Chemotherapy and radiation components of neoadjuvant treatment of pancreatic head adenocarcinoma: Impact on perioperative mortality and long-term survival.

BACKGROUND: We compared outcomes of neoadjuvant therapy delivered as chemotherapy-only (Chemo) versus concurrent chemoradiation (ChemoRT) versus chemotherapy followed by radiation (Chemo-ChemoRT) among pancreatic head adenocarcinoma patients receiving pancreaticoduodenectomy. METHODS: National Cancer Data Base cases diagnosed 2006-2011 treated by neoadjuvant therapy and pancreaticoduodenectomy. RESULTS: 1163 pts received neoadjuvant treatment with Chemo (n = 309; 26.6%), ChemoRT (n = 626; 53.8%), or Chemo-ChemoRT (n = 228; 19.6%). Odds of 30-day and 90-day mortality were not influenced by delivery of any neoadjuvant therapy type. Median overall survival for Chemo, ChemoRT, and Chemo-ChemoRT groups were 25.6 (95% confidence interval 23.1-28.7), 22.9 (21.4-24.8), and 26.9 (23.7-29.4) months, respectively. There was no statistically significant difference between Chemo and Chemo-ChemoRT groups (log rank test p = 0.854), while there was significant difference of ChemoRT (p = 0.017 versus Chemo; p = 0.021 versus Chemo-ChemoRT). Multivariate model suggests delivery of concurrent ChemoRT as opposed to neoadjuvant therapy with full dose systemic chemotherapy is associated with shortened survival (aHR = 1.311, p = 0.001). CONCLUSIONS: There is no detectable difference in early outcomes (30-day and 90-day postsurgical mortality) among pancreaticoduodenectomy patients treated with various types of neoadjuvant therapy. Overall survival appears better among patients exposed preoperatively to full dose systemic chemotherapy rather than concurrent chemoradiation only. Further studies with more detailed data sources are needed.

Maternal juvenile rheumatoid arthritis may be associated with preterm birth but not poor fetal growth.

OBJECTIVE: Adverse pregnancy outcomes in mothers with juvenile rheumatoid arthritis (JRA) are not known. The objective of this study was to examine the risk of preterm birth and restricted fetal growth in pregnant mothers diagnosed with JRA, and to examine the impact of race/ethnicity and maternal age on this association. STUDY DESIGN: Hospital discharge records for mothers who gave birth in 2011 and 2012 were examined in the National Inpatient Sample (NIS) database. JRA, preterm birth (<37 weeks of gestation), birth weight that is small for gestational age (SGA) and other demographic and clinical variables were identified using ICD-9 (International Classification of Disease--9th revision) diagnostic codes. The associations of JRA with preterm birth and restricted fetal growth were examined controlling for confounding variables. RESULT: The sample included 8,273,987 birthing mothers, of these 1236 (0.01%) had JRA. The prevalence of preterm birth and SGA was 6.08% and 2.34%, respectively. Preterm birth in mothers with JRA was 12.9% compared with 6.1% in mothers without JRA with an adjusted odds ratio (OR) of 2.1 (confidence interval (CI): 1.74 to 2.42, P<0.001). The incidence of SGA in infants born to mothers with JRA was 3.34% compared with 2.34% in non-JRA mothers, which was not statistically significant. Adjusted OR for preterm birth in association with JRA among White mothers was 1.78 (CI: 1.41 to 2.24, P<0.001). However, Hispanic mothers with JRA (12%) were the ethnicity to suffer the most from preterm birth with an adjusted OR of 4.43 (CI: 2.97 to 6.62, P<0.001). Preterm birth among advanced maternal age (AMA) mothers with JRA was 25% compared with 7% in those without JRA with an adjusted OR of 5.42 (CI: 3.51 to 8.35, P<0.001). CONCLUSION: JRA is associated with preterm birth but not with SGA. This association is significantly influenced by race/ethnicity and maternal age. More studies are needed to examine these findings in relation to medications used, severity of the disease and exacerbation during pregnancy to understand the genetic/socioeconomic factors behind these racial/ethnic differences.

1º Congreso AADYND: Categoría Premio Congreso / Gasto energético y hemodiálisis crónica / Valoración nutricional cualitativa de los menús y diseño de la carta de restaurantes / Ferias Municipales: Viabilidad como canal de comercialización / Prueba piloto para conocer aceptabilidad, preferencia y saciedad de colaciones dulces con baja densidad energética y alto aporte proteico en mujeres perimenopáusicas / Rol de la infección por Helicobacter pylori en la regulación hormonal del apetito y el índice de masa corporal / Incursionando nuevas áreas de trabajo: "El licenciado en nutrición en una unidad de cuidados intensivos neonatales" / Diseño y proyección de audiovisuales animados como estrategia comunicativa / Proceso de mejora de las bases y condiciones para la concesión del servicio de confitería de la Facultad de Ciencias de la Salud (FCS). Universidad Nacional de Salta (UNSa) / Consumo de frutas en estudiantes universitarios

Introducción: Existen controversias sobre el comportamiento del gasto energético en reposo (GER) en pacientes en hemodiálisis (HD), algunos autores señalan que la HD aumenta el GER, mientras que otros no hallaron diferencias significativas. Objetivos: Determinar si el GER en pacientes en HD es superior al de individuos que no dializan. Determinar si el GER en pacientes en HD es mayor durante el momento de diálisis en comparación al momento que no dializan. Materiales y método: Para el objetivo 1, diseño comparativo a muestras independientes, observacional, prospectivo, transversal; para el objetivo 2, comparativo a muestras relacionadas, observacional, prospectivo, longitudinal. La muestra quedó conformada por 30 individuos en HD crónica y 30 controles apareados por edad, sexo, actividad física y estado nutricional. Se midió el GER utilizando un calorímetro indirecto móvil. Para el análisis estadístico se aplicaron test de diferencias (p < 0,05). Resultados: El GER de los individuos en HD no fue significativamente mayor al del grupo control (test de medias 56,8kcal, IC -76,6/190,2, p=0,1955; test de medianas 49,9kcal, IC -84,9/189,9, p=0,2142; test de signos 56,6%, IC 37,4/74,5, p=0,292). En los individuos en HD, el GER aumentó significativamente durante la sesión (test de medias 173kcal, IC -83,6/262,4, p=0,00022; test de medianas 170kcal, IC 85/255, p=0,00024; test de signos 83,33%, IC 65,3/94,3, p=0,00016). Al subdividir este grupo según presencia o ausencia de diabetes, se mantuvo el incremento del GER durante la diálisis. (test de medias 210kcal, IC 75,1/344,9, p 0,0044; test de medianas 212,5kcal, IC 65/340, p 0,0028; test de signos 85,71%, IC 42,1/99,6, p 0,06). Conclusiones: El GER de pacientes en HD no está incrementado con respecto a individuos sanos. En el paciente en HD crónica el GER aumenta durante el procedimiento dialítico en comparación al día que no asiste a diálisis.

Introducción: La carta de menú del restaurante, aparece como el elemento de comunicación más fuerte y a veces el único que se establece entre el restaurante y el consumidor. La tendencia creciente de comer fuera de casa convierte a los restaurantes en establecimientos cruciales para la promoción de un patrón alimentario saludable para toda la población. Una oferta alimentaria variada y equilibrada desde el punto de vista nutricional es el camino adecuado para mejorar la calidad de los menús, y con ello llevar mensajes nutricionales para mejorar la salud poblacional. Objetivos: Analizar el valor nutricional cualitativo de los menús y el diseño de la carta en los restaurantes de la ciudad de Mar del Plata en el año 2014. Materiales y método: La selección de restaurantes se llevó a cabo al azar por estratificación en zonas geográficas. Se realizó un análisis de valoración nutricional cualitativa de los menús con los datos recolectados. Simultáneamente, se analizó el diseño de las cartas de menús a través de una grilla de observación planteada específicamente para tal fin. Es un estudio descriptivo; no experimental y de tipo transversal. Resultados: Del menú se analizó un total de 258 entradas, 1186 platos principales, 137 guarniciones y 198 postres. La mayoría de las entradas y los platos principales ofrecidos están compuestos por proteínas animales, representado el 84% y el 70%, respectivamente. El promedio por restaurante es de 28 platos principales con papas fritas de guarnición. El diseño de la carta en su mayoría es sencillo y claro, sin elementos de comunicación visual llamativos. Conclusiones: Los menús analizados presentan un desequilibrio en su valor nutricional, con un exceso en proteína animal y poca oferta de platos con carbohidratos bajos.

Introducción: La perimenopausia se asocia con mayor probabilidad de padecer trastornos de la alimentación, destacándose la compulsión glucídica, que lleva a consumir fundamentalmente alimentos con alto contenido de carbohidratos entre comidas. Objetivos: evaluar aceptabilidad, preferencia y saciedad de colaciones dulces de baja densidad energética (DE) y alto aporte proteico en muestra de mujeres adultas perimenopáusicas. Materiales y método: A partir de receta estándar de merengues, se desarrollaron tres variantes con disminución de DE y sacarosa (Muestra A y C se reemplazó sacarosa por azúcar light y sucralosa en diferentes proporciones; Muestra B se disminuyó sacarosa y se agregó sucralosa). Se realizó ensayo de aceptabilidad y preferencia en 75 evaluadoras no entrenadas y prueba de saciedad a 27 evaluadoras no entrenadas, utilizando encuesta autoadministrada y escala hedónica de Likert de 9 puntos. Análisis estadístico: medidas de tendencia central, ANOVA, prueba de Friedman y Software "Statgraphics Centurion XVII" para pruebas de aceptabilidad. Resultados: Se desarrollaron merengues para las tres muestras de 1 g. cada uno, con disminución del 31% en la DE y 1,03 mg. de triptófano por unidad. La muestra B (se disminuyó la sacarosa al 88,7% y se agregó sucralosa en 11,3%), fue la de mayor preferencia y aceptabilidad por sus características sensoriales. Sobre esta muestra se aplicó el test de saciedad (libre demanda), obteniendo una media de ingesta de 10 unidades (Rango: 3-15). El 22,2% de las mujeres consumió 3 a 8 merengues; 51,8% 9 a 12 merengues y 25,9% más de 12 merengues. Se pudo observar que las mujeres estaban plenamente saciadas a los primeros 30 minutos, manifestando que a los 120 minutos tuvieron apetito. Conclusiones: La colación más aceptada y preferida fue la que mantuvo sacarosa y una proporción fue sustituida por edulcorante no calórico. El test de saciedad demostró que la colación seleccionada logró saciedad a corto plazo.

Introducción: Helicobacter pylori coloniza la mucosa gástrica y se asocia con el desarrollo de patologías gastrointestinales, pudiendo afectar la secreción de hormonas moduladoras del apetito. Objetivo: Evaluar la asociación entre la colonización gástrica por H. pylori, las concentraciones séricas de grelina y leptina y el índice de masa corporal (IMC) en pacientes con sintomatología digestiva. Materiales y método: Se llevó a cabo un estudio transversal que incluyó 163 pacientes dispépticos (18 - 70 años) derivados al Hospital de Gastroenterología "Dr. Carlos Bonorino Udaondo". Se realizó una encuesta sociodemográfica, recordatorio de 24 horas y se midió circunferencia de cintura (CC), peso y talla para el cálculo del IMC. La presencia de H. pylori se diagnosticó mediante 13C-Test del Aire Espirado (13C-UBT). Las concentraciones séricas de grelina y leptina se determinaron mediante enzimoinmunoensayo. Para el análisis estadístico se utilizaron los Tests de χ2, Mann-Whitney, correlación de Spearman y regresión lineal (SPSS19.0). Resultados: La prevalencia de la infección por H. pylori fue de 53,4% (IC95%;45,7-65,8%). La ingesta promedio de energía, carbohidratos, proteínas y lípidos no se asoció a la infección. Las prevalencias de sobrepeso/ obesidad y adiposidad central no difirieron significativamente entre H. pylori positivos y negativos (p=0.09 y p=0.87, respectivamente). La mediana de la concentración de grelina fue 306.5 pg/mL (RIC;230.0- 385.5) en H. pylori positivos y 358.3 pg/mL (RIC;253.8-547.8) en negativos. La infección se asoció con menores concentraciones séricas de grelina (p=0.016) aún ajustando por IMC y género (p=0.019), no habiéndose encontrado asociación entre los valores de leptina y la infección (p=0,76). Los niveles de grelina sérica se correlacionaron negativamente con el IMC (r=-0,25; p=0,0013), mientras que la correlación leptina-IMC fue positiva (r=0,56; p<0,00001) en la población total. Conclusiones: La colonización por H. pylori en pacientes con sintomatología digestiva se asoció con menores concentraciones séricas de grelina, enfatizando su rol en la regulación hormonal del apetito.

Introducción: La alimentación del recién nacido de pretérmino (RNPT) es un gran desafío. La administración óptima de nutrientes requiere de una infraestructura organizada y profesionales de distintas áreas que trabajen en forma conjunta. A partir de la necesidad de cumplir con estándares de calidad respecto del estado nutricional de pacientes neonatales, la Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital Universitario Austral (HUA) sugirió la incorporación de un licenciado en nutrición para colaborar en diferentes aspectos del cuidado nutricional de los mismos. Objetivos: Promover la inserción del licenciado en nutrición como parte del equipo colaborador del cuidado nutricional del neonato. Evaluar posibles herramientas que el licenciado en nutrición pudiera aportar dentro de una UCIN. Materiales y método: Se trabajó con monitoreo continuo de pacientes ingresados en la UCIN del HUA de Pilar durante el periodo de diciembre 2012 hasta la actualidad. Se diseñó una planilla para cargar datos de los pacientes que ingresan a la Unidad obtenidos de la historia clínica informatizada de la institución (Pectra Digital Gate®). Resultados: A partir de los datos recolectados se obtuvo información sobre: días de recuperación del peso de nacimiento; número de días para cubrir requerimientos propuestos; número de días que recibe NPT; aumento de peso de los últimos 7 días; monitoreo de soporte nutricional indicado y recibido; porcentaje de leche materna vs fórmula recibida. Se colaboró en el diseño de planillas de fraccionamiento de leches, protocolos de inicio de alimentación del recién nacido de bajo peso al nacer y uso de fortificadores de la leche materna; se optimizó el registro de la alimentación enteral y parenteral recibida en la historia clínica; se realizó asesoramiento de productos y búsqueda bibliográfica para la incorporación de nuevas fórmulas dentro del Vademécum de la institución. Conclusión: La existencia de protocolos básicos actualizados, cálculo de los requerimientos energéticos en función de la situación clínica y el estado nutricional, monitoreo de la alimentación enteral y parenteral, cumplimento del objetivo calórico, son algunos indicadores que pueden utilizarse como herramienta para medir la calidad de la actividad asistencial. El asesoramiento y monitoreo del cuidado nutricional del neonato son parte de las funciones que los nutricionistas pueden cumplir dentro de dichas unidades. La inclusión en la enseñanza de grado y postgrado del cuidado nutricional de este grupo es de vital importancia dentro del aprendizaje continuo del licenciado en nutrición.

Introducción: El proyecto se enmarca en el Programa de Ciudadanía Porteña, programa de asistencia alimentaria implementado por el Ministerio de Desarrollo Social de la Ciudad de Buenos Aires, basado en transferencia directa de ingresos a familias en situación de vulnerabilidad Objetivos: Realizar educación alimentaria nutricional en 3 mensajes: lactancia materna, alimentación complementaria e hidratación a usuarios del programa en salas de espera de las sedes en que realizan trámites. Materiales y método: Se diseñaron y proyectaron 3 animaciones audiovisuales de corta duración, cada una con contenidos de cada mensaje principal de los objetivos. Se entregaron 3 folletos para complementar la información del video. Se realizaron 148 encuestas directas a los beneficiarios que asistieron a las sedes del programa para evaluar la incorporación de los mensajes. Resultados: Se analizaron las encuestas por mensaje. Lactancia materna: 98% vio el video; 81,6 % recordó el tema principal; el beneficio de defensas fue el mayor con el 33%; 28% leyó el folleto; 42% opinó es bueno amamantar hasta los 2 años y más. Alimentación complementaria: 87% vio el video; 47,5% respondió como tema principal: Primeras comidas del bebé; 24% y el 17% según sede leyeron el folleto; 60% respondió como tema del folleto: Qué alimentos dar a los bebés por edades; 31% opinó en comenzar la alimentación complementaria antes de los 6 meses. Hidratación y consumo: 76% vio el video; 86% respondió correctamente el tema principal del video; 44% respondió como principal beneficio del agua saca la sed; 6% tomó el folleto. Conclusiones: Los mensajes fueron comprendidos satisfactoriamente. La implementación de la animación es un recurso práctico y moderno que facilita la incorporación de los mensajes. Su proyección repetitiva permite llegar a mayor cantidad de beneficiarios, el material gráfico tuvo menor recepción.

Introducción: El pliego de condiciones para la concesión de un servicio de confitería establece la calidad requerida. Por tal motivo es esencial especificar adecuadamente las condiciones del servicio que se espera recibir para brindar satisfacción a los usuarios y partes interesadas.Objetivos: Analizar el proceso y el pliego de bases y condiciones para la concesión del servicio de confitería de la FCS de la UNSa. Proponer mejoras para orientar las actividades futuras en relación a la compra, selección, preparación distribución y control del servicio. Materiales y Método: Se realizó una encuesta de satisfacción para conocer la calidad percibida por los usuarios de la confitería de la FCS. Se analizaron el proceso y los subprocesos de concesión del servicio, el pliego de condiciones mediante el cual se rige la actual concesión. Se aplicó el diagrama de Espina de Pescado para determinar la causa raíz el problema. Resultados: Los clientes manifestaron insatisfacción en relación a la variedad de preparaciones y la omisión de alimentos saludables como vegetales, pescados, lácteos descremados, jugos de frutas, cereales integrales. Problema raíz: pliego de condiciones incompleto y poco detallado. Conclusiones: El plan de mejoras en relación al pliego de bases y condiciones requiere tener en cuenta aspectos tales como: calidad de la materia prima, plan de menú, tipo y cantidad de comidas, ingredientes, formas de preparación, características físico químicas de las preparaciones saludables, porción estándar, presentación y tipos de vajilla.

Introducción: La importancia del consumo de frutas es vital debido a sus propiedades nutritivas, por su aporte de vitaminas, minerales, fibra y agua. Las Guías Alimentarias para la Población Argentina (GAPA) recomiendan el consumo diario de 2 a 3 frutas. Objetivos: Estimar la prevalencia de consumo inadecuado de frutas y determinar la prevalencia de dicho consumo por exceso o déficit, en estudiantes. Estimar la prevalencia de los motivos por los cuales no se consumen frutas en estudiantes. Materiales y método: Diseño descriptivo, observacional y transversal. La muestra quedó conformada por 486 estudiantes universitarios y terciarios. Se midió el consumo de frutas a través de una encuesta diseñada para tal fin. El análisis estadístico se realizó mediante el paquete VCCstat V.Beta 2.0. Resultados: El 23,5% de la muestra pertenecía a alguna carrera de ciencias de la salud. El 74% (IC95% 69,9-77,9) de los estudiantes no cumplió con la recomendación diaria de las GAPA. De este porcentaje, un 96,4% (IC95% 93,8-98) no llegó a consumir al menos dos frutas diarias, mientras que solo un 3,6% (IC95% 1,9-6,1) de los encuestados superó dicha recomendación. Se encontró un 34,6% (IC95%30,3-38,9) de estudiantes con consumo nulo. Entre los motivos de este hallazgo, un 72% (IC95% 64,5-78,6) lo adjudicó a la "falta de hábito". Entre los motivos restantes se destacan "no me gusta" con el 10,7% (IC95%6,4-16,4) y "falta de practicidad" con el 9,5% (IC95%,5-15). Conclusión: La mayoría de los estudiantes consume menos cantidad de frutas que la recomendada. Debido a la falta de hábito, un gran porcentaje de estudiantes no incorpora frutas en su alimentación diaria.

Adopting electronic medical records: what do the new federal incentives mean to your individual physician practice?

Under President Obama's American Recovery and Reinvestment Act of 2009, the federal government is offering incentives to physicians to adopt electronic health records. The goal is to improve quality of care and constrain costs. Higher incentive payments are available for those physicians who act quickly to meet the government's standards. Physicians who practice in "health professional shortage areas" and who serve mainly Medicaid recipients may qualify for additional incentives. Although compliance is "voluntary, "physicians who have not met the standards by 2015 will face reductions in their Medicare reimbursements unless they can show a significant hardship. Physicians can get started by contacting hospitals with which they are affiliated and professional associations to find out what vendors are being used in their service area. Agreements for electronic health records should be reviewed carefully to ensure that physicians' interests are protected.

Helicobacter spp. from gastric biopsies of stranded South American fur seals (Arctocephalus australis).

Gastrointestinal lesions with uncertain etiology have been widely described among pinnipeds. The aim of our study was to investigate the presence of Helicobacter spp. in the gastric mucosa of South American fur seals (Arctocephalusaustralis). Gastric biopsies from thirteen seals, stranded on the shores of the Southwestern Atlantic Ocean in Argentina, were evaluated for the presence of Helicobacter spp. by PCR and DNA sequence analysis. Six gastric biopsies were positive for Helicobacter spp. Pairwise sequence comparisons showed less than 95% identity to novel Helicobacter spp. described from pinnipeds from North America and Australia. However, phylogenetic analysis revealed that the South American fur seal sequences clustered with 99-100% homology with H. cetorum, a species isolated from dolphins and whales. The presence of H. cetorum in pinnipeds, if confirmed by its isolation from the gastric mucosa of these mammals, demonstrates the wide host range of this bacterium in the marine environment.

Detection of Helicobacter and Campylobacter spp. from the aquatic environment of marine mammals.

The mechanism by which Helicobacter species are transmitted remains unclear. To examine the possible role of environmental transmission in marine mammals, we sought the presence of Helicobacter spp. and non-Helicobacter bacteria within the order Campylobacterales in water from the aquatic environment of marine mammals, and in fish otoliths regurgitated by dolphins. Water was collected from six pools, two inhabited by dolphins and four inhabited by seals. Regurgitated otoliths were collected from the bottom of dolphins' pools. Samples were evaluated by culture, PCR and DNA sequence analysis. Sequences from dolphins' water and from regurgitated otoliths clustered with 99.8-100% homology with sequences from gastric fluids, dental plaque and saliva from dolphins living in those pools, and with 99.5% homology with H. cetorum. Sequences from seals' water clustered with 99.5% homology with a sequence amplified from a Northern sea lion (AY203900). Control PCR on source water for the pools and from otoliths dissected from feeder fish were negative. The findings of Helicobacter spp. DNA in the aquatic environment suggests that contaminated water from regurgitated fish otoliths and perhaps other tissues may play a role in Helicobacter transmission among marine mammals.

Why physician groups are self-insuring.

Given the medical malpractice crisis in a number of states, many physicians are looking at alternatives to conventional insurance coverage. These options typically involve some form of risk sharing where the medical group assumes additional risks based on experience. This article identifies several options-retrospective payment plans, risk retention groups, captives, and rent-a-captives--and their associated risks and opportunities.

Iron bioavailability from fortified fluid milk and petit suisse cheese determined by the prophylactic-preventive method.

In this research, we measure the iron bioavailability of micronized ferric orthophosphate when it is used to fortify low-fat fluid milk enriched with calcium and petit suisse cheese using the prophylactic-preventive method in rats. Four groups of male weaned rats received a basal diet (control diet; 6.5 ppm Fe), a reference standard diet (SO4Fe; 18.2 ppm Fe), a basal diet using iron-fortified fluid milk as the iron source (milk diet; Fe ppm 17.9), and a basal diet using iron-fortified petit suisse cheese as the iron source (cheese diet; 18.0 ppm Fe) for 22 d. The iron bioavailability of the different sources was calculated as the ratio between the mass of iron incorporated into hemoglobin during the experiment and the total iron intake per animal. The relative biological values with regard to the reference standard (RBV%) were 61% and 69% for the milk and cheese diet, respectively. These results show that according to this method, the iron bioavailability in both fortified foods can be considered as medium bioavailability rates.

Nutritional and technological behavior of stabilized iron-gluconate in wheat flour.

Food fortification has been shown to be an effective strategy to overcome iron malnutrition. When a new iron compound is developed for this purpose, it must be evaluated from a nutritional and technological point of view before adding it into foods. In this way, we have evaluated ferrous gluconate stabilized by glycine as a new iron source to be used in wheat flour fortification. We performed biological studies in rats as well as sensory perceptions by human subjects in wheat flour fortified with this iron source. The productions of pentane as a rancidity indicator as well as the change of the sensorial properties of the biscuits made with stabilized ferrous gluconate-fortified wheat flour were negligible. Iron absorption in water from this iron source was similar to the reference standard ferrous sulfate. Nevertheless, because of the phytic acid content, iron absorption from fortified wheat flour decrease 40% for both iron sources. The addition of zinc from different sources did not modify iron absorption from ferrous sulfate and stabilized ferrous gluconate in water and wheat flour. The iron absorption mechanism as well as the biodistribution studies demonstrate that the biological behavior of this iron source does not differ significantly from the reference standard. These results demonstrate that the iron source under study has adequate properties to be used in wheat flour fortification. Nevertheless, more research is needed before considering this iron source for its massive use in food fortification.

Determination of relative bioavailability of zinc in a petit suisse cheese using weight gain and bone zinc content in rats as markers.

The aim of the study was to determine the relative bioavailability of zinc gluconate stabilized with glycine in a Petit Suisse cheese from an infant dessert. Weight gain and bone zinc content were the nutritional responses evaluated for the diets of different zinc content: 2 ppm (basal) and 5, 10, and 30 ppm from zinc gluconate stabilized with glycine and zinc sulfate. Nonlinear regression analysis of the fitted curves for weight gain determined a relative zinc bioavailability of 100% for the Ymax ratio and 96% for Ymax/t1/2 ratio for zinc gluconate stabilized with glycine (R2=0.7996 for zinc sulfate and 0.8665 for zinc gluconate stabilized with glycine). The slope ratio analysis from linear regression of femur zinc determined a relative zinc bioavailability of 93% for zinc gluconate stabilized with glycine (R2=0.8693 for zinc sulfate and 0.8307 for zinc gluconate stabilized with glycine). Zinc gluconate stabilized with glycine has similar bioavailability as zinc sulfate in a Petit Suisse cheese nutritional matrix, with the advantage that the stabilized compound does not modify the sensorial characteristics of the fortified cheese.

Normal growth rate in rats is recovered after a period of zinc deficiency by restoration of zinc supply by means of a zinc-fortified Petit Suisse cheese.

Fortification of a Petit Suisse cheese with zinc sulfate and zinc gluconate stabilized with glycine was used as a tool to overcome zinc-deficiency effects on total-body growth and skeletal growth. Animals were divided in 4 groups of 10 rats: basal (B), control (C), depletion-repletion 1 (DR1), and depletion-repletion 2 (DR2). These four groups were fed with four diets: basal (2 ppm Zn), control (30 ppm Zn), DR1, and DR2; they received a basal diet for 14 d and a control diet for the other 14 d of the experiment, using zinc sulfate for DR1 and zinc gluconate stabilized with glycine for DR2. After 28 d of the experiment, total-body weight and weight gain of the control and DR1 and DR2 animals were not statistically different (p<0.05), Femur weight and femur zinc content of DR1 and DR2 did not achieve the values of control animals (p<0.05), but they were higher than that of basal animals. Our results show that restoration of dietary zinc levels by means of food fortification normalized weight gain, as an indicator of total-body growth, and presented a trend to normalize bone weight, as a marker of skeletal growth, in young rats and independently of the zinc source used.

Review article: is there a link between micronutrient malnutrition and Helicobacter pylori infection?

Helicobacter pylori causes a chronic gastric infection, which is usually life-long. Many epidemiological studies have shown that this is probably one of the most common bacterial infections throughout the world involving 30% of the population living in developed countries and up to 80-90% of the population in developing regions. Concomitantly, developing regions also have high prevalence of micronutrient malnutrition. In the last few years, some studies have suggested that H. pylori infection may affect the homeostasis of different micronutrients including iron, vitamin B12, folic acid, alpha-tocopherol, vitamin C and beta-carotene. In this article, we discuss the current scientific information of the effect that H. pylori infection may produce on micronutrient malnutrition.

Zinc deficiency and growth: current concepts in relationship to two important points: intellectual and sexual development.

Zinc deficiency remains a serious health problem worldwide affecting developed as well as developing countries. Despite the evidence proving that zinc deprivation during the periods of rapid growth negatively affects the cognitive brain as well as sexual development, there are few complete studies carried out in children. The present article proposes a revision of the evidence gathered until now on the relationship existing between zinc deficiency and intellectual and sexual development during the stages of childhood, preadolescence, and adolescence.

Metabolismo del hierro: conceptos actuales sobre un micronutriente esencial / Iron metabolism: current concepts of an essential micronutrient

Iron is an essential micronutrient involved in multiple biochemical and physiological process. In this review we discuss the most relevant aspect of its metabolism in order to reach a better comprehension of the relevant roll that this micronutrient plays in human health.

Evaluation of different formulations to label exogenous natural surfactant labeled with (99m-Tc-ENS): stability and toxicity studies

El surfactante natural exógeno (ENS) marcado con 99mTc (99mTc-ENS) es un nuevo agente ventilatorio para la centellografía aérea pulmonar. Con el fin de elegir una formulación estable de ENS para ser marcado rutinariamente con 99mTc en Centros de Medicina Nuclear, las propiedades de dos formulaciones (ENS + cloruro estannoso + ácido gentísico y ENS + cloruro estannoso + ácido ascórbico) y una formulación control liofiolizada del ENS fueron analizadas mensualmente por un período de 12 meses. Sus propiedades fisicoquímicas, sus porcentajes de marcación y sus distribuciones biológicas fueron adecuadas durante este período. La formulación ENS + cloruro estannoso + ácido gentísico presenta la menor dispersión en los resultados de biodistribución, por lo cual esta formulación fue elegida para la futura producción de 99mTc-ENS. El estudio de toxicidad aguda de esta última formulación demostró que la dosis tóxica es al menos 1000 veces mayor que la dosis diagnóstica

Effect of heated and humidified carbon dioxide gas on core temperature and postoperative pain: a randomized trial.

BACKGROUND: Intraoperative hypothermia is a common event during laparoscopic operations. An external warming blanket has been shown to be effective in preventing hypothermia. It has now been proposed that using heated and humidified insufflation gas can prevent hypothermia and decrease postoperative pain. Therefore, we examined the extent of intraoperative hypothermia in patients undergoing laparoscopic Nissen fundoplication using an upper body warming blanket. We also attempted to determine whether using heated and humidified insufflation gas in addition to an external warming blanket would help to maintain intraoperative core temperature or decrease postoperative pain. METHODS: Twenty patients were randomized to receive either standard carbon dioxide (CO2) gas (control, n = 10) or heated and humidified gas (heated and humidified, n = 10). After the induction of anesthesia, an external warming blanket was placed on all patients in both groups. Intraoperative core temperature and intraabdominal temperature were measured at 15-min intervals. Postoperative pain intensity was assessed using a visual analogue pain scale, and the amount of analgesic consumption was recorded. Volume of gas delivered, number of lens-fogging episodes, intraoperative urine output, and hemodynamic data were also recorded. RESULTS: There was no significant difference between the two groups in age, length of operation, or volume of CO2 gas delivered. Compared with baseline value, mean core temperature increased by 0.4 degrees C in the heated and humidified group and by 0.3 degrees C in the control group at 1.5 h after surgical incision. Intraabdominal temperature increased by 0.2 degrees C in the heated and humidified group but decreased by 0.5 degrees C in the control group at 1.5 h after abdominal insufflation. There was no significant difference between the two groups in visual analog pain scale (5.4 +/- 1.6 control vs 4.5 +/- 2.8 heated and humidified), morphine consumed (27 +/- 26 mg control vs 32 +/- 19 mg heated and humidified), urine output, lens-fogging episodes, or hemodynamic parameters. CONCLUSION: Heated and humidified gas, when used in addition to an external warming blanket, minimized the reduction of intraabdominal temperature but did not alter core temperature or reduce postoperative pain.

Cardiac function during laparoscopic vs open gastric bypass.

BACKGROUND: Hypercarbia and increased intraabdominal pressure during prolonged pneumoperitoneum can adversely affect cardiac function. This study compared the intraoperative hemodynamics of morbidly obese patients during laparoscopic and open gastric bypass (GBP). METHODS: Fifty-one patients with a body mass index (BMI) of 40-60 kg/m2 were randomly allocated to undergo laparoscopic (n = 25) or open (n = 26) GBP. Cardiac output (CO), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), heart rate (HR), and mean arterial pressure (MAP) were recorded at baseline, intraoperatively at 30-min intervals, and in the recovery room. Systemic vascular resistance (SVR) and stroke volume (SV) were also calculated. RESULTS: The two groups were similar in terms of age, weight, and BMI. Operative time was longer in the laparoscopic than in the open group (p < 0.05). The HR and MAP increased significantly from baseline intraoperatively, but there was no significant difference between the two groups. In the laparoscopic group, CO was unchanged after insufflation, but it increased by 5.3% at 2.5 h compared to baseline and by 43% compared to baseline in the recovery room. In contrast, during open GBP, CO increased significantly by 25% after surgical incision and remained elevated throughout the operation. CO was higher during open GBP than during laparoscopic GBP at 0.5 h and at 1 h after surgical incision (p < 0.05). During laparoscopic GBP, CVP, MPAP, and SVR increased transiently and PAWP remained unchanged. During open GBP, CVP, MPAP, and PAWP decreased transiently and SVR remained unchanged. There was no significant difference in the amount of intraoperative fluid administered during laparoscopic (5.5 +/- 1.6 L) and open (5.6 +/- 1.7 L) GBP. CONCLUSION: Prolonged pneumoperitoneum during laparoscopic gastric bypass does not impair cardiac function and is well tolerated by morbidly obese patients.

Evaluation of core temperature during laparoscopic and open gastric bypass.

BACKGROUND: Intraoperative hypothermia is a common event during open and laparoscopic abdominal surgery. The aim of this study was to compare changes in core temperature between laparoscopic and open gastric bypass (GBP). METHODS: 101 patients with a body mass index (BMI) of 40-60 kg/m2 were randomly assigned to open (n = 50) or laparoscopic (n = 51) GBP. Anesthetic technique was similar for both groups. An external warming blanket and passive airway humidification were used intraoperatively. Core temperature was recorded at preanesthesia, at baseline (after induction) and at 30-min intervals; intra-abdominal temperature was additionally measured at 30-min intervals in a subset of 30 laparoscopic GBP patients. The number of patients who developed intraoperative and postoperative hypothermia (< 36 degrees C) was recorded. Length of operation for both groups and the amount of CO2 gas delivered during laparoscopic operations were also recorded. RESULTS: There was no significant difference between groups with respect to age, gender, mean BMI, and amount of intravenous fluid administered. After induction of anesthesia, core temperature significantly decreased in both groups; 36% of patients in the open group and 37% of patients in the laparoscopic group developed hypothermia. This percentage increased to 46% in the open group and 41% in the laparoscopic group during the operation, and then decreased to 6% in the open group and 8% in the laparoscopic group in the recovery-room. Core temperature increased during the operative procedure to reach 36.5 +/- 0.6 degrees C in the open group and 36.3 +/- 0.5 degrees C in the laparoscopic group at 2.5 hours after surgical incision. Intra-abdominal temperature during laparoscopic GBP was significantly lower than core temperature at all measurement points (p < 0.05). Operative time was longer in the laparoscopic group than in the open group (232 +/- 43 vs 201 +/- 38 min, p < 0.01). Mean volume of gas delivered during laparoscopic GBP was 650 +/- 220 liters. CONCLUSION: Perioperative hypothermia was a common event during both laparoscopic and open GBP. Despite a longer operative time, laparoscopic GBP did not increase the rate of intraoperative hypothermia when efforts were made to minimize intraoperative heat loss.

Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.

OBJECTIVE: To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). SUMMARY BACKGROUND DATA: Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. METHODS: From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. RESULTS: There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. CONCLUSIONS: Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.