Afrontamiento y adaptación en cuidadores principales de niños hospitalizados, según el modelo de Callista Roy / Coping and adaptation in primary caregivers of hospitalized children, based on Callista Roy's model / Enfrentamento e adaptação em cuidadores primários de crianças hospitalizadas, segundo o modelo Callista Roy

Objetivo: identificar el nivel de afrontamiento y adaptación de los cuidadores principales de niños hospitalizados en dos centros de Medellín, desde el modelo Callista Roy, durante el año 2019. Metodología: estudio transversal descriptivo prospectivo. El tamaño de muestra fue de 400 cuidadores principales. Se incluyeron mayores de 18 años, quienes firmaron el consentimiento informado. Se utilizó una encuesta sociodemográfica y la Escala de Medición del Proceso de Afrontamiento y Adaptación, versión en español (EsCAPS, abreviada), previa autorización. Las variables cualitativas se presentan en frecuencias absolutas y relativas, y las cuantitativas en mediana acompañada del rango intercuartílico (RIC). Resultados: todos los cuidadores eran mujeres, con mediana de edad de 30 años y RIC 25-37, 119 (29,5%) tenían un nivel educativo técnico y tecnólogo, su estrato socioeconómico estaba entre los estratos uno, dos y tres (84.6%). De ellas, 160 (39.7%) vivían en unión libre. En cuanto a los niños, la mediana de edad fue de 24 meses (RIC 2-72). El diagnóstico principal fue de afecciones respiratorias, 113/398 (28.4%). La mediana del puntaje de afrontamiento global fue 56 (RIC 50-60), lo que ubica a la mayoría en un nivel de afrontamiento bajo. Conclusión: los cuidadores principales de niños hospitalizados tienen un grado bajo de afrontamiento, es necesario fortalecer los planes de cuidado para mejorar el bienestar de los cuidadores.

Objective: To identify the level of coping and adaptation of primary caregivers of hos-pitalized children during 2019 in two centers of Medellin, based on Callista Roy's model.Methodology: Prospective descriptive cross-sectional study. The sample size was made up of 400 primary caregivers. Participants over 18 years who signed the informed consent were included. A sociodemographic survey and the Coping Adaptation Processing Scale version in Spanish (abbreviated EsCAPS) were used, with prior authorization. Qualitative variables were expressed in absolute and relative frequencies, while quantitative ones were expressed using median and interquartile range (IQR).Results: All the caregivers were women, with a median age of 30 years and IQR: 25-37. 119 (29.5%) were technicians and technologists, who belonged to socioeconomic strata 1, 2, and 3 (84.6%). 160 (39.7%) of them lived in a common-law marriage. Amongst hospitalized children, the median age was 24 months and the IQR 2-72; the most frequent diagnosis was respiratory disorders, 113/398 (28.4%). The median global score was 56, with an IQR of 50-60, placing most of them in a low coping level.Conclusion: Primary caregivers of hospitalized children have a low level of coping. It is necessary to strengthen the care plans for the welfare of caregivers.

Objetivo: identificar o nível de enfrentamento e adaptação dos cuidadores principais de crianças hospitalizadas em dois centros de Medellín, a partir do modelo Callista Roy, durante 2019.Metodologia: estudo transversal descritivo prospectivo. O tamanho da amostra foi de 400 cuidadores principais. Foram incluídos os maiores de 18 anos que assinaram o Termo de Consentimento Livre e Esclarecido. Utilizou-se um levantamento sociodemográfico e a Escala de Medição do Processo de Enfrentamento e Adaptação, versão em espanhol (EsCAPS, abreviatura), com autorização prévia. As variáveis qualitativas são apresentadas em frequências absolutas e relativas e as variáveis quantitativas em mediana acompan-hadas do intervalo interquartil (IQR).Resultados: todos os cuidadores eram mulheres, com mediana de idade de 30 anos e IQR 25-37, 119 (29,5%) possuíam escolaridade técnica e tecnológica, estrato socioe-conômico entre os estratos um, dois e três (84,6%). Destes, 160 (39,7%) viviam em união estável. Em relação às crianças, a mediana de idade foi de 24 meses (IQR 2-72). O diagnóstico principal foram doenças respiratórias, 113/398 (28,4%). A pontuação geral mediana de enfrentamento foi de 56 (IQR 50-60), o que coloca a maioria em um nível de enfrentamento baixo.Conclusão: os cuidadores principais de crianças hospitalizadas apresentam baixo grau de enfrentamento, é necessário fortalecer os planos de cuidado para melhorar o bem-estar dos cuidadores.

Primer aislamiento de Leptospira borgpetersenii serovar Hardjo tipo Hardjo Bovis a partir de un caso clínico en Argentina / First isolation of Leptospira borgpetersenii serovar Hardjo type Hardjo Bovis from aclinical case in cattle in Argentina

Resumen Se describe el primer aislamiento y la tipificación molecular de Leptospira borgpetersenii serovar Hardjo Bovis en Argentina, obtenido a partir de orina de vacas abortadas de unrodeo de cría ubicado en Saladillo, provincia de Buenos Aires. Los abortos coincidieron con unperíodo de importantes inundaciones, en el que varios animales presentaron títulos serológicossospechosos y posterior seroconversión. El porcentaje de abortos alcanzó el 3,5% del total delrodeo, compuesto por 1700 vacas, y se aisló el microorganismo en 7 de 20 muestras de orinaobtenidas.

Abstract We here describe the first isolation and molecular typing of Leptospira borgpe-tersenii serovar Hardjo Bovis in Argentina, obtained from urine of aborted cows from abreeding herd located in Saladillo, Buenos Aires Province. The abortions occurred in coincidence with important floods with many cows presenting suspicious serological titers and subsequentseroconversion. The percentage of abortions was 3.5% of a herd of 1700 cows and the microor-ganism was isolated from 7 of the 20 urine samples obtained.

Octreótido de liberación prolongada para el tratamiento de hemorragia digestiva alta en Pediatría / Long-acting Release Octreotide for Pediatric Upper Gastrointestinal Bleeding

Resumen: Introducción: La hemorragia digestiva por hipertensión portal, sin alternativa de tratamiento endos- cópico o quirúrgico por localizaciones ectópicas, no identificadas del sitio de sangrado o caracterís ticas anatómicas, constituye un desafío terapéutico en Pediatría. El tratamiento habitual incluye la infusión de octreótido endovenoso. En los últimos años, la presentación de octreótido de liberación prolongada (OCT-LAR) para administración mensual intramuscular, resulta una alternativa tera péutica atractiva. Objetivo: Reportar el caso de un lactante con hemorragia digestiva por hiperten sión portal que recibió tratamiento exitoso con OCT-LAR. Caso Clínico: Paciente de 8 meses de vida, con malformación de vena porta extrahepática y episodios reiterados de sangrados digestivos con re querimientos transfusionales e infusiones de octréotido, sin posibilidad de tratamiento endoscópico o quirúrgico. Indicamos OCT-LAR intramuscular mensualmente. Después de diez meses de iniciado el tratamiento, el paciente no repitió sangrados digestivos y no presentó efectos adversos relacionados a la medicación. Conclusión: Consideramos que el reporte de este caso puede resultar de utilidad al presentar una nueva alternativa para el tratamiento de pacientes pediátricos con sangrado digestivo por hipertensión portal sin posibilidades terapéuticas convencionales.

Abstract: Introduction: Upper gastrointestinal bleeding (UGIB) secondary to portal hypertension (PHT), without endoscopic or surgical treatment options due to an ectopic or unidentified bleeding site or the patient's anatomic characteristics, is challenging in pediatric hepatology. The usual treatment in these cases includes intravenous Octreotide. Recently, the availability of long-acting release Octreo tide (OCT-LAR) for monthly intramuscular administration has become an interesting therapeutic alternative. Objective: To report the case of an infant with UGIB due to PHT who was successfully treated with OCT-LAR. Clinical Case: Eight-month-old patient with repeated episodes of UGIB due to extrahepatic portal vein malformation, requiring blood transfusions, and intravenous octreotide infusions. As neither endoscopic nor surgical treatment were feasible, we decided to start IM OCT- LAR monthly. After ten months of treatment, the patient did not present bleeding episodes. No medication-related events were observed. Conclusion: We consider that this report could help in the management of similar pediatric patients with UGIB due to PHT without conventional therapeutic possibilities.

Diabetes mellitus asociada a pancreatitis autoinmune: caso clínico / Autoimmune pancreatitis associated with diabetes mellitus: report of one case

Autoimmune pancreatitis is uncommon, responds to steroids and is usually associated with diabetes mellitus. We report a 73 year-old male who, two months after a diagnosis of diabetes mellitus, presented with obstructive jaundice and weight loss. Abdominal magnetic resonance imaging was suggestive of an autoimmune pancreatitis and serum IgG4 was 339 mg/dl (normal range 3-201). The patient was treated with prednisone 40 mg/day with a good clinical and laboratory response. During outpatient care, the dose of prednisone was tapered.

Proteomic profile of Piper tuberculatum (Piperaceae) / Perfil proteômico e metabólico de Piper tuberculatum (Piperaceae)

Abstract Piper tuberculatum (Piperaceae) is a species that accumulates especially amides as secondary metabolites and several biological activities was previously reported. In this article, we report a proteomic study of P. tuberculatum. Bidimensional electrophoresis (2D SDS-PAGE) and mass spectrometry (ESI-Q-TOF) were used in this study. Over a hundred spots and various peptides were identified in this species and the putative functions of these peptides related to defense mechanism as biotic and abiotic stress were assigned. The information presented extend the range of molecular information of P. tuberculatum.

Resumo Piper tuberculatum (Piperaceae) é uma espécie que acumula especialmente amidas como metabólitos secundários e diversas atividades biológicas dessa espécie foram relatadas anteriormente. No presente artigo, relatamos um estudo proteômico dessa espécie. Eletroforese bidimensional (2D SDS-PAGE) e espectrometria de massas (ESI-Q-TOF) foram utilizadas nesse estudos. Mais de cem spots e vários peptídeos foram identificados nesta espécie e as funções putativas desses peptídeos relacionadas a mecanismo de defesa como estresse biótico e abiótico foram atribuídos. As informações apresentadas ampliam a gama de informações moleculares dessa espécie.

Trombocitopenia inducida por tamoxifeno y letrozol / Thrombocytopenia induced by tamoxifen and letrozole

El tamoxifeno y el letrozol son fármacos muy utilizados en el tratamiento del cáncer de mama. Está descrito que la trombocitopenia (recuento plaquetario inferior a 100.000/mm3) es un efecto secundario raro tras el tratamiento con tamoxifeno. Sin embargo, no es un efecto adverso conocido del letrozol. Presentamos dos casos clínicos en los que tras tratamientos prolongados con estos fármacos nos encontramos con que las pacientes desarrollan trombocitopenia. En ambos casos, este efecto adverso desaparece en pocas semanas tras la retirada del fármaco.

Letrozole and tamoxifen are drugs used in the treatment of breast cancer. It is reported that thrombocytopenia (less than 100,000 / mm3 platelet count) is a rare side effect of tamoxifen. However, it is not a known side effect of letrozole. We present two cases in which after prolonged treatment with these drugs we found that the patients develop thrombocytopenia. In both cases, this adverse effect disappears a few weeks after drugs were stopped.

Resolución quirúrgica de la colecistitis aguda: ¿influye el tiempo de evolución? / Cholecystectomy for acute cholecystitis: affect the time of evolution in the outcomes?

Introducción: La colecistectomía laparoscópica precoz es nuestra conducta para el tratamiento de la colecistitis aguda; sin embargo, la consulta tardía y el tratamiento postergado por dificultades de acceso hacen que el tiempo de resolución muchas veces sobrepase los 7 días de iniciados los síntomas. Nuestro objetivo es comparar los resultados quirúrgicos entre los pacientes operados antes y después de este periodo. Material y métodos: Serie de casos consecutivos de pacientes con diagnóstico de colecistitis aguda operados entre junio de 2013 y diciembre de 2014 en el Servicio de Cirugía del Hospital de Coquimbo. De 358 casos, se excluyen aquellos asociados a colangitis, pancreatitis aguda, ASA ≥ 4 y cuadro mayor de 30 días. Consecuentemente se incluyen 233 pacientes que se dividen en «grupo precoz¼ (GP), operados antes del séptimo día de iniciados los síntomas, y «grupo tardío¼ (GT), operados después de este periodo. Se analizan la presentación de la serie y la asociación entre variables cualitativas y cuantitativas mediante la prueba de χ² y t de Student, respectivamente. Resultados: El GP presenta una estadía hospitalaria de 3,9 (± 2,0) días y el GT de 7,2 (± 5,2), (p = 0,0001); el periodo postoperatorio es de 1,9 (± 1,6) y de 2,9 (± 4,4) días, respectivamente (p = 0,055). La tasa de conversión en el GP es del 2,1% y en el GT del 9,7% (p = 0,027); la tasa global de complicaciones postoperatorias es del 3,2 y 10,7%, respectivamente (p = 0,033). Discusión: Nuestros resultados respaldan la colecistectomía precoz en pacientes con colecistitis aguda. Se pone de manifiesto un problema de gestión, en que la postergación de la resolución quirúrgica empeora los resultados y conlleva mayor riesgo de complicaciones.

Introduction: The treatment for acute Cholecystitis should be an early Laparoscopic Cholecystectomy. However, this resolution often exceed 7 days after the clinical symptoms onset. Mainly, for delayed consultation of the patients, access difficulties and delayed surgical resolution in our hospital. The aim is compare the surgical outcomes of patients that have had a Cholecystectomy before 7 days after the clinical symptoms onset with those operated after this period. Material and methods: Between June 2013 and December 2014, 358 patients were Cholecystectomy for acute Cholecystitis at the Hospital of Coquimbo. Those associated to Cholangitis, Acute Pancreatitis, ASA ≥ 4 and Gallbladder Cancer, were excluded; 233 patients were included. They were allocated into two groups according to the treatment timeframe: ‘Early Group’ (EG) for those operated before the seventh day of symptoms onset and ‘Late Group’ (LG) for those operated after this period. A retrospective study was used to collect data demographics, clinical and surgical outcomes. All these factors were compared between the two groups. Results: The EG had a hospital stay of 3.9 (± 2.0) days and the LG 7.2 (± 5.2) (P = .0001); the postoperative stay was 1.9 (± 1.6) and 2.9 (± 4.4) (P = .055) days, respectively. The conversion rate in the EG was 2.1% and 9.7% in the LT (P = .027); the overall rate of postoperative complications was 3.2% and 10.7% (P = .033), respectively. Conclusions: The findings support an early Cholecystectomy in patients with acute cholecystitis. There is a management problem in terms of delayed surgical resolution which worsens surgical outcomes and increase morbidity.

Morfología de la placenta en recién nacidos con defecto congénito / Morphology of the placenta in newborns with congenital defects

El objetivo del estudio fue comparar el índice de madurez placentaria y las alteraciones histopatológicas en placentas de recién nacidos/óbitos con y sin defecto congénito (DC). Se realizó un estudio tipo casos y controles. Se incluyeron n=25 casos yn=50 controles sin DC. Los casos se clasificaron de acuerdo a la presencia de DC aislado (n=17) omúltiple (n=8). Se incluyeron recién nacidos/óbitos (RN) con una edad gestacional (EG) > 20 semanas. Se excluyeron embarazos gemelares. Se recolectó información sobre las características clínicas del producto y de la madre, antropometría del RN y su evaluación de APGAR. Se examinó la placenta, macroscópica y microscópicamente, para determinar la presencia y extensión de alteraciones histopatológicas. Se determinó el índice de madurez placentaria (IMP), calculado dividiendo el número de membranas vásculo sinciciales en 1 mm2 entre el grosor de las mismas (µ). El IMP (media ±DE) fue de 27.77±14 en el grupo de controles, 30.31±12 en el grupo de casos aislados y 16.76± 1 en el grupo de DC múltiple (p<0.05).El resto de las variables evaluadas no mostraron diferencias significativas entre grupos. En conclusión este trabajo muestra una menor madurez placentaria asociada con la presencia de DC múltiple.

The objective of the study was to compare the placental maturity index (PMI) and pathohistological alterations of placentas from newborn/stillborns (NB) with or without congenital defects (CD). A case control study was carried out. N=25 CD cases and n=50 controls without CD were included. Cases were classified according to the presence of simple (n=17) or multiple (n=8) CD. Newborn/stillborns with gestational age >20 weeks were included. Twin pregnancies were excluded. We collected information on clinical characteristics of the NB and the mother, NB anthropometry and APGAR score. The placenta was macro and microscopically examined to determine the presence and extension of histological alterations. The PMI was obtained by dividing the number of vasculo-syncytial membranes in 1 mm2, by their thickness (µ). The PMI (Mean ± SD) was 27.77 ± 14 in the control group, 30.31 ± 12 in the group diagnosed with simple CD, and 16.76 ± 1 in the group diagnosed with multiple CD (p<0.05. The rest of the assessed variables did not show significant difference between groups. In conclusion, this work shows a lower placental maturity associated with the presence of multiple CD.

Declaración de la Academia Chilena de Medicina sobre el Título V de la Ley 20. 850 (Ley Ricarte Soto) y su proyecto de reglamento “De los ensayos clínicos de productos farmacéuticos y elementos de uso médico” / Declaration of the Chilean Academy of Medicine of Law 20. 850 On clinical trials of pharmaceutical products and medical devices” and of the bylaw that will regulate its application

In Chile, high cost treatments required by selected medical conditions are financed by the State, according to Law 20.850. A bylaw under discussion by the Senate regulates clinical trials, posing complex issues that will endanger local interest in front-line research: 1. The exclusive and mandatory control bestowed to the Institute of Public Health during all stages of the trials and also the surveillance of institutions performing clinical trials, overriding their Clinical Research Review Boards; 2.The 10 year period during which any adverse event is assumed to have been caused by the medication or devise evaluated by the trial, unless the contrary is proven in a judicial process; 3. Individuals submitted to the trials are entitled to free post trial access to the treatment received during the study, financed by the trial supporting entities and as long as the drug or devise is considered to be useful. While agreeing with the need to have a National Registry of Clinical Trials, we predict that the mentioned critical issues in the bylaw will lead to difficulties and unnecessary judicial processes, thus limiting clinicians’ interest in performing research. We propose to modify the bylaw, excluding responsibilities on events associated with the natural evolution of the medical condition, with patients’ ageing or with comorbidities and clinical events considered unpredictable when the protocol was accepted. We recommend that the free post trial access should be a joint decision involving the patient and the attending physician, taking in consideration that the volunteer has been exposed to risks and burdens, or when discontinuation of treatment entails a vital risk until the treatment under study has been approved and becomes available in the national market.

Proteomic profile of Piper tuberculatum (Piperaceae)

Abstract Piper tuberculatum (Piperaceae) is a species that accumulates especially amides as secondary metabolites and several biological activities was previously reported. In this article, we report a proteomic study of P. tuberculatum. Bidimensional electrophoresis (2D SDS-PAGE) and mass spectrometry (ESI-Q-TOF) were used in this study. Over a hundred spots and various peptides were identified in this species and the putative functions of these peptides related to defense mechanism as biotic and abiotic stress were assigned. The information presented extend the range of molecular information of P. tuberculatum.

Resumo Piper tuberculatum (Piperaceae) é uma espécie que acumula especialmente amidas como metabólitos secundários e diversas atividades biológicas dessa espécie foram relatadas anteriormente. No presente artigo, relatamos um estudo proteômico dessa espécie. Eletroforese bidimensional (2D SDS-PAGE) e espectrometria de massas (ESI-Q-TOF) foram utilizadas nesse estudos. Mais de cem spots e vários peptídeos foram identificados nesta espécie e as funções putativas desses peptídeos relacionadas a mecanismo de defesa como estresse biótico e abiótico foram atribuídos. As informações apresentadas ampliam a gama de informações moleculares dessa espécie.

Cetoacidosis diabética normoglicémica en el embarazo: caso clínico / Normoglycemic diabetic ketoacidosis in pregnancy: report of one case

Normoglycemic diabetic ketoacidosis should be suspected in pregnant women presenting nausea, vomiting, abdominal pain and anorexia. We report a 39 years old woman with a 32 weeks pregnancy who sought emergency care due to hyperemesis. She was hospitalized with the following diagnoses: pregnancy hypertension syndrome, gestational diabetes, morbid obesity and poor prenatal control. The evaluation of the feto-placental unit showed perception of fetal movements, non-reactive non-stress baseline record and a biophysical profile of 6/8. Fetal maturation was initiated. Laboratory tests showed a metabolic acidosis, a low pH, an increased Gap anion, elevated ketonemia and a blood glucose of 172 mg/dl. A diagnosis of normoglycemic diabetic ketoacidosis was formulated and treatment with hydration and regular insulin according to capillary blood glucose levels was started. An emergency caesarean section was performed. The newborn weighed 2.650 kg, had a length of 46 cm, was large for gestational age, had an Apgar score of 2.7, had perinatal asphyxia, convulsive syndrome and a possible congenital cardiopathy. Once the ketoacidosis was resolved during the immediate puerperium, slow acting insulin was initiated.

Efectos del entrenamiento en superficies inestables sobre el equilibrio y funcionalidad en adultos mayores / Effect of training on an unstable balance and function in eldery people

OBJETIVO: determinar los efectos de un programa de ocho semanas de entrenamiento en superficies inestables con y sin trabajo de fuerza, sobre el equilibrio y la capacidad funcional en adultos mayores de 60 años, pertenecientes al programa "Escuelas populares del deporte" del INDER Medellín. METODOLOGIA: se llevó a cabo un estudio experimental simple, ciego y enmascarado con asignación al azar de 34 sujetos a dos grupos de intervención con y sin trabajo de fuerza sobre superficies inestables; se midió el equilibrio unipodal, bipodal con ojos abiertos y cerrados, además de pruebas funcionales como Up and Go, arm curl y chair test. RESULTADOS:las intervenciones con y sin trabajo de fuerza mejoraron el equilibrio total en 57,0 y 69,5 segundos respectivamente, sin diferencias estadísticamente significativas en la comparación entre los grupos (p= 0,13). Se mejoró la velocidad de la marcha con ambas intervenciones sin diferencias intragrupos estadísticamente significativas (p= 0,33) pero importantes para la práctica. CONCLUSION: ambas intervenciones mejoran el equilibrio, sin embargo existen diferencias importantes para la práctica a favor del programa sobre superficies inestables sin trabajo de fuerza, pues la intervención tiene un mejor efecto sobre el equilibrio unipodal y bipodal tanto con ojos abiertos como con cerrados.

OBJECTIVE:to determine the effects of an eight-week training program on unstable surfaces with and without strength work regarding balance and functional capacity in adults over 60 who belong to the inder sport schools program in Medellín. METHODOLOGY: simple single-blind and masked experimental trials were conducted on 34 subjects who were randomly assigned to two intervention groups with and without strength work on unstable surfaces. Unipodal and bipodal balance was measured while the subjects' eyes were open and closed. In addition, functional tests such as Up and Go, Arm Curl and Chair Test were conducted. RESULTS : interventions with and without strength work improved total balance in 57.0 and 69.5 seconds respectively. The differences between the groups were not statistically significant (p = 0.33), nonetheless they were important. CONCLUSION: both interventions improve balance, however there are differences that are important in practice. These differences favor the program involving unstable surfaces without an unstable without strength work because the intervention has a better effect on unipodal and bipodal balance both with open and closed eyes.

NIÑOS y adolescentes con necesidades educativas especiales / CHILDREN and adolescents with special educational needs

Se viven tiempos de grandes y rápidos cambios socioeconómicos, culturales y tecnológicos. Las sociedades actuales promueven la equidad en un sentido amplio, afirmando el valor de la diversidad y la necesidad de la inclusión. Los conceptos de Necesidades Educativas Especiales (NEE) y de inclusión cobran fuerza, con la reafirmación del derecho fundamental de todos los niños/as y jóvenes a acceder a la educación, reconociendo que cada uno de ellos "posee características, intereses, capacidades y necesidades de aprendizajes que le son propios". En este artículo se revisan los conceptos actuales de discapacidad, NEE e inclusión, las principales condiciones que afectan a niños y adolescentes que tienen NEE y se discute en torno a las diferentes modalidades y herramientas pedagógicas actualmente disponibles en el sistema educativo chileno para cumplir esta tarea.

Our present time is one of huge and fast socioeconomic, cultural and technologic changes. Societies move towards a broadly understood equity, asserting the value of diversity and the need for Inclusion. Concepts such as Special Educational Needs (SEN) and Inclusion, acquire strength with the assertion of the universal fundamental right of children and adolescents to access Education, recognizing that each one "possess their own features, interests, capacities, and learning needs". In this article we review the present predominant notions on Disability, SEN and Inclusion, the main conditions affecting children and youth with SEN and the modalities and tools available in our educational system in order to accomplish this task.

Contenido de sodio en pan elaborado en panaderia de distribución nacional y comparado con una panadería local en la ciudad de Chillán de Chile / Comparison of sodium content in bread from a bakery with national distribution and a local bakery of Chillán city, Chile

Introduction: The Chilean Ministry of Health (MINSAL) and the Chilean Federation of Bakers (FECHIPAN) agreed to progressively decrease sodium content in bread from 800 to 500 mg/100 g bread in 100 bakeries in 2011 and in 100% of bakeries in 2014. Objective: To analyze and compare the sodium content in bread from a bakery with national distribution (A) and a local bakery (B). Materials and methods: A total of 100 samples were analyzed in each bakery 50 each of the two types of bread known as marraqueta and hallulla (types of bread rolls). Analysis was performed at different times of the day and at different days of the week. Sodium content was determined by the AOAC (2005) method using atomic absorption spectrophotometry and compared with the sodium content declared in the nutrition label in bakery A. Differences between content for type of bread, bakery and time of sampling were established by ANOVA and Student's t-test with the STATA 12.0 software at a p<0.05 level of significance. Results: Total sodium in bread (mg/100 g unit) was estimated as 619.6±127.7 mg for hallulla and 641.0±93.3 for marraqueta. There were no significant differences in sodium content in both bakeries (p=0.971) and type of bread (p=0.177). Sodium content was higher on Wednesdays (p<0.0001, p=0.016) and at 17 hours (p<0.000001, p=0.028) in hallulla and marraqueta, respectively. Total sodium content in both bakeries varied between 412.5 and 954.5 mg/100 g. Conclusions: Bread from both bakeries showed similar sodium contents although they exceeded the MINSAL-FECHIPAN agreement by 26% to 80%.

Introducción: El Ministerio de Salud de Chile (MINSAL) y la Federación de Panaderos de Chile (FECHIPAN) acordaron reducir progresivamente el contenido de sodio en el pan de 800 mg a 500 mg/100 g pan, en 100 panaderías el 2011 y en 100% de ellos el año 2014. Objetivo: Analizar el contenido de sodio en pan de una panadería de distribución nacional (A) comparada con una de tipo local (B). Materiales y métodos: Se analizaron 100 muestras de pan por panadería, 50 de marraqueta y 50 de hallulla, en diferentes horas y días de la semana. El contenido de sodio se determinó con el método AOAC (2005) mediante espectrofotometría de absorción atómica y se comparó con el contenido de sodio declarado en el etiquetado nutricional de la panadería A. Se utilizó ANOVA y T-student para establecer diferencias del contenido de sodio por tipo de pan, panadería y hora de extracción, utilizando el software STATA 12.0 con un nivel de significancia p<0,05. Resultados: El sodio total en el pan (mg/100 g pan) se estimó en 619,6±127,7 mg para hallulla y 641±93,3 para marraqueta, sin diferencias significativas para su contenido en ambas panaderías (p=0,971) y tipo de pan (p=0,177). El sodio fue mayor el día miércoles (p<0,0001 - p=0.016) y a las 17 horas (p<0,000001 - p=0.028) en pan hallulla y marraqueta respectivamente. Con variabilidad en el contenido de sodio total en ambas panaderías entre 412,5 a 954,5 mg/100 g. Conclusiones: El pan de ambas panaderías presenta similar contenido de sodio pero excediéndose 26% a 80% del acuerdo MINSAL-FECHIPAN.

Percepción del nivel cognoscitivo sobre manejo postural continuo en cuidadores de pacientes en silla de ruedas / Perception of cognition level about continuous postural management in caregivers of patients in wheelchairs

Introducción: Los pacientes con alteraciones neurológicas severas dependen del cuidado de terceros, muchas veces son las familias quienes asumen este rol, pero se desconoce cuánto logran integrar del manejo postural continuo. Objetivo: Determinar la percepción del nivel cognoscitivo de los cuidadores, en relación al manejo postural continuo, de pacientes en silla de ruedas, que asisten al Instituto Teletón Concepción, durante el año 2011. Pacientes y Métodos: Se realizó un estudio cualitativo fenomenológico con muestra de casos tipos en 8 cuidadores, que permitió profundizar en las experiencias individuales de estos, a través de entrevistas semi-estructuradas. Se realizó análisis semántico estructural sobre el discurso de los cuidadores. Resultados: Se estableció los códigos principales bajo los cuales los cuidadores comprenden el manejo postural continuo, el cual se entendió por el concepto de alineación corporal, la condición muscular del paciente y las expectativas de rehabilitación. Hay un mayor reconocimiento de los padres a la información entregada por sus pares, dándole mayor valor emocional. Las experiencias particulares de cada cuidador pueden ser una fuente positiva de refuerzo del programa de manejo postural continuo. Conclusiones: Los cuidadores refieren poseer amplios conocimientos del manejo postural continuo, pero no son capaces de detallar los aspectos básicos del mismo, evidenciando una falta de integración del conocimiento en esta área.

Introduction: Patients with severe neurological disorders depend on a third party for their care. Usually it is within their own families, that someone takes over that role, however, it is unknown to what extent they are able to integrate “continuous postural management”. Objective: To determine caregivers’ cognitive perception level with regards to “continuous postural management”, of patients who use wheelchairs and who attended Teletón Institute at Concepción, Chile, during the year 2011. Patients and Method: A phenomenological qualitative research using type cases samples in 8 caregivers was carried out. This made possible to go in depth with their individual experiences by conducting semi-structured interviews. A structural semantic analysis about the caregivers’ speech was done. Outcomes: Main codes under which caregivers understand “continuous postural management” were established. This was understood as the concept of body or corporal alignment, patients’ muscular condition and rehabilitation expectancies. There is greater acknowledgment from parents regarding information provided by their peers, which adds greater emotional value. Therefore, each caregiver’s individual experience may become a constructive strengthening source for the “continuous postural management” program. Conclusions: Caregivers reported having broad knowledge regarding “continuous posture management”, however they were unable to provide details about its basic characteristics, thus showing lack of knowledge integration in this area.

Estudio del control metabólico en pacientes diabéticos en hemodiálisis crónica: hemoglobina glicosilada, fructosamina y glicemias capilares / Study of metabolic control in diabetic patients on chronic hemodialysis: glycated hemoglobin, fructosamine and capillary glycemia

Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.