Consenso experto sobre los aspectos nutricionales de las leches infantiles de inicio y continuación / Expert consensus on the nutritional aspects of initial and follow-on infant formulas

INTRODUCCIÓN: La alimentación infantil en los primeros meses/años de vida condiciona la salud a corto y largo plazo. La lactancia materna es la alimentación ideal por sus innumerables beneficios. Sin embargo, cuando no es posible la alimentación con leche materna, las fórmulas infantiles constituyen la mejor alternativa. El objetivo del estudio fue definir el papel de las fórmulas de inicio y continuación para lactantes mediante la opinión de un panel de expertos en gastroenterología y nutrición infantil. MATERIAL Y MÉTODOS: Encuesta realizada mediante el método Delphi por 48 especialistas en pediatría y nutrición infantil. El cuestionario constaba de 62 ítems, estratificados en 5 bloques, sobre aspectos nutricionales de las fórmulas infantiles. RESULTADOS: Se consensuó el 64,6% de los ítems, estableciéndose un acuerdo no unificado respecto a aspectos nutricionales y su impacto sobre el desarrollo corporal, cerebral y la maduración inmune. CONCLUSIONES: Según los expertos encuestados, existe consenso sobre la adecuada composición en lípidos, lactosa, calcio, vitamina D y prebióticos, de las fórmulas infantiles, para el correcto desarrollo cerebral, inmunitario y somático. No hubo consenso en aspectos aún no bien definidos, como la calidad nutricional de las proteínas, la utilización de espesantes y la suplementación con taurina, probióticos y simbióticos. Son necesarios más estudios que determinen estos aspectos

INTRODUCTION: Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition. MATERIAL AND METHODS: A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas. RESULTS: A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity. CONCLUSIONS: According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects

[Expert consensus on the nutritional aspects of initial and follow-on infant formulas]. / Consenso experto sobre los aspectos nutricionales de las leches infantiles de inicio y continuación.

INTRODUCTION: Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition. MATERIAL AND METHODS: A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas. RESULTS: A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity. CONCLUSIONS: According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects.

Id-1B, an alternatively spliced isoform of the inhibitor of differentiation-1, impairs cancer cell malignancy through inhibition of proliferation and angiogenesis.

Id-1 is a member of the helix-loop-helix family of proteins that regulates the activity of transcription factors to suppress cellular differentiation and to promote cell growth. Overexpression of Id-1 in tumor cells correlates with increased malignancy and resistance to chemotherapy and radiotherapy. Id-1B is an isoform generated by alternative splicing that differs from the classical Id-1 in the 13-C-terminal amino acids, whose function is at present unknown. We have studied the role of Id-1B in cancer and its expression in healthy/malignant lung tissues. Overexpression of Id-1B in A549 lung and PC3 prostate cancer cells reduced anchorage-dependent and independent proliferation and clonogenic potential. Moreover, it increased the proportion of cells in the G0/G1 phase of the cell cycle and p27 levels, while reduced phospho-Erk and cyclin A levels. Through microarray analysis, we identified genes involved in cell growth and proliferation that are specifically deregulated as a consequence of Id-1B overexpression, including IGF2, BMP4, Id2, GATA3, EREG and AREG. Id-1B overexpressing cells that were treated with 4Gy irradiation dose were significantly less resistant to cell death. In vivo assays demonstrated that tumors with high Id-1B levels exhibited less growth (p<0.01), metabolic activity (glucose uptake) and angiogenesis (p<0.05) compared to tumors with low Id-1B expression; mice survival was significantly extended (p<0.05). Quantification by qRT-PCR revealed that expression of Id-1B was significantly lower (p<0.01) in human lung tumors compared to their matched nonmalignant counterparts. In conclusion, our results demonstrate that Id-1B decreases the malignancy of lung and prostate cancer cells, sensitizes them to radiotherapy-induced cell death, and counteracts the protumorigenic role of the classical form of Id-1.

Evaluación de la toxicidad del extracto acuoso de las hojas de yacón (Smallanthus sonchifolius) administrado por vía oral en ratas / Evaluation of the subchronic toxicity of oral admnistration of aqueous extract of yacon leaves (Smallanthus sonchifolium) in rats

El Smallanthus sonchifolius, oriundo de los Andes y llamado vulgarmente yacón, es conocido por su uso como normoglicemiante e hipolipemiante así como por su utilidad como antioxidante. En la presente investigación evaluamos la toxicidad subcrónica del extracto acuoso de sus hojas, luego de su administración oral en ratas albinas Holtzman. Objetivo: Evaluar la toxicidad del extracto acuoso de las hojas de yacón en ratas albinas sanas. Material y método: Se realizó un estudio experimental en 40 ratas Holtzman, distribuidas en dos grupos (hembras y machos), a las cuales se administró, por vía oral, durante 90 días, dosis de 100, 200 y 500 mg/Kg/día, del extracto acuoso de hojas de yacón. Se tomaron muestras de sangre del plexo orbital del ojo a los 0, 45 y 90 días para llevar a cabo análisis bioquímicos y hermatológicos. Se realizaron, además exámenes histopatológicos de cerebro, hígado y riñones. Resultados: No se encontraron variaciones significativas en ninguno de los exámenes en comparación con las ratas controles (p ø 0.05). Conclusión: El consumo del extracto de hojas de yacón, durante 90 días, no produjo signos de toxicidad en los órganos estudiados.

The Smallanthus sonchifolius, vulgarly known as yacon, an Ades's species is well known for its use as by it's normoglycemic, hipolipemic and antioxidant effects. There are only few studies on this plant. At present we have investigations about it's chemical composition, harverts process, and medical use. In this paper we evaluated the toxicity of the aqueous extract of the organic leaves of Smallanthus sonchifolius on Holtzman albin rats subcronic oral administration of the extract during 90 days. Objective: To evaluate the subchronic toxicity of aqueous extract of the yacon leaves on healthy albina rats. Material and method: An experimental study has been performed on 40 Holtzman rats. Male a female rats were grouped separately. They received oral daily doses of 100, 200 y 500 mg/Kg/ yaconÆs leaves aqueous extract. Blood samples were taken from the rat orbital plexus of the rats at 0,45 and 90 days of treatment for biochemical and haematologic analysis. Histological examination of brain, liver and kigneys was also done. Results: Non significant differences were found in the examinations of the three groups in comparison with control (p ø 0.05). Conclusion: The Smallanthus sonchifolius aqueous extract consumption during 90 days did not produce toxicity signs in the organs studied.

Effect of yacon (Smallanthus sonchifolius) on colonic transit time in healthy volunteers.

BACKGROUND: Yacon is a root crop which contains high amounts of fructooligosaccharides (FOS). The aim of this study was to investigate the effects of yacon syrup on colon transit time in healthy volunteers. METHODS: In a placebo-controlled, double-blind study yacon was administered to 16 healthy individuals (8 males, 8 females) in a dose of 20 g daily (equal to 6.4 g FOS) in a 2-week crossover design. Each period was interrupted by a 2-week wash-out phase. Transit time was assessed by a radio-opaque marker technique. RESULTS: Transit time (mean +/- SEM) through the gastrointestinal tract was significantly decreased from 59.7 +/- 4.3 to 38.4 +/- 4.2 h (p < 0.001). Yacon was well tolerated with an excellent side effect profile. Bloating is not an uncommon side effect observed with FOS, but bloating-related disturbances were not significantly more often reported with yacon compared to placebo. Stool frequency increased from 1.1 +/- 0.1 to 1.3 +/- 0.2 times per day and the consistency showed a tendency for softer stools as assessed by a numerical depicted stool protocol. Neither parameter did, however, reach statistical significance. CONCLUSION: Yacon markedly accelerates colonic transit in healthy individuals. Further studies are needed in constipated patients to confirm these preliminary data. Due to the low caloric content of yacon, the root could be a useful treatment in constipated diabetics or obese patients.

Celopatía alcohólica: un antiguo y actual dilema / Alcoholic jealousy: an old and current dilemma

La relación entre el alcohol y los celos es una creencia asentada tanto entre la población en general como dentro del mundo médico y psiquiátrico en particular. Por otra parte, en estos años está aumentando el interés sobre los aspectos forenses que tienen los celos patológicos, ya que muchas veces son causa de grave violencia, homicidio y suicidio. Autores clásicos han descrito una alta prevalencia de celos patológicos en pacientes alcohólicos e incluso se llegó a dar a la celopatía un valor patognomónico de alcoholismo. Sin embargo, estudios de estos últimos años ponen en cuestión dicha relación y llaman la atención sobre otros factores. En este trabajo analizamos la información proporcionada por la bibliografía disponible con el propósito de añadir luz sobre la valoración de un concepto tan clásico como poco estudiado. Los resultados muestran distintas definiciones y clasificaciones de los celos patológicos y aunque en la mayoría de los estudios se destaca la prevalencia de celopatía en los alcohólicos se cuestiona su carácter patognomónico. También se plantea en los artículos revisados la existencia de celos patológicos en pacientes con otras patologías psiquiátricas distintas al alcoholismo, señalándose que hay factores predisponentes y desencadenantes que explicarían el desarrollo de la celopatía. Las importantes dificultades metodológicas de los artículos publicados y la escasez de estudios disponibles no permiten confirmar la etiología alcohólica de la celopatía, por lo que es bastante controvertido considerar la celopatía alcohólica como entidad específica. Incluso, habría que considerar que el diagnóstico más preciso en estos pacientes sería el de trastorno paranoide en combinación con la dependencia alcohólica, es decir considerarlos como un diagnóstico dual

The relation between alcohol and jealousy is a deeply rooted belief within the general population as well as in the medical, and particularly psychiatric, environment. Furthermore, in recent years there has been a growing interest on the forensic aspects of pathological jealousy, since they are a frequent cause of severe violence, homicide and suicide. Some authors have described a high prevalence of pathological jealousy in alcoholic patients, even awarding it a pathognomonic value in alcoholism. Nevertheless, recent studies do not completely support this relation, and draw attention to other factors. Results from the various studies contain several definitions and classifications of pathological jealousy, and although most of them highlight the prevalence of jealousy in alcoholic patients, they question its pathognomonic quality. Also, the presence of pathological jealousy in subjects with psychiatric disorders other than alcoholism is suggested, indicating the existence of predisposing and triggering factors which could explain the development of pathological jealousy. Yet, the important methodological difficulties in the published articles and the shortage of studies do not allow the confirmation of the alcoholic etiology in pathological jealousy; this is the reason why considering alcoholic jealousy as a separate entity is debatable. In this sense, the best diagnosis in these patients would be paranoid disorder combined with alcoholic dependence, hence, a dual diagnosis

Síndrome depresivo y craneofaringioma / Depressive disorder and craniopharyngioma

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Tratamiento inmediato o tardío con imipenem en pacientes con cáncer y neutropenia por quimioterapia a dosis altas: Resultados de un estudio comparativo aleatorizado / Immediate vs. delayed imipenem treatment in cancer patients with profound neutropenia induced by high-dose chemotherapy: Results of a randomized study

Se realizó un estudio para comparar el uso profiláctico de imipenem cuando aparece neutropenia intensa (tratamiento inmediato) y el uso terapéutico de imipenem cuando se inicia una fiebre neutropénica (tratamiento tardío) en pacientes con cáncer tratados con quimioterapia a dosis altas. Participaron 65 pacientes que iban a recibir dos ciclos de quimioterapia con ciclofosfamida, etopósido y cisplatino (CEP) a dosis altas. Se distribuyó aleatoriamente a los pacientes en dos grupos para recibir imipenem al aparecer neutropenia (brazo tratado con imipenem inmediato, brazo con tratamiento profiláctico) o bien al inicio de una fiebre relacionada con la neutropenia (brazo tratado con imipenem tardío, brazo con tratamiento terapéutico). Cuando se llevó a cabo el segundo ciclo de quimioterapia CEP, se cruzaron los tratamientos con imipenem. De los 65 pacientes, 41 recibieron los dos ciclos previstos y 24 sólo el primer ciclo. En comparación con el brazo de imipenem tardío, el brazo tratado con imipenem inmediato se asoció a una menor incidencia de fiebre (86,3 por ciento frente al 100 por ciento, p=0,0142) y a menos infecciones por gramnegativos (4/51 [7,8 por ciento] frente a 14/55 [25,5 por ciento], OR=0.24, p=0.031). Hubo menos episodios de neumonía (2 por ciento frente a 12,7 por ciento), "shock" séptico (0 por ciento frente a 3,6 por ciento) y muertes debidas a infección (0 por ciento frente a 3,6 por ciento), aunque estas diferencias no llegaron a ser estadísticamente significativas. Con respecto al imipenem de administración tardía, por cada siete pacientes tratados con imipenem inmediato se evitó un episodio de fiebre relacionada con la neutropenia; por cada seis pacientes tratados con imipenem inmediato se evitó un caso de infección por gramnegativos; y por cada nueve pacientes tratados con imipenem inmediato se evitó un episodio de neumonía. No hubo diferencias en la incidencia de infecciones por grampositivos ni en la duración de la hospitalización entre los dos brazos de tratamiento. En conclusión, y comparado con el uso tardío convencional, el tratamiento con imipenem inmediato reduce la frecuencia de neutropenia febril y las infecciones por gramnegativos en los pacientes que reciben quimioterapia a dosis elevadas. (AU)

Immediate vs. delayed imipenem treatment in cancer patients with profound neutropenia induced by high-dose chemotherapy: results of a randomized study.

A study was carried out to compare the use of prophylactic imipenem administered at the onset of profound neutropenia (immediate) with therapeutic imipenem administered at the onset of neutropenic fever (delayed) in cancer patients treated with high-dose chemotherapy. A total of 65 patients who were scheduled to receive two cycles of high-dose cyclophosphamide, etoposide, cisplatin (CEP) chemotherapy were randomized to receive imipenem either at presentation of neutropenia (immediate imipenem arm, prophylactic arm) or at commencement of neutropenic fever (delayed imipenem arm, therapeutic arm). Treatment was crossed over when the second CEP chemotherapy cycle was received. Of the 65 patients, 41 received the two planned cycles and 24 received only the first. Compared with the delayed imipenem arm, the immediate imipenem arm was associated with lower fever incidence (86.3% vs. 100%, p=0.0142) and Gram-negative bacteria infection [4/51 (7.8%) vs. 14/55 (25.5%), OR=0.24, p =0.031]. There were fewer episodes of pneumonia (2% vs. 12.7%), septic shock (0% vs. 3.6%) and deaths from infection (0% vs. 3.6%), but these differences did not reach statistical significance. With regard to delayed imipenem, for every seven patients with immediate imipenem, one episode of febrile neutropenia was avoided; for every six patients administered immediate imipenem, one case of Gram-negative infection was avoided; and for every nine patients administered immediate imipenem, one episode of pneumonia was avoided. There were no differences in the incidence of Gram-positive infections nor in the length of hospitalization between the two treatment arms. In conclusion, compared to its conventional delayed use, immediate imipenem significantly reduces the frequency of febrile neutropenia and Gram-negative infections in patients with high-dose chemotherapy.

[PET detection of recurring rectal adenocarcinoma in an unusual location. Case report]. / Detección mediante PET de recidiva de adenocarcinoma rectal de localización inusual. A propósito de un caso.

A rare pattern of colon cancer recurrence is presented. A 63-year-old man underwent surgical resection after diagnosis of colon cancer. The postsurgical-pathologic examination showed a stage II colon cancer (MAC B2). Six courses of adjuvant chemotherapy (Mayo protocol) were started within four weeks of surgery. During follow-up, serial serum carcinoembryonic antigen levels became progressively elevated in an otherwise asymptomatic patient who showed no signs of recurrence in any of the conventional imaging tests performed (chest X-ray, abdominal ultrasound, and abdominal CT-scan). Positive findings suggesting lymph node mediastinal metastases were present in the PET scan. Surgical resection and pathologic examination demonstrated metastases of colon adenocarcinoma.

[Primary retroperitoneal hydatid cyst]. / Quiste hidatídico retroperitoneal primario.

OBJECTIVE: To review the pathogenesis, clinical features and treatment of a rarely observed site of presentation of hydatid cyst. METHODS/RESULTS: A case of an isolated retroperitoneal hydatid cyst is presented. Diagnosis was based on the immunodiagnostic test and radiological examination. Treatment was by surgery. CONCLUSIONS: Isolated retroperitoneal hydatic cyst is rare. The abdominal mass is the most frequent sign, and less frequently, concomitant compressive syndrome. Diagnosis is based on the biological examinations, percutaneous puncture and radiological findings. Treatment is by surgery. Azoles are useful for intraoperative ruptured cysts and to reduce the risk of recurrence.

Methotrexate, uracil and tegafur, and leucovorin chemotherapy for patients with breast cancer in progression after high-dose chemotherapy with peripheral blood progenitor cell transplant: a phase II study.

Thirty-four patients with metastatic breast cancer (MBC) who had progression of disease after high-dose chemotherapy (HDCT) with peripheral blood progenitor cell support (PBPC) had methotrexate, uracil and tegafur (UFT), and leucovorin (MUL) therapy administered: methotrexate administered intramuscularly in combination with UFT given orally and leucovorin given orally. All patients had received extensive prior chemotherapy including a high-dose regimen with PBPC support. Two complete responses (CR) and 11 partial responses (PR) were observed (objective response rate: 13/34 or 38%, 95% confidence interval 22-56%). Seven additional patients had stable disease (SD), 4 of whom (12% of the total population) of 6 months or longer duration, with the clinical benefit rate (CR + PR + SD of at least 6-month duration) reaching 50%. Median follow-up was 38 months, and the median time to progression and the median overall survival time from the start of MUL were 5.5 and 11 months, respectively. Toxicity was mainly gastrointestinal. Eight patients (24%) had World Health Organization grade II or greater diarrhea and/or enteritis and, consequently, the UFT dose was reduced. Emesis was mild and easily manageable with thiethylperazine given orally. The regimen did not produce significant myelosuppression or alopecia. In conclusion, patients with MBC retain chemosensitivity even when they progress after HDCT/PBPC and can be treated again with chemotherapy. MUL is active and well tolerated in patients with MBC progressing after HDCT. Further studies with this regimen, as salvage chemotherapy or as maintenance chemotherapy after HDCT/PBPC, would appear to be warranted.

[The evaluative cycle of the process of an overall geriatric evaluation program at a health center]. / Ciclo evaluativo del proceso de un programa de valoración geriátrica global en un centro de salud.

OBJECTIVE: To improve the procedures in an Elderly Persons' Care programme. DESIGN: A complete evaluative cycle of the care process, with an analysis phase and a phase to implement corrective measures. SETTING: Primary care. Ortuella (Bizkaia) Health Centre. PATIENTS AND PARTICIPANTS: Data on the first 50% on the list of residents over 75 in Ortuella were analysed in this evaluation (n = 249). Residents in elderly people's homes, people passing through and who had recently moved were excluded. In the re-evaluation all those still to be evaluated were analysed once corrective measures had been implemented (n = 81). INTERVENTIONS: After analysis of the first phase, corrective measures were applied, and both the coverage and the correct performance of activities generated in the development of the programme were re-evaluated. MEASUREMENTS AND MAIN RESULTS: There was similar coverage (72.3 to 66.7%). There was improvement in registration (76.9 to 90.7%), long-treatment card (60 to 85.7%), medicines (42.9 to 75%) and nutritional habits (46.1 to 57.1%). Action taken on visual (93.1 to 75%) and hearing (76 to 71.4%) pathologies deteriorated. CONCLUSIONS: The programme's procedures improved with simple corrective measures (a session concerning proper recording of the history and how to follow the protocol; professionals who controlled registration and coverage). A proper record was important.

[Verrucous carcinoma of the penis: local excision with the Mohs micrographic technique]. / Carcinoma verrucoso de pene: exéresis local mediante técnica micrográfica de Mohs.

OBJECTIVES: We report on two cases of verrucous carcinoma of the penis that had been treated conservatively by local excision using the Mohs micrographic technique. METHODS/RESULTS: The clinical features, diagnosis and treatment of verrucous carcinoma of the penis are discussed. CONCLUSIONS: Local excision according to the Mohs micrographic technique may suffice in cases with non-invasive verrucous carcinoma of the penis. If the lesion involves the penile shaft, partial or total amputation of the glans penis is indicated, depending on the degree of involvement. Lymphadenectomy does not appear to be necessary since lymph node metastasis is rare.

[Uses of endoscopic video-camera in open surgery]. / Usos de la vídeo-cámara endoscópica en cirugía abierta.

OBJECTIVES: To describe a method to obtain images of open surgery at the lowest possible cost. The images provide useful information for patient records and teaching. METHODS: We have utilized a submersible endoscopic camera with no special features, close up lenses or automatic focussing device and a color printer. RESULTS: The quality of the images are similar to those obtained with a more sophisticated video camera. The pictures were processed with a video printer. CONCLUSIONS: We believe that using the endoscopic camera in open surgery is a low-cost alternative to the more sophisticated video camera systems.

[The adaptation for a health centre of a functional screening process aimed at elderly people]. / Adaptación de un screening funcional dirigido a población anciana en un centro de salud.

OBJECTIVE: To find out what the functional capacity of people aged 75 or over is and to adapt the screening questionnaire for further use. DESIGN: Descriptive crossover study. SETTING: Health Centre. PATIENTS AND OTHER PARTICIPANTS: People aged 75 or over registered at the Health Centre (HC). 78 people were chosen by systematic sampling. There were 18 losses. MEASUREMENTS AND MAIN RESULTS: A screening questionnaire was administered to make a clinical, functional and social assessment and record problems and performances. The average time taken per questionnaire was 28 minutes (SD 6.9). 76.7% completed it at the HC. There was a notably high percentage of problems detected (21.8%): 209 out of the 960 possible boxes for problems. Over 40% of these problems--with the exception of boxes for economic status and mobility--had previously either not been identified or were not treated. Hearing, sight and teeth were the most frequent complaints (33.3%, 51.6% and 51.6%, respectively) and were unidentified or untreated in 85%, 67.7% and 80.6% of cases. CONCLUSIONS: We consider that the systematic installation of this adapted screening method would be useful.

[Spontaneous perirenal hematoma. Report of 2 cases]. / Hematoma perirrenal espontáneo. Aportación de dos casos.

We report on two cases of spontaneous perirenal hematoma secondary to ruptured angiomyolipoma in a patient with tuberous sclerosis and another patient with a simple renal cyst. The diagnostic and therapeutic aspects of this rare disease entity are discussed.

[Syringocele of the Cowper's glands in adults: presentation of a case]. / Siringocele de las glándulas de Cowper en el adulto: presentación de un caso.

Enlargement of Cowper gland ductus (syringocoeles) is an uncommon lesion, normally found in children and young adults. The paper presents a case of one adult syringocoele, treated through transurethral route, and reviews the lesion's etiology, clinic, radiology and therapy.