La sed ¿un mecanismo suficiente para lograr euhidratación?: una revisión narrativa / Is thirst sufficient as a mechanism for achieving euhydration? a narrative review

Capitán, C. y Aragón, L.F. (2023). La sed ¿un mecanismo suficiente para lograr euhidratación?: una revisión narrativa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. El papel de la percepción de sed para mantener el balance hídrico ha sido ampliamente estudiado, tanto durante el ejercicio como después de este. Sin embargo, la forma de evaluarla y la eficacia de los instrumentos existentes son aún áreas que necesitan más investigación. El objetivo de esta revisión fue integrar, de forma general, la información disponible en la literatura sobre el funcionamiento del mecanismo de la sed como respuesta a la deshidratación durante y después del ejercicio. Se explican los mecanismos fisiológicos y las respuestas de estos durante y posterior al ejercicio; además, se describen los instrumentos disponibles en la literatura científica, sus debilidades y fortalezas, y se plantea una serie de preguntas que aún no tienen respuesta en el área. En esta revisión se presenta el aspecto teórico de los mecanismos de la sed, además, se discuten los estudios científicos que respaldan o refutan el comportamiento de estos mecanismos en el ejercicio. Finalmente, se hace un resumen de las principales conclusiones extraídas de la literatura científica sobre la sed como un mecanismo suficiente para prevenir la deshidratación tanto durante como después del ejercicio.

Capitán, C. y Aragón, L.F. (2023). Is thirst sufficient as a mechanism for achieving euhydration? a narrative review. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. The role of thirst perception for keeping hydric balance, both during and after exercise, has been extensively studied. However, the way to assess it and the effectiveness of the existing instruments are areas that still require further research. The objective of this review is to integrate, in a general way, the information available in the literature on the functioning of the thirst mechanism as a response to dehydration during and after exercise. The physiological mechanisms and their responses during and after exercise are explained. In addition, a description of the instruments available in scientific literature is included, together with their weaknesses and strengths, and a series of as yet unanswered questions in this area are raised. This review presents the theoretical aspect of thirst mechanisms, and discusses the scientific studies that support or refute the behavior of these mechanisms in exercise. Finally, a summary is made of the major conclusions drawn from the scientific literature on thirst as a sufficient mechanism to prevent dehydration both during and after exercise.

Capitán, C. y Aragón, L.F. (2023). A sede é um mecanismo suficiente para alcançar a hidratação? uma revisão narrativa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 21(1), 1-16. O papel da percepção da sede na manutenção do equilíbrio hídrico tem sido amplamente estudado, tanto durante quanto após o exercício. Entretanto, como avaliá-la e a eficácia dos instrumentos existentes ainda são áreas que necessitam de mais pesquisas. Esta revisão visou integrar, de forma geral, as informações disponíveis na literatura sobre o funcionamento do mecanismo da sede em resposta à desidratação durante e após o exercício. Ele explica os mecanismos fisiológicos e suas respostas durante e após o exercício, descreve os instrumentos disponíveis na literatura científica, seus pontos fracos e fortes, e levanta uma série de questões que permanecem sem resposta no campo. Esta revisão apresenta o aspecto teórico dos mecanismos da sede e discute os estudos científicos que respaldam ou refutam o comportamento desses mecanismos no exercício. Finalmente, é feito um resumo das principais conclusões extraídas da literatura científica sobre a sede como mecanismo suficiente para prevenir a desidratação tanto durante quanto após o exercício.

Fluid intake, hydration status and body mass changes in U-15 judo athletes during a training day

Despite numerous studies related to dehydration there is still a lack of scientific literature presenting hydration status and fluid intake of judo athletes during different periods. Therefore, the aim of this study was to investigate, fluid intake, hydration status and body weight changes of young judo athletes during a typical day of training in preparation period. Twenty-two young judo athletes (age: 12 ± 0.7 y, experience: 3.5 ± 1.1) voluntarily participated in this study. Hydration status and weight were examined in the morning, before and immediately after the training. All athletes trained 90 min and they consumed fluids ad libitum during the exercise. According to morning urine specific gravity (USG) values, 81.2% of the athletes were dehydrated while only 18.8% of the athletes were euhydrated. Pre-training urine measurements showed that 63.64% of the athletes presented dehydration and 77.27% of the athletes completed the training in dehydrated condition despite fluid availability during the training. Mean body weight loss during training was -0.64 ± 0.66%. It can be concluded that young judo athletes presented high prevalence of dehydration as indicated by USG values. Most of the athletes were dehydrated during a typical training day and completed the training in more dehydrated conditions compared to pre training values despite ad libitum fluid intake. It is of great importance to evaluate hydration status of the athletes before training to refrain from common practice of fluid restriction for weight loss and adverse effects of a persistent state of fluid deficit on physical and health related state.

Atención de enfermería en adultos jóvenes con insuficiencia renal aguda: Revisión narrativa / Nursing care in young adults with acute kidney failure: Narrative review

El daño renal está reconocido como la reducción de la función renal, el cual se ve generalmente reflejado por una caída en la diuresis. A nivel mundial, el porcentaje de personas que padece daño renal va en aumento, esto debido a múltiples aspectos. En este sentido, se reconoce que el personal de enfermería es quien idóneamente tiene un gran rol en la educación de la población, para la prevención del daño renal agudo, previniendo con ello el daño renal crónico. De esta manera, en el escrito se abordan aspectos generales más relevantes, de la hidratación, la alimentación, la actividad física, el consumo de alcohol, la automedicación y la prevención de infecciones de las vías urinarias, como parte de los aspectos modificables y en los que las personas tienen directa injerencia en sus acciones, con la debida información, con los que el personal de enfermería puede reforzar sus recursos en materia de educación a la población. De la misma manera, se muestran estudios de diseño cuasiexperimental, como una manera de resaltar que puede medirse el impacto de la educación en la población en una época en donde requerimos tener mayor evidencia de la efectividad de las intervenciones que realicemos.

Renal insufficiency it is recognized as the reduction of the renal function, reflected by the decreased urine output. Worldwide, the amount of people whom have renal insufficiency it is growing, by many reasons. Because of this, is recognized that nursing staff is the best option at the population education, in order to prevent acute renal insufficiency, preventing with this, chronical renal insufficiency. In this document, it is possible to review, the most important general aspects of hydration, feeding, physical activity, alcohol consumption, self-medication and prevention of urinary tract infections, as part of modifiable aspects that people handle as part of their personal health actions, with the proper information, with which nursing staff can strengthen their resources in health education to the population. In this way, this paper shows some quasi-experimental studies, as a way to highlight that it is possible to measure the impact of population education, in a moment that the health system requires more evidence of the effectiveness of the interventions.

Perfil de composición corporal en militares élite chilenos / Body composition profile of elite Chilean military

RESUMEN: La Bioimpedancia Eléctrica (BIA), al ser una técnica no invasiva pero de elevada precisión, se ha convertido en la actualidad en una herramienta valiosa para determinar la composición corporal en militares, facilitado el control de las distintas variables que se asocian a cada especialidad. El objetivo del presente estudio fue describir el perfil de composición corporal en militares de elite al momento de finalizar un curso de especialización. Participaron 11 militares con un rango de edad entre 22 y 29 años. Se evalúo la composición corporal a través de BIA, inmediatamente después de finalizado un curso de especialización para militares de élite. Las evaluaciones en los militares sobre las variables de la composición corporal a través de BIA mostraron: peso corporal de 84,3 ± 4,52 kg, talla 1,78 ± 0,06 m, índice de masa corporal (IMC) 26,5 ± 1,09, tejido adiposo de 13,7 ± 3,65 %, tejido muscular 49,5 ± 2,34 %, masa libre de grasa 72,7 ± 5,23 kg y 53,2 ± 3,78 l de agua corporal total. Conclusiones: Los militares de elite presentaron elevados niveles de masa libre de grasa, tejido muscular y bajos niveles de tejido adiposo lo que favorece el desarrollo de las actividades militares especializadas y disminuye el riesgo de lesiones. Los datos aquí recogidos sirven como marco de referencia para futuros estudios.

SUMMARY: Electrical bioimpedance (BIA), being a non- invasive technique but with high precision, has become a valuable tool for determining body composition in the military, facilitating the control of the different variables associated with each specialty. The aim of the present study was to describe the body composition profile of elite military personnel at the end of a specialization course. Eleven military personnel between 22 and 29 years of age participated in the study. Body composition was assessed by BIA immediately after completion of a specialization course for elite military personnel. Assessments in the military on body composition variables through BIA showed: body weight of 84.3 ± 4.52 kg, height 1.78 ± 0.06 m, body mass index (BMI) 26.5 ± 1.09, adipose tissue of 13.7 ± 3.65 %, muscle tissue 49.5 ± 2.34 %, fat free mass 72.7 ± 5.23 kg and 53.2 ± 3.78 l of total body water. Conclusions: Elite military personnel presented high levels of fat free mass, muscle tissue and low levels of adipose tissue which favors the development of specialized military activities and decreases the risk of injury. The data collected here serve as a frame of reference for future studies.

Elite Croatian junior taekwondo competitors: morphological characteristics and body composition reference values / Competidores croatas de taekwondo junior de élite: características morfológicas y valores de referencia de composición corporal

SUMMARY: The main purpose of this study was to determine the body composition and anthropometric reference values of male and female junior Croatian taekwondo competitors according to official weight category. Additional aim of the study was to identify possible differences in variables between the weight categories. The sample comprised 247 junior participants of the national taekwondo championships divided into male (N=121) and female (N=126). The variable sample was defined by a set of 8 measurements: Body height (cm), Body mass (kg), Body mass index, Body fat (%), Body fat (kg), Muscle mass (kg), Lean body mass (kg) and Total body water (%). Results confirm previous studies proving that younger taekwondo practitioners have higher levels of body fat than their more experienced peers (seniors). Significant differences were only found between lean and heavy categories. Male junior taekwondo athletes show total body water percentages from 57.4 to 74.8 %, with significantly lower percentages in higher weight categories, while female athletes in heigher categories demonstrate a worrying level of hydration status, therefore endangering their performance and overall health. As the first paper that investigates the reference values of junior taekwondo athletes but based on official weight categories it is especially important as each weight category warrant different body composition requirements, as seen from significant differences across different variables. Future studies should include motor abilities inspection throughout the weight categories and possible use of calculation of metabolic age.

RESUMEN: El objetivo principal de este estudio fue determinar la composición corporal y los valores de referencia antropométricos de los competidores croatas masculinos y femeninos de taekwondo junior según la categoría oficial de peso. Además, se analizó identificar las posibles diferencias en las variables entre las categorías de peso. La muestra estuvo compuesta por 247 participantes junior de los campeonatos nacionales de taekwondo divididos en hombres (N = 121) y mujeres (N = 126). La muestra variable se definió mediante un conjunto de 8 medidas: altura corporal (cm), masa corporal (kg), índice de masa corporal, grasa corporal (%), grasa corporal (kg), masa muscular (kg), masa corporal magra (kg) y agua corporal total (%). Los resultados confirmaron estudios previos que demuestran que los practicantes de taekwondo más jóvenes tienen niveles más altos de grasa corporal que sus pares más experimentados (personas mayores). Solo se encontraron diferencias significativas entre las categorías magra y pesada. Los atletas masculinos de taekwondo junior muestran porcentajes de agua corporal total del 57,4 al 74,8 %, con porcentajes significativamente más bajos en las categorías de peso más alto, mientras que las atletas femeninas en las categorías más altas, demuestran un nivel preocupante de estado de hidratación, poniendo en peligro su rendimiento y salud en general. Como el primer artículo que investiga los valores de referencia de los atletas de taekwondo junior, pero basado en categorías de peso oficiales, es especialmente importante ya que cada categoría de peso garantiza diferentes requisitos de composición corporal, como se puede observar en las diferencias significativas entre las diversas variables. Los estudios futuros deberían incluir un análisis de las habilidades motoras en todas las categorías de peso y el posible uso del cálculo de la edad metabólica.

The Hydration Status of Female Collegiate Soccer Players Over Consecutive Training and Match Days / Estado de Hidratación de Jugadoras de Fútbol Universitarias Durante Días de Entrenamiento y Partidos Consecutivos

Abstract Purpose: Hydration has been shown to play a pivotal role in sport. Soccer is a team sport in which the integrity of all players is vital for team performance; thus, individual player hydration status is important. The primary aim of this study was to investigate the hydration status of female collegiate soccer players during regular season. Methods: Sixteen collegiate female soccer players (age: 20.4 ± 0.8 years; height: 163.6 ± 6.9 cm; weight: 65.3 ± 12 kg) provided urine over 9 days to monitor their hydration status. Hydration was determined by urine specific gravity (Usg). Usg was analyzed in the morning (AM) and in the afternoon before practice/game (PM). Results: All 16 players were at least minimally hypohydrated (Usg > 1.010) in the AM on 5 of the 9 days tested. Players had significantly higher Usg values in the AM as compared to PM (F(1,250) = 23.09; p < 0.0001); however, there was no significant time*day interaction (F(1,250) = 1.98; p = 0.16). Conclusion: Data show a high prevalence of hypohydration occurring in this specific population. This sub-optimal hydration status could be a cause for concern in terms of overall performance. Efforts should be made to integrate hydration interventions and daily monitoring to minimize hypohydration in players.

Resumen Propósito: Se ha demostrado que la hidratación juega un papel fundamental en el deporte. El fútbol es un deporte de equipo en el que la integridad de todos los jugadores es vital para su rendimiento; por lo tanto, el estado de hidratación de cada jugador es importante. El objetivo principal de este estudio fue investigar el estado de hidratación de las jugadoras universitarias de fútbol durante la temporada regular. Métodos: Dieciséis jugadoras universitarias de fútbol (edad: 20.4 ± 0.8 años; estatura: 163.6 ± 6.9 cm; peso: 65.3 ± 12 kg) proporcionaron muestras de orina durante 9 días para controlar su estado de hidratación, la cual se determinó por la gravedad específica de la orina (Usg). La Usg se analizó en la mañana (AM) y en la tarde antes del entrenamiento o el juego (PM). Resultados: Las 16 jugadoras estaban al menos mínimamente hipohidratadas (Usg > 1.010) en la AM en 5 de los 9 días medidos. Las jugadoras tuvieron valores Usg significativamente más altos en AM en comparación con PM (F (1,250) = 23.09; p < 0.0001); sin embargo, no hubo interacción significativa de tiempo * día (F(1,250) = 1.98; p = 0.16). Conclusión: los datos muestran una alta prevalencia de hipohidratación en esta población específica. Este estado de hidratación subóptimo podría ser motivo de preocupación en términos de rendimiento general. Se deberían hacer esfuerzos para integrar las intervenciones de hidratación y el monitoreo diario para reducir al mínimo la hipohidratación en las jugadoras.

Resumo Objetivo: Foi demonstrado que a hidratação desempenha um papel fundamental no esporte. O futebol é um esporte coletivo no qual a integridade de todos os jogadores é vital para o desempenho da equipe; portanto, o estado de hidratação de cada jogador é importante. O objetivo principal deste estudo foi investigar o estado de hidratação de universitárias jogadoras de futebol do sexo feminino durante a temporada regular. Métodos: Dezesseis universitárias jogadoras de futebol (idade: 20,4 ± 0,8 anos; altura: 163,6 ± 6,9 cm; peso: 65,3 ± 12 kg) forneceram amostras de urina por 9 dias para monitorar seu estado de hidratação. A hidratação foi determinada pela gravidade específica da urina Usg. Sua Usg foi analisado pela manhã (matutino) e à tarde (vespertino) antes do treino ou jogo. Resultados: As 16 jogadoras estavam minimamente hipohidratadas (Usg > 1.010) no período matutino em 5 dos 9 dias medidos. As jogadoras apresentaram valores de Usg significativamente maiores no período matutino em comparação ao vespertino (F (1.250) = 23,09; p <0,0001); no entanto, não houve interação tempo * dia significativa (F (1.250) = 1,98; p = 0,16). Conclusão: os dados mostram uma alta prevalência de hipohidratação nesta população específica. Este estado de hidratação abaixo do ideal pode ser uma preocupação em termos de desempenho geral. Devem ser feitos esforços para integrar intervenções de hidratação e monitoramento diário para minimizar a hipohidratação em jogadoras.

Enfermedad renal crónica y COVID-19: la importancia de la hidratación / Chronic kidney disease and COVID-19: the importance of hydration

Resumen Como es bien sabido, desde el mes de diciembre se encendieron las alarmas por la aparición de la enfermedad COVID-19 (Coronavirus 2019) en China, la cual es causada por el virus SARS-CoV-2 y se ha expandido a nivel mundial. Entre los síntomas frecuentes encontramos fiebre, fatiga, mialgias, tos seca, anorexia, disnea y producción de esputo y síntomas menos comunes como cefalea, odinofagia, rinorrea y otra sintomatología diferente a la respiratoria, como síntomas gastrointestinales dados por náuseas y diarrea. La proteinuria en cualquier grado, la hematuria de cualquier grado, el aumento de la elevación de la creatinina en pacientes con creatinina basal elevada y la generación de AKI 2 y 3 son los directamente relacionados con la mortalidad intrahospitalaria desde el punto de vista renal, lo que hace que debamos estudiar más aun la enfermedad renal crónica, para poder tomar las medidas necesaria de prevención. En cuanto a la hidratación, se considera, por lo tanto, que si el paciente presenta buena diuresis, los 2 litros de excreción serían necesarios para eliminar los solutos no necesarios del cuerpo, considerando que esta cantidad se logra sumando también las pérdidas extrarrenales; entonces, si el paciente mantiene una función urinaria adecuada a pesar de su grado de insuficiencia renal, una ingesta de líquidos entre 2,5 y 3,5 litros logra las metas. Los pacientes con enfermedad renal crónica deben tomar las medidas de prevención, aún más por ser población de riesgo, recordando por lo tanto algunas, las cuales son la mejor estrategia para evitar la transmisión viral: lavado frecuente de manos, distanciamiento social, evitar contacto con personas infectadas o con sospecha de infección por el virus SARS-CoV-2, usar tapabocas, mantener higiene en su domicilio, lavar superficies o limpiarlas con sustancias a base de alcohol, y algo que no se puede olvidar: estamos aprendiendo del virus, y debemos mantenernos informados del comportamiento del mismo y de los cambios que este pueda generar en la población y en el comportamiento de la enfermedad, para así mismo tomar las medidas.

Abstract As is well known since December, alarms went off for the appearance of the COVID-19 disease (Coronavirus 2019) in China, which is caused by the SARS-CoV-2 virus and has spread worldwide. Frequent symptoms include fever, fatigue, myalgia, dry cough, anorexia, dyspnea and sputum production, and less common symptoms such as headache, odynophagia, rhinorrhea, and other symptoms other than breathing, such as gastrointestinal symptoms due to nausea and diarrhea. Proteinuria in any degree, hematuria of any degree, increased creatinine variation in a patient with elevated baseline creatinine, and the generation of AKI 2 and 3 are those directly related to in-hospital mortality from the renal point of view, which means that we must study chronic kidney disease even more, in order to take the necessary preventive measures. Regarding hydration, it is considered, therefore, that if the patient presents good diuresis, the 2 liters of excretion would be necessary to eliminate the unnecessary solutes from the body, considering that this amount is achieved by also adding extrarenal losses. Therefore, if the patient maintains adequate urinary function despite his degree of kidney failure, a fluid intake of between 2.5 and 3.5 liters achieves the goals, also taking into account. Patients with chronic kidney disease should take preventive measures, even more so as they are a risk population, therefore remembering some, which are the best strategy to avoid viral transmission: frequent hand washing, social distancing, avoiding contact with people infected or suspected of infection with the SARS-CoV-2 virus, wearing face masks, maintaining hygiene at home, washing surfaces or cleaning them with alcohol-based substances and something that cannot be forgotten, remember that we are learning from the virus and that we must keep us informed of the behavior of the same and of the changes that it may generate in the population and in the behavior of the disease, so as to take the measures.

Bioelectrical vector analysis in obese adolescents / Análise vetorial por bioimpedância em adolescentes obesos

ABSTRACT Objective: To evaluate the hydration of obese and non-obese adolescents by vectorial bioimpedance analysis, in addition to verifying the associations between obesity and bioelectrical impedance vectorial analysis (BIVA) parameters. Methods: A cross-sectional study with adolescents between 14 and 18 years old (n=489, 300 boys and 189 girls). Electric bioimpedance (BIA; Quantum_II, RJL system, Rome, Italy) provided resistance and reactance parameters to calculate phase angle (PA), fat-free mass (FFM) and body fat (%BF). The confidence ellipses were compared, and the construction of the tolerance ellipses allowed individual and qualitative evaluation of the vectors and classification in dehydrated, normohydrated and hyperhydrated. Results: 78 obese and 411 eutrophic adolescents participated. Resistance (p<0.001) and reactance (p<0.001) and their normalization by stature (p<0.001) were reduced in the obese, whereas the PA was higher (p=0.003). %BF was 11.3% higher in obese adolescents. The main vector of the obese, both male (D=1.38; p<0.001) and female (D=1.49; p<0.001), indicated greater hydration. The ellipse of tolerance of the total sample showed that 25 (32.1%) were hyperhydrated and 02 (2.6%) vectors positioned in the sense of dehydration. A total of 17 (53.2%) girls and 16 (34.8%) boys were hyperhydrated. Logistic regression showed an inverse relation of BMI with resistance (p<0.001), reactance (p<0.001) and both normalized by stature. Adolescents with increased PA (p<0.001) were twice as likely to present obesity. Conclusions: Obese adolescents were hyperhydrated and there was an inverse relationship of BMI with resistance and direct with PA.

RESUMO Objetivo: Avaliar a hidratação de adolescentes obesos e não obesos por meio dos gráficos da análise vetorial por bioimpedância (BIVA), além de verificar as associações entre a obesidade e os parâmetros da BIVA. Métodos: Estudo transversal realizado com adolescentes entre 14 e 18 anos (n=489, 300 meninos e 189 meninas). A bioimpedância elétrica (BIA; Quantum_II, RJL system, Roma, Itália) ofereceu os parâmetros de resistência e reactância para calcular o ângulo de fase (AF), a massa livre de gordura (MLG) e a gordura corporal (GC). As elipses de confiança foram comparadas e a construção das elipses de tolerância permitiu a avaliação individual e a qualitativa dos vetores e, ainda, a classificação em desidratados, normohidratados e hiper-hidratados. Resultados: Participaram do estudo 78 adolescentes obesos e 411 eutróficos. A resistência (p<0,001), a reactância (p<0,001) e a normalização desses pela estatura (p<0,001) estavam reduzidas nos obesos, enquanto o AF foi superior (p=0,003). O percentual de gordura corporal (%GC) foi 11,3% maior nos adolescentes obesos. O vetor principal dos obesos, tanto masculino (Distância de Mahalanobis (D)=1,38; p<0,001) quanto feminino (D=1,49; p<0,001), indicou maior hidratação. A elipse de tolerância da amostra total mostrou que 25 adolescentes (32,1%) estavam hiper-hidratados e dois (2,6%) vetores posicionados no sentido de desidratação. Dezessete (53,2%) meninas e 16 (34,8%) meninos estavam hiper-hidratados. A regressão logística mostrou relação inversa do índice de massa corpórea (IMC) com a resistência (p<0,001) e a reactância (p<0,001), ambas normalizadas pela estatura. Os adolescentes com aumento do AF (p<0,001) apresentaram duas vezes mais chances de serem classificados como obesos. Conclusões: Os adolescentes obesos estavam hiper-hidratados e houve relação inversa do IMC com a resistência e direta com o AF.

Manejo clínico-terapéutico del donante multiorgánico / Multiorgan donor clinical-therapeutic management

La mayor parte de los potenciales do-nantes de órganos proceden de las Uni-dades de Emergencias y Cuidados Inten-sivos, lugar en donde se ubican la ma-yoría de los pacientes con trastorno neu-rológico agudo y grave1.Durante el diagnóstico de muerte ence-fálica (ME) comienza el auténtico man-tenimiento del donante, ya que hay mo-mentos críticos, como la realización del test de apnea. Durante la fase previa al es-tablecimiento de ME el paciente ha sido tratado de manera agresiva con todos los métodos a nuestro alcance, muchos de ellos encaminados a preservar la perfu-sión cerebral manitol, tiopental sódico, etc., nos encontramos a menudo con po-tenciales donantes con gran inestabilidad hemodinámica e importantes alteraciones del medio interno1.El mantenimiento del donante multior-gánico constituye un desafío para el equipo de la Unidad de Cuidados In-tensivos. Este proceso implica poner en práctica el conocimiento total del manejo de disfunción multiorgánica en un paciente muerto. El tiempo de dete-rioro de los órganos juega también un rol en el tratamiento de todas las compli-caciones que se presentan en este tipo de pacientes. La adherencia a un protocolo de manejo es fundamental para lograr que un mayor número de donantes se trasladen a quirófano para la extracción de órganos viables2.

INTRODUCTION:Most of the potential organ donors come from the Emergency and Intensive Care Units, where most of the patients with acute and severe neurological disorder are located1.During the diagnosis of brain death, the authentic maintenance of the donor begins, as there are critical moments, such as the apnea test. Since during the pre-establishment phase of brain death the patient has been treated aggressi-vely with all the methods at our dis-posal, many of them aimed at preser-ving cerebral perfusion manitol, thio-pental sodium, etc., we often find our-selves with potential donors with high hemodynamic instability and significant changes in the internal environment1.The maintenance of the multiorgan donor is a challenge for the Intensive Care Unit team. This process involves putting into practice the total knowledge of the management of multi-organ dys-function in a dead patient. The time of deterioration of the organs also plays a role in the treatment of all the complica-tions that occur in this type of patients. Adherence to a management protocol is essential to ensure that a greater number of donors are transferred to the opera-ting room for the extraction of viable organs2.

Periotestometry and tissue hydration. How are these indicators related?

The mobility of teeth in terms of periotestometry and hydration of periodontal tissues in terms of bioimpedance spectrometry were studied in healthy volunteers without dental and concomitant somatic diseases. It was found that teeth of these subjects have both low and pathological mobility. It was also revealed as increased hydration (edema), indicating the presence of inflammation, and reduced hydration, indicating atrophic processes in periodontal tissues. A comparison of the data of periotestometry and bioimpedance spectrometry showed that the indicators of mobility of the teeth and hydration of the periodontal tissues reflect different characteristics of the functional state of dentoalveolar system, and can be used as complementary in the diagnostic studies.

La reemergencia del dengue: un gran desafío para el sistema sanitario latinoamericano y caribeño en pleno siglo XXI / Reemergence of dengue: a great challenge for the health Latin American and Caribbean system, in the middle of XXI century

Se efectuó una revisión actualizada sobre el dengue, fundamentalmente centrada en los países de la Región, teniendo en cuenta de que se trata de una enfermedad infecciosa reemergente, que continúa representando un problema de salud pública a escala universal, cada vez más común y disperso en áreas tropicales y subtropicales, debido a sus condiciones demográficas y climatológicas

An up-dated review on dengue was carried out, fundamentally centered in the Region countries, keeping in mind that it is a reemerging infectious disease, which still represents a public health problem of universal scale, more and more common and disseminated in tropical and subtropical areas, due to its demographic and climatological conditions

Desidratação, acidente vascular cerebral e disfagia: revisão sistemática da literatura / Dehydration, stroke and dysphagia: systematic review

RESUMO Objetivos trata-se de revisão sistemática da literatura científica sobre a associação entre o acidente vascular cerebral, desidratação e disfagia orofaríngea. Estratégia de pesquisa o levantamento bibliográfico foi realizado nas bases de dados científicos: MEDLINE, LILACS, SciELO, Web of Science e Cochrane. Critérios de seleção foram incluídos os estudos que preencheram os seguintes critérios de inclusão: ser artigo original, com resumo disponível; ter sido publicado entre os anos de 2001 e 2018 e nos idiomas português, inglês ou espanhol; abordar o tema desidratação em indivíduos após acidente vascular cerebral. A triagem e análise dos estudos foram realizadas por dois avaliadores independentes. Resultados dentre os 484 artigos localizados para a triagem, 43 foram selecionados para leitura completa e 18 foram incluídos na análise final. Foram descritos diferentes métodos de avaliação do estado de hidratação nos indivíduos após acidente vascular cerebral, tais como: análise da relação BUN /creatinina, osmolaridade plasmática, relação ureia/creatinina, gravidade específica da urina, coloração da urina, ingestão hídrica, balanço hídrico, bioimpedância elétrica, avaliação clínica, análise de eletrólitos isolados. A prevalência de desidratação em pacientes após acidente vascular cerebral, durante a internação, variou de 11% a 66% e está associada à gravidade e piora na evolução clínica. Conclusão foi possível compreender a complexidade do processo de mensuração do estado de hidratação em indivíduos após acidente vascular cerebral e sua associação com a disfagia. Estudos enfocando essa temática são de extrema relevância, visto a sua influência sobre a taxa de mortalidade e morbidade nesta população.

ABSTRACT Purpose this is a systematic review of scientific literature associated with stroke, dehydration and oropharyngeal dysphagia (OD). Research Strategy bibliographic survey was conducted in scientific databases: MEDLINE, LILACS, SciELO, Web of Science and Cochrane. Selection criteria studies that met the following inclusion criteria were included: being original article with summary available; have been published in the last seventeen years (2001-2018) and in Portuguese, English or Spanish languages; and addressing dehydration in individuals after stroke Screening and analysis of the studies were performed by two independent evaluators. Results among the 484 articles found for screening, 43 were selected for full reading and 18 articles were included in the final analysis. Different methods of assessing hydration status have been described in individuals post-stroke, such as ratio analysis blood urea nitrogen (BUN)/creatinine, plasma osmolality, urea / creatinine, urine specific gravity, urine color, water intake, water balance, bioelectrical impedance analysis (BIA), clinical evaluation and analysis of electrolytes. The prevalence of dehydration in post-stroke during hospitalization varied from 11% to 66% and is associated with severity and deterioration in the clinical evolution. Conclusion It was possible to understand the complexity of the measurement of hydration status in individuals after stroke and its association with dysphagia. Studies focusing on the association between dehydration and stroke are very important, due to its influence on mortality and morbidity in this population.

Signos de alarma en pacientes cubanos con dengue según nueva clasificación revisada de la Organización Mundial de la Salud / Warning signs in Cuban patients with dengue fever according to new reviewed classification of the World Health Organization

Se realizó un estudio observacional, descriptivo y transversal en el Instituto de Medicina Tropical Pedro Kourí de La Habana, donde estuvieron ingresados 485 pacientes desde enero hasta diciembre de 2012 con diagnóstico de infección por dengue, de los cuales se escogió una muestra de 247. Entre los signos de alarma más comunes sobresalieron la cifra ascendente del hematocrito (54,6 por ciento y el dolor abdominal intenso o mantenido o de ambos tipos (46,1 por ciento . Las señales de alarma aparecieron por lo general al ceder la fiebre; del total de pacientes que las presentaron en algún momento de su evolución, 81,2 por ciento fueron tratados con hidratación intravenosa precoz y ninguno evolucionó hacia la forma grave de la enfermedad. La terapia hidratante parenteral se inició tardíamente en 18,8 por ciento de los afectados, incluidos todos aquellos en estado grave.

An observational, descriptive and cross sectional study was carried out in Pedro Kourí Tropical Medicine Institute from Havana, where 485 patients were admitted from January to December, 2012 with diagnosis of infection due to dengue fever, from whom a sample of 247 was chosen. Among the most common warning signs there were the increasing values of hematocrit (54.6 percent), and the intense or sustained abdominal pain or both types (46.1 percent). The warning signs generally appeared when fever ceased, and of the total of patients that presented it, 81.2 percent at some moment of their clinical course were treated with early intravenous hydration, and none developed the serious form of the disease. The parenteral hydration therapy began belatedly in 18.8 percent of the affected, including all those in severe state.

Impacto del componente hiperclorémico de la acidosis metabólica en el estado de hidratación y en el tratamiento de la cetoacidosis diabética / Impact of the hyperchloremic component of metabolic acidosis on the patient's hydration status and the treatment of diabetic ketoacidosis

Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes -amp;#91;17 varones, mediana de edad: 14,5 años (2,4-18)-amp;#93;, 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.

Introduction. Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. Objectives. To determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. Results. Forty patients (17 males, median age: 14.5 years -amp;#91;2.4-18-amp;#93;) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). Conclusions. The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.

Hidratação em atividades físicas de longa duração: uma revisão / Hydration in physical activities long term: a review

Introdução: a prática atividade física prolongada aumenta a dissipação de calor acarretando o processo fisiológico da desidratação. Por outro lado, a hidratação é de suma importância para evitar os efeitos negativos da perda hídrica. Objetivo: revisar os métodos de avaliação do processo de desidratação e estratégias de hidratação em atividades físicas de longa duração. Metodologia: foi realizado revisão de literatura integrativa. Foram consultados livros em biblioteca e artigos em diversas bases de dados (Google Acadêmico, Lilacs, Medline, Scielo e Bireme), utilizando os seguintes unitermos: hidratação; desidratação; reposição hídrica; atividade física; longa duração. A primeira parte da revisão foi realizada de forma narrativa e levantadas informações acerca de líquidos corporais, conceitos de desidratação, bem como, estratégias de hidratação. Na revisão sistemática foram totalizados 15 artigos, sendo 12 manuscritos com modelo humano, 02 revisões de literatura e 01 trabalho contendo diretrizes gerais sobre reposição hídrica, após o levantamento os artigos Recebido em: 03/11/2017 foram discutidos em seus métodos de avaliação de desidratação e estratégias de intervenção para hidratação em diversas modalidades prolongadas de atividade física. Conclusão: o método de avaliação da massa corporal é amplamente utilizado como indicador de desidratação e como estratégica de intervenção de hidratação. Verifica- -se também que o consumo de água isolada não reduz os efeitos da desidratação. A maioria dos estudos encontrados foi realizada com atletas, sugerindo assim que investigações com indivíduos praticantes de atividade física para a saúde sejam encorajadas para criação de estratégias de reposição hídrica para tal população.

Introduction: the prolonged practice of physical activity increases the heat dissipation causing the physiological process of dehydration. On the other hand, hydration is of paramount importance to avoid the negative effects of water loss. Objective: to review methods of evaluation of the dehydration process and hydration strategies in long-term physical activities. Methodology: an integrative literature review was carried out. Library books and articles were consulted in several databases (Google Scholar, Lilacs, Medline, Scielo and Bireme), using the following key words: hydration; dehydration; water replenishment; physical activity; Long term. The first part of the review was conducted in a narrative manner and raised information about body fluids, dehydration concepts, as well as, hydration strategies. In the systematic review, 15 articles were totalized, being 12 manuscripts with human model, 02 literature reviews and 01 work containing general guidelines on water replacement, after the survey the articles were discussed in their methods of evaluation of dehydration and intervention strategies for hydration in various prolonged modalities of physical activity. Conclusion: the method of assessing body mass is widely used as an indicator of dehydration and as a strategy of hydration intervention. It is also verified that the consumption of insulated water does not reduce the effects of dehydration. Most of the studies found were performed with athletes, thus suggesting that investigations with individuals practicing physical activity for health should be encouraged to create water replacement strategies for such population.

Hábitos de consumo de bebidas e infusiones sin alcohol y su relación en el estado nutricional en los empleados de mostrador de cuatro farmacias de la ciudad autónoma de Buenos Aires / Consumer habits of beverages and herbal infusions without alcohol intake and its relationship to the nutritional status of employees of four pharmacies from the autonomous city of Buenos Aires

The nutrition transition occurred in recent years was accompanied by changes in the pattern of fluid intake worldwide, replacing water for beverages that provide calories. The aim of this study was to characterize the habitual consumption of non-alcoholic drinks and teas in a group of clerks and relate it to the presence of excess weight. A quantitative, descriptive, correlational, cross-sectional study was performed. A 24h recall and a food frequency questionnaire was used. During the month of August 2012 , 72 individuals, of whom 55.6 % were overweight and obese ( Ow/Ob) were interviewed. The average fluid intake was 2,188 ml/day resulting in 18.22 % water, 24.8 % of drinks and tea without sugar and 56.9 % of drinks and sweetened teas. The latter group contributed 13.8 % of Kcal/day/person, exceeding the WHO recommendations. 64% of respondents exceeded that recommendation, highlighting the Ow/Ob group with 85% inadequacy and 19.6 % of total daily Kcal as simple sugars. These data confirm that there is a relationship between sugar consumption and the presence of excess weight.

La transición nutricional ocurrida en estos últimos años se ha acompañado por cambios en el patrón de ingesta de líquidos a nivel mundial, desplazando al agua por bebidas que aportan calorías. El objetivo de este estudio fue caracterizar el consumo habitual de bebidas e infusiones analcohólicas en un grupo de empleados de comercio y relacionar el mismo con la presencia de exceso de peso. Se realizó un estudio un estudio cuantitativo, descriptivo, correlacional y de corte transversal. Se utilizó un recordatorio de 24 horas y un cuestionario de frecuencia de consumo. Durante el mes de Agosto del 2012, se entrevistaron 72 individuos, de los cuales, un 55.6% presentó sobrepeso y obesidad (Sp/Ob). El consumo promedio de líquidos fue de 2188 ml/día, resultando 18.22% de agua, 24.8% de bebidas e infusiones sin azúcar y 56.9% de bebidas e infusiones azucaradas. Este último grupo aportó 13.8% de las Kcal/día/persona, superando las recomendaciones de la OMS. El 64% de los entrevistados superó dicha recomendación, destacándose el grupo Sp/Ob con un 85% de inadecuación y 19.6% del total de Kcal diarias como azúcares simples. Estos datos confirman que existe una relación entre el consumo de azúcares y la presencia de exceso de peso.

Modelo de los determinantes de la actitud hacia la rehidratación / Model of the determinants of attitudes toward rehydration / Modelo das determinantes da atitude em relação a reidratação

[{"text": "Las políticas de salud suponen que el factor clave de sus programas preventivos está en la participación de la gente \r\nrespecto a su rehidratación, porque esta se considera un instrumento de prevención de las enfermedades crónicas dege\r\n-\r\nnerativas, que han incrementado su tasa de morbilidad recientemente. En tal sentido, el objetivo del presente trabajo es \r\nestablecer un modelo de las relaciones causales entre factores sociodemográficos y cognitivos relativos al consumo de \r\nbebidas. Para tal propósito, se llevó a cabo un estudio transversal y correlacional con una muestra de 100 afiliados a \r\nun hospital público. A partir de un modelo estructural (X2 = 163.873, 28 gl, p = .000; GFI = .875; AGFI = .840; PGF \r\n= .681; RMSEA = .027; RMR = .066), se estableció que la edad determinó negativamente la actitud hacia la rehidra\r\n-\r\ntación (\r\nß \r\n= -.22) mientras que las creencias de rehidratación grupal (CRG) incidieron de manera positiva (\r\nß\r\n = ,47.). En \r\nel marco de las teorías actitudinales, se discutió la inclusión de las normas y percepciones como sus determinantes.", "_i": "es"}, {"text": "Health policies assume that the key factor in their preven\r\n-\r\ntion programs is the participation of the people regarding \r\nrehydration, which is considered as an instrument of \r\nprevention of chronic degenerative diseases that in recent \r\ndays have increased it morbidity rate. The purpose of this \r\narticle is to establish a model of contributing relation\r\n-\r\nships between sociodemographic and cognitive factors \r\nrelated to beverage consumption. A cross-sectional and \r\ncorrelational study was performed with a sample of 100 \r\nmembers of a public hospital. From a structural model \r\n(X2 = 163,873, 28 df, p = .000, GFI = .875, AGFI = .840; \r\nPGF = .681, RMSEA = .027, RMR = 0.066) age deter\r\n-mined adversely rehydration attitude (\r\nß\r\n = -.22) while \r\nRehydration Beliefs Group (RBG) had a positive impact \r\n(\r\nß\r\n =, 47.) under the attitudinal theories, the inclusion \r\nof norms and perceptions and their determinants was \r\ndiscussed.", "_i": "en"}, {"text": "As políticas de saúde supõem que o fator-chave nos seus \r\nprogramas de prevenção é a participação das pessoas \r\nem relação à sua hidratação, que é considerado como \r\num instrumento para a prevenção de doenças degena\r\n-\r\ntivas crônicas que ultimamente têm aumentado a taxa de \r\nmorbidez. O propósito deste artigo é estabelecer relações \r\ncontribuintes entre fatores sócio-demográficos e cogni\r\n-\r\ntivos relacionados ao consumo de bebidas. Para isso, \r\nfoi realizado um estudo transversal e correlacional com \r\numa amostra de 100 membros de um hospital público. A \r\npartir de um modelo estrutural (X2 = 163.873, 28 gl, p \r\n= .000; GFI = .875; AGFI = .840; PGF = .681; RMSEA \r\n= .027; RMR = 0.066), a idade determino negativamente \r\na atitude de reidratação (\r\nß\r\n = - 0,22), enquanto o Grupo \r\nCrenças de Reidratação (GCR) teve um impacto posi\r\n-\r\ntivo (\r\nß\r\n =, 47.). De acordo com as teorias atitudinais, a \r\ninclusão de normas e percepções e seus determinantes \r\nforam discutidas.", "_i": "pt"}]

Germinação de sementes de Cynometra bauhiniifolia Benthan (jutairana) em função do dessecamento e da manutenção sob condição úmida / Germination of Cynometra bauhiniifolia Benthan (jutairana) seeds in terms of desiccation and maintenance under humid conditions

Jutairana (Cynometra bauhiniifolia) é uma espécie, normalmente, encontrada nas margens de rios, lagos e igarapés, que atualmente vem sendo utilizada na arborização urbana da cidade de Manaus (AM). Este trabalho teve por objetivo avaliar a viabilidade e o vigor de sementes de Cynometra bauhiniifolia em função da secagem e da manutenção em água de frutos e sementes. Foram desenvolvidos dois ensaios independentes. No primeiro, avaliou-se o efeito do período de secagem (0 a 10 dias), ou do grau de umidade, sobre a germinação e o vigor das sementes, em experimento inteiramente casualizado. No outro, avaliou-se a germinação e o vigor das sementes em função do acondicionamento de frutos, ou de sementes, em água ou ambiente natural, durante o período de 30 dias. Neste, o delineamento foi inteiramente ao acaso, em esquema fatorial 2 (condição da semente: no fruto ou isolada) x 2 (ambiente de condicionamento: na água e em ambiente natural) x 7 (período de acondicionamento: 0, 5, 10, 15, 20, 25 e 30 dias). As sementes de Cynometra bauhiniifolia são dispersas com alto grau de umidade (54,1 por cento) e perdem a viabilidade quando desidratadas. O teor de água crítico situou-se entre 46,6 por cento e 41,4 por cento, enquanto o grau de umidade letal ficou entre 28,2 por cento e <23,9 por cento, o que são características típicas de sementes recalcitrantes. O condicionamento dos frutos e das sementes em água, com aeração, foi satisfatório para a manutenção da viabilidade das sementes por um período de 30 dias.

Jutairana (Cynometra bauhiniifolia) is a species normally found in river banks, lakes and streams, and is currently being usedfor urban tree planting in the city of Manaus(AM), because of its visual and, or, aesthetic appearance. The object of this study was to evaluate the viability and the vigor of Cynometra bauhinnifolia seeds in terms of drying and maintenanceof fruits and seeds in water. This wasundertaken in two independent experiments. In the first, the effect of the drying period (0 to 10 days), or of moisture content in thegermination and vigor of seeds, wasevaluated in an entirely randomized experiment, with 11 treatments and 4 repetitions. In the other,seed germination and vigor was evaluatedin terms of fruit or seed conservation in water or in natural environment, during one month. In this, the delineation was entirely randomized, in factorial 2 (condition of the seed: in the fruit or isolated) X 2 (surrounding of conditioning) X 7 (period of conservation: 0, 5, 10, 15, 20, 25 and 30 days), with four repetitions. The Cynometra bauhinnifolia seeds were dispersed with high moisture content (54,1 percent) and their viability decreased when dehydrated. The critical moisture content was 46,6 percent to 41,4 percent, while the lethal moisture content was between 28,6 percent and <23,9 percent, which is a typical characteristic of recalcitrant seeds. The conditioning of fruits, or seeds, in aerated water was satisfactory for the maintenance of theseed viability for 30 days.