Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré / Clinical characteristics and plasma exchange response in Guillain-Barré patients

RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.

ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes' disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.

Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré / Clinical characteristics and plasma exchange response in Guillain-Barré patients

RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.

ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes' disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.

Antimicrobianos en neonatología. Parte I: Recomendaciones de dosificaciones basadas, en la más reciente evidencia en recién nacidos Comité Consultivo de Infecciones Neonatales, Sociedad Chilena de Infectología / Antibiotics in neonatology. Part I: Dosage recommendations based on the most recent evidence in newborns Advisory Committee on Neonatal Infections, Chilean Society of Infectious Diseases

Resumen Los antimicrobianos son los medicamentos más utilizados en los neonatos durante su primer mes de vida cuando se encuentran en unidades neonatales, principalmente por el alto riesgo que presentan de adquirir infecciones graves como la sepsis. La mayoría de estos antimicrobianos se utilizan con dosis extrapoladas en base a las recomendaciones en población adulta y niños mayores, a pesar de que la fisiopatología en los recién nacidos es absolutamente diferente. Lo anterior lleva a un mayor riesgo a que ocurran más efectos adversos los que pueden conducir a una mayor toxicidad y a fallas terapéuticas, entre otros. En la última década se han realizado mayores estudios farmacocinéticos de antimicrobianos en neonatos; esta reciente evidencia ha permitido nuevas recomendaciones de dosificación considerando el peso y la edad gestacional del recién nacido, entre otras variables, de acuerdo al antimicrobiano estudiado. En base a una mayor evidencia sobre el comportamiento farmacocinético de los antimicrobianos en neonatos, se ha elaborado este documento para así facilitar y promover su correcto uso en las unidades neonatales.

Abstract Antibiotics are the most widely used medications in neonates during their first month of life in neonatal units, mainly due to the high risk they present of acquiring serious infections such as sepsis. Most of these antibiotics are used with extrapolated doses based on the suggestions in the adult population and older children, despite the fact that the pathophysiology in newborns is absolutely different. This leads to a higher risk of more adverse effects occurring, which can lead to greater toxicity and therapeutic failures, among others. In the last decade more and more pharmacokinetic studies of antibiotics have been carried out in neonates, this recent evidence has led to new dosage recommendations taking into account the weight and gestational age of the newborn, among other variables, in agreement to the antibiotic studied. Therefore, based on the need to order and summarize the most up-to-date and most evidence-based information on antibiotics in neonates, this document was prepared to facilitate and promote its correct use in neonatal units.

L-asparaginase de Erwinia chrysanthemi: expressão proteica livre de células e bioconjugação a bacteriófagos / L-asparaginase from Erwinia chrysanthemi: cell-free protein expression and bioconjugation to bacteriophages

A L-Asparaginase (L-ASNase) de Erwinia chrysathemi (ErA) é uma enzima amplamente utilizada para o tratamento da leucemia linfoblástica aguda (LLA). Embora o seu uso como segunda linha de tratamento para a LLA tenha proporcionado consideráveis benefícios clínicos, reações de hipersensibilidade e rápida depuração plasmática ainda são problemas recorrentes. Ademais, extensivos e custosos processos de produção da ErA são necessários para a obtenção da enzima pura. Com base nesses problemas, o presente trabalho propõe (1) o estudo de viabilidade de expressão da ErA em um sistema de síntese proteica livre de células (SPLC) e (2) a conjugação da proteína em bacteriófagos como ferramenta alternativa para o isolamento e monitoramento da depuração plasmática da ErA. Foram utilizados extratos celulares de Escherichia coli suplementados com solução energética contendo creatina fosfato (CP) como fonte de energia para síntese in vitro de ErA. Para conjugação da ErA a bacteriófagos, o sistema SpyTag/SpyCatcher foi implementado: SpyCatcher foi fusionado à porção N-terminal da ErA e bacteriófagos filamentosos da linhagem M13 e fd foram modificados de modo a expressar SpyTag nas proteínas de capsídeo pIII e pVIII, respectivamente. Em relação ao primeiro objetivo, o sistema de SPLC foi capaz de expressar a ErA com atividade. A proteína foi expressa na fração solúvel e apresentou atividade enzimática significativamente superior em relação à reação controle (7,07 ± 0,68 U/mL vs. 1,83 ± 0,14 U/mL). Tempo necessário para obtenção do extrato celular foi reduzido de 45 para 26 hrs, e sete componentes da solução energética foram removidos da composição original sem implicações negativas na eficiência de expressão da ErA, simplificando desta forma o processo de SPLC. Em relação ao segundo objetivo, ErA fusionada à SpyCatcher (SpyCatcher_ErA) foi conjugada com êxito em bacteriófagos capazes de expressar SpyTag fusionadas na porção N-terminal das proteínas pIII (SpyTag_pIII) e pVIII (SpyTag_pVIII). A porcentagem de formação dos conjugados entre SpyCatcher_ErA e SpyTag_pIII ((ErA)5-pIII) foi de 6% enquanto formação dos conjugados entre SpyCatcher_ErA e SpyTag_pVIII ((ErA)50-pVIII) foi de 46%, valores estes confirmados por atividade enzimática. Solução contendo conjugados foram injetados em camundongos e sequenciados/titulados com êxito. Não houve diferença de depuração plasmática entre (ErA)5-pIII e bacteriófago controle, mas houve maior taxa de eliminação de (ErA)50-pVIII em relação ao mesmo bacteriófago não conjugado à SpyCatcher_ErA. Os resultados aqui apresentados confirmam ser possível expressar ErA com atividade biológica em sistemas de SPLC. Além disso, o sistema de conjugação da ErA a bacteriófagos aqui desenvolvido foi capaz de monitorar a concentração de ErA presente na circulação em função do tempo, tornando-se uma potencial plataforma de desenvolvimento de novas proteoformas da ErA com características clínicas melhoradas

L-Asparaginase (L-ASNase) from Erwinia chrysanthemi (ErA) is a widely used enzyme for treatment of acute lymphoblastic leukemia (ALL). Although its use as a second-line treatment has provided significant clinical benefits, hypersensitivity reactions and a fast clearance rate are recurring L-ASNase-related problems. In addition, extensive and costly production processes are required for the manufacturing of pure ErA. Based on these drawbacks, this current work proposes (1) the study of the use of a cell-free protein synthesis (CFPS) system as a viable platform for the synthesis of ErA and (2) the conjugation of the protein on bacteriophages as an alternative tool for the isolation and monitoring of ErA clearance. Escherichia coli-derived cell extracts supplemented with a creatine phosphate-based energy solution were used to synthesize ErA in vitro. To conjugate ErA on bacteriophages, the SpyTag/SpyCatcher system was implemented: SpyCatcher was fused to the N-terminus of the ErA while filamentous phage strains M13 and fd were engineered in order to display SpyTag on their pIII and pVIII capsid proteins, respectively. Regarding the first goal, the CFPS system was able to express an active ErA. The protein was expressed in the soluble fraction and there presented a significant higher enzymatic activity compared to the control reaction (7.07 ± 0.68 U/mL vs. 1.83 ± 0.14 U/mL). Time required to obtain the cell extract was reduced from 45 to 26 hours, and seven energy solution reagents were removed from the original solution without compromising the efficiency of ErA expression, thus simplifying the CFPS process. With respect to the second goal, ErA fused to SpyCatcher (SpyCatcher_ErA) was sucessfully conjugated on bacteriophages capable of displaying SpyTag fused to the Nterminus of the pIII (SpyTag_pIII) or pVIII (SpyTag_pVIII) proteins. Percentage of conjugate formation between SpyCatcher_ErA and SpyTag_pIII (ErA)5-pIII was 6% whereas conjugate formation between SpyCatcher_ErA and SpyTag_pVIII (ErA)50-pVIII was 46%, values that were confirmed by enzymatic activity. Sample containing conjugates were injected into mice and sucessfully sequenced/titrated. No clearance differences were observed between (ErA)5- pIII and a control bacteriophage, but a higher clearance rate was observed for (ErA)50-pVIII compared to SpyTag_VIII non conjugated to SpyCatcher_ErA. The results here presented confirm the expression of a biologically active ErA from a CFPS system. Besides, the development of a conjugation system capable of linking ErA to bacteriophages could be used as a means to monitor the ErA concentration in the blood as a function of time and also as a potential platform to be used in the development of novel ErA proteoforms with improved clinical properties

Artemeter-Lumefantrine therapeutic efficacy, safety and plasma levels in patients with uncomplicated falciparum malaria from the Colombian Pacific region / Eficacia terapéutica, seguridad y niveles plasmáticos del Artemeter-Lumefantrine en pacientes con malaria falciparum no complicada de la región del Pacifico Colombiano

Introduction: In Colombia, the published studies for the treatment of uncomplicated Plasmodium falciparum malaria with Artemether-Lumefantrine are scarce. The aim of the study was to evaluate the therapeutic efficacy and safety profile of this combination. Methods: A clinical trial was performed in adults with uncomplicated P. falciparum malaria using the 28‑day World Health Organization validated protocol. Patients received supervised antimalarial treatment and the primary efficacy endpoint was the clinical and parasitological response. Safety was assessed through adverse events surveillance and plasmatic levels of antimalarial drugs were measured. Results: 88 patients were included. Adequate clinical and parasitological response rate of 100% on day 28 was achieved in 84 patients, diagnosed by thick blood smear examination. There were four parasitological therapeutic failures (5%) detected by polymerase chain reaction. Discusion: Therapeutic efficacy similar to previous studies was established with a slight increase in therapeutic failure. The serum levels of the antimalarials were adequate and the few cases of therapeutic failure were not related. Conclusion: Treatment of uncomplicated P. falciparum malaria with Artemeter-Lumefantrine was effective and safe in the study population. All patients reached adequate plasma concentrations of the drugs; therapeutic failures were not associated with low blood levels of the drug clinical trial.

Introducción: Son escasos los estudios en Colombia sobre eficacia del tratamiento para Plasmodium falciparum con la combinación Artemeter-Lumefantrina. El objetivo de este estudio fue evaluar la eficacia terapéutica y el perfil de seguridad de este tratamiento combinado. Métodos: Se realizó un ensayo clínico en adultos con malaria por P. falciparum no complicada, utilizando el esquema de 28 días recomendado por la Organización Mundial de la Salud (OMS). Los pacientes recibieron el tratamiento supervisado y el desenlace primario evaluado fue la respuesta clínica y parasitológica. La seguridad fue evaluada a través de vigilancia de efectos adversos y medición de niveles plasmáticos del medicamento. Resultados: Se incluyeron 88 pacientes. La tasa de curación clínica y parasitológica fue del 100% en 84 pacientes que tuvieron examen de gota gruesa al día 28. Hubo cuatro (5%) fallas parasitológicas detectada por reacción en cadena de polimerasa. Discusión: La eficacia terapéutica fue similar a la reportada en estudios previos con un ligero aumento de falla terapéutica. Los niveles plasmáticos de los antimalaricos fueron adecuados y no relacionados con la falla terapéutica. Conclusión: El tratamiento de malaria por P. falciparum no complicada con Artemeter-Lumefantrina fue efectiva y segura en la población estudiada. Todos los pacientes alcanzaron niveles en plasma adecuados y no se encontró asociación de falla terapéutica con bajos niveles en sangre.

Aplicación tópica de plaquetas plasmáticas en pacientes con queratitis punteada superficial / Topical use of plasmatic platelets in patients with superficial punctuated queratitis

Se realizó un estudio clínico, prospectivo, intervencionista y comparativo, de 41 pacientes (31 ojos) con diagnóstico de queratitis punteada superficial -seleccionados por muestreo aleatorio simple-, atendidos en el Hospital Infantil Docente Sur Dr Antonio María Béguez César de Santiago de Cuba, desde noviembre del 2016 hasta mayo del 2017, con vistas a demostrar la eficacia del tratamiento tópico con colirio de plaquetas plasmáticas en ellos, para lo cual se conformaron 2 grupos: el A, que recibió tratamiento tópico convencional, y el B con la misma terapia más colirio de plasma rico en plaquetas. Los pacientes tuvieron seguimiento clínico a las dos y cuatro semanas de aplicado el tratamiento. En la mayoría de los pacientes del grupo B el tiempo de cicatrización corneal fue de 7 días y el de curación de 2 semanas; de manera que se demostró la eficacia de este colirio autólogo en la cicatrización corneal, sin riesgo de reacción inmunológica y de bajo costo económico.

A clinical, prospective, interventionist and comparative study of 41 patients (31 eyes) with diagnosis of superficial punctate queratitis -selected by simple random sampling-, assisted in Dr Antonio María Béguez Caesar Southern Teaching Pediatric Hospital in Santiago de Cuba was carried out from November, 2016 to May, 2017, with the objective of demonstrating the effectiveness of the topical treatment of plasmatic platelets in them with eyewash, for which 2 groups were formed: group A with conventional topical treatment, and group B with the same therapy plus eyewash with rich platelets plasm. The patients had clinical follow- up at two and four weeks of having applied the treatment. In most of the patients of group B the time of corneal scaring was of 7 days and that of cure of 2 weeks; so that the effectiveness of this autologous eyewash was demonstrated in the corneal scaring, without risk of immunological reaction and with low economic cost.

Dietary levels and sources of selenium for post weaning piglets / Níveis dietéticos e fontes de selênio para leitões pós-desmame

ABSTRACT: An experiment was conducted to study the effects of two sources and dietary levels of selenium (Se) on performance, Se concentration and glutathione peroxidase activity in plasma and liver of piglets post weaning. A total of 126 weaned pigs male and female Large White × Landrace, at average body weight of 7.2±0.67kg were allotted to seven treatments in a randomized block design, with two Se sources (organic and inorganic), inclusion levels, two levels for the inorganic source (0.30 and 0.60ppm) and four for the organic source (0.15, 0.30, 0.45 and 0.60ppm) and one control diet without Se supplementation containing 0.095ppm, and six replicates of three animals per pen. The experimental period was 35 days post-weaning. The organic source contained 0.2067% (Se-yeast), and the inorganic 45.86% (sodium selenite) analyzed. Piglets that received supplemental Se had lower feed intake compared to those not supplemented. Furthermore, feed conversion was better with dietary supplementation of Se, and the organic source was better than the inorganic source at level of 0.30ppm. Plasma concentration of Se was higher (35.53%) in animals receiving dietary supplementation of this mineral, regardless of the sources studied. There was no effect of sources on plasma and hepatic Se, with the lowest values observed for the non-supplementation and organic Se at dietary level of 0.15ppm. There was a linear reduction of plasma GSH-Px activity with increased supplementation levels of organic Se, and the hepatic GSH-Px activity increased linearly with the increased supplementation, regardless of the source studied.

RESUMO: Um experimento foi conduzido para estudar os efeitos de duas fontes e diferentes níveis de selênio (Se) sobre o desempenho, concentração de Se e atividade da glutationa peroxidase no plasma e fígado de leitões após o desmame. Um total de 126 leitões desmamados machos e fêmeas (Large White × Landrace), com peso corporal médio de 7,2±0,67kg foram distribuídos em sete tratamentos em delineamento em blocos casualizados, com duas fontes de Se (orgânico e inorgânico), com níveis de inclusão: dois níveis para a fonte inorgânica (0,30 e 0,60ppm), quatro para a fonte orgânica (0,15, 0,30, 0,45 e 0,60ppm) e uma dieta de controle sem suplemento de Se contendo 0,095ppm em seis repetições de três animais por baia. O período experimental foi de 35 dias após o desmame. A fonte orgânica continha 0,2067% (Se- Levedura) e a inorgânica (Selenito de sódio) 45,86% de Se analisado. Os leitões que receberam Se suplementar tiveram menor consumo de alimento em comparação com os que não foram suplementados. Além disso, a conversão alimentar foi melhor com a suplementação dietética de selênio e a fonte orgânica foi melhor do que a fonte inorgânica ao nível de 0,30ppm. A concentração plasmática de Se foi maior (35,53%) nos animais que receberam suplementação dietética deste mineral, independentemente das fontes estudadas. Não houve efeito de fontes no Se plasmático e hepático, com os valores mais baixos observados para a não suplementação e Se orgânico no nível de dieta de 0,15ppm. Houve uma redução linear da atividade GSH-Px plasmática com níveis de suplementação aumentados de Se orgânico e a atividade hepática GSH-Px aumentou linearmente com o aumento da suplementação, independente da fonte estudada.

La resistina se asocia con la proteína C reactiva y marcadores de riesgo cardiovascular en niños obesos / Resistin is associated with C reactive protein and cardiovascular risk markers in obese children / A resistina associa-se à proteína C reativa e aos marcadores de risco cardiovascular em crianças obesas

El objetivo del trabajo fue evaluar los niveles de resistina sérica y su asociación con la proteína C reactiva (PCR-hs), óxido nítrico (NO) y lípidos plasmáticos (LP) en sujetos de edad pediátrica. Participaron 366 niños y adolescentes (10-16 años), agrupados en eutróficos (n=162) y obesos (n=204). Se les estudió peso, talla, circunferencia de la cintura, resistina sérica, glucosa e insulina basal, LP, NO, PCR-hs, malondialdehído y tensión arterial. Se calculó el IMC, el índice cintura-talla (IC/T) y el HOMA-IR. Se utilizaron las pruebas t de Student, ANOVA, U de Mann y Whitney o Kruskal- Wallis para comparar entre grupos y la correlación de Spearman para determinar asociación entre variables. Los obesos masculinos presentaron niveles superiores de resistina (p<0,05). El género femenino presentó valores más altos de resistina en eutróficos (p=0,012) y con IC/T normal (p=0,011). A mayor concentración de resistina los eutróficos presentaron niveles más altos de triacilglicéridos, pero los obesos mostraron niveles más bajos de triacilglicéridos, HDLc y NO, más altos de PCR-hs y mayor IMC. Los resultados sugieren que la resistina podría ser un factor de riesgo para la enfermedad cardiovascular por su asociación positiva con la PCR-hs e inversa con el NO y la HDLc, parámetros involucrados en la inflamación y la disfunción endotelial.

The aim of this study was to evaluate seric levels of resitin and their association with high-sensitivity C Reactive Protein (hs-CRP), nitric oxide (NO) and plasmatic lipids (PL) in a pediatric age population. A total of 366 children and adolescents (between 10-16 years old) participated, and were grouped into eutrophic (n=162) and obese (n=204). Weight, height, waist circumference, resistin, fasting blood glucose and insulin levels, PL, hs-CRP, NO, malondialdehyde and blood pressure were measured. BMI, waist to height ratio (W/HR) and HOMA-IR were calculated. T-student, ANOVA, Mann-Whitney U-value or Kruskal-Wallis were used to compare between groups and Spearman correlation was used to determine association among variables. Male obese subjects showed higher resistin levels (p<0.05). Female subjects showed higher resistin values in the eutrophic group (p=0.012) and in the normal W/HR (p=0.011). At higher levels of resistin, the eutrophic group showed higher levels of triacylglycerides, but the obese group showed lower triacylglycerides, HDLc and NO levels and higher hs-CRP levels and BMI. These results suggest that resistin could be a risk factor for cardiovascular disease because of its positive association with hs-CRP and inverse association with NO and HDLc, parameters involved in inflammation and endothelial dysfunction.

O objetivo da pesquisa foi avaliar os níveis séricos de resistina sérica e sua associação com a proteína C-reativa (PCR-hs), óxido nítrico (NO) e lipídios plasmáticos (LP) em crianças e adolescentes. O estudo envolveu 366 crianças e adolescentes (10-16 anos), agrupados em eutróficos (n=162) e obesos (n=204). Os sujeitos foram estudados em relação ao peso, altura, circunferência da cintura, resistina sérica, glicose e insulina basal, LP, NO, PCR-hs, malondialdeído e pressão arterial. Os IMC, índice cintura-altura (IC/A) e HOMA-IR foram calculados. Foram utilizados os Testes t de Student, ANOVA, U de Mann e Whitney ou Kruskal-Wallis para comparar entre os grupos e a correlação de Spearman para verificar a associação entre variáveis. Os obesos masculinos mostraram níveis mais elevados de resistina (p<0,05). O sexo feminino apresentou valores mais altos de resistina em eutróficos (p=0,012) e com IC/T normal (p=0,011). À maior concentração de resistina, os eutróficos apresentaram maiores níveis de triacilglicerídeos, mas os obesos apresentaram níveis mais baixos de triacilglicerídeos, HDLc e NO, mais altos de PCR-hs e maior IMC. Os resultados sugerem que a resistina poderia ser um fator de risco para a doença cardiovascular devido à sua associação positiva com a PCR-hs e inversa com o NO e a HDLc, parâmetros envolvidos na inflamação e disfunção endotelial.

Efeito de soluções eletrolíticas enterais com diferentes osmolaridades sobre o perfil eletrolítico e bioquímico de equinos / Horses treated with enteral electrolyte solutions with differents osmolarities

Foram comparados os efeitos de soluções eletrolíticas com diferentes osmolaridades administradas via enteral por sonda nasoesofágica de pequeno calibre, em fluxo contínuo, sobre o perfil bioquímico em equinos. Foram utilizadas seis fêmeas adultas em dois quadrados latinos 6x3 simultâneos em modelo misto. Os animais foram distribuídos em três grupos e cada grupo submetido aos seguintes tratamentos: HipoMalt - 5g de cloreto de sódio, 0,5g de cloreto de potássio, 0,2g de pidolato de magnésio, 1g de gluconato de cálcio e 10g de maltodextrina diluídos em 1.000mL de água (181mOsmol L-1), HipoDext - 5g de cloreto de sódio, 0,5g de cloreto de potássio, 0,2g de pidolato de magnésio, 1g de gluconato de cálcio e 10g de dextrose diluídos em 1.000mL de água (228mOsmol L-1) e IsoProp - 5g de cloreto de sódio, 0,5g de cloreto de potássio, 0,2g de pidolato de magnésio e 10g de propionato de cálcio diluídos em 1.000mL de água (282mOsm L-1). As soluções contendo dextrose (HipoDext) e maltodextrina (HipoMalt) foram mais eficazes em aumentar a taxa glicêmica sem ocasionar desequilíbrio eletrolítico. Já o tratamento com propionato de cálcio (IsoProp) além de aumentar o lactato plasmático não teve efeito sobre a glicemia.

We compared the effects of electrolyte solutions with different osmolarities administered through enteral route by naso-esophageal probe of small-caliber with continuos flow on the electrolytic and biochemical profile in horses. Six adult females were used in two simultaneous 6x3 Latin squares mixed model. The animals were divided into three groups and received the following treatments: HipoMalt - 5g of sodium chloride, 0.5g of potassium chloride, 0.2g of magnesium pidolate, 1g of calcium gluconate and 10g of maltodextrin diluted in 1.000mL of water (181mOsmol L-1); HipoDext - 5g of sodium chloride, 0.5g of potassium chloride, 0.2g of magnesium pidolate, 1g of calcium gluconate and 10g of dextrose diluted in 1.000mL of water (228mOsmol L-1); IsoProp - 5g of sodium chloride, 0.5g of potassium chloride, 0.2g of magnesium pidolate, 1g of calcium gluconate and 10g of calcium propionate diluted in 1.000mL of water (282mOsm L-1). The hypotonic electrolyte solutions containing dextrose (HipoDext) and maltodextrin (HipoMalt) were more effective in increase the rate glucose without causing electrolyte imbalance. Treatment with calcium propionate (IsoProp) besides increasing plasma lactate had no effect on blood glucose.

Clinical significance of setting nasojejunal nutrition tube in Whipple operation / 中国综合临床

Objective To investigate the clinical significance of setting nasojejunal nutrition tube in Whipple operation,which can promote patient recovery and prevent complications.Methods Fourty-one patients were undergone Whipple operation and they were randomly divided into eternal nutrition (EN) and parenteral nutrition group (PN).Patients in EN group were set nasojejunal nutrition tube during Whipple operation in order to supply eternal nutrition at earlier period,while in PN group were supplied parenteral nutrition in earlier period.The operative procedure time,the complication in post-operation,the cost of hospitalization and the periods of hospitalization of two groups were recorded.The scores of nutritional status were measured.Results The operative time in EN group and PN group were (200.71 ±51.33)min and (160.48 ± 47.62) min,and no significant difference was found between two groups (t =-1.524,P ＞ 0.05).The hospitalization expenses in EN group was (38835.65 ± 537.69)yuan,lower than that in PN group ((47833.18 ±659.24) yuan,t =2.073,P ＜ 0.05).The hospital periods of EN group and PN group were 10 (3) d and 18(3) d,and the difference was significant (Z =-5.374,P ＜0.001).There were 2 cases who occurred complications after operation in EN group,including 1 cases with incision infection,and 1 cases of pancreatic fistula.Nine cases occurred complications in PN group,including 3 cases with incision infection,2 cases with pancreatic fistula,2 cases with pulmonary infection,2 cases with gastric paralysis,and all were cured by conservative treatment.There was statistically significant difference in the incidence of postoperative complications (P =0.027).All cases with complication were recovery after corresponding treatment.At 7th day after operation,hemoglobin in EN group and PN group were (113.09 ± 12.35) g/L and (107.04 ± 11.81) g/L,and the difference was significant (t =2.035,P ＜ 0.05).The levels of retinol binding protein,serumalbumin,serum prealbumin,serum transferrin in EN group were (42.62 ± 5.64) mg/L,(40.24 ± 6.79) g/L,(321.43±31.28) mg/L,(32.86±4.67) mg/L,(32.86 ±4.67) mg/L,significant different from those in PN group ((15.50 ± 4.26) mg/L,(31.52 ± 5.92) g/L; (197.86 ± 37.71) mg/L,(23.59 ± 4.32) mg/L; t=2.398,2.606,2.119,2.569; P ＜0.01 or P ＜ 0.05).Conclusion Nutritional status and prognosis are improved obviously by setting nasojejunal nutrition tube in Whipple operation.And the cost of hospitalization,the periods of hospitalization are decrease.

Afectación de las funciones cognitivas y motoras en niños residentes de zonas rurales de Jujuy y su relación con plaguicidas inhibidores de la colinesterasa: Un estudio piloto / Impairment of cognitive and motor functions in children from rural areas of Jujuy, and its relationship with cholinesterase inhibitor pesticides: A pilot study

El objetivo de este trabajo fue estudiar el efecto de la exposición a plaguicidas en las funciones cognitivas y motoras de 42 niños de una zona rural con mayor probabilidad de exposición a plaguicidas organofosforados y carbámicos (Yuto, Jujuy). Los resultados de las pruebas realizadas para estudiar el efecto fueron comparados con los resultados obtenidos con 29 niños con menor exposición a plaguicidas (León, Jujuy). A todos los participantes se les realizó historia clínica, evaluación médica, revisión de antecedentes, pruebas neuroconductuales, de motricidad gruesa y equilibrio, y medición de biomarcadores (colinesterasa plasmática y eritrocitaria). Se realizó una historia clínica neurológica estándar con las siguientes pruebas: Subtest de Dígitos y Símbolos, Subtest de Recuerdo de Dígitos, Subtest de Laberinto del WISC-III de Wechsler. En la prueba de Laberintos realizada en el presente estudio se observan diferencias entre las localidades y se comprobó una relación lineal inversa entre los años de residencia y la puntuación de la prueba. Se observó reducción en las actividades de acetilcolinesterasas en los niños pertenecientes a Yuto. No se observó una correlación signifca-tiva entre los niveles de actividad de las enzimas y el rendimiento en la prueba, para ninguna de las dos localidades. Los resultados señalaron la probabilidad de que la exposición crónica a bajas dosis de plaguicidas pudiera estar dañando algunas funciones cognitivas y que esto dependería de la duración de la exposición. Por falta de correlación entre las actividades de las enzimas y los resultados adversos en las pruebas neuroconductuales de motricidad y de equilibrio, no fue evidente una asociación entre ambos.

The aim of this research was to study the effects of these toxics on the cognitive and motor functions of a group of 42 children of a rural town with high percentage of exposure to organophosphate and carbamic pesticide (Yuto) and compare the results with a group of 29 children with low percentage of exposure to pesticides. In both cases a research of the patients history was done, a medical revision and a full checkup including neurobehavioral tests, motor and balance tests and biomarkers levels (plasma pseudocholinesterase and erythrocyte cholinesterase). The behavioral assessment was performed by a standard neurological clinic history, a digital and symbol subtest, a digital memory, a maze test, intelligence test WISC-III of Wechsler and gross motor and balance tests. In the group from Yuto, Pearson correlations were done between the years of residency and the neurobehavioral tests and the linear correlation between the years of residency and the acetylcholinesterase activities. In the maze test results there were differences between the two towns and it was proved an inverse lineal relation between the years of residency and the tests scores. It was also observed a reduction in the acetylcholinesterase activities both erythrocyte and plasma in the children from Yuto. Nevertheless there were not signifcant correlations between the levels of enzyme activities and the performance in the tests for neither of the towns. The results achieved did not point out that chronic exposure to low-dose pesticides can produce cognitive malfunctions, such as psychomotor problems. The lack of correlations between the activities of the acetylcholinesterase enzyme and the negative results of the neurobehavioral motor and balance tests couldn´t be associated.

Defensas antioxidantes en la insuficiencia renal crónica experimental / Antioxidant defenses in the experimental chronic renal failure

OBJETIVO: Evaluar el comportamiento de las defensas antioxidantes en relación con las modificaciones funcionales progresivas en la insuficiencia renal crónica experimental. MÉTODOS: Estudio experimental controlado en 40 ratas Wistar provocando insuficiencia renal por ablación de 5/6 de la masa renal. La muestra se dividió en 4 grupos de 10 animales, 1 grupo control y 3 experimentales (E) sometidos a extirpación del riñón derecho y ligadura de dos ramas de la arteria renal izquierda. El grupo experimental E-I evolucionó 2 sem después de la nefrectomía, el grupo E-II 4 sem y el grupo E-III durante 6 semanas. Se realizó aclaramiento plasmático de ácido paraminohipúrico (PAH) e inulina (I) para medir flujo plasmático renal efectivo (FPR) e intensidad de filtración glomerular (IFG) respectivamente. Los cambios de IFG y FPR permitieron constatar las modificaciones funcionales a medida que progresaba la insuficiencia renal. Los indicadores de defensa antioxidante incluyeron la actividad de la enzima superóxido dismutasa (SOD) y los niveles de glutatión reducido (GSH), medidos en homogenado de riñón. Se realizó análisis de regresión lineal para relacionar cambios funcionales y defensas antioxidantes. RESULTADOS: La función renal decreció progresivamente después de la nefrectomía. Se produjo disminución de la actividad de la SOD seguida de una superinducción a las 6 semanas y los niveles de GSH comenzaron a disminuir en la 4ta. sem posnefrectomía. CONCLUSIONES: Los cambios en los indicadores de defensa antioxidante a nivel renal sugieren que el estrés oxidativo aumenta en el órgano correlacionßndose con la pérdida progresiva de la función renal

OBJECTIVE: to evaluate the changes on antioxidant defenses in kidneys while function changes on remaining tissue during progression of renal failure after performing subtotal nephrectomy. METHODS: an experimental trial in 40 Wistar rats was done. The renal failure was induced by surgical ablation of 5/6 of the renal mass, removing the right kidney and tying two branches of the left renal artery to 30 rats; 3 study groups were formed and followed over a period of 2, 4, and 6 weeks. The remaining group of rats was used as control. Functional remainder state was evaluated by measurement of the Glomerular Filtration Rate (GFR) and effective Renal Plasmatic Flow (RPF), through renal plasmatic clearance methods. Measurement of reduced glutathione (GSH) and superoxide dismutase activity (SOD) in renal mass were used as markers of antioxidant defense. Lineal correlation was used to analyze correlations between progressive functional changes and oxidative status. RESULTS: Progressive decreasing of both GFR and RPF were noted. SOD activity diminished initially followed by a super induction at 6th week and GSH levels decreased markedly at 4th week after nephrectomy. CONCLUSION: The variations of antioxidant defenses markers on renal tissue suggest that oxidative stress increases in the remainder kidney correlated to the progressive reduction of the renal function

Relación entre tipo y cantidad de carbohidratos dietarios con el perfil lipídico y ApoB100 en adultos / Relationship between the type and quantity of dietary carbohydrates, and the lipid profile and ApoB100 in adults / Relação entre o tipo e a quantidade de carboidratos na dieta e o perfil lipídico e ApoB100 em adultos

Objetivo. Establecer si existe relación entre el tipo y la cantidad de carbohidratos dietarios consumidos habitualmente con los niveles plasmáticos de lípidos, lipoproteínas y apolipoproteína B100 (ApoB100) Materiales y métodos. La muestra estuvo conformada por la base de datos de 144 de profesores de la Universidad Javeriana que previamente hicieron parte de otra investigación y de la cual se empleo la información sobre su alimentación, niveles plasmáticos de lípidos, lipoproteínas y ApoB100. Para determinar la relación entre las variables dependientes e independientes se realizó análisis de correlación simple y múltiple, en los casos de no correlación, se aplicó la prueba Chi² de independencia para relacionar el consumo de carbohidratos totales, azúcares y fibra total. Adicionalmente el análisis de varianza de un factor comparó los niveles de lípidos, lipoproteínas y ApoB100 con el consumo de carbohidratos totales, azúcares y fibra. Resultados. 76 hombres y 68 mujeres. La mayor parte de la población consume por encima de la recomendación diaria de carbohidratos totales, los hombres presentaron mayor consumo de carbohidratos tipo azúcares y más elevados los niveles plasmáticos de triglicéridos y lipoproteínas de muy baja densidad (VLDL), mientras que mujeres presentaron niveles más elevados en sus lipoproteínas de alta densidad (HDL). Al relacionar gramos de cada tipo de carbohidratos, con los niveles de lípidos, lipoproteínas y ApoB100 no se encontró correlación significativa para ninguno de los casos (p>0,05). Conclusión. No se encontró relación significativa entre el tipo y la cantidad de carbohidratos consumidos con los niveles plasmáticos de lípidos, lipoproteínas y ApoB100.

Objective. To establish if there is any relationship between the type and amount of dietary carbohydrates commonly consumed and the plasmatic levels of lipids, lipoproteins and apolipoprotein B100 (ApoB100). Materials and methods. The final sample was conformed by the database of 144 lecturers of the Pontificia Universidad Javeriana who had previously participated in another survey and from which we used information on their food habits, plasmatic lipid levels, lipoproteins and ApoB100. To determine the relationship between the dependent and independent variables, simple and multiple correlation analyses were done. In the cases of no correlation we applied the independence Chi² test to find the relationship with the consumption of total carbohydrates, sugars and total fiber. Additionally, with a one-factor analysis of variance we compared plasmatic levels of lipids, lipoproteins and ApoB100 with the consumption of total carbohydrates, sugars and fiber. Results. Most of the population consumes above the daily total carbohydrate recommendation, men presented greater carbohydrate consumption of the type of sugars and more elevated plasmatic levels of triglycerides and lipoproteins of investivery low density (VLDL), whereas women presented higher levels of their high density lipoproteins (HDL). When relating grams of each type of carbohydrates with the levels of lipids, lipoproteins and ApoB100, no significant correlation was found for any of the cases (p>0,05). Conclusion. There was no significant relationship between the type and amount of carbohydrates consumed with the plasmatic levels of lipids, lipoproteins and Apo B100.

Objetivo. Estabelecer a possível relação entre o tipo e a quantidade de carboidratos na dieta normalmente consumida com os níveis plasmáticos de lipídios, lipoproteínas e apolipoproteína B100 (ApoB100). Materiais e métodos. A amostra consistiu de um banco de dados de 144 professores da "Universidad Javeriana" que anteriormente fizeram parte de outra pesquisa, e da qual foi utilizada a informação sobre sua alimentação, os níveis plasmáticos de lipídios, lipoproteínas e ApoB100. Para determinar a relação entre as variáveis dependentes e independentes foi realizada uma análise de correlação simples e múltipla, em casos de ausência de correlação foi usado o teste do Chi² de independência para relacionar o consumo dos carboidratos totais, açúcares e fibra total. Além disso, a análise de variância de um fator comparou os níveis de lipídios, lipoproteínas e ApoB100 com o consumo de carboidratos totais, açúcares e fibras. Resultados. 76 homens e 68 mulheres. A maior parte da população consome acima da dose diária recomendada de carboidratos totais, os homens apresentaram maior consumo de carboidratos tipo açúcares, e mais elevados os níveis plasmáticos de triglicérides e lipoproteínas de muito baixa densidade (VLDL), enquanto que as mulheres apresentaram níveis mais elevados em lipoproteína de alta densidade (HDL). Ao relacionar gramas de cada tipo de carboidratos com os níveis de lipídios, lipoproteínas e ApoB100, nenhuma correlação significativa foi encontrada para qualquer um dos casos (p> 0,05). Conclusão. Nenhuma relação significativa foi encontrada entre o tipo e a quantidade de carboidratos consumida com os níveis plasmáticos de lipídios, lipoproteínas e ApoB100.

Optimización de un método para la detección de carbamatos y organofosforados en vegetales / Optimization of a method for the detection of organophosphates and carbamates in vegetables

Debido al alto grado de contaminación por plaguicidas de productos agrícolas y al alto costo que implica su detección se consideró importante optimizar el método de escrutinio de inhibición de colinesterasas humanas en presencia de extractos vegetales. Se demostró que las suspensiones de glóbulos rojos y plasma son estables al menos por tres meses si se mantienen entre 4 y 8 °C. El reactivo de color es estable por al menos dos años y medio en refrigeración y los sustratos de ambas colinesterasas son estables congelados al menos por dos años. La mezcla del extracto vegetal y los glóbulos rojos o plasma debe incubarse 90 minutos a 37 °C para determinar los porcentajes de inhibición enzimática. Se determinó que los porcentajes de inhibición superiores a 16% en la plasmática y a 21% en la eritrocítica indican presencia de plaguicida en los vegetales. Este método de screening optimizado para detectar la presencia de carbamatos y organofosforados tiene ventaja sobre otros por su bajo costo, facilidad y rapidez de análisis sin requerir de equipo costoso y poco versátil. Esta metodología no cuantifica ni identifica el plaguicida presente pero permite diferenciar entre organofosforados y carbamatos si el periodo de incubación del vegetal con eritrocitos o plasma se prolonga por 24 horas a 20-25 °C.

Optimization of the screening method of inhibition of human cholinesterases is considered important because of the high contamination rate of agricultural products with pesticides and its high detection cost. It has been demonstrated that erythrocytes and plasma are stable at least for three months at 4-8 °C. The colour reaction reagent is stable for at least two and a half years at 4-8 °C and the substrate for both cholinesterases is stable when frozen, at least for two years. The solution of vegetable extract and erythrocytes or plasma must be incubated 90 minutes at 37 °C in order to determine the percentages of enzymatic inhibition. It was established that inhibition percentages higher than 16% for the plasmatic solution, and 21% for the erythrocytic solution mean that pesticide is present in vegetables. The advantages of this optimized screening method for the detection of carbamates and organophosphates in vegetables are its low cost and its easy and quick analysis without the need of expensive equipment. This method does not quantify or identify the pesticide, but rather it differentiates organophosphates from carbamates if the incubation time of the vegetable extract with erythrocytes or plasma is maintained at 20- 25 °C for 24 hours.

Zinc plasmático, cobre sérico y zinc y cobre eritrocitarios en adultos sanos de Buenos Aires / Plasmatic zinc, serum copper and erythrocyte zinc and copper levels in healthy adult people living in Buenos Aires

Se estudiaron adultos, clínicamente sanos, 21 varones (V) y 19 mujeres (M), de: edad (años): V: 48±14 (28-78); M: 41±14 (23-66); Índice de masa corporal (kg/m²): V: 26,7±2,3 (23,1-31,9); M: 22,2±3,5 (19,3-29,6). Se realizó una encuesta nutricional y se extrajo sangre en ayunas. Se realizaron las determinaciones de rutina del laboratorio clínico. Se determinó zinc en plasma (ZnPl), cobre en suero (CuS); en eritrocitos: Zinc (ZnGR) y cobre (CuGR), por espectrometría de absorción atómica. La totalidad de los V y M presentaron ingestas adecuadas de energía, proteínas, Zn y Cu. Los resultados expresados como: promedio ± desvío estándar y rangos fueron: ZnPl (μg/dL): V: 93±27 (49-161); M: 79±28 (42-157); ZnGR (μg/dL): V: 1.380±210 (1.110-2.010); M: 1.350±130 (1.090-1.520); CuS (μg/dL): V: 89±20 (40- 122); M: 93±28 (45-157). CuGR (μg/dL): V: 59±12 (37-78); M: 63±19 (30- 110). No se evidenciaron diferencias significativas entre V y M. Los resultados para la población estudiada fueron, percentilos 5 y 95, respectivamente: ZnPl: 49 a 131 μg/dL; ZnGR: 1.130 a 1.610 μg/dL; Zn/Hb: 34,4 a 47,5 μg/g; CuS: 45 a 124 μg/dL; CuGR: 36 a 78 μg/dL. Los valores de ZnPl y CuS se encuadraron dentro de los rangos de valores de referencia internacionales, sin diferencias significativas de acuerdo con el género.

Two groups of adult healthy people were studied: 21 males (M) and 19 females (F). Mean age (ys) was: M: 48±14 (28-78); F: 41±14 (23-66); body mass index (Kg/m²) was: M: 26.7±2.3 (23.1-31.9); F: 22.2±3.5 (19.3-29.6). A nutritional survey was recorded and mean daily intake of energy, protein, Zinc (Zn) and Copper (Cu) were calculated. Fasting blood samples were obtained in order to determine Hemoglobin (Hb), plasmatic Zn (PlZn), serum Cu (SCu), erythrocyte Zn (EZn) and erythrocyte Cu (ECu) levels. Zn and Cu were determined by AAS. Results were: mean±SD and ranges: PlZn (μg/dL): M: 93±27 (49-161); F: 79±28 (42-157); EZn (μg/dL): M: 1380±210 (1110-2010); F: 1350±130 (1090-1520); SCu (μg/dL): M: 89±20 (40-122); F: 93±28 (45-157). ECu (μg/dL): M: 59±12 (37-78); F: 63±19 (30-110). All individuals presented adequate intake of energy, protein, Zn and Cu. There were no significant differences between M and F for PlZn, EZn, Zn/Hb ratio, SCu and ECu. The results for the adult healthy population in Argentina, and which were in accordance with the international published values were: (percentiles 5 y 95, respectively): PlZn: 49 - 131 μg/dL; EZn: 1130 - 1610 μg/dL; Zn/Hb: 34,4 - 47,5 μg/g; SCu: 45 - 124 μg/dL; ECu: 36 - 78 μg/dL.

Hemólisis inducida por el ejercicio: relación entre el nivel de actividad de la glucosa-6-fosfato deshidrogenasa y el grado de hemólisis / Exercise induced hemolysis: relation between the activity of glucose-6-phosphate dehydrogenase and the magnitude of the hemolysis

Introducción: La oxidación, al igual que la hemólisis asociadas con el ejercicio tanto moderado como extenuante han sido condiciones objeto de múltiples estudios, pero sólo en algunos recientes se evaluó cómo las variaciones en la capacidad de los mecanismos antioxidantes enzimßticos eritrocitarios específicos y genéticamente determinados, condicionan distintos grados de susceptibilidad a la hemólisis inducida por el ejercicio, pero esos trabajos se han hecho sobre todo en individuos no sedentarios y con deficiencia franca de la enzima G6PD. Objetivo: El propósito de este trabajo fue determinar si existe o no relación entre el nivel de actividad de la enzima eritrocitaria G6PD y el grado de hemólisis inducida por el ejercicio en hombres adultos sedentarios en apariencia sanos, luego de un tiempo experimental de ejercicio moderado pre-extenuante y equivalente en modalidad y magnitud. Metodología: Se evaluaron 25 voluntarios hombres, sedentarios, en apariencia sanos; se les aplicó una sesión de ejercicio, sobre un cicloergómetro, de una hora de duración, a 70% del VO2pico previamente hallado. Sobre la base de la concentración de hemoglobina plasmßtica se calculó el porcentaje de hemólisis y la haptoglobina consumida, tomando en cuenta la variación en el plasma de la haptoglobina y la hemólisis intravascular inmediatamente después y hasta tres horas luego del ejercicio. Resultados: Se pudo determinar que los individuos presentaron, con base en la determinación de Hb plasmßtica libre, % de hemólisis y consumo de haptoglobina, hemólisis intravascular durante y hasta por lo menos tres horas post-ejercicio.

Introduction: Oxidation and hemolysis associated with physical exercise, moderate and severe, have been studied by several investigations, but only in the most recent have been evaluated how the variations of the genetic determined mechanisms for antioxidative enzymatic erytrocytic capacity, contribute to establish different levels of susceptibility to the hemolysis induced trough exercise, however, those studies have mainly been made on non sedentary subjects with deficiency of enzyme G6PD. Purpose: The objective of this study was to establish if there is either yes or not a relationship between the activity level of erythrocytic activity of the enzyme G6PD and the hemolysis grade, induced by exercise in adult healthy sedentary men and after an experimental bout of moderate exercise pre-exhaustive and equivalent in modality and intensity. Methods: Twenty five men, sedentary and seemingly healthy, were evaluated after an exercise session of 1 hour over a cycloergometer, with 70% of VO2peak previously founded. On the basis of plasmatic Hb, the proportion of hemolysis and haptoglobin consumed, taking in account the variation of plasma haptoglobin and intravascular hemolysis after and at least three hours post-exercise, were calculated. Results: The experimental subjects presented laboratory evidence (free plasma hemoglobin, percentage of hemolysis and haptoglobin) of intravascular hemolysis immediately after and at least past three hours of exercise bouts.

Albumina humana prescrita para casos de desnutrição em hospitais do Rio de Janeiro / Human albumin prescribed for malnutrition in hospitals of Rio de Janeiro

OBJETIVO: Este estudo descreve e analisa a adequação da prescrição da AH, para reposição nutricional, nos hospitais da região metropolitana do Estado do Rio de Janeiro, e explora o uso do SIH/SUS para avaliar o perfil e a qualidade da prescrição de medicamentos. MÉTODOS: As informações foram extraídas do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), entre 1999 e 2001. RESULTADOS: Houve registro de utilização de AH para reposição nutricional em 121 internações de maiores de um ano, nas quais a justificativa mais freqüente foi a desnutrição protéico-calórica (93 por cento). O uso da AH foi classificado como inadequado em 91 por cento dos casos. Em 51 por cento dos casos ocorreu o óbito e a clínica médica foi responsável 87 por cento das internações. A inadequação de prescrição esteve associada positivamente à duração da internação, com RP 1,14 (IC95 por cento 1,01-1,28). O óbito mostrou associação positiva com a idade do paciente, com RP 1,72 (IC 95 por cento 1,19-2,48). A ausência de parâmetros laboratoriais e a insuficiência de informações clínicas no banco limitaram a análise dos dados. O sub-registro no SIH das internações no âmbito do SUS foi outro importante fator limitante para o conhecimento do problema. CONCLUSÃO: Apesar das limitações, o estudo mostrou o elevado nível de inadequação de utilização da AH para reposição nutricional e as possibilidades de uso do banco do SIH/SUS na avaliação da qualidade da prescrição de medicamentos como a AH incluídos entre os procedimentos especiais.

OBJECTIVE:This study describes and analyzes the adequacy of HA prescription, for nutritional replacement, in hospitals of the Rio de Janeiro Metropolitan Area and explores the use of SIH/SUS to evaluate the profile and quality of drug prescription. METHODS: The information was collected from the Hospital Information System of the "Sistema Único de Saúde" SIH/SUS from 1999 to 2001. RESULTS: The use of HA for nutritional replacement was recorded in 121 admittances of subjects during 1 year, the most frequent justification being protein-caloric malnutrition (93 percent). HA use was classified as inadequate in 91 percent of cases. In 51 percent of the cases death occurred and the Clinical Practice Unit was responsible for 87 percent of the admittances. Inadequacy of the prescription was positively associated to length of hospital stay, with RP 1. 14 (IC95 percent 1.01-1.28). Death showed positive association with the patient's age, with RP 1.72 (IC 95 percent 1.19-2.48). The absence of laboratory parameters and lack of clinical databank information have limited data analysis. The SIH sub-registration of admittances, within the SUS ambit was another important restriction for more precise identification of the problem. CONCLUSION: In spite of the limitations, the study disclosed the high level of inappropriate utilization of HA for nutritional replacement and the possibilities of using the SIH/SUS databank to evaluate the quality of prescribing drugs such as HA included in the special procedures.

Relação treonina: lisina para leitões de 6 a 11kg de peso vivo em rações formuladas com base no conceito de proteína ideal / Threonine: lysine ratios for piglets from 6 to 11kg of live weight in diets based on the ideal protein concept

O experimento envolveu 72 leitões, visando a determinar a exigência de treonina e a relação treoninalisina da ração para animais dos 6,04±0,67 aos 11,60±1,22kg. Foi utilizado delineamento de blocos casualizados, com quatro tratamentos e seis repetições. Os tratamentos consistiram de dietas com diferentes níveis de treonina total (0,86; 1,02; 1,18 e 1,34 por cento) e relação treonina total:lisina (54 , 64; 74 e 84 por cento) e níveis constantes de lisina (1,60 por cento), metionina (0,44 por cento) e triptofano (0,29 por cento). Dos 11,60 aos 21,30kg, os leitões receberam a mesma ração. Não foram observadas diferenças para as variáveis de desempenho (consumo diário de ração, ganho diário de peso, ganho diário de peso ajustado para mesmo consumo de ração e conversão alimentar) e para o teor de nitrogênio da uréia plasmática dos leitões. Esses resultados indicam que leitões de 6,0 a 11,0kg não necessitam mais que 0,86 por cento de treonina total na ração (0,72 por cento de treonina digestível) e relação treonina total:lisina de 54:100 (relação treonina digestível:lisina de 49:100).

The experiment was carried out with the objective to determine the threonine requirement and the ratio of total threonine to lysine in diets for piglets from 6.04±0.67 to 11.60±1.22kg. A randomized block design with four treatments and six replicates was used. The treatments consisted of diets with different contents of total threonine (0.86; 1.02; 1.18 and 1.34 percent), different ratios of total threonine to lysine (54, 64; 74 and 84 percent) and constant contents of lysine (1.60 percent), methionine (0.44 percent) and tryptophan (0.29 percent). All animals received the same diet from 11.60 to 21.30kg. No differences were observed for any of the performance variables (daily feed intake, daily weight gain, daily weight gain adjusted for constant feed intake and feed:gain), nor for plasma urea nitrogen of piglets. These results indicate that piglets weighing from 6.0 to 11.0kg, do not need more than 0.86 percent of total threonine in the diet (0.72 percent of digestible threonine) and total threonine: lysine ratio of 54: 100 (digestible threonine:lysine ratio of 49:100).

Colinesterasas eritrocitaria y plasmática en trabajadores con enfermedades crónicas controladas y en usuarios de medicamentos / Erythrocytic and plasmatic cholinesterases in workers with chronic controlled diseases and in users of medicines

Problema: los valores fisiológicos de colinesterasas se conocen para personas y trabajadores sanos, pero poco se sabe de ellos cuando se trata de sujetos con enfermedades crónicas controladas, usualmente con medicamentos. ¿Cuál es el efecto de la enfermedad, de las drogas o de ambas en los niveles de colinesterasas?Objetivos: medir las colinesterasas eritrocitarias y plasmáticas en trabajadores activos y asintomáticos que estuviesen laborando, no expuestos a plaguicidas inhibidores de colinesterasas, que manifestaran padecer alguna enfermedad que estuviera controlada, con o sin tratamiento.Metodología: como parte de un estudio descriptivo prospectivo, diseñado para obtener los valores de referencia en población laboral activa de afiliados al Seguro Social, en Antioquia (Colombia), se aplicó una encuesta para identificar trabajadores con alguna enfermedad que estuviera controlada. La acetilcolinesterasa se midió por dos técnicas diferentes y la butirilcolinesterasa por tres procedimientos distintos.Resultados: la muestra de la población laboral del valle de Aburrá y del Cercano Oriente Antioqueño la integraron 827 personas, de las cuales 19 por ciento dijo tener alguna enfermedad. La prevalencia de enfermedad en Aburrá fue 30 por ciento y en Oriente 9 por ciento (p= 0,0000000). La lista de enfermedades contiene 13 problemas y las más frecuentes fueron hipertensión arterial (29 por ciento), "del hígado" (16 por ciento), anemia (10 por ciento) y artritis (10 por ciento). Entre las 827, 15 por ciento (127 sujetos) estaba recibiendo fármacos en el momento del estudio y 85 por ciento de los usuarios de fármacos empleaba uno solo y el resto usaba dos o más. El 8 por ciento tenía enfermedad y usaba fármacos (E+F+), 74 por ciento carecía de ambos fenómenos (E-F-), 11 por ciento tenía enfermedad pero no usaba medicamentos (E+F-) y 7 por ciento no tenía enfermedad pero si usaba drogas (E-F+). En cada estrato región-sexo, estos cuatro grupos se compararon en función de la colinesterasa, por cada una de las técnicas de medición, y nunca hubo diferencia significativa. Tampoco hubo diferencias importantes cuando se procedió a comparar los valores enzimáticos entre personas con una enfermedad específica y quienes no la tienen, excepto en el caso de "anemia".Conclusiones: los niveles de colinesterasas eritrocitaria y plasmática son similares entre trabajadores sanos o con enfermedades crónicas controladas, con o sin drogas

ABSTRACT PROBLEM: Physiological values of cholinesterase are known in healthy population, but limited information on them is available in individuals with chronic, controlled diseases, either with or without medication. OBJECTIVES: To measure erythrocytic and plasmatic cholinesterase levels in active workers who met the following conditions: to be feeling well and active at their jobs at the time of the study; to suffer from some disease that was under control either with or without medication; not to have been exposed to pesticides based on cholinesterase inhibitors. METHODOLOGY: A survey was carried out among workers affiliated to the Social Security Institute in Antioquia, Colombia, to identify those suffering from some disease and who had it under control. Acetylcholinesterase and butyrylcholinesterase levels were determined using two techniques for the former and three for the latter. Surveyed workers belonged to two different parts of Antioquia, namely: the Aburra Valley and the Near East region. The study sample was made up by 827 persons, 19% of which informed to be suffering from some disease. RESULTS: Prevalence of disease in the Aburra Valley workers was 30% and in those from the Near East region, 9% (p = 0.0000000). The list of their diseases included 13 different ones, the most frequent of which were: hypertension (29%), "liver disease" (16%), anemia (10%), and arthritis (10%). Out of the 827 people, 127 (15%) were under some kind of medication at the moment of the study; of them, 85% were being treated with only one drug. Eight per cent were diseased and under medication (D+, M+), 74% were neither diseased nor under medication (D-, M-), 11% were diseased but were not being treated (D+, M-), and 7% were not diseased but did use some medication (D-, M+). These four groups were stratified according to region and sex and compared as to cholinesterase levels. No significant differences were found. Comparison of enzymatic values among people with or without specific diseases also did not reveal any significant differences, except for anemia. CONCLUSION: Erythrocytic and plasmatic cholinesterase levels are similar in healthy workers and in those with chronic, controlled diseases, regardless of the use or not of medication