew the correct meaning of diarrhoea, with 73.8% of them not knowing the correct cause of diarrhoea. Only 44.3% knew that it could be prevented. Majority 88.7% did not know to look for signs of dehydration. Less than half of the mothers had only heard of ORT. By using c2-test, preparation ORS was found to be associated with the mother's education (p=0.04) proving that knowledge is better among those mothers with formal education. No association was found between ORS preparation and age of the mother (p=0.229), religion (p=0.342), and gender of the child (p=0.061).Conclusions: The findings of this research indicate that only 73.8% of the mothers had knowledge regarding the cause of the diarrhoea and less than half 11.3% has only heard and used ORT properly.

Comparison of Health Education, Oral Rehydration Solution, Metoprolol and Midodrine Intervention in Children with POTS

Introduction: The postural orthostatic tachycardia syndromeis heterogeneous group of disorder. When a healthy individualstands up, gravity causes about 10%-15% of his or her bloodto settle in the abdomen or limbs. This pooling of bloodmeans that less blood reaches the brain, the result of whichcan be a feeling of lightheadedness, darkening of vision, oreven fainting. Hence, the aim of the present study was toevaluate the clinical features and the effectiveness of nonpharmacological and pharmacological treatment in patientswith POTS.Material and Methods: A retrospective medical recordanalysis of the patients referred to pediatric cardiology unitof our Second Xiangya Hospital of Central South Universitysince June 2003 to February 2010 was done. This studyincluded 33 children patients aged 6 to 16 years old among17 male (mean 10.62±2.88 years) and 16 female (mean11.81±1.64 years) after medication within 14 days to 6 monthswith follow up record.Results: The most common presenting symptoms of POTSwere found to be dizziness or light-headedness (66.66%)followed by chest tightness (30.30%), syncope (27.27%),headache (24.24%) and pallor (24.24%) respectively. About75.5% of children patients met diagnostic criteria for POTSduring 5 to 10 minute of HUTT. There was significant statisticdifference in heart rate between before and after treatment oftotal patients during 5 and 10 minute of HUTT (P<0.05). Theoverall improvement found in 24(72.72%) patients whereas9(27.27%) patients not respond to the given treatment regimen.Conclusion: The most common presenting symptom of POTSwas dizziness or light-headedness. Most of the patients meetdiagnostic criteria for POTS during 5 to 10 minute durationof HUTT. Health education, ORS, propranolol and midodrinewere effective in treatment of POTS and helpful to diminishthe upright tachycardia. Whereas health education and healtheducation with midodrine hydrochloride treatment methodwere more likely effective than health education with ORSand health education with metoprolol method

Knowledge, attitude and practices of oral rehydration therapy among mothers coming to tertiary care centre

Background: Diarrhoea is a major cause of morbidity and mortality among under-five children. Correct knowledge regarding oral rehydration therapy (ORT) helps prevent morbidity and mortality due to diarrhoea. The objective of this study is to assess the knowledge, attitude and practice of mothers of under-five children regarding ORT and home management of diarrhoea.Methods: Study period from December 1st, 2017 to December 31st, 2017, total of 200 mothers were enrolled in this study. The data was entered in Microsoft excel sheet and percentages were calculated.Results: 95% of mothers were aware about ORS. ORS was given by parents on own in16%, 55% were advised by doctor. Only 60% knew how to prepare ORS correctly. About 45.7% had used bottle to give ORS and 55.3% used cup and spoon. About 67.9% had knowledge of quantity of ORS to be given during diarrhoea episode. Exclusive breast feeding was practised in 86% of mothers till 6 months of age. Misconceptions about the use of ORS were seen in 60% and more among illiterates. About 21% mothers' felt ORS should be stopped if diarrhoea continues. Only 5% of mothers felt ORS can be given even if child has vomiting. About 9% mothers felt no fluids should be given during diarrhoea.Conclusions: Mothers' knowledge and attitude on use of ORS in diarrhoea need to be improved.

Retrospective analysis of diabetic hyperosmolar hyperglycemia complicated with rhabdomyolysis / 中国基层医药

Objective@#To investigate the clinical characteristics and treatment strategies of diabetic hyperosmolar hyperglycemia (HHS) with rhabdomyolysis (RM).@*Methods@#The clinical data of 40 patients with HHS treated in the General Hospital of Shenyang Military Command from November 2013 to November 2017 were retrospectively analyzed.According to the serum levels of creatine phosphokinase and myoglobin, they were divided into RM group (12 cases) and non-RM group (28 cases). The clinical characteristics and treatment results of the two groups were compared.@*Results@#There were 12 cases in the RM group, 6 cases were diagnosed RM at the time of consultation, and 6 cases developed RM during the course of treatment.Compared with the non-RM group, RM group had lower systolic pressure[(98.3±17.8)mmHg vs.(128.0±18.1)mmHg, t=4.823, P=0.000], higher blood glucose level[(44.4±14.0)mmol/L vs.(32.6±8.1)mmol/L, t=2.717, P=0.016], and more acidosis, mainly manifested by lower pH[(7.16±0.15)vs.(7.32±0.13), t=3.355, P=0.002], lower bicarbonate[(12.92±5.23)mmol/L vs.(19.07±6.80)mmol/L, t=2.792, P=0.008], higher blood D-3 hydroxybutyric acid [(5.84±2.98)mmol/L vs.(2.55±2.13)mmol/L, t=4.012, P=0.000], and renal function was worse[creatinine (257.1±149.8)μmol/L vs.(148.1±85.3)μmol/L, t=2.925, P=0.006]. Individualized rehydration and low dose insulin were given to control blood sugar, and increasing blood pressure, kidney protection, correction of electrolyte disturbance, anti-infection and inhibition of gland secretion were given to the complications.Hydration and alkalization were given to 7 cases of RM, and continuous renal replacement therapy (CRRT) was given to 5 cases.In 10 cases of HHS with RM, creatine kinase decreased, renal function recovered, and 2 patients died.@*Conclusion@#It is very important to improve the understanding of RM in HHS patients, routinely monitor the dynamic changes of muscle enzymes, make a good early diagnosis and prevention of RM.Urine hydration and alkalization should be given in time after RM occurs, and CRRT treatment as early as possible can improve the survival rate of diabetic patients.

Preventive oral rehydration salts Ⅲ could protect intestinal function in rats with exertional heatstroke / 中华危重病急救医学

Objective To observe the damage of various organs of rats with exertional heatstroke (EHS), and to investigate the protective effect of oral rehydration salts Ⅲ (ORSⅢ) on multi-organ function in rats with EHS. Methods Fifty-one male Sprague-Dawley (SD) rats were randomly divided into four groups by random digit table: normal control group (n = 13), EHS group (n = 13), EHS+water group (n = 12), and EHS+ORSⅢ group (n = 13). All rats in the EHS groups received adaptive training for 7 days before the experiment. On the 8th day, the rats of EHS+water and EHS+ORSⅢ groups were orally given 20 mL/kg water or ORSⅢ 30 minutes before the experiment. No pretreatment was performed in the EHS group. EHS model was reproduced by forcing rats to run under hot environment. The rats which refused to exercise and which core temperature > 40.5 ℃ were considered as the onset of EHS. The rats in the normal control group were exposed to room temperature (25±2) ℃ and humidity (50±5)% without any treatment. Six hours later, blood of inferior vena cava was collected, and the levels of serum MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (SCr), blood urea nitrogen (BUN), serum potassium, serum sodium and serum chloride were determined by automatic chemical analyzer. Serum intestinal fatty acid-binding protein (I-FABP) was determined by enzyme linked immunosorbent assay (ELISA). Results The levels of LDH, ALT, AST, BUN, serum sodium and serum chloride in the EHS group were significantly higher than those in the normal control group [LDH (U/L): 1 220±427 vs. 837±485, ALT (U/L): 138 (97, 164) vs. 37 (33, 42), AST (U/L): 409 (380, 566) vs. 86 (78, 104), BUN (mmol/L): 11.7 (9.6, 13.2) vs. 5.9 (5.5, 6.1), serum sodium (mmol/L): 148.0 (143.5, 154.5) vs. 139.0 (138.0, 140.5), serum chloride (mmol/L): 100.9±2.3 vs. 97.3±1.4, all P < 0.05], but no significant difference in CK-MB, SCr or serum potassium could be found [CK-MB (U/L): 1 280±373 vs. 1 379±480, SCr (μmol/L): 38.2±7.5 vs. 35.5±6.3, serum potassium (mmol/L): 5.5 (4.4, 6.2) vs. 4.7 (4.4, 4.9), all P > 0.05]. In the EHS+ORSⅢ group, only serum potassium level was significantly lower than that in the EHS group [mmol/L: 4.0 (3.7, 4.4) vs. 5.5 (4.4, 6.2), P < 0.01], while no significant difference in other parameters was found between the EHS+ORSⅢ group and the EHS group as well as the EHS+water group. Serum I-FABP level in the EHS group was significantly higher than that in the normal control group [μg/L: 36.90 (29.10, 45.00) vs. 11.39 (0.31, 20.80), P < 0.01]. Serum I-FABP level in the EHS+water and EHS+ORSⅢ groups were notably lower than that in the EHS group [μg/L:24.19 (20.00, 28.36), 0.31 (0.31, 5.58) vs. 36.90 (29.10, 45.00), both P < 0.01], additionally, I-FABP level was much lower in the EHS+ORSⅢ group (P < 0.01). Conclusions EHS could lead to liver, intestinal barrier dysfunction and electrolyte disturbance. Pre-treatment of ORSⅢ could alleviate the intestinal dysfunction and electrolyte disorder caused by EHS in rats. It can lower the serum potassium to some extent. However, ORSⅢ failed to protect liver from EHS.

La atención primaria de salud y la salud materno infantil

The Primary Health Care strategy introduced concepts which sought to revolutionize the way how to achieve Health for All at the global level. The Declaration of Alma Ata was a prelude to initiatives and global plans that sought compromise to States and society in achieving access to health equity. The Summit of Action for Children and the Meeting of the Millennium, which agreed health targets to achieve by year 2015 were inspired by the concepts included in Primary Health Care. While it is true that the purposes lying below the postulates in Alma Ata were not reached, there was remarkable progress in aspects related to the Mother and Child Health. The Selective Primary Healthcare inspired the so-called "Revolution for the Child Survival", which identified the main causes of the 15 million deaths in children recorded at the global level at the beginning of the Decade of the eighties of the last century, as well as the simple, low-cost interventions based on the evidence shown to be effective in the prevention of this "silent emergency" represented by the avoidable child deaths. Product of these interventions related to children health and the subsequent inclusion of interventions for the prevention of the 500 000 preventable maternal deaths recorded worldwide at the beginning of this century, has achieved remarkable progress at global level. Peru was one of the countries of the Americas that showed greater progress in reducing maternal and infant mortality. This article seeks to find an explanation of procedures and processes that allowed these achievements at the global level and in Peru, inspired by the principles proposed by the Primary Health Care strategy.

La estrategia Atención Primaria de la Salud introdujo conceptos que buscaron revolucionar la forma como se aspiraba lograr la Salud para Todos a nivel global. La declaración de Alma Ata fue un preludio de iniciativas y planes globales que buscaron comprometer a los Estados y a la sociedad en alcanzar el acceso a la salud con equidad. La Cumbre de Acción por la Infancia y la Reunión del Milenio, en la que se acordó las metas de salud a lograr el año 2015, estuvieron inspiradas en los conceptos incluidos en la Atención Primaria de la Salud. Si bien es cierto, los propósitos que subyacían a los postulados recogidos en Alma Ata no fueron alcanzados, sí hubo notables progresos en aspectos relacionados con la salud Materno Infantil. La Atención Primaria Selectiva de la Salud, inspiró la llamada ‘Revolución por la Supervivencia Infantil, que identificó las principales causas de las 15 millones muertes en niños, que se registraban a nivel global a inicios de la década de los años 80 del siglo pasado, así como las intervenciones sencillas, de bajo costo y basadas en la evidencia que habían mostrado ser efectivas en la prevención de esta ‘emergencia silenciosa que representaban las muertes infantiles evitables. Producto de estas intervenciones relacionadas con la salud infantil y la posterior inclusión de intervenciones para la prevención de las 500 000 muertes maternas evitables que registraba el mundo a inicios del presente siglo, se ha logrado notables progresos a nivel global en estos propósitos. El Perú fue uno de los países de las Américas que mostró mayores progresos en la reducción de la mortalidad materna y en la niñez. El presente artículo busca encontrar una explicación de las intervenciones y procesos que permitieron estos logros a nivel global y en el Perú, inspirados en los postulados propuestos por la estrategia de la Atención Primaria de la Salud.

Comparison of curative effect and serum electrolytes between different oral rehydration salts in treatment of neurally mediated syncope children / 中南大学学报(医学版)

Objective:To compare the curative effect and the changes of serum electrolytes between oral rehydration salts (ORS) Ⅰ and ORS Ⅲ treatment in neurally mediated syncope children.Methods:The children with the symptom of unexplained syncope and pre-syncope were collected in Second Xiangya Hospital from May 2014 to May 2017.After head-up tilt test (HUTT),their serum electrolytes levels were examined.Children who were positive in the HUTT received ORS (ORS Ⅰ or ORS Ⅲ) and health education.Subjects were randomly divided into an ORS Ⅰ group (n=27) and an ORS Ⅲ group (n=49).Results:There was no statistical significance in sex,age,height,body mass,initial diagnosis and re-diagnosis interval between the 2 groups (P＞0.05);the total efficiency after ORS Ⅲ and ORS Ⅰ treatment were 79.59％ and 62.96％,respectively,with no statistical significance (x2=2.483,P＞0.05);the HUTT negative conversion rate after ORS Ⅲ and ORS Ⅰ treatment were 51.02％ and 48.16％,respectively,with no statistical significance (x2=0.058,P＞0.05);before treatment,the serum sodium [(140.20±2.26) mmol/L vs (138.39±2.72) mmol/L;t=2.856,P＜0.05] in the ORS Ⅲ group was higher than that in the ORS Ⅰ group,the serum phosphorus [(1.46±0.19) mmol/L vs (1.65±0.29) mmol/L;t=3.146,P＜0.05] in the ORS Ⅲ group was lower than that in the ORS Ⅰ group;after treatment,the serum sodium [(140.31±2.01) mmol/L vs (138.88±2.08) mmol/L;t=2.692,P＜0.05] and serum calcium [(2.31±0.09) mmol/L vs (2.24±0.11) mmol/L;t=2.696,P＜0.05] in the ORS Ⅲ group were higher than those in the ORS Ⅰ group,the serum phosphorus [(1.45±0.16) mmol/L vs (1.61±0.25) mmol/L;t=3.128,P＜0.05] in the ORS Ⅲ group was lower than that in the ORS Ⅰ group;after ORS Ⅲ treatment,there was no statistical significance in serum electrolytes between HUTT positive group and HUTT negative group (P＞0.05);after ORS Ⅰ treatment,the serum calcium [(2.29±0.10) mmol/L vs (2.19±0.10) mmol/L;t=2.501,P＜0.05]and serum phosphorus [(1.71±0.24) mmol/L vs (1.50±0.21) mmol/L;t=2.392,P＜0.05] in HUTT positive group were higher than those in HUTT negative group.There was no statistical significance in serum sodium,potassium,magnesium,and chloride (P＞0.05);there was no statistical significance in serum electrolytes between pre-treatment and post-treatment in the ORS Ⅰ group and the ORS Ⅲ group (P＞0.05);there was no statistical significance in serum electrolytes between vasovagal syncope and postural orthostatic tachycardia syndrome in the ORS Ⅰ group and the ORS Ⅲ group before ORS treatment (P＞0.05).Conclusion:The ORS Ⅲ and ORS Ⅰ have the similar efficacy in the treatment of children with neurally mediated syncope.ORS Ⅲ is easier to be accepted by children than ORS Ⅰ,with better compliance.

Preparation of microparticles of glycyrrhetinic acid complex TOGA-X4 and in vitro release characteristics / 中草药

Objective To prepare TOGA-X4 microparticles with uniform size and good rehydration property and to obtain the stable and reliable preparation process, and evaluate the in vitro release characteristics. Methods With the average particle size, polydispersity index and rehydration as indexes, optimizing the process of antitumor active substance TOGA-X4 microparticles by stainless steel rapid film emulsification method through single factor investigation to investigate the factors influencing the size and dispersion of the drug microparticles and observe the morphology of the particles by scanning electron microscopy. With the cumulative release degree of TOGA-X4 as index, direct drug release method was adopted to determine the cumulative release rate of TOGA-X4 and the size of TOGA-X4 microparticles. The curve of in vitro drug release was fitted with different release model to estimate the in vitro release characteristics of TOGA-X4 raw powders and TOGA-X4 microparticles. Results The optimized preparation technology contained TOGA-X4 mass concentration of 5 mg/mL in oil phase, PVA mass concentration of 30 mg/mL in for aqueous phase, the ratio of oil to water was 1:1, transmembrane pressure at 0.4 MPa, sucrose aqueous solution of 50 mg/mL as freeze-drying protective agent, curing temperature at 70 ℃; Compared with other in vitro release models, the logistic equation was the fittest model to TOGA-X4 microparticles, zero order equation was the fittest model to TOGA-X4. Conclusion The preparation of microparticles by stainless steel rapid film emulsification is simple, stable and reliable, which can improve the dissolution rate of insoluble drugs and has advantages in the preparation of microparticles of poorly water-soluble drugs.

Consenso Internacional de Gastroenteritis Aguda en Urgencias. Comité de Emergencias SLACIP (Sociedad Latino Americana de Cuidados Intensivos Pediátricos)

Este documento pretende poner al alcance de todo profesional de salud una guía actualizada en el diagnóstico y manejo de la gastroenteritis aguda en pediatría, ya que esta enfermedad es una de las principales causas de consultas y hospitalizaciones. Se realizó una revisión exhaustiva de la literatura proponiendo una herramienta útil con el objetivo de reducir el impacto de la enfermedad en términos de incidencia, morbilidad y mortalidad. El tratamiento de la gastroenteritis debe ir dirigido a la prevención de la deshidratación y el desequilibrio electrolítico que produce, con líquidos adecuados, sales de rehidratación oral y el mantenimiento de la alimentación oral. La causa de esta enfermedad es principalmente viral y los criterios para el uso de antibióticos es controversial. Los coadyuvantes para disminuir el tiempo de enfermedad así como la frecuencia de la diarrea, en muchos de los casos están en estudio; por lo tanto el manejo guiado, estructurado y sistematizado garantizará en muchos casos el éxito del tratamiento de la gastroenteritis en los niños.

This document aims to provide an updated guideline for the diagnosis and management of acute gastroenteritis in pediatrics, as this disease is one of the main causes of consultations and hospitalizations. By performing an exhaustive review of the literature to produce a useful tool, this proposal aims to reduce the impact of the disease incidence, morbidity and mortality. The goal of gastroenteritis treatment is to prevent dehydration and electrolyte imbalance that it can produce, with adequate liquids, oral rehydration salts and maintenance of oral feeding. The causes of this disease are mostly viral and the criteria for antibiotic use is controversial. Treatment modalities to reduce the time of illness as well as the frequency of diarrhea are, in many cases, currently under study; therefore, guided, structured and systematized management will ensure the successful treatment of gastroenteritis in most children.

Assessment of radio frequency heating on composition, microstructure, flowability and rehydration characteristics of milk powder

Abstract Radio frequency heating (RFH) provides higher efficiency and more uniform heating zone compared with conventional method. The aim of present work is to evaluate the effect of RFH (at 90 °C for 5 or 10 min) on the changes in composition (protein oxidation and fat distribution), microstructure, flow characteristic and rehydration property of infant milk powder. The results indicate that the concentration of protein dityrosine was slightly enhanced, more free fat appeared on powder surfaces (> 50% increase), and porosity in powder matrix as tested by SEM was increased after RFH treatment. For powder flowability, raw sample had low cohesiveness (specific energy = 4.39 mJ/g), and RFH provided better flowability and decreased compressibility. Moreover, RFH had some negative impacts on wettability and solubility of powder particles with contact angle increase at least 5% and solubility decrease of 2%~4%, indicating worse rehydration abilities. Guggenheim-Anderson-de Boer (GAB) model was applied to fit moisture vapor sorption isotherms, and longer RFH duration leading to higher c values (about 63% increase at 10 min). In addition, the RFH initiated browning reaction as CIE a* values increased from -1.8 to -1.3.

A temperatura dos repositores hídricos pode influenciar a capacidade aeróbia? / Does the fluid replacers' temperature may influence the aerobic capacity?

O aumento da temperatura interna (Ti) é considerado importante causa da fadiga durante exercícios prolongados realizados no calor. Dentre as estratégias empregadas para atenuá-la, a reposição hídrica é a que mais se destaca por sua praticidade e baixo custo. Por outro lado, pouco se sabe a respeito da influência que a temperatura dos repositores hídricos exerce sobre respostas termorregulatórias e o desempenho aeróbio durante exercícios prolongados em ambientes quentes. Teoricamente, as bebidas em baixa temperatura poderiam conferir vantagem fisiológica, agindo como dissipadores de calor ou proporcionando uma sensação agradável, levando à manutenção da ativação do drive central. Combinados, esses mecanismos podem diminuir os efeitos deletérios da elevação da Ti ao desempenho. Mesmo assim, o número de estudos investigando tal hipótese é escasso. Logo, o objetivo deste Ponto de Vista foi examinar se as evidências existentes apoiam a hipótese de modulação da Ti e melhora do desempenho aeróbio a partir da ingestão de bebidas em baixas temperaturas durante os exercícios prolongados realizados no calor. Encontramos grande heterogeneidade na metodologia dos estudos, sobretudo no que diz respeito 1) ao baixo número amostral; 2) à ausência de soluções controle; 3) à falta de padronização do momento de administração dos repositores hídricos; e 4) ao protocolo de exercício utilizado. Isso dificulta o estabelecimento de conclusões definitivas sobre o assunto, e, portanto, mais estudos são necessários. Contudo, evidências oriundas de poucos estudos bem controlados sugerem que repositores hídricos em baixa temperatura podem atenuar o aumento na Ti e melhorar a capacidade aeróbia durante a realização de exercícios prolongados no calor....(AU)

The increase in internal temperature (Ti) is considered a major cause of fatigue during prolonged exercise in the heat. Among the strategies employed to attenuate it, the fluid replacement is the most used due its cost-effectiveness and practicality. On the other hand, little is known about the influence that the beverage temperature exerts on the thermoregulatory responses and aerobic capacity during prolonged exercise in hot environments. Theoretically, fluid replacers at a low temperature may provide a physiological advantage by acting as a 'heat sink', and providing a pleasant sensation, leading to increased central drive activation. These mechanisms would mitigate the side effects of an increased Ti on performance. Nevertheless, the number of studies dedicated to investigate this hypothesis is scarce. Thus, the aim of this Point of View was to examine whether the existing evidence support the modulation of Ti and improved aerobic capacity hypothesis from fluid replacers at low temperatures during prolonged exercise in hot environments. We have found substantial heterogeneity in the methodology inherent in these studies with regards to the 1) low sample size; 2) absence of control solutions; 3) lack of standardization of the moment of administration of the fluid replacers; and 4) exercise protocol. This causes difficulty in establishing definitive conclusions on this topic, and therefore more studies are required. However, the few existing evidence from well-controlled studies suggest that the fluid replacers at low temperatures can attenuate the increase in Ti and improve aerobic capacity during prolonged exercise in the heat....(AU)