Estrategias de guía e ingredientes dietéticos de precisión para enfermedades crónicas en población pre-sénior y sénior / Precision dietary guidelines and ingredients for chronic diseases in pre-senior and senior populations

El envejecimiento de la población supone un importante reto, económico y cualitativo, para el sistema de salud orientándolo hacia una atención de tipo preventivo, en la que la nutrición de precisión (NP) y la prescripción de hábitos saludables adquieren relevancia capital. El fin de la NP es procurar una nutrición adaptada a cada individuo, entendiendo que la prevención o el tratamiento de trastornos crónicos (obesidad, diabetes, enfermedad cardiovascular, etc.) deben abordarse de un modo integral, considerando información personal y clínica relevante, edad y características feno- y genotípicas. La elaboración de la presente guía surge de la necesidad de desarrollar modelos nutricionales de precisión que permitan la individualización del tratamiento nutricional, con énfasis en el adulto mayor. Las necesidades nutricionales, las recomendaciones dietéticas y los ingredientes para una NP en las personas pre-sénior y sénior quedan resumidas en realizar al menos 3 comidas diarias, reducir las calorías totales, optar por una alimentación variada y equilibrada con alimentos frescos y de alta densidad nutricional, incorporar verduras, legumbres y pescado, consumir productos lácteos y fibra, preferir carnes blancas en lugar de rojas, evitar frituras, embutidos y alimentos procesados, moderar el consumo de sal, café y alcohol, e hidratarse adecuadamente

The aging of the population underlines an important challenge for the health system not only from sanitary and economic reasons but also by quality perspectives concerning preventive care, where precision nutrition (PN) and the prescription or advice on healthy habits becomes relevant. PN focuses on provide nutrition adapted to each individual, understanding that the prevention or treatment of chronic disorders (obesity, diabetes, cardiovascular disease, etc.) must be addressed in a comprehensive way, considering not only relevant personal and clinical information, but also healthy aging and phenotypical and genotypical features. This guide was prepared due to the need to develop precision nutritional models that allow individualized nutritional treatment for each subject and physiopathological particularities with emphasis on the elderly. Therefore, the requirements of the Spanish pre-senior and senior populations, dietary recommendations and precision foods are reviewed in this document: have at least three daily meals, reduce total calories, choose a varied and balanced diet with fresh foods and high nutritional density, add vegetables, legumes and fish, consume dairy products and fiber, prefer white meat instead of red, avoid fried foods, sausages and processed foods, moderate the consumption of salt, coffee and alcohol, and get hydrated

Presencia de Munidopsis robusta en el Caribe colombiano (A. Milne Edwards, 1880) (Crustacea: Anomura: Munidopsidae / Presence of Munidopsis robusta in the Colombian Caribbean (A. Milne-Edwards, 1880) (Crustacea: Anomura: Munidopsidae) / Presença de Munidopsis robusta no Caribe Colombiano (A. Milne Edwards, 1880) (Crustacea: Anomura: Munidopsidae)

Se presenta el primer registro para Colombia de Munidopsis robusta. Los ejemplares fueron recolectados frente a los departamentos de La Guajira y Bolívar a 500 m de profundidad mediante arrastre con una red tipo semi-balón. En cubierta fueron enjuagados con agua de mar y preservados en etanol al 95 %. Las características de la columna de agua fueron evaluadas con una sonda multiparámetros CTDO. Los sedimentos fueron recolectados por medio de un nucleador de caja y se realizó el análisis granulométrico de los mismos. Se incluye la diagnosis de la especie y comentarios sobre distribución y ámbito batimétrico y geográfico. Con este nuevo registro se aumenta a 23 el número de especies de Munidopsis para Colombia. Además, se amplía la distribución de esta especie en el Caribe.

The first record of M. robusta in Colombia is presented. The specimens were collected by demersal trawling at 500 m depth in front of the departments of La Guajira and Bolívar using a semi-ballon net. Collected specimens were washed onboard with seawater and preserved in 95 % ethanol. The characteristics of the water column were measured with a multi-parameter CTDO instrument. Sediments were collected using a Box-corer and a granulometric analysis was performed. A species diagnosis is presented together with comments regarding its distribution and bathymetric and geographic ranges. With this new record, the number of Colombian species of Munidopsis increases to 23. Moreover, the distribution of this species for the Caribbean is extended.

É apresentado o primeiro registro de Munidopsis robusta na Colômbia. Os espécimes foram coletados em frente dos departamentos de La Guajira e Bolívar por arrasto a 500 m de profundidade com uma rede semi-balão. Foram lavados com água do mar a bordo e preservados em álcool a 95 %. As características da coluna de água foram medidas com um instrumento multi-parâmetro CTDO. Os sedimentos foram coletados por meio de um Box-corer e foi realizada uma análise granulométrica. Um diagnóstico da espécie é apresentado juntamente com comentários sobre sua distribuição, batimétrica e áreas geográficas. Com este novo registro, o número de espécies colombianas de Munidopsis aumenta para 23. Além disso, a distribuição desta espécie para o Caribe é aumentada.

Anafilaxia en anestesia / Anaphylaxis in anesthesia

Esta guía representa el consenso actualizado de expertos en el ámbito de las reacciones de hipersensibilidad de distintas sociedades científicas internacionales y la experiencia de nuestra unidad en el diagnóstico de las reacciones de anafilaxia perioperatorias. El correcto manejo de la anafilaxia perioperatoria requiere una sospecha diagnóstica precoz basada en la clínica que presenta el paciente. Se requiere la puesta en marcha de las pruebas de laboratorio inmediatas (triptasa sérica e histamina en plasma) para confirmar la reacción de hipersensibilidad, sin que ello interfiera el inicio precoz del tratamiento adecuado. La adrenalina sigue siendo el fármaco de elección en las reacciones de anafilaxia graves. El anestesiólogo es el responsable de la puesta en marcha de esta primera fase. La investigación tardía del mecanismo responsable y el agente etiológico corresponde a los alergólogos. Finalmente, y de forma conjunta, se debe realizar un informe basado en los hallazgos de los estudios realizados (inmediatos y tardíos) y la concordancia con la clínica. En el informe deben figurar los resultados de las pruebas, los fármacos y/o sustancias identificadas como responsables de la reacción, y las recomendaciones para futuras anestesias (AU)

This article represents the combination of expert consensus on hypersensitivity reactions of distinct international scientific societies and the experience of our unit in the diagnosis of perioperative anaphylactic reactions. The appropriate management of perioperative anaphylaxis requires early diagnostic suspicion, based on the patient's symptoms. Immediate laboratory tests (serum tryptase and plasma histamine) are required to confirm the hypersensitivity reaction but should not interfere with the start of appropriate treatment. The drug of choice in severe anaphylactic reactions continues to be adrenalin. The anesthesiologist is responsible for instigating this first phase while subsequent investigation of the causative mechanism and the etiological agent is performed by allergists. Finally, a joint report based on the findings of the (immediate and late) studies and the patient's symptoms should be provided. This report should contain information on the results of tests, the drugs and/or substances identified as causing the reaction, and recommendations for future anesthesia (AU)

Afinidades biogeográficas de los galateoideos (Decapoda: Anomura) del Caribe y Pacífico colombiano / Biogeographical affinities of Colombian Caribbean and Pacific galateoids (Decapoda: Anomura)

Objetivo. Determinar la distribución y afinidades biogeográficas de los galateoideos de aguas colombianas con base en la literatura y muestras recolectadas durante expediciones realizadas entre 1999 y 2002. Materiales y métodos. Se recolectaron ejemplares en 100 estaciones entre 20 y 550 m de profundidad en el Caribe y Pacífico colombiano. El material recolectado, junto con la información geográfica existente en literatura para las especies conocidas para Colombia se emplearon para realizar mapas de distribución, los cuales se compararon con el “Mapa de ecorregiones marinas del mundo”. Resultados. Se obtuvo la información geográfica para 3247 ejemplares recolectados de 18 especies de los géneros Agononida, Anomoeomunida, Munida, Munidoposis y Pleuroncodes, y se complementó con la obtenida a partir de la literatura para las 40 especies de la superfamilia con presencia conocida en aguas colombianas. Se generaron cinco grupos principales de distribución: especies restringidas al Caribe, al Caribe y Atlántico occidental, Anfiatlánticas, restringidas al Pacífico oriental y Anfiamericanas. Se encontró que el 53 % de las especies recolectadas en el Caribe se presentan también en la provincia Atlántico Norte Cálido-Templado, y para el Océano Pacífico la mayor afinidad se da con la provincia Pacífico Oriental Tropical. Conclusiones. Los galateoideos en aguas colombianas presentan ámbitos geográficos y batimétricos amplios, presentándose simpatría entre algunas especies. Las de aguas someras presentan mayores restricciones que aquellas de distribución en aguas profundas. Los mecanismos de distribución de las especies corresponden con el ciclo de vida de cada una y las corrientes predominantes en las provincias.

Rotura traqueal yatrogénica / No disponible

No disponible

Aflatoxin M(1) and ochratoxin A in a human milk bank in the city of São Paulo, Brazil.

Because infants are more susceptible to the adverse effects of mycotoxins, this work was carried out to determine aflatoxin M(1) (AFM(1)) and ochratoxin A (OA) in milk from the Human Milk Bank of the Southern Regional Hospital, São Paulo, Brazil. Analytical methods were first established and evaluated. The methods involved the extraction of AFM(1) with methanol and OA with 1% aqueous sodium bicarbonate solution and methanol, clean-up with immunoaffinity columns having antibodies specific for each mycotoxin and quantification by high performance liquid chromatography (HPLC) with fluorescence detection. The method established for AFM(1) had mean recovery percentages of 94, 77 and 82% and coefficients of variation of 17.5, 3.4 and 4.2% at 0.01, 0.03 and 0.05 ng ml(-1), respectively. For the OA method, the corresponding values were 84, 84 and 75% for recovery and 14.1, 3.7 and 4.0% for the coefficient of variation. The limit of quantification for both methods was 0.01 ng ml(-1). Of a total of 50 samples analysed, only one was contaminated with AFM1, at 0.024 ng ml(-1), and two with OA, at 0.011 and 0.024 ng ml(-1). Although the incidence observed was low, it is recommended that the study be extended to other milk banks of the city of São Paulo.

Incidentalomas hipofisarios: revisión de 21 casosNo disponible / Pituitary incidentalomas: review of 21 patients

Objetivo La utilización habitual de la tomografía computarizada y la resonancia magnética está incrementando el descubrimiento casual de masas selares. Por este motivo, hemos analizado a los pacientes enviados a nuestra consulta por incidentalomas hipofisarios, para determinar sus características e intentar definir el tratamiento y el seguimiento más adecuado. Pacientes y método Estudio retrospectivo de 21 pacientes con incidentaloma hipofisario. A los pacientes con masas menores de 10 mm se les realizó un estudio hormonal hipofisario basal y ninguno fue tratado quirúrgicamente. A los pacientes con lesiones mayores de 10 mm se les evaluó con una prueba de estimulación múltiple y un estudio campimétrico; posteriormente se trataron quirúrgicamente. El seguimiento medio de los enfermos fue de 3,6 años. Resultados El 85,7 por ciento de los pacientes presentaba un adenoma hipofisario (el 52,38 por ciento macroadenomas y el 33,34 por ciento microadenomas). El 36,36 por ciento de las masas selares de más de 10 mm condicionaba inicialmente alteraciones campimétricas. Se detectaron deficiencias hormonales en el 63,63 por ciento de las masas mayores de 10 mm. Sólo 1 paciente tuvo hipersecreción hormonal. Se realizó cirugía transesfenoidal en 8 casos, y en 1, cirugía transfrontal. Los incidentalomas no tratados quirúrgicamente no han aumentado de tamaño durante el seguimiento ni han desarrollado deficiencias hormonales. Discusión: El incidentaloma hipofisario es un motivo de consulta cada vez más frecuente. Los incidentalomas menores de 10 mm deberían evaluarse clínica y analíticamente para descartar hipersecreción hormonal. En las masas mayores de 10 mm se debe descartar tanto la hipersecreción como la hiposecreción hormonal y estudiar si existe afección campimétrica, ya que éstas pueden estar presentes ya en el momento del diagnóstico. El tratamiento quirúrgico, si fuera necesario, sólo debería realizarlo un cirujano con amplia experiencia (AU)

Un hospital de apoyo al servicio de la sociedad. Nuevas realidades la unidad de preoperatorios de alta resolución / A support hospital at the service of society. New realities: high resolution pre-operative unit (UPAR in Spanish)

El Hospital de la Cruz Roja San José y Santa Adela es un hospital de apoyo, los pacientes provienen de las poblaciones periféricas y la gran mayoría deben repetir su preoperatorio. Dado que nuestras actividades tienen como finalidad la satisfacción de las necesidades del paciente/ usuario, nos preguntamos: ¿podemos mejorar nuestro proceso de lista de espera, y beneficiar al paciente? Hemos revisado nuestro proceso, y la respuesta ha sido "la unidad de preoperatorios de alta resolución" (UPAR) nos ha permitido obtener: disminución de los procesos burocráticos; disminuir consultas sucesivas del preoperatorio; confortabilidad, y trato personalizado, y ahorros al paciente, a la familia y a la organización (AU)

Murine coronavirus spike protein determines the ability of the virus to replicate in the liver and cause hepatitis.

Recombinant mouse hepatitis viruses (MHV) differing only in the spike gene, containing A59, MHV-4, and MHV-2 spike genes in the background of the A59 genome, were compared for their ability to replicate in the liver and induce hepatitis in weanling C57BL/6 mice infected with 500 PFU of each virus by intrahepatic injection. Penn98-1, expressing the MHV-2 spike gene, replicated to high titer in the liver, similar to MHV-2, and induced severe hepatitis with extensive hepatocellular necrosis. S(A59)R13, expressing the A59 spike gene, replicated to a somewhat lower titer and induced moderate to severe hepatitis with zonal necrosis, similar to MHV-A59. S4R21, expressing the MHV-4 spike gene, replicated to a minimal extent and induced few if any pathological changes, similar to MHV-4. Thus, the extent of replication and the degree of hepatitis in the liver induced by these recombinant viruses were determined largely by the spike protein.

Randomized controlled trial of recombinant human granulocyte-macrophage colony-stimulating factor for the treatment of chronic hepatitis c.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) was administered subcutaneously to 45 chronic hepatitis C patients, randomly assigned to receive 0.5, 1 or 2 microg GM-CSF/kg b.w. daily/6 weeks (n=30), or no treatment (n=15). Alanine transaminase (ALT) values normalized in four out of 10 (40%) patients administered 2 microg GM-CSF [1 cleared hepatitis C virus (HCV) RNA] but in none given 0.5 or 1 microg or untreated controls (P=0.0079). Following 4 weeks of rest, patients received 5 million units of interferon (IFN)alpha2b every other day/6 months, alone (n=30), or combined with 2 microg GM-CSF/daily for 3 months (n=15). At treatment end, ALT levels in patients administered the combination normalized more frequently than in those given monotherapy (73% vs 47%, P=0.089). Viraemia decreased significantly in 11/15 (73%) patients administered GM-CSF/IFNalpha2b combination (mean log HCV RNA copies/ml+/-SEM: 4.13+/-0.40 vs 5.29+/-0.23;P=0.011), and in 20/30 (67%) receiving IFNalpha2b monotherapy (4.27+/-0.28 vs 5. 31+/-0.14;P=0.004); 27% and 20% of patients given the combination and monotherapy, respectively, cleared HCV RNA. One patient in each regime had a sustained response after 12 months. 2', 5'-Oligoadenylate synthetase activity (2-5AS) increased during GM-CSF therapy (P=0.033 with the 2 microg dose). 2-5AS increased more in the GM-CSF/IFN-alpha2b combination than with IFNalpha2b monotherapy (P<0.02). GM-CSF provoked a skin reaction at the injection site, accompanied by moderate and reversible rises in eosinophil and leucocyte counts. In summary, daily s.c. GM-CSF administration is safe and shows effects against HCV; the GM-CSF/IFNalpha2b combination has an additional-but transient-antiviral activity in chronic hepatitis C.

Fluorescent "in situ" hybridization of hepatitis C virus RNA in peripheral blood mononuclear cells from patients with chronic hepatitis C.

Although the liver is the main target for hepatitis C virus (HCV) infection, HCV RNA of positive and negative polarity has also been detected in peripheral blood mononuclear cells (PBMCs) by polymerase chain reaction. However, no data have been published on the relationship between the number of HCV-infected PBMCs and serum viremia levels. To address this issue, PBMC samples from 20 patients with chronic hepatitis C were examined by fluorescent "in situ" hybridization. Serum viremia levels and viral load in infected PBMC were measured using the Amplicor Monitor test. HCV was detected in all PBMC samples corresponding to the HCV-positive patients. Fluorescent signals were found mainly in the cytoplasm of the cell. The percentage of positive cells ranged from 0.08% to 4%, with a statistical correlation with the viral load in PBMC (r = 0.69; p =. 001) but not with the serum viremia levels (r = 0.23). It was demonstrated that HCV infection of PBMCs is a common feature of HCV chronic carriers. The results suggest that HCV infection of PBMCs does not contribute significantly to HCV viremia.

Terapia hormonal sustitutiva con estradiol valerato y ciproterona acetato / Substitutive hormonal therapy with estradiol valerate and cyproterone acetate

El tratamiento del síndrome climatérico con (terapia combinada secuencial de 21 días; estradiol valerato 2 mg y ciproterona acetato 1 mg) es adecuado para el control de la sintomatología climatérica y para la prevención de osteoporosis postmenopáusica. Este preparado es tan eficaz como el resto de los preparados estrógeno-progestativos conocidos, presentando reacciones adversas similares. Sin embargo, atendiendo al perfil lipídico, tensión arterial y control del ciclo, el empleo de la ciproterona como gestágeno sí conlleva ciertas ventajas. La mayoría de las mujeres en tratamiento experimentan un aumento de las HDL- colesterol y un mantenimiento de las cifras de tensión arterial, habiéndose incluso descrito descensos estadísticamente significativos de la tensión arterial diastólica. Hasta un 87,7 por ciento de las mujeres tratadas experimenta ciclos regulares. Por tanto, este nuevo preparado hormonal puede ser considerado como un tratamiento de elección para mujeres perimenopáusicas y aquellas postmenopáusicas iniciales que acepten volver a tener menstruaciones

Tumor mixto de glándulas salivales [adenoma pleomorfo] en el septum nasal / Mixed tumor of salivary glands [pleomorphous adenoma] in the nasal septum

La cavidad nasal es un área relativamente infrecuente como punto de origen de tumores: en ésta se localizan cerca del 10 por ciento de las neoplasias de glándulas salivales menores, siendo una de sus variedades el adenoma pleomorfo o tumor mixto. El diagnóstico y tratamiento de esta patología se dificulta por su presentación poco usual , su variado comportamiento biológico, y la dificultad en su manejo por el posible compromiso de estructuras vecinas. Se presenta el caso de una mujer de 37 años de edad, con un cuadro clínico consistente en cefalea, rinorrea verdosa, obstrucción nasal derecha y presencia de masa a nivel de la porción anterosuperior del septum nasal, con diagnóstico anatomopatológico de adenoma pleomorfo

In vitro effect of amantadine and interferon alpha-2a on hepatitis C virus markers in cultured peripheral blood mononuclear cells from hepatitis C virus-infected patients.

The effects of amantadine (1-5 microM) and interferon alpha (IFNalpha)-2a alone (1000 IU/ml) and combined, have been studied in cultured peripheral blood mononuclear cells (PBMC) from 15 chronic hepatitis C patients and ten healthy donors. Amantadine itself did not affect cell viability and had minor effects on the response to mitogens by PBMC. Four patients (27%), but no donors, had hepatitis C virus (HCV) core and NS3-specific proliferative responses. Amantadine suppressed these responses in all cases and its antiproliferative effect was greater than that of IFNalpha (Mann-Whitney's U-test: P < 0.05 in both cases). All PBMC cultures from patients, but none from donors, were HCV RNA positive. Amantadine alone or combined with IFNalpha dose-dependently reduced HCV RNA content in individual PBMC (Wilcoxon's signed rank test: 1 microM, P < 0.05; 2 microM, P < 0.02; and 5 microM, P = 0.16) with respect to untreated cultures. In addition, 7, 13 and 20% of PBMC cultures became HCV RNA negative with 2 microM amantadine alone, IFNalpha alone and their combination, respectively. Finally, in contrast to IFNalpha, amantadine did not modify expression of 2',5'-oligoadenylate synthetase activity or the spontaneous or mitogen-stimulated IFNgamma and interleukin 10 production. In conclusion, these effects in PBMC from HCV patients suggest that the amantadine/IFNalpha combination might be considered a therapeutic option for treating chronic hepatitis C patients.

Modulation by biologic response modifiers of hepatitis C virus antigen-independent cytokine secretion in blood mononuclear cells.

The systemic hepatitis C virus (HCV) antigen-non-specific cytokine responses were investigated in cultures of peripheral blood mononuclear cells. Cytokines of the T helper (Th) 1 [interferon (IFN)gamma and interleukin (IL)-2] and Th2 (IL-4 and IL-10) phenotype, and the pro-inflammatory cytokines tumour necrosis factor alphaIL-1beta and IL-6, were secreted by the cells activated by the HCV antigen-independent pathway. Furthermore, these cytokine responses were shifted towards a Th1 predominance by treatment with IFN-beta and with IL-2, whereas cytokine responses were selectively amplified towards a combined Th1-Th2 profile by granulocyte-macrophage- but not by macrophage colony-stimulating factor. Moreover, pro-inflammatory cytokine production was significantly enhanced by IFN-beta and augmented dose-dependently with GM-CSF and IL-2. Therefore, these immune mediators can promote unique-as well as overlapping-systemic cytokine responses that may be relevant for immunotherapeutic interventions to control HCV infection.

In vitro infection of human peripheral blood mononuclear cells by GB virus C/Hepatitis G virus.

GB virus C (GBV-C), also known as hepatitis G virus, is a recently discovered flavivirus-like RNA agent with unclear pathogenic implications. To investigate whether human peripheral blood mononuclear cells (PBMC) are susceptible to in vitro GBV-C infection, we have incubated PBMC from four healthy blood donors with a human GBV-C RNA-positive serum. By means of (i) strand-specific reverse transcription-PCR, cloning, and sequencing; (ii) sucrose ultracentrifugation and RNase sensitivity assays; (iii) fluorescent in situ hybridization; and (iv) Western blot analysis, it has been demonstrated that GBV-C is able to infect in vitro cells and replicate for as long as 30 days under the conditions developed in our cell culture system. The concentration of GBV-C RNA increased during the second and third weeks of culture. The titers of the genomic strand were 10 times higher than the titers of the antigenomic strand. In addition, the same predominant GBV-C sequence was found in all PBMC cultures and in the in vivo-GBV-C-infected PBMC isolated from the donor of the inoculum. GBV-C-specific fluorescent in situ hybridization signals were confined to the cytoplasm of cells at different times during the culture period. Finally, evidence obtained by sucrose ultracentrifugation, RNase sensitivity assays, and Western blot analysis of the culture supernatants suggests that viral particles are released from in vitro-GBV-C-infected PBMC. In conclusion, our study has demonstrated, for the first time, GBV-C replication in human lymphoid cells under experimental in vitro infection conditions.

Effects of the ribavirin-interferon alpha combination on cultured peripheral blood mononuclear cells from chronic hepatitis C patients.

The effects of ribavirin and interferon (IFN) alpha have been investigated on cultured peripheral blood mononuclear cells, obtained from 15 patients with chronic hepatitis C virus (HCV) infection. At clinically relevant serum concentrations achieved during therapeutic administration, ribavirin did inhibit moderately the mitogen-stimulated mononuclear cell proliferation and growth of the CD4+ and CD8+ T cell subsets without apparent cytolysis. The ribavirin-IFN-alpha combination showed activity against HCV with disappearance of HCV RNA in 27% of cases, and a synergy in the inducibility of the intracellular enzyme 2',5'-oligoadenylate synthetase. Such ribavirin concentrations induced modest increases in the T helper 1-like cytokine production by mononuclear cells. Higher ribavirin concentrations markedly inhibited IFN-gamma production, but augmented interleukins (IL) 2, 4, and 12 secretion. Conversely, IFN-alpha tended to suppress IL 2, 4 and 12, but enhanced IFN-gamma and IL-10 secretion. Thus, ribavirin and IFN-alpha appear to cause diverse effects on immunoregulatory cytokine secretion, and when combined, counteracted for production of IL-2 and IL-12, while upregulated mononuclear cell secretion of IFN-gamma and that of the anti-inflammatory cytokine IL-10. These findings suggest a non-cytolytic modulation of inflammatory responses induced by the drug combination, that may be relevant in the pathophysiology of chronic HCV infection.