Legionella pneumophila macrophage infectivity potentiator protein appendage domains modulate protein dynamics and inhibitor binding.

Macrophage infectivity potentiator (MIP) proteins are widespread in human pathogens including Legionella pneumophila, the causative agent of Legionnaires' disease and protozoans such as Trypanosoma cruzi. All MIP proteins contain a FKBP (FK506 binding protein)-like prolyl-cis/trans-isomerase domain that hence presents an attractive drug target. Some MIPs such as the Legionella pneumophila protein (LpMIP) have additional appendage domains of mostly unknown function. In full-length, homodimeric LpMIP, the N-terminal dimerization domain is linked to the FKBP-like domain via a long, free-standing stalk helix. Combining X-ray crystallography, NMR and EPR spectroscopy and SAXS, we elucidated the importance of the stalk helix for protein dynamics and inhibitor binding to the FKBP-like domain and bidirectional crosstalk between the different protein regions. The first comparison of a microbial MIP and a human FKBP in complex with the same synthetic inhibitor was made possible by high-resolution structures of LpMIP with a [4.3.1]-aza-bicyclic sulfonamide and provides a basis for designing pathogen-selective inhibitors. Through stereospecific methylation, the affinity of inhibitors to L. pneumophila and T. cruzi MIP was greatly improved. The resulting X-ray inhibitor-complex structures of LpMIP and TcMIP at 1.49 and 1.34 Å, respectively, provide a starting point for developing potent inhibitors against MIPs from multiple pathogenic microorganisms.

Estimación del porcentaje de grasa corporal en función del índice de masa corporal y perímetro abdominal: fórmula Palafolls / Estimation of the percentage of body fat based on the body mass index and the abdominal circumference: Palafolls Formula

INTRODUCCIÓN: El sobrepeso y la obesidad tienen rasgos epidémicos a nivel mundial, siendo por tanto un problema de salud pública. La clasificación tradicional con el índice de masa corporal es un buen inicio, pero luego de la evidencia de las actividades bioquímicas del tejido adiposo, su medida es una necesidad. Existen múltiples fórmulas para tal fin, pero con poca posibilidad de aplicación en atención primaria. Proponemos las siguientes fórmulas para su utilización con este fin. Hombres = ([IMC/PA]*10) +IMC. Mujeres = ([IMC/PA]*10) + IMC+10. MATERIAL Y MÉTODOS: Trabajo descriptivo, prospectivo. Se incluyeron 505 mujeres, 489 hombres, con edades entre 30 y 90 años. Se midió el peso, la talla y el perímetro abdominal, siendo calculado índice de masa corporal, porcentaje de grasa con CUN BAE y fórmulas propuestas. Resultados: Se realizaron cálculos comparativos entre CUN BAE y fórmulas a validar: en valores descriptivos no se evidenció diferencia significativa. Mujeres chi2 = 1,1; p = 0,89. Hombres chi2 = 0,8; p = 0,93. El intervalo de confianza y error estándar fueron p = 1. La correlación numérica evidencia r = 0,94; p = 0,0001; R2 = 0,89. El error relativo de la media es en hombre 5,48% y mujeres (-0,43%). La comparación de medianas demostró Wilcoxon=0,8333. El estudio de sensibilidad y especificidad para puntos de corte demuestra por curva ROC AUC = 0,986; p = < 0,0001. CONCLUSIONES: La falta de diferencia significativa entre los resultados de ambas fórmulas hace posible su propuesta para el cálculo del porcentaje graso en el peso corporal en consulta de atención primaria

INTRODUCTION: Overweight and obesity have the features of a worldwide epidemic, making it a public health problem. The traditional classification with the body mass index is a good start, but after the evidence of the biochemical activities of adipose tissue, its measurement is a necessity. There are multiple formulas for this purpose, but with little possibility of applying it in Primary Care. The following formulas are proposed for its use in this setting; Men = (body mass index [BMI/Abdominal Circumference [AC]*10) + BMI. Women = ([BMI/AC]*10) + BMI + 10. MATERIAL AND METHODS: A descriptive, prospective study was conducted, including 505 women and 489 men aged between 30 and 90 years. Weight, height, and abdominal circumference were measured, and the body mass index, percentage of fat using the CUN BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) and proposed formulas were calculated. RESULTS: Comparative calculations were made between CUN BAE and formulas. No significant differences were observed in the descriptive values (Women chi2 = 1.1; P = .89. Men chi2 = 0.8; P = .93. The confidence interval and standard error p = 1. The numerical correlation shows r = 0.94; p = 0.0001; R2 = 0.89. The relative error of the mean in men was 5.48% and -0.43% in women. The comparison of medians demonstrated Wilcoxon = 0.8333. The study of sensitivity and specificity for cut-off points shows a ROC curve AUC = 0.986; P = < .0001. CONCLUSIONS: The lack of significant differences between the results of both formulas, makes it possible to be proposed for the calculation of the fat percentage in body weight in Primary Care Clinics

[Estimation of the percentage of body fat based on the body mass index and the abdominal circumference: Palafolls Formula]. / Estimación del porcentaje de grasa corporal en función del índice de masa corporal y perímetro abdominal: fórmula Palafolls.

INTRODUCTION: Overweight and obesity have the features of a worldwide epidemic, making it a public health problem. The traditional classification with the body mass index is a good start, but after the evidence of the biochemical activities of adipose tissue, its measurement is a necessity. There are multiple formulas for this purpose, but with little possibility of applying it in Primary Care. The following formulas are proposed for its use in this setting; Men=(body mass index [BMI/Abdominal Circumference [AC]*10)+BMI. Women=([BMI/AC]*10)+BMI+10. MATERIAL AND METHODS: A descriptive, prospective study was conducted, including 505 women and 489 men aged between 30 and 90 years. Weight, height, and abdominal circumference were measured, and the body mass index, percentage of fat using the CUN BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) and proposed formulas were calculated. RESULTS: Comparative calculations were made between CUN BAE and formulas. No significant differences were observed in the descriptive values (Women χ2=1.1; P=.89. Men χ2=0.8; P=.93. The confidence interval and standard error p=1. The numerical correlation shows r=0.94; p=0.0001; R2=0.89. The relative error of the mean in men was 5.48% and -0.43% in women. The comparison of medians demonstrated Wilcoxon=0.8333. The study of sensitivity and specificity for cut-off points shows a ROC curve AUC=0.986; P=<.0001. CONCLUSIONS: The lack of significant differences between the results of both formulas, makes it possible to be proposed for the calculation of the fat percentage in body weight in Primary Care Clinics.

Estimación del índice de masa corporal con base en la circunferencia braquial, para pacientes con discapacidad permanente o transitoria / Estimation of body mass index based on brachial circumference in patients with permanent or temporary incapacity

Introducción: Múltiples pacientes están afectados por diversas condiciones que hacen imposible el cálculo del índice de masa corporal (IMC), por la medición del peso y la talla. Por esta razón es nuestro propósito el desarrollo de una herramienta matemática que posibilite, a partir de la circunferencia braquial, su cálculo aproximado, para diagnóstico y seguimiento. La fórmula propuesta para ambos sexos es: circunferencia braquial (cm)×30/32. En los resultados≥28 se deben sumar 2 puntos. Material y métodos: Trabajo prospectivo, descriptivo, observacional, realizado en la consulta de atención primaria, con inclusión de 224 varones y 248 mujeres; se midió el peso, la talla, la circunferencia braquial y se calculó el IMC, por fórmula de Quetelet y la propuesta. Resultados: En varones, el IMC (IC 95%)=0,63, mientras que el FCBC (IC 95%)=0,49 (p=0,95), mientras que en mujeres, el IMC (IC 95%)=0,73 y el FCBC (IC 95%)=0,56 (p=0,95). La relación numérica demostró r=0,82, R2=0,67, p≤0,005. En porcentajes, el 80,3% de los varones (p=0,01) tuvieron sus resultados entre 90 y 110%; en mujeres fue del 85,8% (p=0,0001). La comparación de mediana obtuvo un Wilcoxon p=0,83. Según criterios diagnósticos de la Organización Mundial de la Salud (obesidad, sobrepeso, normal y desnutrición), en ambos sexos se obtuvo una p=0,95. Conclusiones: La fórmula propuesta cuenta con valores sin diferencia significativa en sus resultados, respecto de Quetelet, siendo aplicable en pacientes en condición especial por limitaciones físicas para la medición de peso y talla para el cálculo del IMC

Introduction: Many patients are affected by various conditions, which make it impossible to calculate body mass index (BMI) by measuring weight and height. For this reason, the purpose of this study was to develop a mathematical tool that allows the approximate calculation of the brachial circumference for diagnosis and follow-up. The formula proposed for both sexes is: brachial circumference (cm)×30/32. Results≥28 must be added 2 points. Material and methods: Prospective, descriptive, observational study performed in a primary care clinic, including 224 men and 248 women. Weight, height, brachial circumference, and BMI were calculated using Quetelet's formula and the proposed formula. Results: In men, BMI (CI 95%)=0.63, while BCF (CI 95%)=0.49 (P=.95), while in women BMI (CI 95%)=0.73 and BCF (CI 95%)=0.56 (P=.95). The numerical ratio showed r=0.82, R2=0.67, P<.005. In percentages, 80.3% of the men (P=.01) had their results between 90 and 110%, in women it was 85.8% (P=.0001). The median comparison, obtained a Wilcoxon P=.83. According to diagnostic criteria of the World Health Organization (obesity, overweight, normal and malnutrition) a P=.95 was obtained in both sexes. Conclusions: The proposed formula has values with no significant difference in its results, with respect to Quetelet, being applicable in patients in special condition due to physical limitations for the measurement of weight and height for the calculation of BMI

[Estimation of body mass index based on brachial circumference in patients with permanent or temporary incapacity]. / Estimación del índice de masa corporal con base en la circunferencia braquial, para pacientes con discapacidad permanente o transitoria.

INTRODUCTION: Many patients are affected by various conditions, which make it impossible to calculate body mass index (BMI) by measuring weight and height. For this reason, the purpose of this study was to develop a mathematical tool that allows the approximate calculation of the brachial circumference for diagnosis and follow-up. The formula proposed for both sexes is: brachial circumference (cm)×30/32. Results≥28 must be added 2 points. MATERIAL AND METHODS: Prospective, descriptive, observational study performed in a primary care clinic, including 224 men and 248 women. Weight, height, brachial circumference, and BMI were calculated using Quetelet's formula and the proposed formula. RESULTS: In men, BMI (CI 95%)=0.63, while BCF (CI 95%)=0.49 (P=.95), while in women BMI (CI 95%)=0.73 and BCF (CI 95%)=0.56 (P=.95). The numerical ratio showed r=0.82, R2=0.67, P<.005. In percentages, 80.3% of the men (P=.01) had their results between 90 and 110%, in women it was 85.8% (P=.0001). The median comparison, obtained a Wilcoxon P=.83. According to diagnostic criteria of the World Health Organization (obesity, overweight, normal and malnutrition) a P=.95 was obtained in both sexes. CONCLUSIONS: The proposed formula has values with no significant difference in its results, with respect to Quetelet, being applicable in patients in special condition due to physical limitations for the measurement of weight and height for the calculation of BMI.

Diagnóstico en la patología del olfato: revisión de la literatura / Diagnosis in smell pathology: literature review

La patología del olfato es una afección común en la población, principalmente en adultos mayores, que puede alterar de manera significativa la calidad de vida del paciente, pudiendo ser la manifestación inicial de enfermedades neurológicas como la enfermedad de Parkinson. A pesar de su relevancia, el sentido del olfato continúa siendo poco estudiado en clínica, no obstante la existencia de métodos simples validados para su evaluación. En este articulo realizamos una revisión y análisis de la literatura actual sobre el estudio clínico del olfato, con el objetivo de establecer las herramientas diagnósticas disponibles en la práctica clínica para su estudio.

Olfactory diseases are common to find in the population, mainly in older people, and it can affect significantly life quality. It can also be the first manifestation of neurological diseases, such as Parkinson disease. Despite its relevance, the sense of smell is still not studied although there are simple and validated methods available in the clinical practice. In this article, we make a review and analysis of the actual literature related to smell studies, so that we can establish available diagnosis tools in the clinical practice.

Lycopene, resveratrol, vitamin C and FeSO4 increase damage produced by pro-oxidant carcinogen 4-nitroquinoline-1-oxide in Drosophila melanogaster: Xenobiotic metabolism implications.

4-nitroquinoline-1-oxide (4-NQO) is a pro-oxidant carcinogen bioactivated by xenobiotic metabolism (XM). We investigated if antioxidants lycopene [0.45, 0.9, 1.8 µM], resveratrol [11, 43, 172 µM], and vitamin C [5.6 mM] added or not with FeSO4 [0.06 mM], modulate the genotoxicity of 4-NQO [2 mM] with the Drosophila wing spot test standard (ST) and high bioactivation (HB) crosses, with inducible and high levels of cytochromes P450, respectively. The genotoxicity of 4-NQO was higher when dissolved in an ethanol - acetone mixture. The antioxidants did not protect against 4-NQO in any of both crosses. In the ST cross, resveratrol [11 µM], vitamin C and FeSO4 resulted in genotoxicity; the three antioxidants and FeSO4 increased the damage of 4-NQO. In the HB cross, none of the antioxidants, neither FeSO4, were genotoxic. Only resveratrol [172 µM] + 4-NQO increased the genotoxic activity in both crosses. We concluded that the effects of the antioxidants, FeSO4 and the modulation of 4-NQO were the result of the difference of Cyp450s levels, between the ST and HB crosses. We propose that the basal levels of the XM's enzymes in the ST cross interacted with a putative pro-oxidant activity of the compounds added to the pro-oxidant effects of 4-NQO.

Complicaciones perinatales asociadas con la ganancia excesiva de peso durante el embarazo / Perinatal outcomes associated to overweight gain during pregnancy in women at a regional hospital in northwest of Mexico

Resumen OBJETIVO: evaluar la asociación entre la ganancia de peso durante el embarazo y las complicaciones perinatales: enfermedad hipertensiva del embarazo, diabetes gestacional, cesárea de urgencia y macrosomía fetal. MATERIALES Y MÉTODOS: estudio de casos y controles anidados en una cohorte de pacientes que recibieron control prenatal y atención del parto en el Hospital General Regional del Instituto Mexicano del Seguro Social de Ciudad Obregón, Sonora. Los momios se calcularon según las complicaciones perinatales, el índice de masa corporal pregestacional y la ganancia total de peso durante todo el embarazo. RESULTADOS: se seleccionó una cohorte de seguimiento de 714 pacientes de las que solo se estudió a 426 que, a su vez, se dividieron en dos grupos de 213 cada uno: de casos y controles. En el grupo de casos la frecuencia de obesidad fue de 17.6% (n = 55) y 40.3% (n=126) de sobrepeso. En el grupo control 6.7% (n=21) de obesidad y 50.8% (n=159) en los controles. En comparación con las pacientes con peso pregestacional normal, no se observó riesgo significativo de complicaciones perinatales en las pacientes con sobrepeso previo a la gestación (RM=0.79, IC 95%: 0.57-1.11, p=0.189). En las pacientes con obesidad pregestacional se observó un riesgo significativo (RM=2.63, IC 95%: 1.51- 4.60, p=.001). CONCLUSIONES: la ganancia de peso a lo largo del embarazo, superior a la recomendada, es un factor riesgo significativo de complicaciones perinatales, independiente del peso previo a la gestación.

Abstract OBJECTIVE: To evaluate the association between weight gain during pregnancy and perinatal complications: hypertensive pregnancy disease, gestational diabetes, emergency cesarean section and fetal macrosomia. MATERIALS AND METHODS: Nested case-control study in a cohort of patients who received prenatal care and delivery care at the Regional General Hospital of the Mexican Social Security Institute of Ciudad Obregon, Sonora. The odds were calculated according to perinatal complications, pregestational body mass index and total weight gain throughout pregnancy. RESULTS: A follow-up cohort of 714 patients was selected, of whom only 426 were studied, which in turn were divided into two groups of 213 each: cases and controls. In the group of cases the frequency of obesity was 17.6% (n=55) and 40.3% (n=126) of overweight. In the control group 6.7% (n=21) of obesity and 50.8% (n=159) in controls. Compared with patients with normal pregestational weight, no significant risk of perinatal complications was observed in pre-gestational overweight (OR=0.79, CI 95%: 0.57-1.11, p=0.189). A significant risk was observed in patients with pregestational obesity (OR=2.63, CI 95%: 1.51- 4.60, p=.001). CONCLUSIONS: Weight gain during pregnancy, higher than recommended, is a significant risk factor for perinatal complications, independent of pre-gestational weight.

Ejercicio, bienestar psicológico, calidad de sueño y motivación situacional en estudiantes de educación física / Exercise, psychological well-being, sleep quality and situational motivation in physical education students / Exercício, bem-estar psicológico, a qualidade do sono e motivação situacional em estudantes de educação física

El objetivo de este trabajo ha sido comprobar si la exposición a diferentes intensidades de actividad física aguda ocasionaba cambios en el bienestar psicológico (vitalidad subjetiva y estado afectivo), la calidad del sueño y la motivación intrínseca situacional en estudiantes adolescentes en clases de educación física. Para ello, 120 estudiantes (50 chicos y 70 chicas) con edades comprendidas entre los 16 y 20 años completaron, antes y después de pasar por cada situación experimental, medidas de estas variables. Los resultados mostraron, en primer lugar, que había asociaciones directas entre la vitalidad subjetiva, el estado afectivo positivo y la calidad del sueño. En segundo lugar, se encontró un incremento significativo en la motivación intrínseca situacional y disminución en el estado afectivo negativo post-sesión al comparar las intensidades vigorosa y ligera. La mayoría de las dimensiones del bienestar psicológico mejoraban cuando se comparaban las situaciones pre intervención y post intervención, independientemente de la intensidad del ejercicio. Contrariamente a nuestras hipótesis, la calidad del sueño no mejoró al practicar actividad física. La principal conclusión es que la realización de actividad física aguda, independientemente de la intensidad del mismo, mejora el bienestar. Respecto a la motivación, la actividad física vigorosa es la que provoca mayores cambios motivacionales, debiendo tener este aspecto en cuenta a la hora de diseñar programas de actividad física para adolescentes (AU)

The aim of this study was to determine how the exposure to different intensities of acute physical activity, caused changes in psychological well-being (subjective vitality and affective state), sleep quality and situational intrinsic motivation in adolescent students on physical education classes. 120 students (50 boys and 70 girls) aged between 16 and 20 years, completed different questionnaires to measure these variables. The results showed direct and positive associations between subjective vitality, positive affect state and the quality of sleep and significant differences, increasing situational intrinsic motivation and decreasing post-session negative affect when comparing light and vigorous intensities. Almost all dimensions of psychological well-being improved when comparing the preintervention and post intervention situations, regardless of physical activity intensity. Contrary to our hypothesis, sleep quality did not improve by practice of physical activity. The main conclusion is that the acute exercise, regardless of intensity, improves well-being and that vigorous physical activity is causing major motivational changes, must take this into account when designing physical activity programs for adolescents (AU)

O objectivo deste trabalho consistiu em comprovar se a exposição a diferentes intensidades de exercício agudo ocasionava alterações no bem-estar psicológico (vitalidade subjectiva e estado afectivo), na qualidade de sono e na motivação intrínseca situacional de estudantes adolescentes em aulas de educação física. Para tal, 120 estudantes (50 rapazes e 70 raparigas) com idades compreendidas entre os 16 e os 20 anos preencheram, antes e depois de passarem por cada situação experimental, instrumentos de medida destas variáveis. Os resultados mostraram, em primeiro lugar, que havia associações directas entre a vitalidade subjectiva, o estado afectivo positivo e a qualidade de sono. Em segundo lugar, verificou-se um incremento significativo na motivação intrínseca situacional e uma diminuição do estado afectivo negativo após a sessão, ao comparar as intensidades vigorosa e ligeira. A maioria das dimensões do bem-estar psicológico melhorou quando comparadas as situações pré-intervenção e pós-intervenção, independentemente da intensidade do exercício. Contrariamente às nossas hipóteses, a qualidade de sono não melhorou ao praticar actividade física. A principal conclusão é a de a realização de exercício agudo, independentemente da sua intensidade, melhora o bem-estar. Relativamente à motivação, a actividade física vigorosa é a que provoca maiores alterações motivacionais, devendo ter-se este aspecto em consideração quando forem desenhados programas de actividade física para adolescentes (AU)

Life cycle assessment modelling of waste-to-energy incineration in Spain and Portugal.

In recent years, waste management systems have been evaluated using a life cycle assessment (LCA) approach. A main shortcoming of prior studies was the focus on a mixture of waste with different characteristics. The estimation of emissions and consumptions associated with each waste fraction in these studies presented allocation problems. Waste-to-energy (WTE) incineration is a clear example in which municipal solid waste (MSW), comprising many types of materials, is processed to produce several outputs. This paper investigates an approach to better understand incineration processes in Spain and Portugal by applying a multi-input/output allocation model. The application of this model enabled predictions of WTE inputs and outputs, including the consumption of ancillary materials and combustibles, air emissions, solid wastes, and the energy produced during the combustion of each waste fraction.

Causa infrecuente de hipertensión arterial en lactantes: neuroblastoma congénito quístico suprarrenal: caso clínico / A rare cause of hypertension in childhood: congenital cystic adrenal neuroblastoma: clinical case

The frequency of hypertension (HBP) in children has increased significantly over the past decade. The younger the patient the greater the likelihood of having secondary HBP. Thus, the main causes of hypertension in new-borns are of renovascular or parenchymatous origin. objective: To present the case of an infant with hypertension caused by a congenital cystic neuroblastoma (NB). Case History: Newborn with prenatal diagnosis of adrenal cyst, who evolved with significant hypertension unresponsive to medical therapy. Neuroblastoma was suspected on the basis of magnetic resonance imaging findings and resection of the lesion was able to resolve the hypertension and to confirm the diagnosis by anatomo-pathological study. Conclusion: Most cases of neonatal hypertension are of renal origin, with the 2 largest categories being renovascular and renal parenchymal diseases. NB is the most common neonatal malignancy. It usually presents as an abdominal mass of antenatal diagnosis, being the hypertension an unusual form of presentation.

La frecuencia de hipertensión arterial (HTA) en niños ha aumentado significativamente en la última década. A menor edad del paciente mayor es la probabilidad de que la HTA sea secundaria. Así, las principales causas de HTA en recién nacidos son de origen renovascular o parenquimatoso. objetivo: Presentar el caso de un lactante hipertenso por neuroblastoma (NB) congénito quístico. Caso Clínico: Recién nacido con diagnóstico prenatal de quiste suprarrenal, quien evolucionó con HTA por sobre el percentil 99 para edad, sexo y talla, sin respuesta a terapia farmacológica. La resonancia magnética permitió realizar el diagnóstico presuntivo de neuroblastoma congénito y la resección de la lesión permitió resolver la HTA y confirmar el diagnóstico. Conclusión: La HTA en recién nacidos generalmente se debe a causas secundarias. El NB es el tumor maligno neonatal más frecuente que se puede presentar como una masa abdominal de diagnóstico antenatal, siendo la HTA una forma infrecuente de presentación.

Efecto de la hospitalización sobre la mantención de la lactancia materna en niños menores de 6 meses de edad / Hospitalization and continuity of breastfeeding in infants less than 6 months of age

Objective: To assess the effect of hospitalization for acute morbidity on the continuity of breastfeeding. Patients and Method: Concurrent cohort study of infants under 6 month of age admitted to the Hospital Sótero del Río, with follow-up at 2 and 6 weeks post discharge. Results: 72 patients entered the study. At the time of admission, 91.7 percent of patients were receiving breastfeeding (BF); 19.4 percent of them was exclusive breastfeeding (BFe). At 2 weeks after discharge, BF and BFe was 86 percent and 29 percent (p = NS), respectively. At 6 weeks post discharge, BF and BFe was 80 percent (p = 0.021 compared to admission) and 33 percent (p = NS) respectively. In patients admitted to the pediatric unit, there was an increase in the BFe between the second and sixth week of follow up (29.7 percent and 40.5 percent respectively, p = 0.008). Conclusions: After discharge, there was a decrease in the prevalence of BF similar to that observed in the National Breast Feeding Survey. The hospitalization did not negatively affect the maintenance of breastfeeding, on the contrary, there was an increase in those receiving exclusive breastfeeding, which could be explained by the education on breast feeding that mothers received within the hospital.

Objetivo: Evaluar el efecto de la hospitalización por morbilidad aguda sobre la continuidad de la lactancia materna (LM) en menores de 6 meses de edad. Pacientes y Método: Estudio de cohorte concurrente en pacientes ingresados al Hospital Sótero del Río, con seguimiento de lactancia materna al ingreso, a las 2 y 6 semanas post-alta. Resultados: 72 pacientes ingresaron al estudio. Al momento de la admisión, 91,7 por ciento de los pacientes recibía LM, de ellos, 19,4 por ciento era lactancia materna exclusiva (LME). A las 2 semanas post alta, LM y LME fue de 86 por ciento y 29 por ciento (p = NS), respectivamente. A las 6 semanas post alta, LM y LME fue de 80 por ciento (p = 0,021 respecto al ingreso), y 33 por ciento (p = NS) respectivamente. En los pacientes ingresados a sala, se observó un aumento en la LME entre la segunda y la sexta semana de seguimiento (29,7 por ciento y 40,5 por ciento, respectivamente, p = 0,008). Conclusiones: Posterior al alta, se observó una disminución en la prevalencia de LM similar a la caída observada en la Encuesta Nacional de Lactancia Materna. La hospitalización no afectó negativamente la mantención de la lactancia materna, al contrario, se observó un incremento en aquellos que recibían lactancia materna exclusiva, lo que podría explicarse por la educación en lactancia que reciben las madres durante la hospitalización.

Neumoencéfalo a tensión tras cirugía intracraneal en posición supina / Tension pneumocephalus after intracraneal surgery in the supine position

El neumoencéfalo a tensión es una complicación grave, poco frecuente, que aparece tras cirugía de la fosa posterior con pacientes en posición sentada. Esta complicación puede amenazar la vida del paciente y requerir tratamiento inmediato. Sin embargo, el neumoencéfalo a tensión tras cirugía intracraneal en posición supina se ha publicado en raras ocasiones. Presentamos un caso de neumoencéfalo a tensión tras una craneotomía para la exéresis de un proceso expansivo frontotemporal izquierdo realizada en posición supina (AU)

Tension pneumocephalus is a rare and severe com¬plication appearing after posterior fossa procedures in the sitting position. This complication may endanger the pacientes life and require immediate treatment. However, tension pneumocephalus after neurosurgical procedure in the supine position have been scarcely reported. We report such a complication occurring in a 14-year-old girl submitted to a frontotemporal cra¬niotomy for removal of an astrocytome performed with the patient supine. We discuss ethiopathogenesis and management of this complication (AU)

[Precurarization with rocuronium prevents fasciculations and biochemical changes after succinylcholine administration]. / La precurarización con rocuronio previene las fasciculaciones y los cambios bioquímicos tras la administración de succinilcolina.

OBJECTIVE: To determine the efficacy of rocuronium to prevent fasciculations and biochemical changes after succinylcholine administration. PATIENTS AND METHODS: Prospective, randomized double-blind trial enrolling 60 ASA I-II patients scheduled for elective surgery under general anesthesia. The patients were assigned to 2 groups to receive either 0.06 mg x Kg(-1) of rocuronium or physiological saline solution 90 seconds before administration of 1.5 mg x Kg(-1) of succinylcholine. The incidence and severity of fasciculations and serum concentrations of potassium before anesthesia and 3, 5, and 20 minutes after succinylcholine administration were recorded. Other serum concentrations recorded were myoglobin, creatinine phosphokinase and lactate before anesthesia and 20 minutes after succinylcholine administration. RESULTS: The increases in potassium levels at 3 and 5 minutes (0.3 +/- 0.3 and 0.2 +/- 0.4 mmol x L(-1)) and in myoglobin levels at 20 minutes (38.9 +/- 31.7 ng x mL(-1)) were attenuated by precurarization with rocuronium. The incidence of fasciculations was significantly lower (p<0.001) and their severity significantly less (p<0.001) in patients who received rocuronium before administration of succinylcholine. CONCLUSIONS: Precurarization with rocuronium 90 seconds before succinylcholine administration reduces the incidence and severity of fasciculations and prevents increases in serum potassium and myoglobin concentrations.

[Effects of sevoflurane on mid-latency auditory evoked potentials and the 95% spectral frequency limit]. / Efectos del sevoflurano sobre los potenciales evocados auditivos de latencia media y límite de frecuencia espectral 95%.

OBJECTIVES: To investigate the effects of sevoflurane on mid-latency auditory evoked potentials (MLAEP) and compare them to changes in the encephalographic 95% spectral edge frequency (SEF95). PATIENTS AND METHODS: The effect of sevoflurane on MLAEP and SEF95 was studied in 15 patients. Anesthetic induction was carried out with propofol, remifentanil, and cisatracurium. After anesthetic induction, the patients were ventilated to achieve different expired concentrations of sevoflurane (1%, 1.5%, and 2%) during 3 consecutive 10-minute periods before the start of surgery. SEF95 and the amplitude and latency of the Na, Pa and Nb MLAEP waves were recorded. All the parameters were measured at baseline and during the different expired fractions of sevoflurane. RESULTS: The increase in sevoflurane concentration was accompanied by a significant decrease in amplitude and a statistically significant increase in latency of the Na, Pa and Nb waves. Likewise, SEF95 decreased significantly. A linear relation was demonstrated between sevoflurane concentration and the variables Na, Pa, Nb and SEF95. CONCLUSIONS: Our results indicate that the effect of sevoflurane on the MLEAP of Na, Pa and Nb is similar to that of other anesthetic gases. Even though the amplitude of the Na, Pa and Nb waves decreased in a dose-dependent way, SEF95 correlated more strongly with sevoflurane concentration.

La precurarización con rocuronio previene las fasciculaciones y los cambios bioquímicos tras la administración de succinilcolina / Precurarization with rocuronium prevents fasciculations and biochemical changes after succinylcholine administration

OBJETIVO: El propósito del presente estudio es determinar la eficacia del rocuronio en la prevención de las fasciculaciones y de los cambios bioquímicos que aparecen tras la administración de succinilcolina. PACIENTES Y MÉTODOS: Estudio prospectivo, aleatorio y doble ciego sobre 60 pacientes ASA I-II programados para cirugía electiva bajo anestesia general, distribuidos en 2 grupos según recibieran 0,06 mg-Kg-1 de rocuronio o suero fisiológico 90 segundos antes de la administración de 1,5 mg-Kg-1 de succinilcolina. Se registraron en ambos grupos la incidencia y severidad de las fasciculaciones y las concentraciones séricas de potasio previo a la anestesia y a los 3, 5 y 20 minutos de la administración de succinilcolina. Así mismo, se registraron las concentraciones séricas de mioglobina, creatininfosfoquinasa y lactato antes de la anestesia y a los 20 minutos de la administración de succinilcolina. RESULTADOS: El aumento del potasio a los 3 y 5 minutos (0,3 ñ 0,3 y 0,2 ñ 0,4 mmol-l-1) y de los niveles de mioglobina a los 20 minutos (38,9 ñ 31,7 ng-ml-1), fueron atenuados por la precurarización con rocuronio. La incidencia (p < 0,001) y severidad de las fasciculaciones (p < 0,001) fueron significativamente menores en los pacientes que recibieron rocuronio antes de la administración de succinilcolina. CONCLUSIONES: La precurarización con rocuronio, 90 segundos antes de la administración de succinilcolina, reduce la incidencia y severidad de las fasciculaciones y previene el aumento del potasio y de la mioglobina sérica (AU)

[Tension pneumocephalus after intracranial surgery in the supine position]. / Neumoencéfalo a tensión tras cirugía intracraneal en posición supina.

Tension pneumocephalus is a rare and severe complication appearing after posterior fossa procedures in the sitting position. This complication may endanger the patient's life and require immediate treatment. However, tension pneumocephalus after neurosurgical procedure in the supine position have been scarcely reported. We report such a complication occurring in a 14-year-old girl submitted to a frontotemporal craniotomy for removal of an astrocytome performed with the patient supine. We discuss ethiopathogenesis and management of this complication.

Valoración de las funciones mentales y la comunicación en adultos mayores mapuches y no mapuches en áreas rurales del sur de Chile / Evaluation of mental and communication functions in mapuche and non mapuche elderly subjects in rural communities in southern Chile

The main predictors of functional impairment in the elderly are alterations in mental or communication functions. Aim: To study mental and communication functions in rural elderly subjects of Mapuche and non Mapuche origin. Patients and methods: Elderly subjects coming from a rural Mapuche community and a non Mapuche community were studied. Subjects were interviewed at their homes. The communication and mental function assessments of the Functional Autonomy Measurement System were applied. Results: Fifty one Mapuche and 49 non Mapuche subjects with a mean age of 71 ± 7 and 74 ± 8 years respectively, were studied. Fifty four percent were female and 31% were illiterate. Twenty six percent had impairment in mental functions. The item with the highest difficulty was memory. The visual function was the most severely impaired among communication items. Mapuche elderly subjects had significantly higher degrees of impairment in mental and communication functions. Conclusions: There is a higher degree of mental and communication impairment among rural Mapuche elderly subjects than in their non Mapuche counterparts (Rev Méd Chile 2003; 31: 1257-65).

Paciente con poliartritis séptica y osteomielitis multifocal por diseminación hematógena de Estafilococo aureus / Male with septic polyarthritis and multifocal osteomyelitis due to hematogenous dissemination of Estafilococo aureus

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