Estudio observacional prospectivo unicéntrico sobre el efecto de la prehabilitación trimodal en cirugía colorrectal / A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery

INTRODUCCIÓN: Se ha diseñado un protocolo de prehabilitación trimodal con el objetivo de valorar si contribuye a disminuir la morbilidad postoperatoria, valorar el efecto de la prehabilitación en la estancia hospitalaria global y analizar la evolución de la capacidad funcional antes y después de cirugía. MÉTODOS: Estudio observacional unicéntrico con pacientes con cáncer colorrectal intervenidos quirúrgicamente con intención curativa después de un protocolo de prehabilitación trimodal. Se recoge morbilidad postoperatoria según el Comprehensive Complication Index y estancia hospitalaria, y se compara con una matriz histórica. También se recoge capacidad funcional antes y después de la aplicación del protocolo de prehabilitación. RESULTADOS: En comparación con la población histórica se consigue disminuir el Comprehensive Complication Index global de forma estadísticamente significativa de 13,2 a 11,5. Desglosando por tipo de morbilidad, todas disminuyen en porcentaje sin conseguir significación (infección espacio quirúrgico del 11,7 al 8,4%; infección nosocomial del 15,8 al 10%, y morbilidad médica del 8,6 al 4,2%). La estancia hospitalaria global pasa de 6 a 4 días y el porcentaje de pacientes que se preparan en casa disminuye de forma estadísticamente significativa en ambos casos. CONCLUSIONES: La prehabilitación trimodal puede contribuir a disminuir la morbilidad postoperatoria y la estancia hospitalaria global de los pacientes intervenidos de neoplasia colorrectal

INTRODUCTION: A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery. METHODS: A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol. RESULTS: Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases. CONCLUSIONS: Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery

A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery. / Estudio observacional prospectivo unicéntrico sobre el efecto de la prehabilitación trimodal en cirugía colorrectal.

INTRODUCTION: A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery. METHODS: A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol. RESULTS: Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases. CONCLUSIONS: Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery.

Calidad de vida en pacientes tratados con metadona: el WHOQOL-BREF, estudio psicométrico y resultados de aplicación / Quality of life in patients treated with methadone: The WHOQOLBREF, psychometric study and application results

Objetivo. De entre los muchos instrumentos propuestos para medir la calidad de vida de los pacientes con adicción a opiáceos tratados con metadona el WHOQOL-BREF, propuesto por la World Health Organization, es el que más se utiliza en la actualidad. Este trabajo pretende estudiar la fiabilidad y la validez de constructo de la prueba, aplicada a una muestra amplia y representativa de pacientes, y comparar los resultados con los datos disponibles para población general en España. Se reclutó una muestra de 523 sujetos que se encontraban en tratamiento con metadona, en Madrid y Extremadura. Se efectuó un análisis factorial confirmatorio para probar la estructura teóricamente propuesta y, seguidamente, un análisis paralelo optimizado para conocer el número más adecuado de componentes de la prueba. Los resultados muestran que la prueba presenta sólidos valores de consistencia interna, tanto a nivel del ítem como de las escalas. La estructura tetradimensional teórica se confirma en la muestra con adecuados indicadores de ajuste, aunque también se obtienen serios argumentos para considerar su unidimensionalidad. Se estudió la relación estructural entre los cuatro dominios. El WHOQOL-BREF se muestra como una prueba fiable y válida para su uso en pacientes tratados con metadona, proporcionando una medida multidimensional de la calidad de vida percibida, que incluye factores sociales y ambientales ausentes en otros instrumentos, que son de enorme importancia en el tratamiento de los problemas adictivos

The most commonly instrument used to measure quality of life in patients with addictive behaviors is the WHOQOL-BREF, developed by the World Health Organization. No studies have been found to explore the psychometric properties in Spanish clinical samples. This paper aims to study their reliability as well as the construct validity in a representative sample of patients and comparing the results to the data available for the general population in Spain. A sample was recruited comprised of 523 subjects who were undergoing treatment with methadone in Madrid and Extremadura. A confirmatory factor analysis was completed to test the theoretically proposed structure and then an optimized-parallel analysis was done to establish the most adequate number of components. The result offers solid values for internal consistency both as concerns the items and the scales. The theoretical tetra-dimensional structure is confirmed in the sample although serious arguments are also found for considering its onedimensionality. The structural relationship between the four domains was studied. The WHOQOL-BREF proves to be a reliable and valid test for use on patients treated with methadone, providing a multi-dimensional measure of perceived quality of life that includes social and environmental factors of great importance in treating addiction problems

Suppression of cooling by strong magnetic fields in white dwarf stars.

Isolated cool white dwarf stars more often have strong magnetic fields than young, hotter white dwarfs, which has been a puzzle because magnetic fields are expected to decay with time but a cool surface suggests that the star is old. In addition, some white dwarfs with strong fields vary in brightness as they rotate, which has been variously attributed to surface brightness inhomogeneities similar to sunspots, chemical inhomogeneities and other magneto-optical effects. Here we describe optical observations of the brightness and magnetic field of the cool white dwarf WD 1953-011 taken over about eight years, and the results of an analysis of its surface temperature and magnetic field distribution. We find that the magnetic field suppresses atmospheric convection, leading to dark spots in the most magnetized areas. We also find that strong fields are sufficient to suppress convection over the entire surface in cool magnetic white dwarfs, which inhibits their cooling evolution relative to weakly magnetic and non-magnetic white dwarfs, making them appear younger than they truly are. This explains the long-standing mystery of why magnetic fields are more common amongst cool white dwarfs, and implies that the currently accepted ages of strongly magnetic white dwarfs are systematically too young.

A black hole nova obscured by an inner disk torus.

Stellar-mass black holes (BHs) are mostly found in x-ray transients, a subclass of x-ray binaries that exhibit violent outbursts. None of the 50 galactic BHs known show eclipses, which is surprising for a random distribution of inclinations. Swift J1357.2-093313 is a very faint x-ray transient detected in 2011. On the basis of spectroscopic evidence, we show that it contains a BH in a 2.8-hour orbital period. Further, high-time-resolution optical light curves display profound dips without x-ray counterparts. The observed properties are best explained by the presence of an obscuring toroidal structure moving outward in the inner disk, seen at very high inclination. This observational feature should play a key role in models of inner accretion flows and jet collimation mechanisms in stellar-mass BHs.

Cerebelitis aguda e hidrocefalia secundaria / Acute cerebellitis and secondary hydrocephalus

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Alimentación complementaria en niños asturianos menores de un año de edad / Beikost in children less than one year of age in Asturias

Objetivo: Conocer los hábitos de alimentación complementaria de los niños menores de 12 meses de edad de nuestro Área Sanitaria. Comparar los datos obtenidos en dos estudios idénticos realizados en 1996 y 2000. Material y métodos: Estudio observacional descriptivo y transversal a través de dos encuestas telefónicas idénticas realizadas a madres de niños menores de 12 meses de edad nacidos en nuestro Hospital. Fecha de realización: primera encuesta en abril 1996 y segunda encuesta en abril de 2000. Población diana: niños de nuestro Área Sanitaria menores de un año. Población a estudio: niños menores de un año nacidos en nuestro Hospital entre marzo 1995 y marzo 1996 en primera encuesta, y marzo 1999 y marzo 2000 en segunda encuesta. Muestreo aleatorio estratificado por trimestres. Tamaño muestral deseable: 310 niños por encuesta. Tamaño muestra inicial: 400 niños por encuesta. Resultados: Respuestas válidas: 77,7 por ciento. El día de la entrevista tomaron cereales sin gluten el 33 por ciento de los entrevistados, cereales con gluten el 39 por ciento, zumo de fruta el 54 por ciento, fruta el 64 por ciento, verduras el 55 por ciento, legumbres el 10 por ciento, carne el 47 por ciento, pescado el 12 por ciento y huevo el 10 por ciento. El 24 por ciento inició alimentación complementaria antes del cuarto mes, el 4 por ciento tomó gluten antes del sexto mes, el 5 por ciento carne antes del sexto mes, el 4 por ciento pescado antes del octavo mes, el 23 por ciento había tomado alguna vez sal en la comida durante el primer año, el 18 por ciento azúcar, el 3 por ciento cacao y el 10 por ciento había tomado golosinas o dulces manufacturados. El 94 por ciento tomaba vitamina D el día de la encuesta, el 37 por ciento vitamina C y el 11 por ciento flúor. El 21 por ciento tomó medicamentos el día de la entrevista. Conclusiones: La introducción de la alimentación complementaria sigue un calendario rígido con un alto porcentaje de adherencia según dicen sus madres (AU)

On-column ligand synthesis coupled to partial-filling affinity capillary electrophoresis to estimate binding constants of ligands to a receptor.

This paper describes a two-step procedure whereby on-column ligand synthesis and partial-filling affinity capillary electrophoresis (PFACE) are sequentially coupled to each other to determine the binding constants of 9-fluorenylmethoxy carbonyl (Fmoc)-amino acid-D-Ala-D-Ala species to vancomycin (Van) from Streptomyces orientalis. In this technique four separate plugs of sample are injected onto the capillary column and electrophoresed. The initial sample plug contains a D-Ala-D-Ala terminus peptide and two non-interacting standards. Plugs two and three contain solutions of Fmoc-amino acid-N-hydroxysuccinimide (NHS) ester and running buffer, respectively. The fourth sample plug contains an increasing concentration of Van partially-filled onto the capillary column. Upon electrophoresis the initial D-Ala-D-Ala peptide reacts with the Fmoc-amino acid NHS ester yielding the Fmoc-amino acid D-Ala-D-Ala peptide. Continued electrophoresis results in the overlap of the plugs of Van and Fmoc-amino acid-D-Ala-D-Ala peptide and non-interacting markers. Analysis of the change in the relative migration time ratio of the Fmoc-amino acid-D-Ala-D-Ala peptide relative to the non-interacting standards, as a function of the concentration of Van, yields a value for the binding constant. These values agree well with those estimated using other binding and ACE techniques.

Meningitis por enterovirus. Características epidemiológicas,clínicas y de laboratorio en una serie de 60 niños / Enteroviral meningitis. Clinical and laboratory findings in a series of 60 children

Objetivo: Describir las características epidemiológicas, clínicas y hallazgos de laboratorio en una serie de niños con meningitis por enterovirus. Pacientes y método: Estudio retrospectivo descriptivo de los niños hospitalizados entre mayo de 1996 y septiembre de 1997 con diagnóstico de meningitis por enterovirus (crecimiento del virus en líquido cefalorraquídeo [LCR] o presencia de pleocitosis de LCR junto con crecimiento del virus en frotis faríngeo o rectal). Resultados: Se describen 60 casos de meningitis por enterovirus; todos los casos se agruparon entre los meses de mayo y julio. La mediana de edad fue 6 años. La mitad de los casos consultaron en las primeras 6 h de enfermedad y el 20% en las primeras 2 h. Los síntomas predominantes fueron cefalea (97%) y vómitos (80%). Sólo el 56% de los niños presentaron fiebre en algún momento de su evolución. El 78 por ciento presentaban signos meníngeos en la exploración. El recuento leucocitario fue superior a 15.000/ml en el 28%. El recuento leucocitario en LCR fue superior a 500/ml sólo en 5 niños y 4 casos cursaron sin pleocitosis; en el 45% hubo predominio de polinucleares. Se aisló enterovirus en el LCR en el 43% de los casos. La mediana de la estancia hospitalaria fue 2 días. Recibieron tratamiento antibiótico el 13% de los niños y ninguno presentó secuelas. Conclusiones: Todos los casos se produjeron a finales de primavera. La fiebre fue un síntoma poco frecuente. La fórmula leucocitaria en el LCR es con frecuencia similar a la descrita en las meningitis bacterianas; sin embargo, el resto de los datos citobioquímicos (el número total de leucocitos, la glucorraquia y la proteinorraquia) son características de meningitis vírica; no es excepcional la ausencia de pleocitosis. El rendimiento del cultivo de enterovirus en LCR ha sido superior al publicado en series previas; sin embargo, su utilidad práctica ha sido nula. La evolución ha sido favorable en todos los casos (AU)

[Alice in Wonderland syndrome due to Epstein-Barr virus infection]. / Síndrome de "Alicia en el País de las Maravillas" asociado a infección por el virus de Epstein-Barr.

The Alice in Wonderland syndrome refers to distortions in body image and in the apparent sizes, shapes, and spatial relations of objects seen. The syndrome is usually associated with migraine headaches and has also been reported in several viral infections. We report a 6-year-old boy who presented to the emergency department complaining of several episodes in which the ceiling, the objects and the people around him seemed very small and far away. The child presented no alteration in the level of consciousness. The episodes provoked great fear in the child. Physical examination revealed no abnormalities except pharyngoamygdalitis. Serologic studies (IgM antibodies to viral capsid antigen) confirmed Epstein-Barr virus infection. The child's symptoms resolved spontaneously within 48 hours and he continued to be asymptomatic after a 4 -month follow-up. We consider that all children presenting a clinical picture consistent with the Alice in Wonderland syndrome should undergo serological testing for Epstein Barr virus infection. Diagnosis would enable physicians to reassure the family of the temporary and benign nature of this alarming condition.

[Enteroviral meningitis. Clinical and laboratory findings in a series of 60 children]. / Meningitis por enterovirus. Características epidemiológicas,clínicas y de laboratorio en una serie de 60 niños.

OBJECTIVE: To describe the epidemiologic, clinical and laboratory findings in a series of children with enteroviral meningitis. PATIENTS AND METHODS: We performed a retrospective descriptive study of all the children admitted to our hospital between May 1996 and September 1997 with a diagnosis of enteroviral meningitis, defined as either a positive cerebrospinal fluid (CSF) culture for enterovirus or pleocytosis in conjunction with a positive enterovirus culture at any other site (rectal or pharyngeal swabs). RESULTS: Sixty cases of enteroviral meningitis were found, all of which occurred between May and July. The median age was 6 years. Half the patients were diagnosed in the first 6 hours of illness and 20 % in the first 2 hours. The most frequent symptoms were headache (97 %) and vomiting (80 %). Fever was present in only 56 % of the patients. On physical examination 78 % presented positive meningeal signs. A total white blood cell count of more than 15,000/l was present in 28 %. CSF white cell count was over 500/l in only five patients and in four pleocytosis was absent; a predominance of polymorphonuclear cells was found in 45 %. Enterovirus was isolated 43 % of the CSF specimens. The median length of hospital stay was 2 days. Antibiotic treatment was started in 13 % of the patients and all recovered without sequelae. CONCLUSIONS: All the cases occurred in late spring. Fever was an inconstant finding. Laboratory findings were typical of viral meningitis, although the percentage of neutrophils in CSF varied widely, with more than 50 % of neutrophils in half of the patients; the absence of pleocytosis was not unusual. The enterovirus yield from the CSF specimens was higher than in previously reported in Spanish series but did not influence the management of our patients.

Síndrome de ''Alicia en el País de las Maravillas'' asociado a infección por el virus de Epstein-Barr / Alice in Wonderland syndrome due to Epstein-Barr virus infection

El síndrome de "Alicia en el País de las Maravillas" se caracteriza por la presencia de distorsiones en la imagen corporal y en la percepción del tamaño, distancia, forma o relaciones espaciales de los objetos (metamorfopsia). Habitualmente se encuentra relacionado con episodios de migraña y también se ha descrito en el contexto de diversas infecciones víricas. Se presenta el caso de un niño de 6 años que acudió a urgencias por presentar varios episodios, que él vivía con gran temor, de sensación de lejanía y pequeñez del techo de la habitación y las personas y los objetos de su alrededor, sin alteración del nivel de conciencia. La exploración física mostraba únicamente faringoamigdalitis. Los estudios serológicos (anticuerpos IgM frente al antígeno de la cápside vírica) confirmaron que se trataba de un caso de infección por virus de Epstein-Barr. Los síntomas se resolvieron de forma espontánea en 48 h y el niño seguía asintomático 4 meses después. En el estudio de todo niño con un cuadro clínico compatible con el síndrome de Alicia en el País de las Maravillas debe incluirse la serología frente al virus de Epstein-Barr. Su diagnóstico permite proporcionar a la familia una información tranquilizadora sobre el desenlace de un cuadro tan alarmante (AU)

Epilepsia occipital idiopática de la infancia / Idiopathic childhood occipital epilepsy

Objetivo: Describir las características clínicas y electroencefalográficas y el pronóstico de los niños diagnosticados en nuestro hospital de epilepsia occipital idiopática de la infancia. Métodos: Estudio retrospectivo de las historias clínicas de los niños diagnosticados de epilepsia occipital idiopática en los últimos 10años con descripción de su semiología clínica, características electroencefalográficas y estudios de neuroimagen. Evolución de los pacientes seguidos un mínimo de 5 años. Resultados: De un total de 10 niños estudiados, dos presentaron epilepsia occipital idiopática tipo I (Gastaut), seis tipo II (Panayiotopoulos) y dos formas intermedias. Los pacientes tipo I presentaron crisis diurnas con síntomas visuales: alucinaciones y amaurosis; seguidas de crisis parciales complejas motoras versivas con generalización secundaria. Comenzaron en la infancia tardía y persistieron en la adolescencia al retirar la medicación. Los pacientes con la tipo II presentaron crisis nocturnas con desviación oculocefálica, alteración del nivel de conciencia e hipotonía seguidas de vómitos y movimientos hemiclónicos o generalización tonicoclónica. En 5 de los 10 niños la primera crisis fue en forma de estado de mal epiléptico. La edad de inicio fue entre 1 y 4 años. Los estudios de neuroimagen resultaron normales en todos los pacientes. Los registros electroencefalográficos presentaron una actividad de fondo normal con punta onda lenta occipital que se atenuaba o desaparecía con la apertura ocular. Conclusiones: Nuestros hallazgos tanto clínicos como electroencefalográficos son similares a los de otros autores. Destaca la forma de presentación como estado de mal epiléptico de la epilepsia occipital idiopática tipo II que puede confundirse con otras urgencias neurológicas, pudiendo clarificar el diagnóstico la realización de un electroencefalograma (EEG). La semiología crítica de la tipo II puede solaparse con migraña con aura. A pesar de denominarse benigna, la epilepsia occipital idiopática tipo I puede presentar problemas de aprendizaje y continuar presentando crisis en la adolescencia (AU)

[Idiopathic childhood occipital epilepsy]. / Epilepsia occipital idiopática de la infancia.

OBJECTIVE: To describe the clinical and electroencephalographic (EEG) features, as well as the outcome of children diagnosed with idiopathic childhood occipital epilepsy (COE) in our hospital. METHODS: A retrospective review of the clinical records of children diagnosed with COE in the previous 10years was carried out with description of clinical and EEG features and neuroimaging studies. The outcome of patients followed-up for at least 5 years was also reviewed. RESULTS: Ten children were studied: two with type I (Gastaut) COE, six with type II (Panayiotopoulos) COE, and two with intermediate forms of the disorder. Patients with type I COE suffered daytime seizures with visual symptoms (hallucinations and amaurosis) followed by versive motor partial complex seizures with secondary generalized seizures. Age of onset was late childhood and the seizures reappeared in adolescence when therapy was discontinued. Patients with type II COE had nocturnal seizures consisting of tonic deviation of the head and eyes, some degree of disturbance of consciousness and hypotony followed by vomiting and hemiclonic movements or generalized tonic-clonic seizures. In five children, the first presenting symptom was status epilepticus. In all patients the age of onset was between 1 and 4 years. The results of neuroimaging studies were normal. EEG records showed normal baseline activity with slow wave spikes in the occipital region that disappeared or were reduced by eye opening. CONCLUSIONS: Our clinical and EEG findings are similar to those of other published studies. Type II COE frequently presents as status epilepticus and can be confused with other neurologic emergencies. Ictal EEG is useful to clarify the diagnosis. In type II COE, ictal symptomatology may overlap with migraine with aura. Although designated benign, patients with type I COE may develop learning problems and continue to have seizures throughout childhood.

Niño de 11años con alucinaciones olfativas y auditivas / An eleven-year old child with olfactory and auditory hallucinations

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The epidemiology of cutaneous leishmaniasis in subtropical Ecuador.

An epidemiologic survey (n = 466) was conducted in an area of subtropical rainforest in north-west Ecuador with the following objectives: (1) to determine the prevalence of cutaneous leishmaniasis (CL), (2) to identify the Leishmania species causing human disease, (3) to investigate the major clinical manifestations of leishmaniasis, (4) to study cellular and humoral immune response indicators associated with disease status and (5) to identify risk factors for CL. Fourteen percent of subjects had parasitologically confirmed CL; 33% had evidence of prior disease. However, 17.2% of subjects with a negative CL clinical history presented with a positive Montenegro skin test (MST), indicating the possibility of subclinical infection. The species isolated from subject lesions were L. guyanensis (63%), L. panamensis (33%), and L. brazilensis (4%). Mean specific anti-Leishmania IgG and IgM OD serum levels were highest in subjects diagnosed with current CL, followed by those with prior CL, and were lowest in healthy subjects, respectively (0.56 +/- 0.27 vs 0.33 +/- 0.2 vs 0.22 +/- 0.14; F-ratio = 74; P < 0.00001) and (665 +/- 270 vs 481 +/- 220 vs 301 +/- 128.5; F-ratio = 37; P < 0.00001). Likewise, subjects with present CL had measurably higher MST reactions (13 +/- 6.7 mm) than those with prior CL (10.9 +/- 7.8 mm) or healthy individuals (2.4 +/- 2.5 mm; F-ratio = 106; P < 0.00001). Serum concentrations of IgG were predicted by lesion number (t = 2.5; P = 0.018), size (t = 3.7; P = 0.0006), and duration (t = 3.5; P = 0.0013). Furthermore, the MST induration size increased as a function of lesion number (t = 3.0; P = 0.005) and size (t = 3.4; P = 0.022). Subject age and sex did not predict serum IgG or IgM concentrations or MST reactions in the 3 disease groups. Although no sex differences were found with respect to clinical characteristics, children < or = 12 years of age were almost 3 times more likely to have CL lesions or scars located on the face and head area compared to adults (OR = 2.75; 95% CI = 1.4-5.6, P = 0.004). The risk factors associated with disease included age under 5 years (AOR = 1.5; 95% CI = 0.48-2.35), male gender in adults (AOR = 2.8; 95% CI = 1.1-7.8), and wood and/or cane exterior house walls (AOR = 1.8; 95% CI = 1.4-2.5). In contrast, electric home lighting was associated with decreased risk (AOR = 0.7; 95% CI = 0.4-2.3). The results suggest that it may be possible to modify a portion of the risk of CL by making changes in the housing environment which may help to reduce the amount of human-vector contact.

Nutritional status and cutaneous leishmaniasis in rural Ecuadorian children.

The relationship between nutritional status and cutaneous leishmaniasis (CL) was evaluated in 230 children living in a rural subtropical rainforest in Northwest Ecuador. One-third of the subjects had evidence of either current (13 per cent) or past CL infection (21 per cent). Subjects with current (4.71 +/- 0.44 mg) or previous disease (4.29 +/- 0.35 mg) had lower mean daily dietary iron intakes than non-infected children (5.45 +/- 0.2 mg; chi 2 = 0.048), but not energy, protein, or other micronutrients. The low dietary iron intake data was corroborated by the reduced mean haemoglobin values observed in children with current (11.7 +/- 0.3 mg/dL) or past infection (11.3 +/- 0.2 mg/dL) compared to non-infected subjects (12.7 +/- 0.15 mg/dL; F-ratio = 17.0, P < 0.0001). Mean hematocrit values were also lower in the two infected groups (37.4 +/- 0.9 per cent and 37.4 +/- 0.6 per cent v. 39.5 +/- 0.5 per cent; F-ratio = 4.23, P = 0.0175). Furthermore, they were more likely to suffer from iron-deficiency anaemia than their non-infected counterparts (chi 2 = 4.64, P = 0.03). However, the children with active disease accounted for most of the excess risk for anemia (Fisher's exact test P = 0.009; OR = 10.0, exact 95 per cent CI = 1.37-111.8). Finally, growth stunting (< -2SD height-for-age) was more common in subjects with current (54 per cent) or past infection (51 per cent) compared to those without CL history (31 per cent; chi 2 = 8.03, P = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)