Citicolina, ¿deberíamos seguir indicándola en ECV isquémica? / Citicolina, devemos continuar a indicá-lo nA DCbV isquemica? / Citicoline, should we continue to indicate it in ischemic CVD?

Resumen: La enfermedad cerebrovascular (ECV) isquémica es una condición médica que implica, según su grado, discapacidad importante para el paciente, además de altos costos para su tratamiento agudo y crónico, así como en el manejo de la discapacidad con alta incidencia y prevalencia a nivel mundial. Desde el punto de vista fisiopatológico, representa una catástrofe en el funcionamiento cerebral que involucra daño estructural y funcional. Se han desarrollado múltiples estrategias para el manejo de esta patología; actualmente, el estándar de oro para su manejo es el rt-PA; sin embargo, por sus características, pocos pacientes tienen acceso al mismo. Razón por la que se han desarrollado estrategias farmacológicas diversas para su manejo: la citicolina se ha usado durante años, no obstante, genera controversias dado que su utilidad, demostrada en estudios experimentales, no se ha reproducido en la práctica clínica; más aún, algunos estudios sugieren que podría empeorar el pronóstico del paciente, lo que justificaría el abandono de su uso en el tratamiento de ECV isquémica (ictus). Por tal motivo ofrecemos esta revisión del tema con el fin de brindar herramientas que permitan aclarar dicha controversia.

Abstract: Ischemic cerebrovascular disease (CVD) is a medical condition that, according to its extension, implies significant disability for the patient, as well as high costs for its acute and chronic treatment, as well in the management of disability, with high incidence and worldwide prevalence, from the physiopathological point of view represents a catastrophe in brain functioning that involves structural and functional damage. Multiple strategies have been developed for the management of this pathology, currently the gold standard for its management is the rt-PA, however, due to its characteristics, and few patients have access to it, because it various pharmacological strategies have been developed. Citicoline has been used for years, nevertheless generates controversies since its usefulness, demonstrated in experimental studies, has not been reproduced in clinical practice but some studies suggest that it could worsen the patient's prognosis, which would justify the abandonment of its use in the treatment of ischemic CVD (ictus), for this reason we offer this review of the subject in order to provide tools to clarify this controversy.

Resumo: A doença cerebrovascular (DCbV) isquêmica é uma condição clínica que de acordo com sua extensão, implica em uma significativa incapacidade para o paciente, ademais de altos custos para seu tratamento agudo e crônico, bem como no manejo da incapacidade com alta incidência e prevalência a nível mundial. Do ponto de vista fisiopatológico representa uma catástrofe no funcionamento do cérebro que envolve danos estruturais e funcionais. Múltiplas estratégias têm sido desenvolvidas para o tratamento dessa patologia, atualmente o padrão ouro para o seu manejo é o rt-PA, porém, devido às suas características, poucos pacientes têm acesso a ele, razão pela qual várias estratégias farmacológicas foram desenvolvidas, a citicolina vem sendo utilizada há anos, gera controvérsias, uma vez que sua utilidade, demonstrada em estudos experimentais não foi reproduzida na prática clínica, mas alguns estudos sugerem que ela poderia piorar o prognóstico do paciente, o que justificaria o abandono do seu uso no tratamento de DCbV isquêmica (ictus), por esse motivo oferecemos esta revisão, a fim de fornecer ferramentas para esclarecer esta controvérsia.

Efectividad de la terapia farmacológica oral utilizada para el tratamiento del control postural en niños con parálisis cerebral disquinética: una revisión sistemática / Effectiveness of oral pharmacologic therapy usedfor treatment of postural control in children withdyskinetic cerebral palsy (DCP): a systematic review

Objective: To evaluate the effectiveness of oral pharmacologic therapy in improving postural control and functionality in patients with DCP, with less than 20 years old, compared with any therapy or placebo. Methods: Randomized clinical trials and quasi-experimental with no restriction in publication date or language were included. The search was conducted in PubMed, EMBASE, The Cochrane Library (CENTRAL), Virtual Health Library (LILACS, SCIELO), ClinicalTrials.gov and Opengrey. The risk of bias was assessed according to the Cochrane Handbook for Interventions Systematic Reviews. Results: 3 cross over studies were included, according to the established criteria. The three drugs that were analyzed were: levodopa, and trihexyphenidyl and tetrabenazine, compared to placebo. No study had significant favorable results for the use of the drug over placebo. Conclusion: At the moment there is no evidence to support the use of oral medication in patients with DCP, based on the small number of high quality studies found, it is necessary to increase research on oral pharmacologic therapy in this group of patients.

Objetivo: Evaluar la efectividad del tratamiento farmacológico oral destinado a mejorar el control postural y la funcionalidad en pacientes con parálisis cerebral disquinética (PCD) menores de 20 años comparado con cualquier terapia o placebo. Métodos: Se incluyeron ensayos clínicos aleatorizados y cuasi experimentales sin restricción de fecha de publicación o lenguaje. La búsqueda se realizó en Pubmed, EMBASE, The Cochrane Library (CENTRAL), Biblioteca Virtual de la Salud (LILACS, SCIELO), ClinicalTrials.gov y Opengrey. El riesgo de sesgo fue evaluado de acuerdo al Manual Cochrane de Revisiones Sistemáticas de Intervenciones. Resultados: Se incluyeron 3 estudios cross-over de acuerdo a los criterios establecidos. Los tres fármacos analizados fueron: levodopa, tetrabenazina y trihexifenidilo, comparados con placebo. Ningún estudio tuvo resultados favorables de manera significativa para el uso del medicamento sobre placebo. Conclusión: Por el momento no existe evidencia que sustente el uso de la medicación oral en los pacientes con PCD en base al escaso número de estudios de alta calidad encontrados, siendo necesario que se aumente la investigación sobre el tratamiento farmacológico oral en este grupo de pacientes.

Niveles de ingesta diaria de edulcorantes no nutritivos en escolares de la región de Valparaíso / Daily consumption levels of non-nutritive sweeteners in school age children from the Valparaiso region

Introduction: Artificial sweeteners are substances that do not provide energy and are added to foods to provide a sweet taste. Sweeteners are used to replace sugar either in part or entirely. Objective: To determine the consumption of artificial sweeteners in school children 6 to 14 years of age in the Valparaiso Region of Chile and to compare consumption according to nutritional status. Methods: 281 students of both sexes underwent anthropometric assessment (weight and height) and completed a food survey on the consumption of sweeteners. Results: 100% of students consume foods or products containing artificial sweeteners, although no student consumed more than the maximum allowed. When comparing by nutritional status, obese children, compared to those with normal weight had a higher consumption of sucralose, aspartame, saccharin and acesulfame potassium (p <0.05). Conclusion: The intake of sweeteners is massive, but consumption does not exceed permitted levels in this study sample.

Introducción: Los edulcorantes artificiales son sustancias que no aportan energía y que se agregan a los alimentos para proporcionarles un sabor dulce. Se emplean para reemplazar total o parcialmente el azúcar. Objetivo: Determinar el consumo de edulcorantes artificiales en escolares de 6 a 14 años de la región de Valparaíso y comparar su consumo según su estado nutricional. Métodos: A 281 estudiantes de ambos sexos se les realizó una evaluación antropométrica (peso y talla) y una encuesta alimentaria sobre consumo de edulcorantes. Resultados: El 100% de los estudiantes consumió alimentos o productos con contenido de edulcorantes, aunque ninguno de ellos sobre la dosis máxima admitida. Al comparar por estado nutricional, los estudiantes con obesidad presentaron una mayor consumo de sucralosa, aspartamo, sacarina y acesulfamo de potasio (p<0.05). Conclusión: La ingesta de edulcorantes es masiva, pero su consumo no sobrepasa los niveles permitidos por el Reglamento Sanitario de los Alimentos en la muestra estudiada.

Descripción histológica de las glándulas anexas del aparato digestivo de avestruz (Struthio camelus var. domesticus) / Histologic description of the annexed glands from the ostrich digestive system (Struthio camelus var. domesticus)

En la última década, la crianza del avestruz en Chile ha ido aumentando sustancialmente, por lo cual se ha hecho necesario incrementar los estudios para mejorar la producción de esta especie. La literatura señala sólo estudios sobre la fisiología y anatomía de esta especie. Nuestro objetivo es aportar al conocimiento de la histología normal de las glándulas anexas al aparato digestivo. Esta investigación se realizó con 6 avestruces clínicamente sanas, de las que se obtuvieron muestras representativas del hígado, pro ventrículo y páncreas. Se realizaron cortes histológicos, los que fueron teñidos y montados para su análisis comparativo bajo microscopio de luz, entre avestruz y gallina. La histología de las glándulas anexas del aparato digestivo es semejante a la descrita en la gallina. Sin embargo, en el hígado los cordones de hepatocitos se disponen en forma radial, tanto alrededor de la vena central como de los espacios porta, característica no observada en otras especies. Con respecto al pro ventrículo, en la mucosa se observan glándulas tubulares simples o ramificadas, semejantes a las glándulas fúndicas de los mamíferos. En la submucosa se observan glándulas túbuloalveolares compuestas con células parietales. El páncreas no presenta diferencias destacables.

In the last decade the upbringing of the ostrich in Chile has increased substantially, for this reason it is necessary to increase the studies to improve the production of this species. The literature only points out studies on the physiology and anatomy of this species. The purpose of this work is to contribute to the knowledge of the normal histology from the annexed glands to the digestive system. This study was carried out clinically using 6 healthy ostriches, of which representative samples of the liver, proventricle and pancreas. Histological sections were realized, mounted and stained for their comparative analysis under low light microscope to describe with those cited in the hen. The histology of the annexed glands from the digestive system is similar to the described in the hen. However, in the liver the arrangement hepatic cords so is in the central vein such as the portal spaces is radial, characteristic not observed in other species. In relation to the histology of the proventricle, the tubular glands are quite, similar to the fundic glands of the mammals. In the submucosa compound tubulosacular glands are observed, with parietal cells. The pancreas doesn't present prominent differences.

Ebony (Phitecellobium flexicaule Benth) and proteins fractionation, solubilization, characterization and production of an isolate

Different combinations of pHs (2 to 12) and temperatures (25, 30 and 35 degrees C) were tested to obtain a protein isolate from ebony (Pithecellobium flexicaule, Benth) seeds. Seed proteins contained 54.6 per cent albumins, 32 per cent globulins, 5.7 per cent glutelins and 1.3 per cent prolamins. The isoelectric points for albumins, globulins and glutelins were in the pH range of 2.3-2.7. The average molecular weight of albumins ranged from 92 to 100 kDa and for the four globulin subunits in the range of 28.4 to 57.3 kDa. For isolate production, proteins were sequentially extracted with distilled water and a 5 per cent NaCl solution. The resulting supernatants were mixed. The best extraction was achieved at pH 11 and 25 degrees C. 45.6 per cent of the total seed protein was precipitated at pH 2.6 yielding an isolate with 90 per cent protein (N x 6.25). The isolate contained high quantities of lysine, leucine, threonine and phenylalanine but were low in sulfur containing amino acids methionine and cysteine. The extraction process reduced tannins, phytates and trypsin inhibitor in 53, 70 and 70 per cent, respectively. In vivo protein digestibility of the protein isolate was 85.4 per cent and the corrected digestibility essential amino acid score was of 44 per cent due to the lack of sulfur containing amino acids. In order to upgrade the protein quality of ebony isolate it is recommend to supplement with methionine or sulfur containing rich foods.