Fracaso antropométrico y altura geográfica en escolares jujeños asistidos alimentariamente / Anthropometric failure and geographical altitude in food assisted schoolchildren from Jujuy

INTRODUCCIÓN: Alteraciones en el crecimiento y/o el desarrollo de los niños implica el fracaso, no sólo del crecimiento, sino también en otros aspectos del bienestar infantil. La caracterización de este fracaso y una evaluación de la situación nutricional resulta vital para identificar situaciones de riesgo. OBJETIVO: Analizar el estado nutricional de escolares jujeños, entre 4 y 9 años, evaluados con el Índice de Fracaso Antropométrico Extendido y su relación con la altura geográfica, las diferentes modalidades de asistencia alimentaria escolar y el sexo, en dos momentos del año escolar. MÉTODOS: Estudio transversal. Se evaluaron 5806 escolares entre 4 y 9 años, asistidos alimentariamente por el programa de Comedores Escolares de la provincia de Jujuy. Se registró peso y talla en dos momentos del año escolar y se consideró la altura geográfica y el sexo. Se determinó bajo peso, baja talla, emaciación y exceso ponderal y se construyó el Índice de Fracaso Antropométrico Extendido. Se estimaron estadísticos descriptivos, prevalencias, se realizaron comparaciones y regresiones logísticas para evaluar la relación entre las variables. RESULTADOS: La categoría "sin fracaso" presentó la mayor frecuencia en ambas mediciones, seguida por exceso de peso y acortamiento. Entre mediciones hubo un lapso promedio de 5 meses y en ese tiempo se observó una reducción del fracaso antropométrico total, acortamiento + bajo peso, acortamiento y exceso de peso + acortamiento. Las diferencias por altura geográfica reflejaron que la malnutrición por déficit fue mayor en tierras altas y la malnutrición por exceso en tierras bajas. A su vez, solo el sexo tuvo relación con el fracaso antropométrico, siendo mayor la probabilidad en mujeres. CONCLUSIONES: Este estudio sugiere que la asistencia alimentaria escolar tendría un efecto positivo en la situación nutricional de escolares, ya que reduciría el riesgo de malnutrición por la eventual inseguridad alimentaria de sus hogares

INTRODUCTION: Alterations in the growth and/or development of children implies failure, not only on growth, but also in other aspects of child welfare. The characterization of this failure and an assessment of the nutritional situation is vital to identify risk factors. OBJECTIVE: To analyze the nutritional status of schoolchildren from Jujuy, between 4 and 9 years old, evaluated with the Extended Anthropometric Failure Index and its relationship with geographical altitude, the different modalities of school food assistance and sex, in two moments of the school year. METHODS: Cross-sectional study.5806 schoolchildren from Jujuy between 4 and 9 years old were evaluated, food-assisted by the School Dining Program in the province of Jujuy. Weight and height were recorded at two times of the school year and geographic height and gender were considered. Underweight, stunting, wasting and weight excess were determined and the Extended Anthropometric Failure Index was constructed. Descriptive statistics and prevalence were estimated. Comparisons and logistic regressions were made to assess the relationship between the variables. RESULTS: The "no failure" category presented the highest frequency in both measurements, followed by excess weight and stunting. Between measurements there was an average span of 5 months and at that time a reduction in total anthropometric failure, stunting + underweight, stunting and excess weight + stunting was observed. Differences in geographical altitude reflected that deficit malnutrition was higher in the highlands and malnutrition due to excess in the lowlands. In turn, only sex was related to anthropometric failure, being the probability higher in women. CONCLUSIONS: This study suggests that school food assistance would have a positive effect on the nutritional status of schoolchildren, since it would reduce the risk of malnutrition due to eventual food insecurity in their homes

Errores técnicos de medida en el diagnóstico de la desnutrición infantil: datos procedentes de intervenciones de Acción Contrael Hambre entre 2001 y 2010 / Technical errors of measurement in the diagnosis of child malnutrition: data from ACF interventions between 2001 and 2010

Se analiza la calidad de las medidas antropométricas efectuadas por 199 antropometristas que actuaron en 17 encuestas nutricionales de Acción Contra el Hambre efectuadas en Afganistán, Bangladesh, Bolivia, Mali, República de Myanmar y Filipinas. Para las tres dimensiones analizadas: peso, talla y perímetro del brazo (MUAC) el error técnico de medida (ETM) absoluto es aceptable, aunque supera el reseñado en la estandarización del Multicenter Growth Reference Study de la Organización Mundial de la Salud (OMS). El nivel de competencia de los equipos de antropometristas que midieron en las 17 intervenciones difiere significativamente. El error técnico de medida relativo (ETM%) supera el margen de tolerancia para el peso en una de las encuestas y en cinco para el MUAC. Por lo que respecta al ETM% inter-observador, se encuentra en un rango adecuado para la talla y el peso, pero excede el nivel de tolerancia recomendado en 11 de las 17 campañas de intervención. Se recomienda hacer énfasis en la formación del personal técnico encargado de tomar las medidas antropométricas y tener especial cuidado en la medida del MUAC (AU)

We analyze the quality of the anthropometric measurements made by 199 anthropometrists who acted in 17 nutritional surveys conducted by ACF in Afgha - nistan, Bangladesh, Bolivia, Mali, Republic of Myanmar and the Philippines. For the three dimensions analyzed: weight, height and arm circumference (MUAC) the technical error of measurement (TEM) is acceptable, although it is over high than standardization values, outlined in the Multicenter Growth Reference Study of the World Helath Organization (WHO). The level of competence anthropometrists teams that measured in the 17 interventions differ significantly. The relative technical error of measurement (TEM%) exceeds the tolerance for the weight in one survey and five for MUAC. With respect to the TEM% inter-observer is in a suitable range for height and weight, but exceeds the recommended tolerance level in 11 of the 17 intervention campaigns. It is recommended to emphasize the training of technical staff in charge of taking anthropometric measurements and take special care in measuring the MUAC (AU)

Valoración del grado de conocimientos y experienciaen nutrición artificial entre los especialistasen medicina intensiva de la Región de Murcia / Evaluation of intensivit´s knowledge and experience in artificial nutrition in the Murcia region (Spain)

Objetivos. El conocimiento de la nutrición artificial es un apartado obligatorio en la formación de los especialistas en medicina intensiva por su importancia en el tratamiento del paciente crítico. En el presente estudio se pretende valorar la formación recibida y el grado de conocimientos adquiridos entre los intensivistas de nuestra área. Métodos. Se llevó a cabo una encuesta en tiempo real entre los intensivistas de cinco hospitales de nuestra región. La encuesta constaba de 29 ítems, divida en tres apartados: formación, conocimientos generales y conocimientos en el paciente crítico. Resultados. Se recogieron 52 encuestas (38 especialistas y 14 médicos residentes, o MIR).De ellos, un 83 por ciento había recibido formación sobre el tema durante el período MIR, pero el 66 por ciento la consideraba insuficiente. Esta opinión era significativamente mayor (p < 0,05) en el grupo MIR. Un 66 por ciento de los encuestados adecuaba las dietas a las características del paciente, pero sólo conocían y manejaban "toda" la gama de productos de cada tipo de nutrición un 25 por ciento en el caso de las dietas orales, un 22 por ciento en el de la nutrición enteral y un 36 por ciento en el de la nutrición parenteral. La nota media (desviación estándar [DE]) en el conocimiento de nutrición en el paciente crítico fue de 6,19 (1,80), significativamente mayor (p < 0,05) en los especialistas que en los MIR. Conclusiones. La formación en nutrición se recibe fundamentalmente en el período MIR, aunque en general se considera que es insuficiente. La mayoría de los profesionales utiliza correctamente las dietas existentes. Por último, el grado de conocimientos es medio, y es significativamente mayor en los profesionales con más experiencia (AU)

Sipple's syndrome presenting acutely as severe heart failure.

We describe the case of a 56-year-old man who developed acute hypertension leading to cardiac insufficiency, arrhythmia, severe heart failure and death. The autopsy revealed Sipple's syndrome (multiple endocrine neoplasia syndrome type IIa) and catecholamine-induced cardiomyopathy. This man had received a false diagnosis of primary hypertension 1 year before. The prime objective of this report is to call attention to the necessity of an in depth diagnosis of labile and paroxysmal hypertension. The clinical diagnostic features of phaeochromocytoma as well as the main therapeutic approaches suggested in the literature are commented on.

[Macrophage activation syndrome: a diagnostic challenge]. / Síndrome de activación del macrófago: un reto diagnóstico.

Macrophage activation syndrome, or hemophagocytic syndrome, is a rare disease with high morbidity and mortality. It is a disorder of the mononuclear phagocyte system. Two forms have been described; primary or familial hemophagocytic lymphohistiocytosis and secondary or sporadic hemophagocytic syndrome. Diagnosis of macrophage activation syndrome poses a real challenge for the pediatrician and in many cases is only made at autopsy. We describe two patients with hemophagocytic syndrome associated with parvovirus B19 and Epstein-Barr virus infection.

Síndrome de activación del macrófago: un reto diagnóstico / Macrophage activation syndrome: a diagnostic challenge

El síndrome de activación del macrófago (SAM) o síndrome hemofagocítico es una enfermedad rara y con una alta morbimortalidad. Se encuentra incluido dentro de las histiocitosis de la clase II y se distinguen dos formas: una familiar y otra secundaria a enfermedades subyacentes.El diagnóstico de SAM supone un verdadero reto y muchos casos no llegan a diagnosticarse ante mortem. Se presentan 2 casos de SAM asociados a infecciones por parvovirus B19 y virus de Epstein-Barr (AU)

Effects of kindling in wheat germ agglutinin-horseradish peroxidase [corrected] labeling in neurons of the interamygdaloid pathway in rats.

This paper describes in kindled rats an increment in wheat germ agglutinin-horseradish peroxidase labeling in anterior commissure, bed nuclei of stria terminalis and amygdala. Three groups of animals were analyzed: control, sham-operated and kindled animals with ten convulsive generalized seizures. Results show that kindled animals have an increase in fiber labeling in anterior commissure and in the bed nuclei of stria terminalis, as well as a greater number of labeled neurons in amygdala. This label enhancement is related to the hyperexcitability of neurons produced by epilepsy, and could be associated to the propagation and formation of secondary foci and related plastic changes occurring during kindling.

Striatal transplants prevent AF64A-induced retention deficits.

The relevance of the cholinergic system in mnemonic processes has been repeatedly demonstrated. In addition to the cholinergic systems that project to the telencephalon, there are subcortical nuclei with intrinsic cholinergic cells which appear to be involved in memory consolidation; among these is the striatum. Intrastriatal administration of anticholinergic drugs, as well as excitotoxic and electrolytic lesions have been shown to disrupt the acquisition and retention of instrumentally conditioned behaviors. In the present study male Wistar rats were used to confirm the reported detrimental effects of striatal lesions produced by the cholinotoxin AF64A on long-term retention (LTR) of inhibitory avoidance and spontaneous locomotor activity, to determine its effects on short-term retention (STR) and to investigate whether intrastriatal homotopic transplants can reverse the AF64A-induced behavioral deficits. AF64A-striatal lesions did not interfere with STR but disrupted LTR of the inhibitory avoidance task, and striatal transplants prevented this deficit. Spontaneous locomotor activity increased after the lesion but promptly returned to baseline levels. These results support previous findings showing striatal involvement in long-term but not short-term retention and indicate that homotopic transplants induce behavioral recovery of a learning task in striatal lesioned rats.

[Evolution of the nutritional status of patients with HIV-AIDS. Effects of socioeconomic situation and dietetic counseling]. / Evolución del estado nutricional de pacientes VIH-SIDA. Efecto de su situación socio-económica y del consejo dietético.

OBJECTIVES: To know HIV-AIDS patient's nutritional status in different infection's condition and their relation with the socioeconomic situation and, in that case, the nutritional condition improvement through the dietetic advice appropriated for each patient. METHODS: Prospective study of 79 patients with HIV-AIDS diagnostic in any illness's condition and recopilation of anthropometrics and biochemical variables. At the beginning of the study we got data about socioeconomic situation of patient with a scale of 1 to 5 points each variable and an score top of 35. In the survivors we checked, after dietetic advice, the variables at 6 and 12 months by sanitary personal (physician and nurse) who weren't implicated in direct assistance. The study was analyzed by Student "T" for matched data and the simple correlation test. RESULTS: We have objectivated a lost of initial weight over their habitual's with a progressive impairment in different stage of evolution that weren't modified by dietetic advice. We didn't observed significant variations in the biochemical variables included in advances states and in parameters which are usually affected in malnutrition. In the analysis of relation between nutritional condition and socioeconomic factors, it was estimated a lesser score, that was statistically significative, in patients who had a work, family situation and an affective upset positive. CONCLUSIONS: The results obtained induce to think that the nutritional advices appropriated for each patient are not related, in our series, with progressive deterioration of anthropometrics variables, neither biochemical parameters fluctuations at 6, 12 months of follow-up. The patient's socioeconomic situation is not influenced by nutritional condition except for the work, affectivity and family environment.

Histochemical distribution of NADPH-diaphorase in the cerebral ganglion of the crayfish Cambarellus montezumae.

The presence and localization of NADPH-diaphorase in the cerebral ganglion of the crayfish Cambarellus montezumae was shown. The reactivity of this enzyme was found in the deuterocerebrum, mainly in the commissure, in fibers of olfactory and accessory lobes, and in the laterodorsal group of cells. The presence of this enzyme in these cerebral regions suggests that nitric oxide is involved in primary sensory afferents in the crayfish.

Distribution of NADPH-diaphorase in the perioesophageal ganglia of the snail, Helix aspersa.

In this paper we discuss the anatomical localization of NADPH-diaphorase using Nitroblue tetrazolium in perioesophageal ganglia of Helix aspersa. Our results show that the reaction is present in neurons and fibers of the procerebrum, some positive neurons are found in mesocerebrum, and there were positive fibers in the neuropile of postcerebrum and mesocerebrum; likewise, immunopositive fibers were found in the neuropile of pedal, pleural and parietal ganglia. The presence of NADPH-diaphorase in the interneurons of procerebrum suggests the participation of this enzyme in the production of nitric oxide for the processing of the olfactory information, as has been suggested in mammalian olfactory tissue.

Evidence for enkephalin- and endorphin-immunoreactive cells in the anterior pituitary of the axolotl Ambystoma mexicanum.

An immunohistochemical study of opioid peptides in the hypophysis of the axolotl, Ambystoma mexicanum, was carried out with antisera against leu-enkephalin, beta-endorphin, met-enkephalin, and dynorphin A (1-8). We found leu-enkephalin immunoreactivity in some fibers of the neural lobe and the median eminence. In contrast to previous reports on mammals and other vertebrates, we found leu-enkephalin immunoreactivity in many cells scattered throughout the anterior lobe. As in other vertebrates, the beta-endorphin immunoreactivity was present in all the cells of the intermediate lobe and in a few cells of the anterior lobe. Met-enkephalin and dynorphin A (1-8) immunoreactivities were only present in the neural lobe and the median eminence. The presence of leu-enkephalin and beta-endorphin in the anterior lobe suggests that these peptides could be acting as hormones released from the hypophysis of the unmetamorphosed amphibian.

Mesencephalic projections to the thalamic centralis lateralis and medial prefrontal cortex: a WGA-HRP study.

In order to provide anatomical information for a possible pathway involved in pain mechanisms, rats were injected with horseradish peroxidase wheat germ agglutinin (WGA-HRP) in the centralis lateralis nucleus of the thalamus (Cl) or in the medial prefrontal cortex (PFCx) from which originated retrogradely labelled cells in the dorsal raphe nucleus (DR), locus ceruleus (LC) and surrounding structures. The locations of the Cl and the PFCx injections were previously determined by the presence of evoked single neuronal responses to noxious stimulations. The present study gives evidence for ascending pathways which originated in DR and LC and project to the Cl and PFCx. LC and DR projections suggest a possible route to an ascending modulation pain system.

Dorsal raphe neuronal responses to thalamic centralis lateralis and medial prefrontal cortex electrical stimulation.

The present study gives evidence for ascending pathways from the dorsal raphe nucleus (DR) to the centralis lateralis nucleus (CL) and to the medial prefrontal cortex (PFCx). Single-unit recordings were done at dorsal raphe level and electrical stimulation was applied at CL and PFCx regions causing antidromic and orthodromic activity in DR cells. The speed conduction difference of the antidromic DR responses to CL and PFCx stimulation was significantly different, but the latencies of the same responses showed no differences. Therefore, we conclude that the DR pathways to CL and to PFCx structures reach their target cells at similar times.

Dorsal raphe and nociceptive stimulations evoke convergent responses on the thalamic centralis lateralis and medial prefrontal cortex neurons.

There is evidence for the existence of a descending pain suppression system, but also there are data supporting the hypothesis for the modulation of pain at higher central nervous system levels. In the present study we give evidence for a possible ascending pain modulation pathway which involves the dorsal raphe (DR), the centralis lateralis nucleus (CL) of the thalamus and the medial prefrontal cortex (PFCx). Urethane-anesthetized rats were used. Simultaneous single unit recordings were done in the CL and PFCx regions under noxious and DR stimulations. Cells responding to both types of stimuli exhibit duration responses directly related to the duration of the stimuli. Thus, from our results we conclude a DR influence upon CL and PFCx structures that are involved in the coding of nociceptive information. A possible route for an ascending pain modulation path is proposed.

Habituation and dehabituation of the spinal polysynaptic reflex responses: modification by naloxone and opiates and their anatomical correlates.

The sustained inhibitory action of spinal endorphins could be responsible for the habituation of polysynaptic responses in the spinal cord. To test this hypothesis, acute spinalized unanesthetized cats (decerebrated and curarized) were used. Sural nerve electrical stimulation (0.2 Hz) was provided and a progressive decrease in the reflex response was found. Conversely, the field potential (lamina V) progressively increased during stimulation, reaching its maximum amplitude when ventral root response showed maximum habituation. The administration of naloxone (0.8-10.0 mg/kg) produced dehabituation or prevented habituation. The immunohistological results showed leu-enkephalin-like immunoreactive dot-like structures in close proximity to neurons of laminae VII, VIII and IX in the lumbo-sacral segment of the spinal cord. Our results suggest an involvement of opioid peptides in the habituation process.

Double cortical control acting upon activities of intralaminar thalamic cells.

We report the effects exerted by the cortex upon the intralaminar thalamic nucleic, as revealed by reversible blockade of the cortex with spreading depression in awake rats. Extracellular recordings of spontaneous activity were made simultaneously at thalamic and cortical sites. The effect of peripheral receptive field stimulation was to decrease activity of intralaminar thalamic cells. Cortical recordings revealed the cortical regions affected by spreading depression. Two type of cells were identified depending on the changes in their sensorial responses during the cortical spreading depression propagation. The first exhibited a tonic facilitating cortical control when the cortical spreading depression was located at A 8.0 to A 10.0. The second type exhibited a disappearance of the sensorial responses when cortical spreading depression was located at A 4.0 to A 8.0 and also displayed the tonic facilitating control. This indicates that two different identified cortical regions influenced the thalamic activity.