Estudio descriptivo de las alteraciones en pruebas de neuroimagen en pacientes con cefalea en un ámbito ambulatorio / Descriptive study of the alterations in neuroimaging tests in patients with headache in an outpatient setting

Introducción: Los estudios disponibles ofrecen una guía limitada acerca del uso de la neuroimagen en pacientes con cefalea en el ámbito ambulatorio. El objetivo de este estudio fue describir y analizar la frecuencia y el porcentaje de alteraciones en neuroimagen en pacientes valorados por cefalea en una consulta de neurología, así como determinar qué datos de alarma clínicos (red flags) se asocian con mayor frecuencia a estas alteraciones. Pacientes y métodos: Realizamos un estudio observacional, descriptivo y transversal de una serie de pacientes con cefalea de la consulta de neurología del Hospital Universitario de Móstoles a los que se les realizó una prueba de neuroimagen. ResultadosSe incluyó a 279 pacientes en el estudio (190 mujeres y 89 hombres). Ningún paciente sin datos de alarma clínicos presentó alteraciones graves en la neuroimagen y, de los que presentaban datos de alarma clínicos (219 pacientes), sólo el 2,3% (cinco pacientes) presentó alteraciones graves. Los dos datos de alarma clínicos que se asociaron de forma significativa a una mayor probabilidad de alteraciones graves en la neuroimagen fueron la cefalea que se desencadena o empeora significativamente con cambios posturales o maniobras de Valsalva y la cefalea crónica diaria desde su inicio. Conclusiones: La prevalencia de alteraciones significativas en neuroimagen en pacientes con cefalea en un ámbito ambulatorio fue baja, incluso en presencia de datos de alarma clínicos, por lo que la utilidad de estos datos de alarma parece ser menor en un contexto ambulatorio. Podría ser razonable intentar reducir el uso de la neuroimagen en pacientes con cefalea en el ámbito ambulatorio.(AU)

Introduction: Available studies provide limited guidance on the use of neuroimaging in patients with headache in the outpatient setting. The aim of this study was to describe and analyse the frequency and the percentage of neuroimaging abnormalities in patients evaluated for headache in a neurology clinic, as well as to determine which red flags are most commonly associated with these abnormalities. Patients and methods: We conducted an observational, descriptive and cross-sectional study of a series of patients with headache from the neurology department of the Hospital Universitario de Móstoles who underwent a neuroimaging test. Results: A total of 279 patients (190 women and 89 men) were included in the study. No patient without any red flags had severe abnormalities in the neuroimaging study and, of those with red flags (219 patients), only 2.3% (five patients) displayed severe abnormalities. The two red flags that were significantly associated with an increased likelihood of severe neuroimaging abnormalities were headache that is triggered or significantly worsened by postural changes or Valsalva manoeuvres and chronic daily headache since onset. Conclusions: The prevalence of significant neuroimaging abnormalities in headache patients in an outpatient setting was low, even in the presence of red flags, and so their utility appears to be lower in an outpatient setting. It may be reasonable to try to reduce the use of neuroimaging with headache patients in the outpatient setting.(AU)

[Descriptive study of the alterations in neuroimaging tests in patients with headache in an outpatient setting]. / Estudio descriptivo de las alteraciones en pruebas de neuroimagen en pacientes con cefalea en un ámbito ambulatorio.

INTRODUCTION: Available studies provide limited guidance on the use of neuroimaging in patients with headache in the outpatient setting. The aim of this study was to describe and analyse the frequency and the percentage of neuroimaging abnormalities in patients evaluated for headache in a neurology clinic, as well as to determine which red flags are most commonly associated with these abnormalities. PATIENTS AND METHODS: We conducted an observational, descriptive and cross-sectional study of a series of patients with headache from the neurology department of the Hospital Universitario de Mostoles who underwent a neuroimaging test. RESULTS: A total of 279 patients (190 women and 89 men) were included in the study. No patient without any red flags had severe abnormalities in the neuroimaging study and, of those with red flags (219 patients), only 2.3% (five patients) displayed severe abnormalities. The two red flags that were significantly associated with an increased likelihood of severe neuroimaging abnormalities were headache that is triggered or significantly worsened by postural changes or Valsalva manoeuvres and chronic daily headache since onset. CONCLUSIONS: The prevalence of significant neuroimaging abnormalities in headache patients in an outpatient setting was low, even in the presence of red flags, and so their utility appears to be lower in an outpatient setting. It may be reasonable to try to reduce the use of neuroimaging with headache patients in the outpatient setting.

TITLE: Estudio descriptivo de las alteraciones en pruebas de neuroimagen en pacientes con cefalea en un ámbito ambulatorio.Introducción. Los estudios disponibles ofrecen una guía limitada acerca del uso de la neuroimagen en pacientes con cefalea en el ámbito ambulatorio. El objetivo de este estudio fue describir y analizar la frecuencia y el porcentaje de alteraciones en neuroimagen en pacientes valorados por cefalea en una consulta de neurología, así como determinar qué datos de alarma clínicos (red flags) se asocian con mayor frecuencia a estas alteraciones. Pacientes y métodos. Realizamos un estudio observacional, descriptivo y transversal de una serie de pacientes con cefalea de la consulta de neurología del Hospital Universitario de Móstoles a los que se les realizó una prueba de neuroimagen. Resultados. Se incluyó a 279 pacientes en el estudio (190 mujeres y 89 hombres). Ningún paciente sin datos de alarma clínicos presentó alteraciones graves en la neuroimagen y, de los que presentaban datos de alarma clínicos (219 pacientes), sólo el 2,3% (cinco pacientes) presentó alteraciones graves. Los dos datos de alarma clínicos que se asociaron de forma significativa a una mayor probabilidad de alteraciones graves en la neuroimagen fueron la cefalea que se desencadena o empeora significativamente con cambios posturales o maniobras de Valsalva y la cefalea crónica diaria desde su inicio. Conclusiones. La prevalencia de alteraciones significativas en neuroimagen en pacientes con cefalea en un ámbito ambulatorio fue baja, incluso en presencia de datos de alarma clínicos, por lo que la utilidad de estos datos de alarma parece ser menor en un contexto ambulatorio. Podría ser razonable intentar reducir el uso de la neuroimagen en pacientes con cefalea en el ámbito ambulatorio.

Regularization of a Mathematical Model of the Wheatley Heart Valve.

This note considers the mathematical model published in the Journal of Biomechanical Engineering by McKee et al. [McKee, S., Cuminato, J. A., Stewart, I. W., and Wheatley, D. J., 2021, "A Mathematical Representation of the Wheatley Heart Valve," ASME J. Biomech. Eng., 143(8), p. 081006]. The model presented there suffers from the fact that there is a line discontinuity in the first derivative producing what appears to be a kink in each of the leaflets. This note is concerned with regularizing the shape of the valve while holding to Wheatley's essential idea [Wheatley, D. J., 2016, "Heart Valve," U.S. Patent No. 9,259,313, UK Patent No. 2,982,340 (2017), European Patent No. 2,979,666 (2017)].

Organ-specific responses during brain death: increased aerobic metabolism in the liver and anaerobic metabolism with decreased perfusion in the kidneys.

Hepatic and renal energy status prior to transplantation correlates with graft survival. However, effects of brain death (BD) on organ-specific energy status are largely unknown. We studied metabolism, perfusion, oxygen consumption, and mitochondrial function in the liver and kidneys following BD. BD was induced in mechanically-ventilated rats, inflating an epidurally-placed Fogarty-catheter, with sham-operated rats as controls. A 9.4T-preclinical MRI system measured hourly oxygen availability (BOLD-related R2*) and perfusion (T1-weighted). After 4 hrs, tissue was collected, mitochondria isolated and assessed with high-resolution respirometry. Quantitative proteomics, qPCR, and biochemistry was performed on stored tissue/plasma. Following BD, the liver increased glycolytic gene expression (Pfk-1) with decreased glycogen stores, while the kidneys increased anaerobic- (Ldha) and decreased gluconeogenic-related gene expression (Pck-1). Hepatic oxygen consumption increased, while renal perfusion decreased. ATP levels dropped in both organs while mitochondrial respiration and complex I/ATP synthase activity were unaffected. In conclusion, the liver responds to increased metabolic demands during BD, enhancing aerobic metabolism with functional mitochondria. The kidneys shift towards anaerobic energy production while renal perfusion decreases. Our findings highlight the need for an organ-specific approach to assess and optimise graft quality prior to transplantation, to optimise hepatic metabolic conditions and improve renal perfusion while supporting cellular detoxification.

Using an Integrated -Omics Approach to Identify Key Cellular Processes That Are Disturbed in the Kidney After Brain Death.

In an era where we are becoming more reliant on vulnerable kidneys for transplantation from older donors, there is an urgent need to understand how brain death leads to kidney dysfunction and, hence, how this can be prevented. Using a rodent model of hemorrhagic stroke and next-generation proteomic and metabolomic technologies, we aimed to delineate which key cellular processes are perturbed in the kidney after brain death. Pathway analysis of the proteomic signature of kidneys from brain-dead donors revealed large-scale changes in mitochondrial proteins that were associated with altered mitochondrial activity and morphological evidence of mitochondrial injury. We identified an increase in a number of glycolytic proteins and lactate production, suggesting a shift toward anaerobic metabolism. Higher amounts of succinate were found in the brain death group, in conjunction with increased markers of oxidative stress. We characterized the responsiveness of hypoxia inducible factors and found this correlated with post-brain death mean arterial pressures. Brain death leads to metabolic disturbances in the kidney and alterations in mitochondrial function and reactive oxygen species generation. This metabolic disturbance and alteration in mitochondrial function may lead to further cellular injury. Conditioning the brain-dead organ donor by altering metabolism could be a novel approach to ameliorate this brain death-induced kidney injury.

The Effect of Protease Inhibitors on Digestive Proteolytic Activity in the Raspberry Weevil, Aegorhinus superciliosus (Guérin) (Coleoptera: Curculionidae).

The raspberry weevil, Aegorhinus superciliosus (Guérin) (Coleoptera: Curculionidae), is an economically important pest of blueberry in southern Chile. The digestive protease activity of adult insects was investigated using general and specific substrates and inhibitors. Enzymatic assays demonstrated the presence of trypsin- and chymotrypsin-like serine proteinases. Furthermore, in vitro assays using phenylmethylsulfonyl fluoride (PMSF) and soybean trypsin inhibitor (SBTI) at 0.01 and 0.1 mM showed percentages of enzymatic inhibition between 0 and 16% for PMSF and 67 to 76% for SBTI, whereas in vivo assays indicated that SBTI caused between 50 and 90% mortality in males and between 80 and 100% in females. Our data indicate the presence of serine proteases and suggest that digestive proteases could be a target for the design and development of strategies to control the raspberry weevil.

Pediatric liver transplantation experience and outcome in Chile.

INTRODUCTION: In 1994 our group began its experience with pediatric liver transplantation. The experience gained during this period is the largest in the country, positioning the Hospital Luis Calvo Mackenna and Clinica Las Condes as major referral centers in the public and private sectors. The aim of this study was to report our experience of our pediatric liver transplantation program during this period. METHODS: The liver transplantation database of Hospital Luis Calvo Mackenna and Clinica Las Condes between January 1994 and July 2011 was reviewed recording age, gender, indications for transplantation, surgical technique, complications, and survival. Survival rates were calculated using Kaplan-Meier analysis. RESULTS: During the period described 230 transplantations were performed in 189 pediatric patients. Fifty-five percent were male patients. The average age was 5 years. The main causes of transplantation were biliary atresia (50%), fulminant hepatic failure (25%), and other cholestatic diseases by 10%. Vascular and biliary complications were the leading cause of graft loss and retransplantation. The overall rate of retransplantation at 5 years was 20%. The technique of living donor was used in 28% of the cases. The 1-year patient actuarial survival rate was 80%, 73% at 5 years, and 68% at 10 years. In the last 3 years the survival rate at 1 year exceeds 90%. DISCUSSION: Our program includes more than 90% of the national liver experience. The incorporation of living donor is a milestone that has enabled us to save many patients who previously died while waiting for an organ. Its use in cases of full acute liver failure has allowed us to dramatically reduce mortality on the waiting list. Our results in the last 3 years reflect the experience that results in a significant decrease in mortality, comparing favorably to other series published in the international literature.

Liver transplantation in children weighing less than 10 kg: Chilean experience.

BACKGROUND: Orthotopic liver transplantation is the treatment of choice for most terminal liver diseases in children. In small children (≤ 10 kg), this procedure is challenging and has special considerations. The aim of this study is to describe the experience of a Chilean liver transplantation program in this subgroup of patients. METHODS: The liver transplant database of Hospital Luis Calvo Mackenna and Clinica Las Condes was reviewed. All children less than 10 kg undergoing liver transplantation between January 1994 and July 2011 were included. Patient and graft outcomes and main complications were analyzed. RESULTS: We have performed 230 pediatric liver transplantations, 49 of them in 41 patients weighing less than 10 kg. The first indication for transplantation was biliary atresia in 25 patients (61%). A living related donor was used in 23 cases (51%). Actuarial survival was 75.7% at 1 year and 67.1% at 5 years. The main cause of death was infection, and the leading cause of graft loss was vascular complication. DISCUSSION: Our transplant program includes 2 centers that perform more than 90% of pediatric liver transplantations in Chile, including public health pediatric patients from all around the country. Patients weighing less than 10 kg represent the most challenging group in pediatric liver transplantation due to higher rates of vascular and biliary complications and postoperative infections.

Reacción anafiláctica secundaria a quiste hidatídico hepático roto / Anaphylactic reaction secondary to a ruptured liver hydatid cyst: case report

We report a four years old girl consulting in the emergency room for severe abdominal pain and vomiting secondary to a blunt abdominal trauma during a bicycling accident. A chest and abdomen CAT scan showed ruptured hydatid cysts in the lung and liver and free intraperitoneal fluid. During evolution, the patient developed respiratory distress, bronchial obstruction, a papular exanthema and edema. Due to lack of response to steroids, she was operated excising the ruptured hepatic cyst and performing a peritoneal lavage. The patient had a good postoperative evolution. In a second surgical procedure, the lung cyst was excised. The patient is currently receiving albendazole and is asymptomatic after nine months of follow up.

La hidatidosis es una enfermedad parasitaria, zoonótica y endémica de gran importancia en nuestro país. El quiste hidatídico no complicado suele ser asintomático y es más frecuente encontrarlo en población adulta, siendo infrecuente su diagnóstico en la población pediátrica. Presentamos el caso de una paciente de 4 años de edad derivada al Servicio de Urgencia del Hospital de Chillán por cuadro de abdomen agudo posterior a trauma abdominal con manubrio de bicicleta, cuyo estudio tomográfico reveló la presencia de quiste hidatídico hepático y pulmonar rotos, que evoluciona con reacción anafiláctica secundaria.

Chilean experience in liver transplantation for acute liver failure in children.

BACKGROUND: Acute liver failure (ALF) in children is a life-threatening condition, associated with high mortality, and in almost one third of the cases, with no other therapeutic option than orthotopic liver transplant (OLT). The aim of this study was to present our experience with OLT for ALF in pediatric patients in Chile. Patients fulfilling the criteria for ALF who were transplanted in our centers were prospectively included in an excel Microsoft database. We analyzed demographics, etiology, surgical techniques, complications, and long-term results. PATIENTS AND METHODS: Between 1994 and 2009, we transplanted 52 pediatric patients with ALF. The most frequent known etiology was acute hepatitis A in 9 cases (18%), but in 26 cases (50%) it was impossible to determine the etiology. Thirty- one patients were males (63%). The overall mean age was 7.5 years and the mean weight, 28.1 kg. Thirty-five (67%) received a cadaveric graft. Among them in 18 cases (34%) the liver had to be reduced but 17 (33%) received whole livers. There were 17 (33%) recipients of living-related livers. Twenty-two patients needed reoperation, including 13 due to surgical complications (59%) and 9 (41%) as planned interventions. Ten patients were retransplanted. RESULTS: Actuarial survival of patients at 1 year was 80% and at 5 and 10 years, 72%. Graft survival at 1 year was 79%, at 5 years 69%, and at 10 years 50%. CONCLUSION: We have reported a series of pediatric liver transplant patients due to ALF whose results were comparable to other reported series. Living donor transplantation for ALF should be considered and offers a low morbidity rate without mortality.

Perfil microbiológico del saco herniario en hernias complicadas operadas en el Servicio de Urgencias / Infection of hernia sac of complicated abdominal hernias

Background: When a complicated hernia is operated, there may be a higher risk of infection when a mesh is placed in a place potentially colonized by intestinal bacteria translocated from the gut. Aim: To perform a microbiological study of the hernia sac of patients subjected to emergency surgery due to complicated hernias. Material and Methods: Prospective study of patients operated for complicated abdominal hernias. Prior to the repair, a culture was obtained from the exposed sac. A portion of this sac was excised and cultured also. Results: Forty one patients aged 46 to 88 years (30 females) were studied. Only one sac tissue sample culture was positive. In six patients, the sac surface cultures disclosed coagulase negative Staphiloccocus. These patients did not receive antimicrobial therapy and although a mesh was placed, no comphcation was recorded. It is possible that these positive cultures were due to contamination of samples. Conclusions: From a microbiological point of view it is safe to place a mesh during the repair of complicated hernias.

La incarceración de una hernia abdominal es una de las emergencias quirúrgicas más comunes. La reparación protésica de las hernias complicadas está aún en discusión, ya que muchos cirujanos temen la infección de la malla al implantarla en un sitio inflamado y potencialmente colonizado por bacterias translocadas desde el tubo digestivo. Nuestro estudio tiene como objetivo el determinar la presencia de estos microorganismos en el saco hemiario de los pacientes adultos operados de urgencia con diagnóstico de hernia abdominal complicada, a través de cultivos de la superficie y fragmento del mismo, junto con establecer una correlación con las variables clínicas y de laboratorio del paciente al ingreso. Se estudiaron 41 pacientes, observándose un cultivo positivo en la muestra de tejido del saco. Por otro lado, seis pacientes cuyas muestras de superficie resultaron con desarrollo de Staphiloccocus coagulosa negativo, a pesar de no utilizarse terapia antibiótica y haberse reparado con malla, presentaron una excelente evolución sin complicaciones ulteriores, por lo tanto, no descartamos que las muestras correspondan a falsos positivos debido a contaminación de las mismas. Nuestra casuística permite aportar con un antecedente más al algoritmo de decisiones acerca de la utilización de prótesis en hernioplastía de urgencia. Nos parece que desde el punto de vista microbiológico local, la reparación protésica parece ser segura.

Duration of delayed graft function is an important predictor of 1-year serum creatinine.

OBJECTIVE: The purpose of this study was to evaluate the importance of various factors on 1-year serum creatinine (SCr) as a surrogate endpoint for allograft survival among a series of kidney transplantations performed at 2 centers. PATIENTS AND METHODS: Two hundred sixty consecutive renal transplantations were included with overall mean age of 40 +/- 13 years, including 55% men and 19% living donor grafts. Factors considered for analysis were donor and recipient ages, and sexes, number of transplantations, panel-reactive antibodies, total number of HLA mismatches, cold ischemia time (CIT), acute rejection (AR) rate, and presence/duration of delayed graft function (DGF). Multiple regression analyses were performed for 1-year SCr, AR rate, and DGF duration. RESULTS: One-year SCr was 1.46 +/- 0.5 mg/dL, 6-month AR rate was 22%, and DGF rate was 29% of mean duration 3 +/- 8 days. Multiple regression analysis for lower 1-year SCr value identified as significant female recipient sex, lower donor age, absence of AR within 6 months, and decreased DGF duration (P < .05). The only significant factor affecting AR rate was DGF duration. Finally, prolonged CIT was associated with a longer DGF duration. CONCLUSIONS: We confirmed that 1-year SCr was primarily affected by well-known factors, such as AR incidence, donor age, and female recipient sex. However, we identified DGF duration as a significant factor affecting 1-year SCr. AR rate was also associated with DGF duration, which in turn depended upon longer CIT.

Dorsolateral prefrontal N-acetyl-aspartate concentration in male patients with chronic schizophrenia and with chronic bipolar disorder.

OBJECTIVES: A study of N-acetyl-aspartate (NAA) can provide data of interest about cortical alterations in psychotic illnesses. Although a decreased NAA level in the cerebral cortex is a replicated finding in chronic schizophrenia, the data are less consistent for bipolar disease. On the other hand, it is likely that NAA values in schizophrenia may differ in men and women. METHODS: We used proton magnetic resonance spectroscopy ((1)H MRS) to examine NAA levels in the prefrontal cortex in two groups of male patients, one with schizophrenia (n=11) and the other with bipolar disorder (n=13) of similar duration, and compared them to a sample of healthy control males (n=10). Additionally, we compared the degree of structural deviations from normal volumes of gray matter (GM) and cerebrospinal fluid (CSF) in the dorsolateral prefrontal cortex. RESULTS: Compared to controls, schizophrenia and bipolar patients presented decreased NAA to creatine ratios, while only the schizophrenia group showed an increase in CSF in the dorsolateral prefrontal region. There were no differences in choline to creatine ratios among the groups. CONCLUSIONS: These data suggest that the decrease in NAA in the prefrontal region may be similar in schizophrenia and bipolar disorder, at least in the chronic state. However, cortical CSF may be markedly increased in schizophrenia patients.

Score de Alvarado: utilidad diagnóstica en el paciente pediátrico / Alvarado Score: diagnostic use in the pediatric patient

La apendicitis aguda constituye la primera causa de abdomen agudo quirúrgico en la etapa preescolar y escolar, y su diagnóstico temprano es un reto para los cirujanos pediatras. El Score de Alvarado, descrito en 1995, es un método sencillo que toma en cuenta parámetros clínicos y de laboratorio, con la finalidad de realizar un diagnóstico temprano de apendicitis aguda. Se incluyeron en el estudio una muestra al azar de 117 pacientes, 63 varones y 54 hembras, con edades comprendidas entre 1 y 12 años, y con clínica sospechosa o evidente de apendicitis aguda. De los 81 pacientes operados, 78 (96.29 por ciento) presentaron Score de Alavarado mayor o igual a 6 puntos, mientras que en los 36 pacientes que no fueron intervenidos quirúrgicamente, ninguno obtuvo Score Alvarado mayor o igual a 7 puntos. Concluimos que este método demostró tener gran utilidad, ya que un Score de 5 puntos o menos descarta el diagnóstico a apendicitis, mientras que un score de 7 o más tiene el 100 por ciento de efectividad, confirmada con histología. Paciente con 5 ó 6 puntos que no tenga modificación del Score tras 12 horas de observación descarta el diagnóstico

[Specific developmental language disorder: a theoretical approach to its diagnosis, aetiology and clinical symptoms]. / Trastorno específico del desarrollo del lenguaje: una aproximación teórica a su diagnóstico, etiología y manifestaciones clínicas.

AIM: This article presents an updated review about the definition, diagnostic criteria, classifications, etiology and the evolution of the specific language impairment (SLI). DEVELOPMENT: The specific language impairment is characterized by a developmental language delay and an impaired language, that persist over time and it is not explained by sensorial, motor and mental disabilities, neither by psycopathological disorders, socio-emotional deprivation, nor brain injury. The diagnosis is based on exclusional criteria. Some researchers propose different classifications considering the children performance in language comprehension and language production. Genetical linkage to the FOXP2 gen in the SPCH1 region of the chromosome 7 and to the chromosomes 13, 16 y 19 has been reported. The neuroimage studies have shown alterations in the volume and perfusion of some brain structures related to language. The manifestations of SLI may change during the development of the children and may disturb the self-esteem, the academic performance and the social abilities. CONCLUSIONS: The variability in the linguistic and cognitive performance, and the variety in the etiological findings in children with SLI, don't allow to settle the affected population as an homogeneous group. Different theoretical positions have emerged as a consequence of this condition.

Trastorno específico del desarrollo del lenguaje: una aproximación teórica a su diagnóstico, etiología y manifestaciones clínicas / Specific developmental language disorder: A theoretical approach to its diagnosis, aetiology and clinical symptoms

Objetivo. Se presenta una revisión teórica actualizada de la definición, los criterios diagnósticos, las propuestas de clasificación, la etiología y la evolución del trastorno específico del desarrollo del lenguaje (TEDL). Desarrollo. El TEDL, comúnmente conocido como SLI (del inglés specific language impairment) en la literatura inglesa, se determina por un retraso y una alteración del desarrollo del lenguaje que persisten en el tiempo y que no pueden explicarse por deficiencias sensoriales, motoras, mentales, trastornos psicopatológicos, deprivación socioafectiva, ni lesiones cerebrales evidentes. El diagnóstico se basa en criterios de exclusión. Algunos autores plantean propuestas de clasificación considerando las características del desempeño de los niños en cuanto a la comprensión y la expresión del lenguaje. Se ha encontrado una asociación genética con el gen FOXP2 de la región SPCH1 del cromosoma 7, y en los cromosomas 13, 16 y 19. Los estudios de neuroimagen muestran alteraciones en el volumen y la perfusión de estructuras relacionadas con el lenguaje. Las características semiológicas del TEDL pueden cambiar a medida que el niño crece y afectar a la autoestima, el rendimiento escolar y las habilidades sociales. Conclusiones. La variabilidad en los perfiles de desempeño lingüístico y cognitivo y los diversos hallazgos etiológicos de los niños con TEDL no permiten caracterizar la población afectada como un grupo homogéneo. Esto ha generado diferentes posicionamientos teóricos, que han enriquecido la comprensión del espectro de manifestaciones del TEDL (AU)

Aim. This article presents an updated review about the definition, diagnostic criteria, classifications, etiology and the evolution of the specific language impairment (SLI). Development. The specific language impairment is characterized by a developmental language delay and an impaired language, that persist over time and it is not explained by sensorial, motor and mental disabilities, neither by psycopathological disorders, socio-emotional deprivation, nor brain injury. The diagnosis is based on exclusional criteria. Some researchers propose different classifications considering the children performance in language comprehension and language production. Genetical linkage to the FOXP2 gen in the SPCH1 region of the chromosome 7 and to the chromosomes 13, 16 y 19 has been reported. The neuroimage studies have shown alterations in the volume and perfusion of some brain structures related to language. The manifestations of SLI may change during the development of the children and may disturb the self-steem, the academic performance and the social abilities. Conclusions. The variability in the linguistic and cognitive performance, and the variety in the etiological findings in children with SLI, don’t allow to settle the affected population as an homogeneous group. Different theorical positions have emerged as a consequence of this condition (AU)

Evaluacion nutritiva y sensorial de raciones del programa de complementacion de la alimentacion de la Junta Nacional de Auxilio Escolar y Becas (JNAEB). / Nutritional and sensorial evaluation of foodstuffs from the food suplementation program of the National Committe of Assistence to Schoolchildren (JNAEB)

Debido a la importancia que tiene la alimentacion en ninos en edad escolar se estimo interesante, como un primer paso, evaluar nutritiva y sensorialmente dos guisos concentrados y enlatados: base de carbonada y base de menestron, provenientes de tres industrias nacionales, los cuales son distribuidos a escolares chilenos a traves de los programas de Complementacion de la Alimentacion aplicados por la JNAEB. Del estudio realizado cabe destacar que solo dos de las 6 lotes analizados cumplen con lo declarado en cuanto a contenido proteico. La alimentacion complementaria de solo una de las industrias alcanza a superar el numero de calorias exigidas por la JNAEB. Sin embargo, en cuanto a contenido de proteinas todas estan dentro de las especificaciones. La calidad sensorial de los guisos es significativamente diferente dependiendo de la industria de las fabricas, siendo el color el parametro que presento mayor deterioro en todos los casos