Desafío diagnóstico y terapéutico de carcinoma mucoepidermoide palatino: reporte de un caso

Resumen Las neoplasias en glándulas salivales son infrecuentes, representando menos del 3% de los tumores de cabeza y cuello. El carcinoma mucoepidermoide es el tumor maligno más común en glándulas salivales, siendo su principal ubicación la parótida. Clínicamente se asemeja a otras lesiones de mucosa oral, por lo cual, es importante realizar un correcto diagnóstico diferencial. Su comportamiento biológico se relaciona con el grado histológico tumoral, factor relevante en el pronóstico y tratamiento de esta neoplasia. Presentamos el caso de un paciente hombre de 75 años afectado con un tumor en paladar con diagnóstico de carcinoma mucoepidermoide de bajo grado. Como tratamiento se realizó una maxilectomía parcial y una placa obturadora en base a una prótesis removible y posterior reconstrucción con un colgajo libre microvascularizado. Actualmente el paciente se encuentra en controles periódicos, libre de enfermedad. Los tumores de glándulas salivales son un desafío diagnóstico, requieren de exámenes imagenológicos y del estudio histopatológico. Cuando existen dudas en el diagnóstico, se debe considerar repetir la toma de la muestra o la obtención de biopsias de más de una zona representativa que permita el diagnóstico de la lesión.

Abstract Salivary gland neoplasms are infrequent lesions representing less than 3% of head and neck tumors. Mucoepidermoid carcinoma is the most common malignant tumor in salivary glands, being the parotid the most usual location. Clinically, it resembles other oral mucosa lesions, therefore, it is important to make a correct differential diagnosis. Its biological behavior is related to the tumor histological grade, a relevant factor in the prognosis and treatment of this neoplasm. We reported a case of a 75-year-old-man, with a tumor in the palate, diagnosed as low-grade mucoepidermoid carcinoma. A partial maxillectomy and an obturator plate were performed based on a removable prosthesis and subsequent reconstruction with a microvascularized free flap. The patient is currently undergoing regular checkups, maintaining disease free. Salivary gland tumors are a diagnostic challenge, requiring imaging tests and histopathological study. In case of doubts with the diagnosis, it should be considered to biopsy more than area or to repeat the biopsy in order to obtain a representative sample that allows the diagnosis of the lesion.

Nitrofuran drugs beyond redox cycling: Evidence of Nitroreduction-independent cytotoxicity mechanism.

Nitrofurans (5-nitro-2-hydrazonylfuran as pharmacophore) are a group of widely used antimicrobial drugs but also associated to a variety of side effects. The molecular mechanisms that underlie the cytotoxic effects of nitrofuran drugs are not yet clearly understood. One-electron reduction of 5-nitro group by host enzymes and ROS production via redox cycling have been attributed as mechanisms of cell toxicity. However, the current evidence suggests that nitrofuran ROS generation by itself is uncapable to explain the whole toxic effects associated to nitrofuran consumption, proposing a nitro-reduction independent mechanism of toxicity. In the present work, a series of nitrated and non-nitrated derivatives of nitrofuran drugs were synthesized and evaluated in vitro for their cytotoxicity, ROS-producing capacity, effect on GSH-S-transferase and antibacterial activity. Our studies showed that in human cells non-nitrated derivatives were less toxic than parental drugs but, unexpectedly preserved the ability to generate intracellular ROS in similar amounts to nitrofurans despite not entering into a redox cycle mechanism. In addition, some non-nitrated derivatives although being uncapable to generate ROS exhibited the highest cell toxicity among all derivatives. Inhibition of cytosolic glutathione-S-transferase activity by some derivatives was also observed. Finally, only nitrofuran derivatives displayed antibacterial effect. Results suggest that the combined 2-hydrazonylfuran moiety, redox cycling of 5-nitrofuran, and inhibitory effects on antioxidant enzymes, would be finally responsible for the toxic effects of the studied nitrofurans on mammalian cells.

Effect of lithium on the properties of a liquid crystal formed by sodium dodecylsulphate and decanol in aqueous solution.

Understanding the molecular interactions that rule the physicochemical properties of molecular assemblies is of particular interest when trying to explain the behavior of much more complicated systems, such as the cell membranes. This work was devoted to study a discotic nematic lyotropic liquid crystal, formed by sodium dodecylsulphate (3% SDS-d25) and decanol (20% DeOH-α-d2), dissolved in aqueous solutions (0.1% D2O) of Na2SO4 or Li2SO4. The average size of the aggregates was estimated using fluorescence quenching experiments, and their dynamics were studied by measuring the (2)H-NMR quadrupole splitting (ΔνQ) and the longitudinal relaxation times (T1) of the deuterated species. To provide an atomic insight into these assemblies, molecular dynamics simulations of the systems were carried out with atomic detail. As a previous step in this study, a reparameterization of the standard GROMOS 87 force field was required to perform the equilibrated simulations and to prevent instabilities emerging during the simulations. Finally, an excellent agreement between simulation and experimental data was obtained. In addition, variations in the long range electrostatic interactions at the aggregate/solution interface, the orientation and the reorientational relaxation time of the water dipole, the translational diffusion coefficient of sodium ions, and the amphiphile-counterion coordination associated with the presence of Li(+) in the solution were other key aspects investigated to explain the variation in the quadrupole splittings (ΔνQ) in the presence of lithium in solution.

Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral / Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4 percent inpatients, 2.2 percent outpatients). Campylobacter prevalence in poultry was 34 percent. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3 percent of human samples and 11.8 percent of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

Las aves de consumo constituyen uno de los principales reservorios y fuente de infección humana de la campilo-bacteriosis. Se analizaron 341 muestras de deposiciones, 291 humanas y 50 aviares. De las muestras, 220 de niños con síndrome diarreico agudo-SDA (183 hospitalizados y 37 consultantes ambulatorios) y 71 niños sanos. A las 23 cepas obtenidas se les realizó CIM por dilución en agar a eritromicina y ciprofloxacina, serotipificación de Penner y genotipiicación por RAPD-PCR. Se encontró Campylobacterjejuni sólo en pacientes con SDA, de ellos 5,4 por ciento ambulatorios y 2,2 por ciento hospitalizados. En aves, la prevalencia de Campylobacter spp., fue de 34 por ciento. Hubo resistencia cruzada a ácido nalidixico y ciprofloxacina en 33,3 por ciento cepas de origen humano y 11,8 por ciento animal. Las cepas humanas fueron no tipiicables por el método de Penner. Predominó entre las aves el serotipo F. Se obtuvo un total de 14 genotipos (4/5 humanos y 10/15 aviares). En conclusión, la especie predominante en aves de corral y en humanos fue C. jejuni, existiendo una alta prevalencia de cepas de origen humano y aviar resistentes a quinolonas. Los genotipos y serotipos aviares no fueron encontrados en cepas de origen humano, lo que indica que podría existir otra fuente de infección, por lo que se requiere estudiar otros reservorios.

[Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry]. / Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral.

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4% inpatients, 2.2% outpatients). Campylobacter prevalence in poultry was 34%. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3% of human samples and 11.8% of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

Regulation of corticostriatal synaptic plasticity by G protein-coupled receptors.

Dopamine modulation of excitatory neurotransmission is critical in the control of movement, emotion and reward. In the striatum, medium size spiny neurons (MSNs) are responsible for the integration of cortical and thalamic information that flows through parallel, partly overlapping, loops and determines adequate experience-dependent responses. Dopamine acts on MSNs through two sets of G protein-coupled receptors (GPCRs), the D1-like and D2-like receptors, which can have opposing or synergistic downstream effects. Notably, these two types of striatal dopamine receptors are segregated into the striatonigral (direct) and striatopallidal (indirect) projecting neurons. Thus, dopamine receptor expression determines the morphological and functional neuronal phenotype of MSNs. Moreover, dopamine regulates glutamatergic corticostriatal transmission, critically controlling the induction of long-term potentiation and long-term depression at these synapses, regulating striatal synaptic plasticity. In addition to dopamine receptors, the induction and expression of plasticity mechanisms is regulated by other GPCRs, most importantly adenosine A2(A) receptors, metabotropic glutamate mGluR5 receptors and endocannabinoid CB1 receptors. This review focuses on synaptic modulation and plasticity on excitatory corticostriatal synapses by GPCRs.

Síndrome de Melkersson Rosenthal: reporte de un caso y revisión de la literatura / Melkersson-Rosenthal syndrome: case report and literature review

El Síndrome de Melkersson Rosenthal se describe como la asociaciónde edema labial (queilitis granulomatosa de Miescher) y/o facial recurrente,parálisis facial recidivante y lengua fisurada. El edema labial recurrentese presenta en uno o ambos labios, el cual puede llegar a ser persistente.Cuando se presenta en forma aislada se considera como una forma monosintomaticade este síndrome. El objetivo de esta revisión es mostrar el seguimientode un caso clínico atendido en nuestro servicio con el diagnósticosíndrome de Melkersson Rosenthal que presenta una gran queilitis granulomatosaasociada a lengua fisurada, cuyo tratamiento consistió en la infiltraciónde corticoides intralesionales y una posterior queiloplastía(AU)

Melkersson-Rosenthal syndrome is described as theassociation of recurrent lip edema (Miescher’s cheilitis granulomatosa)and/or facial edema, recurrent facial paralysis, and plicated tongue.Recurrent edema occurs in one or both lips, and can be persistent.When lip edema alone occurs, the case is considered amonosymptomatic form of this syndrome. The aim of this reviewwas to discuss the follow-up of a patient seen in our departmentwith the diagnosis of Melkersson-Rosenthal syndrome who presentedintense cheilitis granulomatosa associated with plicated tongue.The patient was treated with infiltration of intralesional corticoidsand later cheiloplasty(AU)

Peptide binding at the GLP-1 receptor.

The receptor for GLP-1 [glucagon-like peptide-1-(7-36)-amide] is a member of the 'Family B' of GPCRs (G-protein-coupled receptors) comprising an extracellular N-terminal domain containing six conserved cysteine residues (the N-domain) and a core domain (or J-domain) comprising the seven transmembrane helices and interconnecting loop regions. According to the two-domain model for peptide binding, the N-domain is primarily responsible for providing most of the peptide binding energy, whereas the core domain is responsible for binding the N-terminal region of the peptide agonists and transmitting the signal to the intracellular G-protein. Two interesting differences between the binding properties of two GLP-1 receptor agonists, GLP-1 and EX-4 (exendin-4), can be observed. First, while GLP-1 requires its full length to maintain high affinity, the eight N-terminal residues of EX-4 can be removed with little reduction in affinity. Secondly, EX-4 (but not GLP-1) can bind to the fully isolated N-domain of the receptor with an affinity matching that of the full-length receptor. In order to better understand these differences, we have studied the interaction between combinations of full-length or truncated ligands with full-length or truncated receptors.

Scorpion envenoming in two regions of Colombia: clinical, epidemiological and therapeutic aspects.

To determine clinical and epidemiological features of scorpion stings in two departments of Colombia, a descriptive study was performed in the hospitals of 10 towns from Antioquia (2 256 071 inhabitants) and five from Tolima (630 424 inhabitants). One hundred and twenty-nine cases were admitted during one year, 51 in Antioquia, 78 in Tolima and 41 were children less than 15 years old. Most stings (70.5%) occurred inside the house; 27.9% were on the hands and 26.4% on the feet. The scorpion species involved were Tityus pachyurus (51), Centruroides gracilis (31), T. fuehrmanni (29), T. asthenes (7) and Chactas spp. (1). In 10 cases the scorpion involved was not identified. Systemic envenoming signs (e.g. vomiting, tachypnea) were significantly more frequent in children than in adults (P < 0.05). Four children had hypertension, but none developed pulmonary oedema. One 3-year-old girl, stung by T. asthenes, had acute oedematous pancreatitis. Ninety-eight patients had mild envenoming. Moderate (27 patients) and severe (four patients) envenoming was significantly more frequent in children than in adults (P = 0.003; relative risk = 2.97). A pepsin-digested anti-Centruroides spp. antivenom was administered to 19 of 31 patients presenting systemic envenoming signs. No adverse reactions to antivenom were observed.

Structure and aggregation number of a lyotropic liquid crystal: a fluorescence quenching and molecular dynamics study.

The structure and aggregation number of a discotic lyotropic liquid crystal, prepared from tetradecyltrimethylammonium chloride (TDTMACl)/decanol (DeOH)/NaCl/H2O, have been examined using fluorescence quenching of pyrene by hexadecylpyridinium chloride and molecular dynamics (MD). The fluorescence method gives an aggregation number of 258 +/- 25 units (DeOH + TDTMACl). From the MD simulation, a lower limit for the aggregate dimension of 130 units of DeOH + TDTMACl is predicted. A stable oblate aggregate of 240 units was studied in detail. A strong polarization between the ammonium headgroups and chloride ions is observed from the calculated trajectory. DeOH headgroups are located, on average, 0.3 nm more to the interior of the aggregate than the TDTMACl headgroup and contribute to widening the interface by forming H-bonds with water. The radial distribution function of the ammonium headgroup shows that there are 16 water molecules in the first solvation sphere. The diagonal elements of the order parameter tensor of the tail atoms of both surfactants indicate that the interior of the micelle preserves about the same degree of order as at the interface, up to the last three atoms of the aliphatic chain, where the order starts to decrease.

Índice de gravedad en neumonía comunitaria hospitalizada / Severit predictiion index in hospitalized communitary acquired pneumonia

Fine's severity prediction index (SPI), was retrospectively analyzed in community acquired pneumonia (CAP), in patients at Concepción Regional Hospital, from June to August 2000. We studied 57 CAP patients: 23 as low risk and 34 as high risk patients. In comparison to low risk patients the main features of high risk patients were: older age (p < 0.00001), higher comorbility (p < 0.004), longer hospitalization (p < 0.0007) and higher mortality (p < 0.018). Mortality in low risk patients was similar to Fine's study: 4.3 versus 3.5%. In high risk patients mortality was 26% versus 38%. Main complications in our series were mechanical ventilation (43.8%), PaO2/FiO2 < 250 mmHg (43.8%), and hepatic coma (38.5%). As a conclusion, we recommend the use of SPI in CAP at Emergency Services in order to better evaluate mortality, optimizing criteria of hospital admission.

Se evaluó el Índice de Gravedad de Fine (IG) en neumonías de la comunidad (NAC) hospitalizadas en el Hospital Regional de Concepción en trabajo retrospectivo con 57 casos entre Junio y Agosto del año 2000. Se estudiaron 23 pacientes catalogados de bajo riesgo y 34 de alto riesgo. Características de alto riesgo fueron, mayor edad (p < 0,00001), mayor comorbilidad (p < 0,0004), estadía prolongada (p < 0,00007) y mayor mortalidad (p < 0,018). La mortalidad de bajo riesgo fue similar a la de Fine, 4,3% versus 3,5%, siendo menor en el grupo de alto riesgo, 26% versus 38%. Factores de mayor complicación en NAC fueron, ventilación mecánica (43,8%), PaO2/FiO2 < 250 mmHg (43,8%) y coma hepático (35,8%). Conclusión: es aconsejable el uso del IG en NAC a nivel de Servicios de Urgencia, para evaluar los riesgos de mortalidad, optimizando así los criterios de ingreso al hospital.

Electron spin resonance studies and theoretical quantum calculations of free radicals generated from anthracenetrione by electrochemical and microsomal reduction.

The ESR spectra of radicals obtained by electrolytic reduction of 4,4-dimethylanthracene-1,9,10 (4H)-trione (1) and the regioisomeric quinones 8-acetyloxymethyl-4,4,5-trimethyl- (2), and 5-acetyloxy-methyl-4,4,8-trimethyl-(4H)-1,9,10-anthracenetrione (3) were measured in DMSO and analyzed by quantum chemical calculations. The electrochemistry of these compounds was characterized using cyclic voltammetry, in DMSO and DMF solvents and compared with nifurtimox. The quinones were also reduced by microsomal NADPH-cytochrome P-450 reductase and the corresponding radicals species were also detected by ESR spectroscopy. AMI, INDO, and ADF calculations were performed to obtain the optimized geometries, theoretical hyperfine constants, and spin distributions, respectively. Density functional theory was used to rationalize the reduction potential of these compounds.

Adaptación psicosocial en pacientes amputados: un seguimiento / Psychosocial adaptation in amputes: follow up study

Se revisaron 182 fichas de pacientes amputados durante los años 1990 a 1992 en el Hospital del Trabajador de Santiago, registrándose variables sociodemográficas, tipo de accidente, diagnóstico psiquiátrico y situación psicosocial. Se realizó una entrevista de seguimiento a 130 de esos pacientes 5 a 7 años después del accidente aproximadamente. Los diagnósticos más frecuentes fueron las reacciones de ajuste ansioso (33 por ciento) y mixtas (19 por ciento). El 87 por ciento se encuentra trabajando con buen nivel de satisfacción y el 90 por ciento se siente apoyado por su familia. El 42 por ciento presenta dolor fantasma que se relaciona con altos niveles de angustia y depresión y con el nivel de amputación. También el 42 por ciento muestra franca disminución de la actividad social. Se encontraron elevados índices de angustia y depresión en la muestra

Organic personality disorder after traumatic brain injury: cognitive, anatomic and psychosocial factors. A 6 month follow-up.

OBJECTIVE: The purpose of the study is to describe psychosocial adjustment in patients who present Organic Personality Disorder (OPD) after TBI in relation to patients with TBI without OPD. METHOD: The group included patients who were admitted as inpatients in the Neurology Service. Exclusion criteria were: previous personality disorders; previous alcohol and drugs addiction, history of head injury and other neurological diseases. For this purpose, a semi-structured interview based on the ICD-10 was applied to the patient or significant other during the 1st or 2nd week after the accident. Selected patients were evaluated with psychological and psychosocial tests and questionnaires 6 months after head injury, among them: WAIS, Benton Test, Rey Osterrieth Test, Wisconsin Cards, Psychosocial Scale and Neurobehavioural Rating Scale (NRS-27). RESULTS: No significant differences were observed in relation to demographic characteristics, type of head injury, GCS, or psychometric results. Significant differences were found in the answers to neurobehavioural and psychosocial questionnaires, showing more impairment in patients with OPD. CONCLUSIONS: The results show that, in this group, patients with OPD after TBI present more psychosocial adjustment and emotional problems than patients with TBI without OPD diagnosis. The difference found is independent of cognitive impairments.

Reoperaciones en esofagitis por fracaso de cirugía antirreflujo previa / Re-operation in esophagitis due to failure of previous anti-reflux surgery

Se analizan 8 pacientes operados con esofagitis por fracaso de cirugía antirreflujo previa. La edad promedio fue de 49 años (margen 33 a 64 años), 5 hombres y 3 mujeres. Las indicaciones de las reoperaciones fue el fracaso del tratamiento médico y las complicaciones de la esofagitis. Las técnicas usadas fueron: Nissen con y sin VCC (3 casos), operación de Merendino (1 caso), exclusión duodenal (3 casos), esófago gastrectomía proximal (1 caso). Mortalidad inmediata: 1 caso (necrosis gástrica post Nissen-VSS). Los resultados fueron catalogados de excelentes y buenos: 5 casos. Fracasos: 3 casos (incluye el paciente fallecido). Se plantean alternativas de manejo quirúrgico destacándose los buenos resultados obtenidos con la exclusión duodenal

[Overview of the epidemiology of Chagas' disease in Chile]. / Panorama general de la epidemiología de la enfermedad de Chagas en Chile.

Chile is a long and narrow country located in the south western coast of South America. Chagas' disease exists in the seven first (18 degrees 30'-34 degrees 36' South lat.) of the total of thirteen administrative regions of the country. In the 1982-1990 period a series of studies considering different epidemiological aspects of this parasitic zoonosis has been carried out with the following results: 5,601 rural of periurban dwellings were surveyed for the presence of Triatoma infestans (the most important and almost exclusive vector of Trypanosoma cruzi in Chile). 37.4% of the dwellings were infested according to the inhabitants and 29.4% were found infested according to the presence of tracks or insects captured. In 659 (17.2%) out of 3,822 T. infestans captured and examined T. cruzi was found in their abdominal contents. The most common sources of T. infestans feeding were mammals (89.0%), including man, and birds (9.5%). An indirect hemagglutination test (IHAT) for Chagas' disease, a very sensitive and specific reaction, was performed to 5,050 domestic mammals, resulting positive 7.9% of cats, 7.0% of dogs, 7.0% of goats, 4.9% of sheep and 4.1% of rabbits. 2,579 (16.9%) out of 15,418 persons were positive for the IAHT for Chagas' disease. The rates of infection were rather similar in males (17.5%) and females (16.2%) with an increase in infection rates in accordance with increase of age of individuals. The overall frequency of ECG abnormalities in positive IHAT persons was 18.7% against 8.8% in those with negative IHAT, whereas ECG abnormalities considered as suggestive of a chagasic etiology were 6.8% and 2.2% respectively. The esophageal motility in 311 persons with a positive IHAT and in 150 with a negative IHAT was found altered in 42.8% and 18.7% respectively. In the corresponding urban sectors of the 7 regions mentioned 2.7% of blood donors, 2.3% of delivering mothers, 2.6% of newborns and 0.6% of school children had positive IHAT. 646 chagasic women and 709 non-chagasic women in their reproductive span of life, and the products of the pregnancies that they had in a 6-year period were followed-up. No significant differences were found neither in the number nor in the evolution of pregnancies in both groups of mothers. Xenodiagnosis of children from chagasic mothers resulted positive in 6.3-8.9%, showing the transmission of T. cruzi by the placental route. Recently, 3 cases of congenital Chagas' disease of second generation have been demonstrated.(ABSTRACT TRUNCATED AT 400 WORDS)

Algunas características de las familias mapuches del consultorio La Pincoya: estudio de casos y controles, Santiago 1984 / Some characteristics of the mapuche families of La Pincoya health care centre: case study an controls, Santiago 1984

Se describe y analiza a los hijos de mapuches de un consultorio urbano del Area Metropolitana Norte de Santiago de Chile en relación a algunas variables biológicas y de atención médica con el objeto de contribuir al conocimiento de la adaptación de ese grupo racial al ambiente urbano de la capital. Se empleó para el estudio el método de casos y controles, con un grupo de familias no mapuches del mismo consultorio. Los resultados revelan que en las variables de atención médica estudiadas: inscripción precoz del recién nacido; promedio de controles de niño sano por enfermera; vacunaciones; parto en maternidad; número de consultas por morbilidad, no hay diferencias significativas entre ambos grupos. En cuanto a las variables biológicas en estudio estas presentan diferencias favorables a los mapuches en: normalidad del parto; mayor duración de la lactancia natural; más altos pesos de nacimiento; menor desnutrición en el primer año, si bien las tallas son algo más bajas y es mayor el número de obesos y de niños con sobre-peso. Estos resultados sugieren una adecuada adaptación a las formas de vida urbana en lo que se refiere a salud, del grupo en estudio; pero creemos que se debe seguir investigando en otros consultorios para reunir información extrapolable a la población urbana de la Región Metropolitana