Identificação de polímeros de microplásticos encontrados no trato digestivo de peixes do Lago de Amatitlán, Guatemala / Identification of microplastic polymers found in the digestive tract of fish from Lake Amatitlán, Guatemala

O objetivo desta pesquisa foi a identificação, por meio de espectroscopia no infravermelho com transformada de Fourier combinada com reflectância total atenuada (FTIR-ATR), de microplásticos extraídos do trato gastrointestinal de peixes coletados no Lago de Amatitlán, para determinar os principais polímeros e a possível origem da contaminação por esses materiais. Foram analisados 68 microplásticos, correspondendo a 10% do total de microplásticos extraídos. Estes originaram-se de 36 espécimes, sendo 35 da espécie Oreochromis niloticus e um de Parachromis managuensis, dos quais foram analisados de 1 a 5 microplásticos por espécime. Os polímeros identificados foram polipropileno (PP), nylon, polietileno de alta densidade (HDPE), tereftalato de polietileno (PET), látex, poliestireno (PE), polietileno de baixa densidade (LDPE) e poliuretano (PU). O polipropileno (32), o polietileno de alta densidade (13) e o nylon (10) foram os polímeros mais frequentes. Os possíveis itens plásticos que podem ter originado os microplásticos incluem brinquedos, equipamentos de laboratório, baldes, embalagens de alimentos, tubulações, isolamento para cabos, têxteis, cordas e móveis que são produzidos na indústria do plástico, localizada principalmente na vertente sul da cidade da Guatemala. Além disso, as espécies de peixes do presente estudo sustentam pescarias importantes, o que levanta problemas de saúde humana, uma vez que a ingestão de peixes que consomem plásticos tem o potencial de aumentar a carga corporal de substâncias químicas perigosas, pois estas aderem superficialmente aos plásticos no ambiente e são posteriormente bioacumuladas.

The objective of this research was the identification, through Fourier transform infrared spectroscopy combined with attenuated total reflectance (FTIR-ATR), of microplastics extracted from the gastrointestinal tract of fish collected in Lake Amatitlán, to determine the main polymers and the possible origin of contamination by these materials. 68 microplastics were analyzed, corresponding to 10% of the total microplastics extracted. These originated from 36 specimens, 35 of the species Oreochromis niloticus and one of Parachromis managuensis, of which 1 to 5 microplastics per specimen were analyzed. The polymers identified were polypropylene (PP), nylon, high-density polyethylene (HDPE), polyethylene terephthalate (PET), latex, polystyrene (PE), low-density polyethylene (LDPE) and polyurethane (PU). Polypropylene (32), high-density polyethylene (13) and nylon (10) were the most frequent polymers. Possible plastic items that may have caused microplastics include toys, laboratory equipment, buckets, food packaging, pipes, insulation for cables, textiles, ropes and furniture that are produced in the plastics industry, located mainly on the south side of Guatemala City. Furthermore, the fish species in the present study support important fisheries, which raises human health concerns, since the ingestion of fish that consume plastics has the potential to increase the body load of dangerous chemicals, as they adhere superficially to the plastics in the environment and are subsequently bioaccumulated.

Dietoterapia en artritis reumatoide: Revisión de la evidencia

La artritis reumatoide (RA), es una enfermedad crónica reumática, caracterizada por un daño articular progresivo y manifestaciones extraarticulares, que pueden desencadenar una discapacidad. La etiología de las patologías autoinmunes, incluyendo la RA, es compleja, abarcando factores de tipo genético, hormonal, dietarios y ambientales. Sin embargo, los mecanismos fisiológicos por los que estos agentes contribuyen a la patogenia aún no están definidos completamente. Estudios sugieren un impacto de la disbiosis del microbioma intestinal en la patogénesis de la artritis reumatoide sugiriendo también la alteración de la permeabilidad intestinal como una posible causa. Esta se puede relacionar con patrones dietarios influyentes en la prevención de esta patología así como una propuesta de tratamiento complementario al manejo farmacológico tradicional, considerando el riesgo aumentado de estos pacientes de desarrollar síndrome metabólico y "caquexia reumatoide", una acumulación de tejido adiposo acompañado de una disminución de tejido muscular debido a los cambios catabólicos debido a la inflamación crónica e inactividad física a consecuencia de las dificultades motoras. Ante evidencia reciente que propone patrones de alimentación e intervenciones dietarias como tratamiento complementario a la terapia farmacológica en el manejo de la RA, la siguiente revisión narrativa cualitativa se propone revisar la efectividad de intervenciones propuestas en términos de dolor y actividad de enfermedad, encontrando dentro de la amplia heterogeneidad de intervenciones propuestas, aquellos patrones dietéticos con efecto modulador de la microbiota intestinal como la dieta mediterránea y sus variaciones en contexto de la promoción de un estilo de vida serían positivas como terapia complementaria a esta patología.

Rheumatoid arthritis (RA) is a chronic rheumatic disease characterised by progressive joint damage and extra-articular manifestations that can lead to disability. The aetiology of autoimmune diseases, including RA, is complex, involving genetic, hormonal, dietary, and environmental factors. However, the physiological mechanisms by which these agents contribute to pathogenesis have not yet been fully defined. More recent studies suggest an impact of gut microbiome dysbiosis on the pathogenesis of autoimmune diseases in both animal and human models, including rheumatoid arthritis, also suggesting altered intestinal permeability as a possible cause. This modification of the gut microbiome may be related to influential diet patterns in the prevention of this pathology, as well as a proposed complementary treatment to traditional pharmacological treatment, also considering the increased risk for these patients of developing metabolic syndrome and "rheumatoid cachexia", an accumulation of adipose tissue accompanied by a decrease in muscle tissue due to catabolic changes due to chronic inflammation and physical inactivity as a consequence of motor difficulties in RA. With the emergence of recent evidence proposing dietary interventions and eating patterns as adjunctive treatment to drug therapy in the management of RA, the following narrative qualitative review proposes reviewing recent evidence on the effectiveness of various proposed dietary interventions in the treatment of rheumatoid arthritis in terms of pain and disease activity, finding between a high heterogeneity of proposed interventions, those dietary patterns with modulating effect on the gut microbiome as Mediterranean diet and its variations in the context of promoting a healthy lifestyle would be positive as a complementary therapy for this disease.

La pediatría social. Herramienta necesaria para combatir la pandemia de COVID-19 en Cuba / Social Pediatrics: A Necessary Tool to Combat the COVID-19 Pandemic in Cuba

Introducción: La pediatría social se orienta hacia la atención integral del niño. Estudia las causas sociales que alteran su salud y también los problemas de esta índole que repercuten en su entorno social. En el contexto de la actual pandemia, caracterizada por alta morbilidad y mortalidad, se produjeron significativas consecuencias psicosociales. Objetivo: Describir el impacto de la pediatría social sobre la salud infanto-juvenil durante la pandemia de COVID-19. Métodos: Se realizó una revisión en las bases de datos bibliográficas PubMed y BVS. Se empleó el Google Académico como motor de búsqueda. Se utilizaron, en español y en inglés, los siguientes descriptores: pediatría social, pandemia COVID-19, aislamiento social, bienestar psicológico, salud mental y población pediátrica. Análisis y síntesis de la información: Se expusieron argumentos desde la mirada psicosocial del pediatra, relacionados con el desarrollo y el bienestar socioemocional de los niños, y la repercusión sobre ellos del aislamiento social; además, se describió el impacto de la pandemia en la infancia, y el papel desempeñado por el especialista y otros profesionales vinculados con la atención pediátrica. Conclusiones: La pandemia se caracterizó por afectar todas las esferas de la vida del niño. La pediatría social resultó indispensable en el enfrentamiento de las consecuencias médico-biológicas, psicológicas y sociales que ocasionó el azote de la COVID-19, por lo que su rol influyó en el restablecimiento del equilibrio biopsicosocial de la población infantil(AU)

Introduction: Social pediatrics is oriented towards the comprehensive care of children. It studies the social causes that alter their health, and also the problems of this nature that affect their social environment. In the context of the current pandemic, characterized by high morbidity and mortality, there were significant psychosocial consequences. Objective: To describe the impact of social pediatrics on children and adolescents health during the COVID-19 pandemic. Methods: A review was conducted in the bibliographic databases PubMed and VHL. Google Scholar was used as a search engine. The following descriptors were used in Spanish and English: social pediatrics, COVID-19 pandemic, social isolation, psychological well-being, mental health and pediatric population. Analysis and synthesis of information: Arguments were presented from the psychosocial perspective of the pediatrician, related to the development and socio-emotional well-being of children, and the impact on them of social isolation. In addition, the impact of the pandemic on children was described, and the role played by the specialists and other professionals linked to pediatric care. Conclusions: The pandemic was characterized by affecting all spheres of the child's life. Social pediatrics was indispensable in confronting the medical-biological, psychological and social consequences caused by the scourge of COVID-19, so its role influenced the restoration of the biopsychosocial balance of the children population(AU)

Biomarcadores en la sepsis y su valor predictivo en pacientes pediátricos

RESUMEN Introducción: La sepsis en niños, es causa de gran preocupación entre los pediatras. La incorporación de nuevos biomarcadores posibilita la obtención de un diagnóstico rápido y preciso. Objetivo: Determinar la capacidad predictiva de mortalidad de un grupo de biomarcadores en pacientes pediátricos con sepsis. Métodos: Estudio multicéntrico descriptivo analítico, prospectivo y longitudinal en 60 pacientes ingresados en dos Unidades de cuidados intensivos: Hospital Dediátrico docente "Borrás-Marfán" y Hospital Pediátrico Universitario "William Soler" entre diciembre de 2016 y diciembre de 2018, con diagnóstico de sepsis severa y shock séptico. Se caracterizó la muestra según variables demográficas, origen y estadios de la sepsis y mortalidad; además se determinaron los biomarcadores más sensibles para el diagnóstico inicial y de mejor valor predictivo. Se empleó la estadística descriptiva y se realizaron pruebas diagnósticas con más de dos resultados (curva ROC). Resultados: Se observó una distribución similar de la muestra en cuanto sexo, con una media edad promedio de 5 años; dos tercios se diagnosticaron como sepsis graves y 23,3 % falleció El lactato fue el marcador con mayor sensibilidad. Conclusiones: Los biomarcadores más sensibles para el diagnóstico inicial de la sepsis fueron: lactato, proteína C reactiva y velocidad de sedimentación globular; los dos primeros junto a los leucocitos, neutrófilos y plaquetas, también resultaron buenos predictores de mortalidad. La velocidad de sedimentación globular fue el biomarcador predictor de mortalidad menos significativo.

ABSTRACT Introduction: Sepsis in children is a cause of great concern among pediatricians. New biomarkers makes it possible to obtain quick and accurate diagnosis. Objective: To determine the predictive capacity of mortality of a group of biomarkers in pediatric patients with sepsis. Methods: An analytical, prospective and longitudinal descriptive multicenter study was carried out in 60 patients admitted to two intensive care units at Borrás-Marfán Teaching Pediatric Hospital and William Soler University Pediatric Hospital from December 2016 to December 2018. These patients had a diagnosis of sepsis severe and septic shock. The sample was characterized according to demographic variables, origin and stages of sepsis and mortality. In addition, the most sensitive biomarkers for the initial diagnosis and the best predictive value were determined. Descriptive statistics were used and diagnostic tests were performed with more than two results (ROC curve). Results: A similar distribution of the sample was observed in terms of sex, with average age of 5 years; two thirds were diagnosed as severe sepsis and 23.3% died. Lactate was the marker with the highest sensitivity. Conclusions: The most sensitive biomarkers for the initial diagnosis of sepsis were lactate, C-reactive protein and erythrocyte sedimentation rate; the first two, together with leukocytes, neutrophils, and platelets, were also good predictors of mortality. Erythrocyte sedimentation rate was the least significant predictor of mortality biomarker.

Body fat composition and miR-378 expression profiling in patients with type 1 diabetes

Purpose@#Type 1 diabetes (T1D) is an autoimmune disease that involves genetic, epigenetic, and environmental factors. Change in body composition is a potential mechanism for explaining the increased incidence of T1D. Micro RNA-378 (miRNA-378) is a positive regulator of adipogenesis that has yet to be studied in such patients. This study aims to evaluate the miRNA-378 expression profile in peripheral mononuclear cells of T1D patients and controls and to determine its possible association with levels of body fat, interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). @*Methods@#Twenty-four T1D subjects and 20 controls under 18 years of age without autoimmune diseases were studied. miRNA-378 expression profile was determined by TaqMan probes. Body composition was determined by multifrequency bioimpedance. IL-6 and TNF-α serum levels were determined by LUMINEX. AntiGAD65, anti-IA2, and anti-ZnT8 antibodies were quantified in serum by enzyme immunoassays. Statistical significance was considered P<0.05. @*Results@#Similar body mass index and body fat (kg) were observed between the T1D and control subjects (P=0.55 and P=0.69, respectively). The miRNA-378 expression profile was significantly higher in T1D patients compared with the controls (P<0.05). Lower miRNA-378 expression in prepubertal controls was observed compared to pubertal controls, prepubertal T1D, and pubertal T1D (P<0.05). AntiGAD65, AntilA2, and AntiZnT8 were positively correlated with miRNA-378 (P=0.002, P=0.053, and P=0.007). No statistically significant correlation was observed between miRNA-378 expression and IL-6, TNF-α, or body fat. @*Conclusion@#Elevated miRNA-378 expression in T1D patients compared with controls is linked to pubertal stage but is not associated with proinflammatory status or body composition.

El ácido láctico y la escala SEGRAV-23 como valores pronósticos de gravedad en niños críticos / Lactic acid and SEGRAV-23 scale as predictive values of severity in critically-ill children

INTRODUCCIÓN: los sistemas de valoración de la gravedad son medios para cuantificar objetivamente la situación clínica del paciente, determinar el pronóstico y evaluar la eficacia y eficiencia del tratamiento. El lactato es un biomarcador que ha demostrado su magnífica capacidad predictiva de mortalidad, lo que hace que se mantenga dentro de las recomendaciones de expertos y en todas las guías relevantes. OBJETIVO: determinar el pronóstico de gravedad del ácido láctico y del índice Sistema para evaluar la gravedad de las enfermedades (SEGRAV-23), en niños ingresados en la Unidad de Cuidados Intensivos Pediátricos en el periodo febrero de 2011 a febrero de 2013. MÉTODOS: se realizó un estudio observacional, analítico, longitudinal y prospectivo en el cual se estudiaron 208 pacientes ingresados en las unidades de cuidados intensivos pediátricos de los hospitales "Dr. Luis Díaz Soto" y "Juan Manuel Márquez", en el periodo de febrero de 2011 a febrero de 2013. Para determinar el grado de dependencia entre vivos y fallecidos en el índice SEGRAV-23 y los valores del lactato, se utilizó el chi cuadrado de Pearson con una p menor de 0,05 para garantizar una confiabilidad de un 95 %. RESULTADOS: con respecto al SEGRAV-23 y los valores de lactato se observó que el 32,3 % de los pacientes con lactato entre 5-7 mmol/L se mantuvo con el reporte de muy graves, y el 14,7 % críticos. El 43,7 % de los fallecidos presentaron SEGRAV-23 mayor de 21 puntos. El 35,3 % de los pacientes que presentaron cifras de lactato al ingreso entre 5-7 mmol/L fallecieron. A los 10 días de estadía se evidenció que el 72,7 % de los pacientes que presentaron cifras de lactato entre 5-7 mmol/L fallecieron, al igual que el 80 % de los que tuvieron una hiperlactoacidemia mayor de 7 mmol/L. CONCLUSIONES: el ácido láctico y la escala SEGRAV-23 tienen una aceptable capacidad pronóstica y son buenos indicadores de gravedad del paciente crítico.

INTRODUCTION: the severity scoring systems are means to objectively quantify the patient's clinical situation, to determine the prognosis and to evaluate the efficacy and efficiency of the treatment. Lactate is a biomarker that has demonstrated its great predictive capacity for mortality, which keeps it included in the experts' recommendation and in all relevant guidelines. OBJECTIVE: to determine the severity prognosis of the lactic acid and of the index System for Evaluating the Severity of Diseases (SEGRAV-23) in children admitted to the pediatric intensive care unit in the period of February 2011 to February 2013. METHODS: prospective, longitudinal, analytical and observational study of 208 patients admitted to the pediatric intensive care units in "Dr Luis Diaz Soto" and "Juan Manuel Márquez" hospitals, conducted from February 2011 to February 2013. For the purpose of determining the level of dependence between the living and dead people in the SEGRAV-23 index and the lactate values, Pearson's chi square with p< 0.05 was used to assure 95 % reliability. RESULTS: regarding SEGRAV-23 and the lactate values, it was observed that 32.3 % of patients with 5-7 mmol/L lactate continued to be reported as severely-ill and 14.7 % as critical patients. In the group of dead people, 43.7 % had a SEGRAV-23 index higher than 21 scores whereas 35.3 % of patients with lactate values of 5 to 7 mmol/L on admission died. After ten days of hospitalization, it was evinced that 72.7 % of patients who had 5-7 mmol/L lactate values died as it happened with 80 % of those with over 7 mmol/L hyperlactoacidemia. CONCLUSIONS: lactic acid and the SEGRAV-23 scale have acceptable prognostic capacity and are good severity indicators in critically-ill patients.

Oxidative stress is associated with the number of components of metabolic syndrome: LIPGENE study

Previous evidence supports the important role that oxidative stress (OxS) plays in metabolic syndrome (MetS)-related manifestations. We determined the relationship between the number of MetS components and the degree of OxS in MetS patients. In this comparative cross-sectional study from the LIPGENE cohort, a total of 91 MetS patients (43 men and 48 women; aged between 45 and 68 years) were divided into four groups based on the number of MetS components: subjects with 2, 3, 4 and 5 MetS components (n=20, 31, 28 and 12, respectively). We measured ischemic reactive hyperemia (IRH), plasma levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), total nitrite, lipid peroxidation products (LPO), hydrogen peroxide (H2O2), superoxide dismutase (SOD) and glutathione peroxidase (GPx) plasma activities. sVCAM-1, H2O2 and LPO levels were lower in subjects with 2 or 3 MetS components than subjects with 4 or 5 MetS components. IRH and total nitrite levels were higher in subjects with 2 or 3 MetS components than subjects with 4 or 5 MetS components. SOD and GPx activities were lower in subjects with 2 MetS components than subjects with 4 or 5 MetS components. Waist circumference, weight, age, homeostatic model assessment-beta, triglycerides (TGs), high-density lipoprotein and sVCAM-1 levels were significantly correlated with SOD activity. MetS subjects with more MetS components may have a higher OxS level. Furthermore, association between SOD activity and MetS components may indicate that this variable could be the most relevant OxS biomarker in patients suffering from MetS and could be used as a predictive tool to determine the degree of the underlying OxS in MetS.

Transposição do enxerto vascularizado da fíbula pro fêmur diafisário sem microanastomoses / Vascularized fibular graft transposition to upper femur avoiding microsurgery

OBJETIVO: O estudo descreve uma maneira nova e simples de transplantar o enxerto ósseo vascularizado da fíbula pro fêmur diafisário sem necessidade de microcirurgia, demonstra o caso clínico operado com bom resultado quanto a vascularização e consolidação óssea e, por último, especula sobre possíveis outras aplicações dentro da cirurgia reconstrutiva. MÉTODOS: A fíbula vascularizada é transportada até o fêmur sem necessidade de microcirurgia, alcançando até sua metáfise proximal através das comunicações das perfurantes do músculo gêmeo lateral com as septais fibulares via retalho de pele póstero-lateral da perna que intersecciona os dois sistemas. RESULTADOS: O paciente operado evoluiu sem infecção. Cintilografia esquelética precoce demonstrou vascularização óssea. CONCLUSÃO: O retalho gêmeo fibular é nova arma no arsenal do cirurgião. Sua técnica é factível, reprodutível, seu tempo cirúrgico reduzido e o princípio de construção com ponte através de ilhas de pele e perfurantes poderá ser aplicado na construção de novos retalhos.

OBJECTIVE: The study describes a new and simple way to transplanttranspose a vascularized fibular graft from the fibula to the femur diaphysis without the need for microsurgery, demonstrates a successful clinical case with good results with regards to vascularization and osseous consolidation, and speculates about other applications of this flap procedure in reconstructive surgery. METHODS: A stalked vascularized fibular bone graft was transferred without microsurgery. The bone reached the proximal diaphysis of the femur. Communication between the lateral gastrocnemius arterial system and fibular artery through a skin flap and it's perforating arteries allowed good vascularization to the graft. The concept of "perforating artery-to-perforating artery" was established with their vascular territories intersecting the skin island flap. RESULTS: The patient operated on healed without infection. Bone scintigraphy showed periosteal bone vascularization. CONCLUSION: The Cutaneous Gastrocnemius-Fibular Flap is a new weapon for the reconstructive surgeon. Itïs practical and reliable, and its reduced surgery time and its principle of construction will be applicable to the creation of other flaps.

Relación entre electroencefalograma y neuroimagen en niños con epilepsia focal de difícil control / Relation between electroencephalogram and neuroimaging present in children with epilepsy of difficult control

Las epilepsias focales son las màs frecuentes en los niños, y la resistencia al tratamiento farmacológico puede estar presente hasta en el 30 por ciento de los pacientes. Se realizó este estudio con el objetivo de dirigir la atención hacia la coincidencia topográfica de los paroxismos electroencefalográficos, con lesiones estructurales demostrables por neuroimagen, para facilitar el diseño de estrategias terapéuticas futuras. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, con 44 niños con diagnóstico de epilepsia focal de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente Juan M Márquez, entre enero de 2003 y junio de 2007. Se realizaron estudios por electroencefalograma (EEG) al ingreso y videoelectroencefalograma, además de estudios de neuroimagen por tomografía axial o resonancia magnética nuclear. RESULTADOS. Los paroxismos en EEG involucraron el lóbulo frontal hasta en el 68 por ciento de los pacientes. En el 48 por ciento de los pacientes, los paroxismos electroencefalográficos coinciden con zonas de alteración estructural según neuroimagen, más frecuentes en el lóbulo frontal. En el 25 por ciento no hay coincidencia topográfica y en el 27 por ciento no se precisan alteraciones estructurales. CONCLUSIONES. En las epilepsias focales de difícil control se debe prestar especial atención a las zonas elocuentes con coincidencia entre el EEG y la neuroimagen, para evaluar de forma temprana las alternativas quirúrgicas de tratamiento.

Focal epilepsies are the more frequent conditions in children and a pharmacologic treatment resistance could be present up to 30 percent of patients. Aim of present paper was to direct the attention to topographic coincidence of electroencephalographic paroxysms with structural lesions by neuroimaging facilitating the future therapeutical strategies design. METHODS: A descriptive, longitudinal, prospective study was conducted in 44 children diagnosed with epilepsy of difficult control admitted in Neuropediatrics Service of Juan Manuel Marquez Teaching Children Hospital from January, 2003 to June, 2007. At admission, we made electroencephalogram (EEG) and videoelectroencephalogram (VEEG) studies as well as neuroimaging studies by axial tomography (AT) or nuclear magnetic resonance (NMR). RESULTS: Paroxysms in EEG involved frontal lobule up to the 68 percent of patients. In 48 percent, electroencephalographic paroxysms coincide with structural alteration zones according neuroimaging, more frequent in frontal lobule. In 25 percent there is not topographic coincidence, and in 27 percent there are not specified structural alterations. CONCLUSIONS: In focal epilepsies of difficult control, we must to take care of eloquent zones with coincident between EEG and neuroimaging to assess in time the surgical treatment options.

Ciprofibrate therapy in patients with hypertriglyceridemia and low high-density lipoprotein [HDL]-cholesterol: greater reduction of non-HDL cholesterol in subjects with excess body weight [the ciproamlat study]

Background: hypertriglyceridemia, in combination with low HDL cholesterol levels, is a risk factor for cardiovascular disease. Our objective was to evaluate the efficacy of Ciprofibrate for the treatment of this form of dyslipidemia and to identify factors associated with better treatment response

Methods: multicenter, international, open-label study. Four hundred and thirty seven patients were included. The plasma lipid levels at inclusion were fasting triglyceride concentrations between 1.6 - 3.9 mM/L and HDL cholesterol ?1.05 mM/L for women and ?0.9 mM/L for men. The LDL cholesterol was below 4.2 mM/L. All patients received Ciprofibrate 100 mg/d. Efficacy and safety parameters were assessed at baseline and at the end of the treatment. The primary efficacy parameter of the study was percentage change in triglycerides from baseline

Results: after 4 months, plasma triglyceride concentrations were decreased by 44% [p <0.001]. HDL cholesterol concentrations were increased by 10% [p < 0.001]. Non-HDL cholesterol was decreased by 19%. A greater HDL cholesterol response was observed in lean patients [body mass index <25 kg/m2] compared to the rest of the population [8.2 vs 19.7%, p <0.001]. In contrast, cases with excess body weight had a larger decrease in non-HDL cholesterol levels [-20.8 vs -10.8%, p <0.001]. There were no significant complications resulting from treatment with Ciprofibrate

Conclusions: ciprofibrate is efficacious for the correction of hypertriglyceridemia/low HDL cholesterol. A greater decrease in non-HDL cholesterol was found among cases with excess body weight. The mechanism of action of Ciprofibrate may be influenced by the pathophysiology of the disorder being treated

Factores de riesgo de discapacidad en el adolescente epiléptico / Risk factors for disability in the adolescent epileptic

Ha sido reportada con anterioridad la asociación de discapacidad y epilepsia por varios mecanismos fisiopatológicos y los adolescentes epilépticos no están exentos de presentar limitaciones físicas y/o motoras que, a su vez, pueden influir en su adaptación a la sociedad. Objetivos: Precisar los factores de riesgo (en los que ya ha sido comprobada previamente su influencia en la aparición de epilepsia y/o discapacidad) y su repercusión en los casos estudiados, respecto a la presencia de discapacidad. Pacientes y métodos: En la investigación, fueron incluidos 79 adolescentes diagnosticados como epilépticos, de un total de 150 epilépticos, atendidos en la consulta externa de Neuropediatría del Hospital Pediátrico Juan Manuel Márquez, entre noviembre de 2001 y junio 2002, y se determinó la presencia de discapacidades en ellos y los factores de riesgo asociados a éstas. Resultados: En 25(por ciento) de los pacientes, se determinó que presentaban, al menos, una discapacidad y el factor de riesgo que se asoció con mayor frecuencia a discapacidades fue el antecedente de crisis febriles en 10 de 16 adolescentes epilépticos

La vitamina A y su relación con diarrea aguda y persistente / A vitamin and their relationship to persistent and acute diarrhea

Se describe la composición química, se identifican las fuentes y se analiza el metabolismo y las funciones biológicas de la vitamina A. Revisamos la relación de la vitamina A con los estados diarréicos. Se especula en torno a la relación déficit vitamina A y diarréa, así como la posibilidad de que los estados deficitarios de vitamina A puedan facilitar la colonización bacteriana del tracto gastrointestinal e interferir con la competencia inmunológica

Niveles sericos de vitamina A y su relacion con diarrea aguda y persistente / Seric levels of vitamin A and their relation with acute and persistent diarrhea

Se estudiaron 75 pacientes menores de un año en el período entre enero 1991-abril 1992, los que fueron divididos en tres gurpos: grupo 1: 25 pacientes controles; grupo 2: 25 pacientes con enfermedad diarreica aguda y grupo 3: 25 pacientes con diarrea persistente. A todos se les realizó dosificación sérica de vitamina A, clasificádolos según el resultado en normal niveles mayores de 0,75 Mmol/l, deficiencia no severa entre 0,75 y 0,35 Mmol/I y deficiencia menor de 0,35 Mmol/l. Demonstrandose que la deficiencia de vitamina A constituye un factor de riesgo para la diarrea persistente en nuestro medio