Análisis de la evidencia disponible para el consumo de edulcorantes no calóricos. Documento de expertos / Analysis of the available evidence for the intake of non-caloric sweeteners. Expert document

Resumen Los edulcorantes no calóricos representan una buena alternativa para sustituir los sabores dulces sin la respuesta fisiológica que genera el consumo de azúcares. Por sí solos no son herramientas para el control de peso. Su consumo debe ir acompañado de una dieta correcta y un estilo de vida saludable que incluya actividad física. Su utilidad radica en proporcionar el agradable sabor dulce sin el aporte energético. La inocuidad de cada uno de los compuestos aprobados está comprobada y se reevalúa constantemente para tomar en cuenta los resultados de nuevos estudios. Debido a que no existe un edulcorante perfecto, la variedad ayuda a que se desarrollen productos cada vez más agradables para el consumidor. Este trabajo es fruto de una revisión exhaustiva de la bibliografía y de las discusiones de un panel de expertos de diversas especialidades: toxicología, ginecoobstetricia, pediatría, endocrinología, nutrición, medicina interna, salud pública y medicina preventiva, en el que se analizó extensamente la bibliografía se revisó una variedad de trabajos científicos que responden a las interrogantes que habitualmente se hacen los profesionales de la salud acerca de seguridad en diferentes grupos etáreos y con afecciones específicas, ingestión diaria admisible, etc.

Abstract Non-caloric sweeteners are a good alternative to replace the sweet flavors without the physiological response generated by the consumption of sugars. Alone they are not tools for weight control. Its intake must be accompanied by a proper diet and a healthy lifestyle that includes physical activity. Its usefulness lies in providing a pleasant sweet taste without the energy intake. The safety of each of the compounds is tested and approved and constantly reassessed to take into account the results of new studies. Since there is no perfect sweetener, variety helps that more and more pleasing to the consumer products are developed. This work is the result of a comprehensive review of the literature and discussions of a panel of experts from various specialties: toxicology, obstetrics and gynecology, pediatrics, endocrinology, nutrition, internal medicine, public health and preventive medicine, where literature was widely analyzed reviewing a variety of scientific papers that address the questions that usually are made by health professionals on safety in different age groups and with specific diseases, acceptable daily intake, etc.

Design and implementation of an integrated management system for ochratoxin A in the coffee production chain.

Coffee is an important export product of Ecuador. Producers are challenged by the implementation of regulatory limits for ochratoxin A. Ecuador has four coffee production areas and the potential for mycotoxin contamination varies due to different environmental conditions and cultural differences in harvesting, storage, processing and commercialization. The major contributors to contamination are the lack of selection during harvesting, delays in drying or rewetting, the lack of proper drying and storage conditions, the mixing of products with different levels of moisture, and the potential for cross-contamination. The long commercialization chain involves different intermediaries that use foreign materials to increase the weight of the product without consideration of quality. An integrated mycotoxin management system using the Hazard Analysis Critical Control Point Systems (HACCP) principles was developed to prevent mycotoxin contamination at each stage of production. Critical control points were developed based on the resources available at the different stages of the production chain. Training programmes helped increase awareness about the impact of contamination, but failed to transform knowledge into improved practices. Thus, different demonstrative models specific for each productive region at all production levels were developed to show the application of prevention mechanisms using limited resources and to demonstrate the increased commercial value of coffee produced using good practices throughout the chain so producers have a better disposition to adopt improved practices. Preliminary results show that coffee managed using the models had a better quality, a lower contamination, a higher yield and better commercial value. The use of local resources and low-cost technology was important in demonstrating the practical approach.

[The role of vibroacoustic stimulation in antenatal fetal assessment]. / Papel de la estimulación vibroacústica en la evaluación fetal anteparto.

The value of antepartum fetal heart rate testing has been debated in the last few years. According to several research works, the fetal sleeping periods lead to falsely nonreactive tests. These increase the risk and costs of obstetric care. A randomized prospective clinical trial was undertaken in high risk pregnancies to compare the standard nonstress test with the fetal vibroacoustic stimulation. Acoustic stimulation during 5 seconds with a 75 Hz frequency and 74 dB intensity device was applied to the patients in the study group. Nonreactive results were obtained in 11% of the control group and 3.4% in the study group (z = 2.07, p = 0.00116). A reduction of 5 minutes in the length of the test was observed in the study group. Fetal acoustic stimulation should be considered an alternative to improve the efficacy of nonstress testing, by reducing falsely nonreactive tests results and the time it takes to perform them.

[Medical treatment of uterine leiomyomatosis with an agonist of pituitary gonadotropins (GnRH). Presentation of a case]. / Tratamiento médico de leiomiomatosis uterina con un agonista de gonadotropinas hipofisarias (GnRH). Presentación de un caso.

The uterine leiomyomatosis represents the largest amount of tumors of the uterus, and the treatment in most of the cases is surgical. This tumor of smooth muscle has been associated with the stimulus given of sexual steroids, mainly estrogens. Several analogues by the hypothalamic hormone liberating gonadotropins (GnRH) show an stimulating-inhibiting action upon hypophyseal gonadotropins secretion (LH-FSH), variable effect on ovarian steroidogenesis, depending on the dose and frequency of use. When the decapeptide is used daily and during more than a month, it may block the production of LH, FSH and estrogens, and produces amenorrhea. As uterine myomatosis is a condition that may depend on estrogens, it was decided to treat with an analogue of GnRH (Intranasal Buserelin Acetate), one patient, 28 years old with clinical, histopathologic and ultrasonographic of uterine myomatosis, who presented manifestations of hypochromic, microcytic anemia by frequent intermenstrual bleedings. The application of GnRH analogue was done daily during eight months. The therapeutical result control of the tumor was done by an ultrasonographic study and with hysterosalpingography, before and after. The treatment was stopped because there was a significant diminution in the tumor size and bleeding disappearance. Two months of follow up have not shown changes.

[Human chorionic somatomammotropin (HCS) and placental volume]. / Somatomamotropina coriónica humana (HCS) y volumen placentario.

Human chorionic somatomammotropin (HCS), is synthesize and secreted by the syncytiotrophoblast. Its effects on maternal metabolism are significant but the role of this hormone upon fetal development remains unknown. Nonetheless its measurement during final stages of pregnancy has proved to be useful for prediction of outcome. Since HCS serum levels exhibit progressive augmentation throughout gestation and taking into account its site of origin it has been proposed that could be dependent of changes in placental mass. This has not been totally ascertained, due to the lack of precision of studies designed for this purpose. If a correlation between HCS secretion and placental growth cold be established, it might be expected that determination of both indexes would contribute to obtain a more accurate diagnosis of abnormalities in retroplacental of fetal circulating blood volume. Therefore we studied 55 females without complicated pregnancy whose placental volumes were measured through ultrasound scanning. Serum samples were also collected for HCS quantitation by radioimmunoassay. Determinations were made starting on the 12th week of pregnancy. A progressive as well as a parallel increase of placental volume (154.12-825.01 ml) and HCS (0.48-7.0 Ug/ml) was observed during gestation. The correlation coefficient (r = 0.546) was significant (p less than 0.01). Both parameters correlated also with those obtained for fetal biparietal diameters. These findings support the notion that HCS secretion is proportional to the volume/mL of placental tissue which might be related to the amount of syncytiotrophoblast cells. It was not possible to establish causation upon the correlation observed between HCS and fetal parietal diameters.

[Chorionic gonadotropin (beta-HCG) in the amniotic fluid in normal pregnant women]. / Gonadotropin coriónica (beta-HCG) en el líquido amniótico de embarazadas normales.

Human chorionic gonadotropin beta subunit (beta-HCG) was measured in amniotic fluid and radioimmunoassay levels compared with those obtained in plasma from normal pregnant women. Amniotic beta-HCG exhibited a secretory pattern similar to that seen in the plasma compartment. Nonetheless amniotic beta-HCG had an elevation peak later than its plasma counterpart, with a progressive decrease that persisted throughout gestation without reaching a nadir as it occurred in plasma. Such a pattern of HCG production contained in the amnion is compatible with an HCG conformation released by the syncytiotrophoblast.

[Clinical characterization of a sample of newborns at risk of presenting with an altered neurologic evaluation]. / Caracterización clínica de una muestra de recién nacidos en riesgo de presentar una evaluación neurológica alterada.

Being the Prachtl's Neurological Sieve a systematic condense analysis of neurologic screening which allows to establish a normal or suspicious neurologic condition at a sensibility of 0.85, and specificity of 0.77 with a predictive value of 0.78 (in our experience), we take it as an axis variable capable to discriminate among the population with and without risk of neurologic injury or sequela. Thirty-five newborn infants with an Apgar score at birth equal or below 6, were taken into study for the purpose of featuring the group of neonates on risk to show an altered neurologic evaluation. The study was held under the hypothesis that: low Apgar score, and morbidity and mortality risk index, need to be complemented with hospital outcome (Casaer) and the estimation of factors affecting physical and mental development (Eggermont), in order to be able to feature those neonates in risk for developing a neurologic injury or sequela. Findings showed that Prechtl's Neurological Sieve is directly influenced by the magnitude of recovery from the one to five minutes Apgar Score, by the Casaer's first or initial score and by the Eggermont's assessment items. It is also related in an indirect way to the birth weight, the gestational age, the morbidity and mortality risk index, the 1 and 5 minutes Apgar score and the final or discharge Casaer evaluation.

[Premature rupture of membranes and chorioamnionitis]. / Ruptura prematura de membranas y corioamnionitis.

PIP: Despite advances in perinatal medicine in the past decade, the diagnosis and treatment of premature rupture of membranes remain controversial. Premature rupture occurs in 2.7-7.0% of pregnancies and most cases occur spontaneously without apparent cause. The disparity in reported rates of premature rupture is due to differences in the definition and diagnostic criteria for premature rupture and lack of comparability in the populations studied. Mexico's National Institute of Perinatology has adopted the definition of the American COllege of Gynecology and Obstetrics which views premature rupture as that occurring before regular uterine contractions that produce cervical dilation. 8.8% of its patients have premature rupture according to this definition. 20% of cases occur before the 36th week of pregnancy. Treatment of rupture occurring before 37 weeks must balance the threat of amniotic infection with the dangers of premature birth. Infections appear more common in low income patient populations. Chorioamnionitis is a serious complication of pregnancy and is the main argument against conservative treatment of premature rupture. The rate of maternal infection is directly related to the time elapsing between rupture of the membranes and birth. The rate increases after the 1st 24 hours and is at least 10 times higher after 72 hours. But recent studies suggest that there is no considerable increase in infection if vaginal explorations are avoided and careful techniques are used in treating the patient. Those who advise conservative treatment believe that prenatal outcomes are better because respiratory disease syndrome due to prematurity is avoided. Conservative management requires a white cell count at least every 24 hours and measurement of pulse, maternal temperature, and fetal heart rate ideally every 4 hours. Perinatal mortality rates due to premature rupture of membranes range from 2.5-50%. The principal causes are respiratory disease syndrome, infection, asphyxia, and congenital malformations. Neonatal sepsis occurs in about 5% of live births following premature rupture, but the rate triples after 24 hours, especially in premature infants. The rate of neonatal asphyxia also increases considerable after 24 hours. Congenital malformations, prolapse of the cord, and pelvic presentation are positively associated with premature rupture of membranes. If the decision is made to interrupt the pregnancy, it should be done between 12-24 hours after rupture because the risks of infection and respiratory difficulty are most balanced at that point. Vaginal deliveries should be preferred only if conditions are favorable for a prompt delivery. The gestational age, presence of infection, obstetric condition of the mother, and indication for hysterectomy are the most important points to consider i management of premature rupture.^ieng

Validacion clinica de las pruebas cardiotocograficas anteparto. / Clinical value of cardiotocographic antepartum tests

Se hace una revision historica referente a la inquietud que en la practica de la obstetricia se ha tenido para conocer el estado del feto, especialmente en los embarazos de riesgo elevado, hasta llegar al estado actual de conocimientos y recursos tecnologicos. Se analiza la experiencia de los autores con 200 registros de pruebas sin stress y de tolerancia a la ocitocina con objeto de determinar tanto su sensibilidad y especificidad, como su excludibilidad y diagnosticabilidad, concluyendose lo siguiente: la especificidad mayor que la sensibilidad en ambas pruebas, las cuales se ven influenciadas por la prevalencia de la enfermedad que se estudie. La prueba de tolerancia a la ocitocina en la que se emplean todos los elementos de juicio tiene mayor diagnosticabilidad que la prueba sin stress y en lo que se refiere a la excludibilidad practicamente no existe diferencia entre las dos pruebas

[Obstetrics and perinatal medicine]. / Obstetricia y medicina perinatal.

PIP: Perinatal medicine concerns the period from delivery to the 1st 28 days of life; it includes maternal-fetal and neonatal medicine and the intervention of the specialist in internal medicine, obstetrics, and pediatrics. Currently, factors related to increased obstetrical, fetal or neonatal risk have been used to establish indices to aid the identification of the population more at risk of perinatal morbidity/mortality. A high risk newborn has been defined as presenting possible physical, intellecteual, or social problems which can negatively influence his or her normal development and/or learning abilities. Retrospective analyses conducted in Great Britain and in the U.S. showed that about 19% of the population falls into this category; the percentage is much higher in less industrialized countries. Modern technology can detect 70-80% of cases at risk of perintatal morbidity and mortality, and can intervene, even before delivery, with fetal intrauterine transfusion, fetal monitoring of the heart, and amniocentesis. Perinatology cannot exist without proper equipment and highly specialized personnel, which have been the major cause for the spectacular decrease in neonatal mortality experienced in many countries; still, neonatal mortality is about 4 times higher than general mortality. Many physicians consider family planning an integral part of any neonatal medical program. Several statistics show that 75% of anatomical or functional alterations are due to factors present before birth; such alterations can be epilepsy, mental retardation, deafness, blindness, or cerebral paralysis. Statistics for Mexico show the presence of about 600,000 individuals with serious and permanent problems due to sequelae of perinatal morbidity. Cause-effect relationships are extremely difficult to establish; the influence of socioeconomic factors, low birth weight, or reduced gestational age can be of paramount importance in influencing perinatal morbidity/mortality.^ieng