Trastornos de la alimentación en pacientes hospitalizados en un Servicio de Salud Mental Pediátrico / Eating behavior disorders in patients hospitalized in a Mental Health Service

INTRODUCTION: Los trastornos de la alimentación e ingesta (TAI) tienen una elevada prevalencia durante la adolescencia, asociándose a alta morbimortalidad. En nuestro país no existen datos que caractericen a los adolescentes con TAI que requieren hospitalización. OBJETIVO: Describir y analizar las hospitaliza ciones debidas a TAI en niños y adolescentes en un Servicio de Salud Mental Pediátrico (SSMP). PACIENTES Y MÉTODO: Se recolectaron los datos de los registros clínicos de pacientes con TAI hospitalizados en el SSMP del Hospital Roberto del Río entre 2005-2015. Se estudiaron las variables de ingreso: motivo de hospitalización, tipo de TAI, estado nutricional, repercusión sistémica y variables sicosociales (comorbilidades siquiátricas, funcionamiento de la familia, abuso e ideación/intento suicida). Para la comparación de variables cuantitativas entre grupos se utilizó el test t-Student y para variables categóricas chi-cuadrado o Test Fisher. RESULTADOS: Se incluyeron 93 pacientes, me diana de edad 14,6 años, 84% género femenino. El diagnóstico más frecuente fue anorexia nerviosa (AN) (71%) y la causa más frecuente de hospitalización fue el fracaso del tratamiento ambulatorio, seguido por ideación/intento suicida. Al ingreso, 40% de los pacientes presentaban déficit nutricio nal, 96% comorbilidad psiquiátrica y 88% disfunción familiar. CONCLUSIÓN: La AN fue el TAI más frecuente dentro de los pacientes hospitalizados y el fracaso del tratamiento ambulatorio el principal motivo de ingreso. Esto último podría ser explicado, en parte, por la alta prevalencia de disfunción familiar y comorbilidad psiquiátrica de los pacientes y su familia, que estaría complicando el trata miento ambulatorio.

INTRODUCTION: Eating disorders (ED) have a high prevalence during adolescence, associated with high morbidity and mortality. In our country, there are no data that characterize adolescent inpatients with ED. OBJECTIVE: To describe and analyze hospitalizations of children and adolescents due to ED admitted in a Pediatric Mental Health Service (PMHS). PATIENTS AND METHOD: Data were collected from the clinical record of patients with ED hospitalized in the PMHS of the Hospital Roberto del Río during 2005-2015. The following admission variables were studied: cause for hospitalization, ED type, nu tritional status, systemic involvement, and psychosocial variables (psychiatric comorbidities, family functioning, abuse, and suicide ideation/attempt). The t-Student test was used for quantitative varia bles and the chi-square or Fisher Test for qualitative variables for the comparison between groups. RESULTS: 93 patients were included, with an average age of 14.6 years, 84% of them were women. The most frequent diagnosis was anorexia nervosa (AN) (71%) and the most frequent cause for hospita lization was the failure of outpatient treatment, followed by suicide ideation/attempt. At admission, 40% of the patients had malnutrition, 96% psychiatric comorbidity, and 88% family dysfunction. CONCLUSION: AN was the most frequent ED among inpatients and the failure of outpatient treatment was the main cause for hospitalization. The latter could be explained, in part, by the high prevalence of family dysfunction and psychiatric comorbidity of patients and their families which would com plicate outpatient treatment.

Trastornos de la conducta alimentaria: alteraciones cardiovasculares al ingreso y evolución a 3 meses / Female adolescents with eating disordes: cardiac abnormalities

Background: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. Aim: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. Patients and Methods: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. Results: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. Conclusions: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.

Perfil neuropsicológico de las pacientes con trastornos de la conducta alimentaria / Neuropsychological profile of patients with eating disorders

Los trastornos de la conducta alimentaria (TCA), entre los que se encuentran la anorexia nerviosa (AN) y la bulimia nerviosa (BN), presentan una gran relevancia social, económica y sanitaria. Recientemente se ha observado que las alteraciones conductuales típicas de estas pacientes podrían ser explicadas, al menos en parte, por determinados déficits cognitivos. Es por ello que la evaluación neuropsicológica parece ser necesaria para obtener una mayor comprensión de esta clase de trastornos. El objetivo de este estudio fue evaluar si existían diferencias en el funcionamiento neuropsicológico de un grupo de mujeres jóvenes con AN y BN en comparación con otro grupo de mujeres sanas sin TCA (grupo control). Los resultados obtenidos pusieron de manifiesto que las pacientes con TCA presentaron una peor ejecución en la memoria audio-verbal y episódica, una menor flexibilidad cognitiva y una peor capacidad de planificación, en comparación con un grupo de mujeres normativas. No obstante, las pacientes de este estudio se encontraban dentro de los parámetros de normalidad en la memoria visoespacial, en la atención, en la velocidad de procesamiento, en la memoria de trabajo, en la capacidad de inhibición de respuestas automáticas, en la fluidez verbal y en la cognición social. En conclusión, la identificación y caracterización de estas alteraciones cognitivas podría ayudar a identificar nuevos objetivos terapéuticos y desarrollar estrategias de tratamiento más específicas para los pacientes con TCA. De hecho, sería importante desarrollar e implementar programas de rehabilitación cognitiva coadyuvantes a la psicoterapia para este tipo de pacientes.

Eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN) have great social, economic, and healthcare relevance. It was recently observed that the typical behavioral alterations of these patients could be explained, at least partly, by certain cognitive deficits. For this reason, neuropsychological evaluations might contribute to better understanding these types of disorders. This study aims to evaluate whether there were differences in the neuropsychological functioning of a group of young women with AN and BN, compared to another group of healthy women without eating disorders (control group). The results obtained showed that patients with eating disorders had worse performance on audio-verbal and episodic memory, less cognitive flexibility, and worse planning capacity than the control group. However, cognitive functioning was unimpaired for visuospatial memory, attention, processing speed, working memory, ability to inhibit automatic responses, verbal fluency, and social cognition. In conclusion, the identification and characterization of these cognitive alterations could help to identify new therapeutic objectives and develop more specific treatment strategies for patients with ED. In fact, it would be important to develop and implement adjuvant cognitive rehabilitation programs alongside the current psychotherapy for these patients.

Night eating syndrome: How to treat it? / Síndrome do comer noturno: como tratar?

Summary Night eating syndrome (NES) is characterized by caloric intake ≥ 25% of total daily after dinner and/or by two or more weekly nocturnal awakenings accompanied by food ingestion. Causes of NES are not entirely clear and seem to involve a desynchronization between the circadian rhythms of food ingestion and sleep, resulting in a delayed pattern of food intake. Estimates of the prevalence of NES in the general population are around 1.5%, and although much higher frequencies have been described in obese individuals, a causal relationship between NES and obesity is not clearly established. Since the first NES reports, several treatment modalities have been proposed, although, in many cases, the evidence is still insufficient and there is no consensus on the ideal approach. In order to conduct a critical review of proposed treatments for NES since its original description, a systematic search of articles published in journals indexed in Medline/Pubmed database in the period 1955-2015 was performed. Seventeen articles addressing non-pharmacological and pharmacological therapies met the selection criteria. Based on the articles analyzed, we conclude that serotonergic agents and psychological interventions, particularly cognitive behavioral therapy, have been shown to be effective for the treatment of NES. A combination of non-pharmacological and pharmacological therapies must be considered in future studies on the treatment of these patients.

Resumo A síndrome do comer noturno (SCN) caracteriza-se por ingestão calórica ≥ 25% do total diário após o jantar e/ou por dois ou mais despertares noturnos semanais acompanhados de alimentação. As causas da SCN não estão totalmente esclarecidas e parecem envolver uma dessincronização entre os ritmos circadianos de alimentação e sono, resultando em um atraso do padrão alimentar. Estimativas da prevalência de SCN na população geral estão em torno de 1,5% e, embora frequências bem mais elevadas tenham sido descritas em obesos, uma relação de causalidade entre SCN e obesidade não está claramente estabelecida. Desde os primeiros relatos da SCN, várias modalidades de tratamento têm sido propostas, embora, em muitos casos, a evidência ainda seja insuficiente e não exista um consenso sobre a abordagem ideal. Com o objetivo de realizar uma revisão crítica dos tratamentos propostos para a SCN, desde sua descrição original, foi realizada uma busca sistemática de artigos publicados nos periódicos indexados na base de dados MedLine / Pubmed entre 1955 e 2015. Dezessete artigos, abordando terapias não farmacológicas ou farmacológicas, preencheram os critérios de seleção. Com base nos artigos analisados, conclui-se que os agentes serotonérgicos e intervenções psicológicas, particularmente, a terapia cognitivo-comportamental, têm mostrado eficácia no tratamento da SCN. Uma combinação de terapias não farmacológicas e farmacológicas precisa ser considerada em estudos futuros sobre o tratamento desses pacientes.

Trastornos de la alimentación y deglución en niños con parálisis cerebral: condiciones clínicas acompañantes / Feeding and swallowing disorders in children with cerebral palsy: co-occurring clinical conditions

Introduction: Cerebral Palsy (CP) is frequently accompanied by other cooccurring clinical conditions (CCC). Feeding and swallowing disorders (FSD) are a common problem among CP population and tend to be more complex when associated to certain CCC. Objective: To quantify the frequency of CCC in a group of children with CP and FSD, of both genders, GMFCS I to V, between the age of 3 to 6 years. Patients and Methods: 49 patients diagnosed with CP and FSD underwent 5 assessments: 1) physiatric evaluation; 2) Gross Motor Functional Classification System (GMFCS); 3) Eating and Drinking Ability Classification System (EDACS); 4) videofluoroscopic swallowing study; and 5) sensory processing test.Results: All 49 patients had at least one of the CCC usually present in CP, with an average of 3,8 (from 1 to 6). All GFMCS and EDACS levels were affected, including mild ones. Some of the CCC showed high frequencies: intellectual disability (ID) (83,7 percent), sensory processing disorder (SPD) (75,5 percent), sialorrhea (71,4 percent), malnutrition (67,4 percent), altered alertness (67,4 percent) and constipation (61,2 percent).There was a high frequency of association between CCC. In more than 50 percent of the cases, the association of ID with most of the other conditions was the commonest.Conclusions: Children diagnosed with CP and FSD present with multiple CCC able to worsen their prognosis. All GMFCS and EDACS levels are affected. ID is the most frequent CCC, being also the most associated with the others.

Introducción: La Parálisis Cerebral (PC) cursa junto a numerosas condiciones clínicas acompañantes (CCA), destacando los trastornos de la alimentación y deglución (TAD). En PC numerosas CCA pueden interactuar con los TAD y complicarlos. Objetivo: Cuantificar la frecuencia de determinadas CCA en niños con PC, GMFCS I a V, de 3 a 6 años, portadores de TAD. Pacientes y Métodos: 49 pacientes con PC y TAD fueron sometidos a 5 evaluaciones: 1) valoración fisiátrica; 2) Gross Motor Functional Classification System (GMFCS); 3) Eating and Drinking Ability Classification System (EDACS); 4) videofluoroscopía (VFC); y 5) pauta de integración sensorial. Resultados: Todos los pacientes con PC y TAD presentaron alguna de las CCA consideradas, con un promedio de 3,8 por niño (rango 1-6), afectando a todos los niveles GMFCS y EDACS, incluidos los leves. Algunas tuvieron elevada frecuencia: déficit cognitivo (DC) (83,7 por ciento), trastorno de la integración sensorial (TIS) (75,5 por ciento), sialorrea (71,4 por ciento), desnutrición (67,4 por ciento), alerta alterada (67,4 por ciento) y constipación (61,2 por ciento). Hubo una alta frecuencia de asociación de CCA, siendo más común la asociación de DC con varias de las otras condiciones, en más del 50 por ciento de los casos. Conclusiones: Los niños con PC y TAD cursan con CCA múltiples que complican su cuadro clínico. Todos los niveles GMFCS y EDACS se ven afectados. El DC es la condición más frecuente y muestra más asociación con las otras.

Trastornos de la alimentación y deglución en niños con parálisis cerebral: presencia y severidad / Feeding and swallowing disorders in children with cerebral palsy: presence and severity

Introduction: Feeding and swallowing disorders (FSD) are common among children with cerebral palsy (CP) and have a high potential for morbidity related complications and death. Objective: To determine presence, severity and characteristics of FSD in a group of children with CP, of both genders, GMFCS I to V, between 3 and 6 years. Patients and Methods: 50 patients underwent 4 assessments: 1) description of clinical characteristics of CP; 2) clinical swallowing evaluation; 3) videofluoroscopic swallowing study; and 4) determination of presence and severity of FSD. Results: There was male predominance, with an average age of 5 years, 78 percent GMFCS III to V. Bilateral motor involvement, mixed motor symptoms and signs, and hypotonic axial muscles predominated. The presence of a FSD was high, either considered in general (98 percent of children) or considered only for solid food (98 percent) or liquids (96 percent). In all cases, FSD was most common in children with more motor involvement. All swallowing phases were affected in different proportions, especially with solid food. Recognizing normal cases from affected ones is best when using several assessing tools (5 percent of children were normal when Campora scale was used, 1 percent according to EDACS and 5 percent using videofluoroscopy).The perception of FSD was reduced in both the caregiver and the medical team. Conclusions: FSD are frequent in CP. All GMFCS levels can be affected, especially those including more motor involvement. Swallowing phases were all altered, mainly pre-oral stage for solid food. Complementing several assessing tools seems to be the best way when approaching to CP children with FSD.

Introducción: Los trastornos de la alimentación y deglución (TAD) son frecuentes en niños con Parálisis Cerebral (PC), mostrando elevados potenciales de morbimortalidad. Objetivo: Establecer la presencia, severidad y características de los TAD, en un grupo de niños y niñas con PC, GMFCS I a V, entre 3 años y 6 años. Pacientes y Métodos: 50 pacientes seleccionados fueron sometidos a 4 evaluaciones: 1) características clínicas de la PC; 2) valoración de la deglución; 3) videofluoroscopía; y 4) determinación de presencia y severidad del TAD. Resultados: Población predominantemente masculina, con edad promedio de 5 años, 78 por ciento GMFCS III a V. Predominaron la topografía bilateral, la semiología motora mixta y el hipotono axial. La presencia de TAD fue muy alta, considerada en general (98 por ciento de los casos), o sólo para sólidos (98 por ciento) o líquidos (96 por ciento), siendo más frecuente a mayor compromiso motor. Todas las fases deglutorias estuvieron alteradas en diversa proporción, especialmente con sólidos. Hubo diferencias en la detección de casos normales y alterados al aplicar distintos métodos evaluativos (5 por ciento de niños normales según escala de Campora, 1 por ciento por EDACS y 5 por ciento por videofluoroscopía).La sospecha de TAD estuvo reducida en cuidadores y profesionales rehabilitadores. Conclusiones: Los TAD son frecuentes en PC. Todos los niveles GMFCS pueden estar afectados, con más frecuencia los de mayor compromiso motor. Todas las fases deglutorias aparecen comprometidas, sobretodo la preoral para sólidos. El complemento de herramientas de evaluación parece ser lo ideal al enfrentar un paciente con TAD.

Personality prototype as a risk factor for eating disorders

Objective: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. Method: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. Results: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. Conclusions: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Avaliação da densidade mineral óssea em adolescentes do sexo feminino com transtorno alimentar / Evaluation of bone mineral density in female adolescents with eating disorders

OBJETIVO: Avaliar a densidade mineral óssea (DMO) lombar em meninas com transtorno alimentar no diagnóstico e após seis meses e um ano de tratamento. SUJEITOS E MÉTODOS: Estudo prospectivo com 35 adolescentes do sexo feminino, portadoras de AN ou TANE acompanhadas por um ano. A densitometria óssea (DO) da coluna lombar L1-L4 pelo método de absorciometria com raios X de dupla energia (DXA) foi realizada no início, após seis meses e um ano de tratamento. RESULTADOS: Houve aumento do peso, da altura e do índice de massa corporal (IMC), progressão da idade óssea (p < 0,001), e 70% das adolescentes com amenorreia secundária restabeleceram os ciclos menstruais. No entanto, não houve diferença significativa do escore Z da DO lombar ao longo de um ano (p = 0,76). CONCLUSÃO: A recuperação da DMO não ocorre ao mesmo tempo em que a restauração do eixo hipotalâmico-hipofisário-gonadal.

OBJECTIVE: To evaluate lumbar bone mineral density (BMD) in girls with eating disorders in the beginning of the treatment, at six months, and after one year of treatment. SUBJECTS AND METHODS: This prospective study involved 35 female adolescents with AN or EDNOS treated during one year. Lumbar (L1-L4) bone mineral density by DXA was performed in the beginning of treatment, at six months, and after one year of treatment. RESULTS: There was improvement in weight, length, BMI, bone age (p < 0.001), and 70% of the adolescents with secondary amenorrhea had their menstrual cycles restored. However, the Z-score of lumbar BMD did not show differences during one year of follow-up (p = 0.76). CONCLUSION: The recovery of BMD does not occur together with the restoration of hypothalamic-pituitary-gonadal axis.

Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes

Objective: To evaluate the frequency of risk behaviors for eating disorder (ED) in patients with type 1 diabetes (T1D) and their association with gender, nutritional status, variables related to T1D, and body satisfaction. Method: 189 individuals with T1D (12-56 years old) answered the Bulimic Investigation Test (BITE), the Eating Attitude Test (EAT), the Binge Eating Scale (BES), Stunkard's Figure Rating Scale, and questions regarding control of T1D. Association between ED risk behaviors and the selected variables was assessed with the chi-square test and Student's t-test; factors that influenced the risk of ED were identified by means of logistic regression. Results: Of the patients with T1D, 58.7% were at risk of ED (45, 40, and 16% according to the EAT, BITE and BES, respectively). There were significant differences between groups with and without risk for ED related to BMI (p = 0.009), gender (p = 0.001), insulin omission (p = 0.003), use of the carbohydrate counting method (p = 0.019), and body dissatisfaction (p = 0.001). The risk of ED was nine times higher in patients who reduced or omitted insulin (p = 0.036). Conclusions: Patients with T1D demonstrated a high frequency of body dissatisfaction and ED risk behaviors; the omission or reduction of insulin was an important risk factor. .

Controle neuronal e manifestações digestórias na paralisia cerebral / Digestive tract neural control and gastrointestinal disorders in cerebral palsy

OBJETIVOS: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. FONTES DOS DADOS: Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. SÍNTESE DOS DADOS: O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado de humor e capacitação dos cuidadores. Trata-se, portanto, de etiologia multifatorial. As desordens digestórias mais prevalentes são disfagia, doença do refluxo gastroesofágico e constipação intestinal, com consequentes quadros de infecções respiratórias de repetição e repercussão deletéria no estado nutricional. CONCLUSÕES: Indivíduos com paralisia cerebral apresentam alterações neurológicas do controle do sistema digestório, portanto manifestações digestórias são frequentes. As questões abordadas são fundamentais para profissionais das equipes interdisciplinares que atendem indivíduos com paralisia cerebral acerca da importância da anamnese ampla, exame clínico e complementar detalhado que incluam investigação das desordens gastrointestinais associadas e suas consequências. A detecção precoce dessas alterações digestórias pode respaldar medidas de reabilitação mais eficientes no sentido de melhoria da qualidade de vida desses indivíduos.

OBJECTIVES: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment. SOURCES: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. SUMMARY OF THE FINDINGS: The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. CONCLUSIONS: Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.

Enteropatogenicidad de bacterias aisladas de peces, del agua y plancton de su entorno en Venezuela / Enteropathogenicity of bacteria isolated from fish, water and plancton from their environment in Venezuela

Las enfermedades de transmisión alimentaria asociadas al consumo de pescado, constituyen en la actualidad un grave problema sanitario en Venezuela, ya que la aparición de patologías gastrointestinales se ha hecho cada vez más frecuente, quizás originada directamente por miembros de la bacterioflora de peces dulceacuícolas. En tal sentido, el objetivo de esta investigación se centró en la determinación de la enteropatogenicidad, específicamente la citotoxicidad y enterotoxicidad de cepas bacterianas aisladas de tilapias, truchas arco iris y cachamas, provenientes de granjas y del medio silvestre. Para ello, se emplearon un total de 12 cepas, dos por cada especie bacteriana: Aeromonas hydrophila, Escherichia coli, Klebsiella pneumoniae, Pseudomonas fluorescens, Plesiomonas shigelloides y Vibrio cholerae, empleando la línea celular Vero y a través del modelo de inoculación en ratones lactantes. La producción de enterotoxinas resultó positiva para el 42 por ciento de las cepas, observándose distensión abdominal con fluido intestinal de color blanquecino en ratones inoculados con A. hydrophila, K. pneumoniae y V. cholerae, mientras que en aquellos inoculados con E. coli, el fluido se observó hemorrágico. El 100 por ciento de las cepas resultaron citotóxicas en el ensayo con células Vero, produciendo alteraciones intra (granulaciones tóxicas) y extracelulares (disgregación y cambios en la morfología celular). Estos resultados permiten inferir sobre la existencia de un vínculo entre el consumo de pescado y la aparición de enfermedades en el humano.

Diseases transmitted through food products associated to fish consumption, actually constitute a serious sanitary problem in Venezuela, because gastrointestinal pathologies are more frequent, maybe originated directly from members of freshwater fish bacterioflora. For this, the objective of this research was focused in the enteropathogenicity determination, specifically citotoxicity and enterotoxicity of strains isolated from tilapias, rainbow trouts and cachamas, captured from farms and natural environments. In that sense, 12 strains were used, two of each of the following species: Aeromonas hydrophila, Escherichia coli, Klebsiella pneumoniae, Pseudomonas fluorescens, Plesiomonas shigelloides and Vibrio cholerae, using a Vero cellular line and the suckling mouse model. The enterotoxin production resulted positive for 42 percent of the strains, observing abdominal distension with a whitish intestinal fluid in mice inoculated with Aeromonas hydrophila, Klebsiella pneumoniae and Vibrio cholerae, while in those inoculated with E. coli the fluid was hemorraghic. All the strains resulted citotoxic in the trial with Vero cells, producing intracellular (toxic granulations) and extra cellular alterations (desegregation and changes in the cellular morphology). These results allow the inference that there is a relation between fish consumption and the appearance of disease in humans.

Cortex insular y su rol putativo en la configuración de trastornos alimenticios / Insular Cortex and putative role in the configuration of eating disorders

El estudio neurocientífico de los desordenes alimenticios, ha experimentado importantes avances en la ultima década, posibilitando dilucidar sustratos cerebrales asociados a la configuración de diversas patologías. El lóbulo insular ha sido escasamente estudiado, trabajos de neuroimagen recientes han permitido conocer su representación anatómica, citoarquitectónica y funcional, así como su conexión con el sistema límbico y neocortex. Su activación, ha sido implicada en diversos procesos: sensomotores viscerales, somatosensoriales (incluyendo el dolor), motores, volitivos, gustativos, auditivos, vestibulares, emocionales y funciones cognitivas como el lenguaje (Ackermann, H.; Riecker, A; 2004). El presente artículo, tiene por objetivo analizar los correlatos neurofisiológicos asociados a desordenes alimenticios (obesidad, anorexia y bulimia). Sugiriendo una activación tónica diferencial en ínsula, que permitiría explicar la experiencia de saciedad y valoración afectiva a estímulos apetitivos, alterada en desordenes alimenticios.

The study neurocientífico of food disorders, has experienced significant progress in the last decade, enabling elucidate substrates brain associated with the configuration of various pathologies. The lobe island has been little studied, neuroimaging recent work has revealed his anatomical representation, citoarquitectónica and functional as well as its connection with the limbic system and neocortex. Their activation has been implicated in various processes: sensomotores visceral, somatosensory (including pain), motors, volitivo, taste, hearing, vestibular, emotional and cognitive functions such as language (Ackermann, H.; Rieck, A, 2004). This article aims to analyze the neurophysiological correlates associated with food disorders (obesity, anorexia and bulimia). Suggesting an activation pattern in differential island, which would explain the experience of satiety and valuation emotional stimuli to appetite, altered food disorders.

Aspectos psicobiológicos do comportamento alimentar / Psychobiological aspects of feeding behavior

Esta revisão aborda alguns aspectos psicobiológicos ligados à manifestação do comportamento alimentar, e tem como objetivo evidenciar a relação entre os principais processos neuropsicológicos e a neurociência nutricional. Algumas estruturas neurais estão associadas ao controle alimentar por mecanismos distintos e correlatos que ocorrem no hipotálamo, hipocampo e em outras áreas como no cerebelo, bulbo olfatório, glândulas pituitária e pineal que exercem funçöes distintas, porém influênciam o comportamento alimentar, intermediadas geralmente por neurotransmissores comuns. Os precursores dos neuroquímicos apresentam funçöes específicas, sendo a influência na alimentação relevante no contexto comportamental da escolha de alimentos. Os processos sensoriais na alimentação como paladar, olfato, visão e audição interagem entre si e com outras estruturas e vias neurais, participando também do controle do apetite e da saciedade, que culminam na iniciação e no término da alimentação. A interação entre aspectos neurais no processo de consumo de alimento promove a manifestação do comportamento alimentar específico para cada espécie em seu ambiente.

Alteraciones neuroendocrinológicas en bulimia nerviosa / Neuroendocrin alterations in bulimia nervosa

La bulimia nerviosa es un trastorno de la conducta alimentaria que se caracteriza por tener una etiología multidimensional que incluye factores genéticos, biológicos, psicológicos, familiares y socioculturales, cuyas características más importantes son, básicamente, conductas de descontrol alimentario y de purga, alteración del estado de ánimo y anomalías neuroendócrinas. Estas pacientes presentan disfunciones en diferentes sistemas de neurotransmisores, relacionados de forma directa con la modulación del apetito, del humor y de la funciones neuroendócrinas. Dichos trastornos biológicos desempeñan, con toda probabilidad, un importante papel, y, junto con otros factores de tipo psicosocial y de personalidad que contribuyen al desarrollo y mantenimiento del "complejo sintomático" bulimia nerviosa. La bulimia nerviosa se caracteriza, pues, esencialmente por: a) pérdida de control sobre la conducta alimentaria de la que derivan. a.1) los episodios de ingesta voraz y consumo de una gran cantidad de comida en corto espacio de tiempo, seguida de a.2) conductas compensatorias para evitar el aumento de peso: el ayuno, vómitos autoinducidos, abuso de laxantes y diuréticos, ejercicio físico exagerado. b) alteraciones de humor y c) alteraciones neuroendócrinas (a las cuales haremos referencia más adelante)

Transtornos del comportamiento alimentario en deportistas practicantes de Karate-do

Objetivos: determinar la frecuencia de transtornos del comportamiento alimentario (TCA) en practicantes de karate-do y establecer su relación con ansiedad y depresión. Métodos: los sujetos fueron evaluados mediante encuestas para tamizaje para TCA (ECA), depresión y ansiedad (Zung), las cuales fueron repetidas y validadas por entrevista según el DSM-IIIR. Resultados: participaron 21 mujeres y 37 hombres, de 22,7+/- 5,7 años. La ECA fue positiva en 14 mujeres y 7 hombres. Se diagnosticaron 15 casos de TCA en la entrevista con predominio de las mujeres (p<0.02) y asociación con sobrepeso (p>0,001). La ECA tuvo una sensibilidad de 93 por ciento y especificidad de 84 por ciento. Los Zung fueron compatibles con depresión en 22,4 por ciento y ansiedad en 17 por ciento y hubo asociación con los TCA (p>0.001 y p>0.005, respectivamente). Conclusiones: 1) La frecuencia de TCA es alta entre los practicantes de karate do, especialmente entre las mujeres; 2) los TCA se asocian con transtornos de depresión y ansiedad.

Assessment of sensorial oral stimulation in infants with suck feeding disabilities.

A non-randomized single blind study was undertaken to determine the clinical and physiological changes in suck feeding after sensorial oral stimulation, in fourteen patients age 9 to 210 days old with sucking alterations. Patients lacked at least one of the five oral reflexes, plus two or more abnormal sucking sings or at least one abnormal sucking sign, plus two or more abnormal oral reflexes. Oral sensorial therapy was performed thrice daily for five days. The number of absent oral reflexes, number of abnormal sucking signs, volume of milk for nursing and sucking rate, were registered. Differences of medians were tested using Freidman's test and differential of proportions using Cochran's Q test. After therapy, oral reflexes were recovered (2, 0-4 vs. 5,5-5, p = 0.0000, median rank of absence oral reflexes) and the number of abnormal sucking signs decreased (6,1-9 vs. 1, 0-4; p = 0.0000). There were statistically significant improvements in patients who had lost launch up nipple ability (p = 0.005), delay at the beginning of sucking (p = 0.0022), drawing of milk from the mouth (p = 0.0001), cyanosis (p = 0.0084), weaning (p = 0.0004) and prolonged sucking (p = 0.0038). Even in patients with moderate improvement, no statistical differences were observed in nipple rooting (p = 0.09) and coughing (p = 0.09). No changes were observed in patients who had cried (p = 0.31) and spitted (p = 0.51) during feeding. At the end of therapy, volumes of consumed milk were increased at each feeding (10 ml, 0-40 vs. 50 ml, 25-60; p = 0.0001). Sucking rates also increased (22 sucks/minute, 10-35 vs. 40.5, 35-48; p = 0.0044). Oral sensorial and motor stimulation normalise oral motor reflexes, diminish the clinical abnormal sucking signs and increase milk volumes ingested for nursing.

Qué será bueno para el apetito?

En la crianza de un niño, la alimentación desempeña un gran papel, es comprensible en consecuencia que se convierta en una preocupación importante para los padres y en un motivo de consulta frecuente para los médicos. No es raro oír las quejas de ellos: "no come nada", "está muy delgado", "no come sino dulces"o las preguntas "qué será bueno para el apetito?", "ha comido bastante?", "ha digerido bien?" Son todas estas y más inquietudes las que llevan al pediatra a buscar una respuesta para sus pacientes. El presente trabajo reúne distintos conceptos sobre el tema a la luz de la experiencia clínica de su autora, los analiza y propone algunas medidas prácticas para resolver esta dificultad.

El efecto de la adrenalina sobre el consumo de alimento y la expresión de C-fos en el sistema nervioso central / The effect of adrenalin on the consumption of food and the expression of C-fos in the CNS

La administración intraportal o intraperitoneal (IP) de adrenalina (A) produce hipofagia en la rata, mientras que la inyección intravenosa o intramuscular (IM) no lo hace. Se ha sugerido que la A actúa a nivel hepático para controlar la ingesta de alimento por medio de aferencias vagales hacia el cerebro. En el presente trabajo se utilizó la expresión del gene C-fos como índice de actividad neuronal y se compararon los efectos respectivos de la A IP e IM sobre la ingesta y la activación de áreas del cerebro que reciben información vagal aferente. Ratas Wistar machos fueron inyectadas con solución salina o A (100µg/Kg) por vía IP o IM. En un primer experimento, se determinó el consumo de alimento. En un segundo experimento, se analizó inmunohistoquímicamente la expresión de c-fos en diversas áreas del cerebro. La A IP redujo el consumo de alimento en un 75 por ciento (p<0.01) mientras que la A IM no tuvo efecto alguno. Los resultados de la expresión de c-fos indican que aquellas regiones del núcleo del tracto solitario/área postrema que reciben aferencias gastrointestinales y hepática son activadas de manera específica por la administración IP de A. Esto concuerda con la posibilidad de que su efecto hipofágico implique aferencias vagales, posiblemente de origen hepático. Sin embargo, algunos niveles superiores de integración, como los núcleos parabraquial y paraventricular no parecen estar involucrados, o lo están de manera inespecífica

Trastornos del comportamiento alimentario. Características clínicas y evolución

Los pacientes atendidos en dos hospitales universitarios con trastorno de comportamiento alimentario, desde enero de 1989 hasta marzo de 1994, fueron evaluados utilizando los criterios de DSM-III-R. Ingresaron al estudio 35 pacientes, 33 mujeres y dos hombres, de 24 mas o menos 14 años. La duración de la enfermedad fue de 58 mas o menos 70 meses; en 50 por ciento de los casos comprometía seriamente el estado de salud, la autoimagen corporal y la vida de relación. Como factores de riesgo se encontraron antecedentes de obesidad familiar en 66 por ciento, alteración de la autoimagen en 43 por ciento, antecedente de depresión 40 por ciento y ruptura afectiva en 14 por ciento. Se diagnosticó anorexia en 23 por ciento de los casos, bulimia en 17 por ciento y trastorno no especificado en los otros. Las pacientes anoréxicas eran significativamente más jóvenes, su peso y talla eran muy inferiores, su estado general estaba más comprometido. El 50 por ciento de los pacientes rechazó cualquier tipo de tratamiento. Se observó mejoría en 67 por ciento de los pacientes seguidos durante un año. Los trastornos del comportamiento alimetario son frecuentes en nuestro medio. Pueden producir serias alteraciones en la vida personal y de relación de las personas afectadas.