Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients.

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis.

BACKGROUND: Malnutrition and inflammation are highly prevalent and associated with poor outcomes in continuous ambulatory peritoneal dialysis (CAPD). Nutritional supplements are commonly used; however, presence of systemic inflammation could limit their effect. AIM: To evaluate the impact of systemic inflammation on nutritional status of CAPD patients receiving an oral protein supplement. METHODS: Prospective observational study; 34 malnourished patients (subjective global assessment; SGA) received both nutritional counseling and oral egg albumin-based protein supplement. During 6-month of follow-up, patients had monthly clinical, and quarterly biochemical and inflammation [interleukin 6 and high sensitivity C-reactive protein (hsCRP)] evaluations. According to baseline hsCRP, patients were classified in two groups: Inflammation (>3 mg/L) and No-inflammation (≤3 mg/L). RESULTS: Comparing baseline vs final, macronutrient intake and SGA increased in both groups, however, improvement of SGA was more marked in the No-inflammation group at the end of the study: 70% improved, 25% no change and 5% worsened (p = 0.001); whereas in the Inflammation group results were: 50% improved, 36% no change and 14% worsened (p = 0.03). Additionally, at final evaluation, serum albumin tended to increase more in the No-inflammation (3.0 ± 0.9 vs 3.4 ± 1.1 g/dL, p = 0.08) than in Inflammation group (2.8 ± 0.6 vs 3.0 ± 0.9 g/dL, p = 0.66), and body mass index significantly increased in No-inflammation group (20.3 ± 3.0 vs 21.6 ± 3.3 kg/m2, p < 0.001) but not in Inflammation group (21.9 ± 3.0 vs 22.5 ± 3.3 kg/m2, p = 0.09). CONCLUSIONS: The presence of systemic inflammation in malnourished CAPD patients seemed to limit the trend for improvement on nutritional status observed with counseling and oral egg albumin-based protein supplement in patients without inflammation.

Reliability and validity of a clinical competence test for dietitians caring patients with early chronic kidney disease.

The aim of the present study was to develop and validate a test to evaluate dietitian's clinical competence (CC) about nutritional care in patients with early chronic kidney disease (CKD). The study was conducted through five steps: (1) CC and its dimensions were defined; (2) test items were elaborated, and choice of response format and scoring system was selected; (3) content and face validity were established; (4) test was subjected to a pilot test and those items with inadequate performance were removed; (5) criterion validity and internal consistency for final validation were established. A 120-items test was developed and applied to 207 dietitians for validation. Dietitians with previous CKD training obtained higher scores than those with no training, confirming the test validity criterion. According to item analysis, Cronbach's α was 0⋅85, difficulty index 0⋅61 ± 0⋅22, discrimination index 0⋅26 ± 0⋅15 and inter-item correlation 0⋅19 ± 0⋅11, displaying adequate internal consistency.

Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients / La severidad del desgaste energético-proteico y la obesidad se relacionan independientemente con la mala calidad de vida en pacientes de diálisis peritoneal

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status.Aim: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD.This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured.Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52–75), 55 (45–72), 46 (43–58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001).As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education. (AU)

El desgaste proteico-energético (DEP) y la mala calidad de vida relacionada con la salud (CVRS) se asocian de forma independiente con la morbimortalidad en diálisis peritoneal continua ambulatoria (DPCA). El DEP puede reducir la CVRS; sin embargo, planteamos la hipótesis de que la CVRS se ve afectada de forma independiente por los grados de DEP o por los criterios individuales del estado nutricional. Objetivo : Evaluar la CVRS de acuerdo a la gravedad de la DEP e indicadores del estado nutricional en DPCA.Este es un estudio transversal en 151 pacientes. Se empleó la evaluación global subjetiva (EGS) y el estado nutricional se clasificó como normal, DEP leve-moderada y DEP grave. La CVRS se evaluó mediante el uso del cuestionario Kidney Disease Quality of Life Short Form™, incluidos los componentes físicos (PCS), mentales (MCS) y de enfermedad renal (KDCS) y sus subescalas. Se midieron la ingesta dietética, las variables antropométricas y bioquímicas.El 46% de los pacientes tenía un estado nutricional normal, el 44% tenía DEP leve-moderada y el 10% DEP grave. En comparación con los pacientes bien nutridos, aquellos con DEP leve-moderada (p=0,06) y grave (p=0,005) tenían una puntuación de CVRS más baja (68 [52-75], 55 [45-72], 46 [43-58], respectivamente). Igualmente, la PCS, MCS y KDCS y sus subescalas tuvieron valores más bajos, conforme la DEP fue más severa. Los pacientes con obesidad e hipoalbuminemia tenían puntuaciones de CVRS general y de sus componentes significativamente más bajas que sus contrapartes. La ingesta dietética no se asoció con la calidad de vida. En el análisis multivariado la obesidad, el DEP (por EGS), la hipoalbuminemia y el bajo nivel educativo predijeron una mala CVRS (χ2 58,2; p<0,0001).En conclusión, la gravedad del DEP se relacionó con una peor CVRS, ya sea como puntuación global o en cada componente o subescala de los pacientes con DPCA. ... (AU)

Willingness to change diet and exercise behavior is associated with better lifestyle in dialysis patients close to a kidney transplant.

BACKGROUND & AIMS: Evidence suggests that multiple-behavior interventions (with a specialist) have a greater impact on public health than single-behavior interventions, particularly in a chronic patient. However, there is little understanding of some very basic principles concerning multiple health behavior change, especially in situations such as kidney transplantation, which requires a great willingness to change negative lifestyle behaviors to achieve intermediate and long-term success. We compared healthy lifestyles and nutritional status according to the willingness to change dietary and exercise behavior in dialysis patients from a living donor kidney transplant program. METHODS: 400 dialysis patients had a dietetic, anthropometric, protein-energy wasting [subjective global assessment (SGA)] and biochemical evaluation. Lifestyle was evaluated with an adapted instrument to measure lifestyle in chronic disease. Willingness to change behaviors was evaluated by the trans-theoretical model; 2 groups were formed: willingness to change dietary and exercise behaviors and unwillingness to change. RESULTS: Willingness to change dietary behavior was 50% and exercise 25%. Patients with willingness to change dietary and exercise behaviors had better healthy lifestyle scores, and higher frequency of healthy food consumption. Healthy lifestyle score (R2 = 0.37, p < 0.0001) was predicted by older age, higher educational degree, shorter time on dialysis, and the highest willingness to change dietary and exercise behaviors. CONCLUSIONS: Willingness to change dietary and exercise behaviors was associated with healthy lifestyle, as well as with higher frequency of healthy food consumption and with lower frequency of unhealthy food consumption.

Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients.

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

Breathing Biofeedback Relaxation Intervention for Wheelchair Users in City Navigation.

Manual wheelchair users experience numerous invisible barriers while navigating cities, often reporting how stressful journeys are. This stress affects a wheelchair user's quality of life. To alleviate such psychological burden, we propose a novel intervention strategy with a respiratory biofeedback interface which is designed to help users feel relaxed in urban navigation. We conducted a study in a real-world setting to explore its potential to provide real-time psychological support. From qualitative and quantitative analysis, we report on the strengths and weaknesses of the approach.

Caracterización de la tuberculosis en pacientes de la provincia Guantánamo, Cuba / Characterization of tuberculosis in patients from the Guantánamo province, Cuba

RESUMEN Introducción: La lucha contra la tuberculosis es una responsabilidad social y profesional que requiere de su caracterización, la que no se ha realizado en Guantánamo en la última década. Objetivo: Caracterizar la tuberculosis en pacientes de la provincia Guantánamo durante el periodo comprendido entre 2012 y 2019. Método: El universo se constituyó por el total de pacientes diagnosticados (n=136). Se estudiaron las siguientes variables: edad, sexo, localización de la enfermedad, resultados de la baciloscopía, categoría al egreso y grupos de riesgo de tuberculosis. La información se obtuvo mediante los registros de enfermedades de declaración obligatoria cada año, y las encuestas epidemiológicas de los controles de focos realizados, y se resumió en números absolutos y porcentajes. Resultados: En el 80,1 % de los casos la tuberculosis se localizó en los pulmones, y fue más común el diagnóstico de pacientes con baciloscopía positiva (63,2 %). El 76,7 % de los pacientes con baciloscopía positiva fueron masculinos. Los grupos de riesgos para tuberculosis más usuales fueron: fumadores (26,4 %), inmunodeprimidos (21,6 %) y el alcoholismo (19,1 %). Conclusiones: En la provincia Guantánamo prevalece la tuberculosis de localización pulmonar y los pacientes con bacteriología positiva. Los afectados sobre todo son hombres, tienen edad entre 45 a 54 años y son de reciente diagnóstico. La enfermedad incide más en aquellos con antecedente de ser fumadores, inmunodeprimidos y los alcohólicos.

ABSTRACT Introduction: The fight against tuberculosis is a social and professional responsibility, which requires its characterization, which has not been carried out in Guantánamo in the last decade. Objective: To characterize tuberculosis in patients in the Guantánamo province during the period between 2012 and 2019. Method: The universe was made up of the total number of diagnosed patients (n = 136). The following variables were studied: age, sex, location of the disease, smear results, category at discharge, and tuberculosis risk groups. The information was obtained through the notifiable disease registries for each year and the epidemiological surveys of the outbreak controls carried out, and was summarized in absolute numbers and percentages. Results: In 80.1% of cases, tuberculosis is in the lungs, and the diagnosis of patients with positive smear microscopy (63.2%) is more common. 76.7% of smear-positive patients are male. The most common risk groups for tuberculosis are: smokers (26.4%), immunosuppressed (21.6%) and alcoholism (19.1%). Conclusions: In Guantánamo province, pulmonary localization tuberculosis and patients with positive bacteriology prevail. Those affected are mainly men, they are between 45 and 54 years old and have recently been diagnosed. The disease affects more in those with a history of being smokers, immunosuppressed and alcoholics.

Neuroergonomic Assessment of Wheelchair Control Using Mobile fNIRS.

For over two centuries, the wheelchair has been one of the most common assistive devices for individuals with locomotor impairments without many modifications. Wheelchair control is a complex motor task that increases both the physical and cognitive workload. New wheelchair interfaces, including Power Assisted devices, can further augment users by reducing the required physical effort, however little is known on the mental effort implications. In this study, we adopted a neuroergonomic approach utilizing mobile and wireless functional near infrared spectroscopy (fNIRS) based brain monitoring of physically active participants. 48 volunteers (30 novice and 18 experienced) self-propelled on a wheelchair with and without a PowerAssist interface in both simple and complex realistic environments. Results indicated that as expected, the complex more difficult environment led to lower task performance complemented by higher prefrontal cortex activity compared to the simple environment. The use of the PowerAssist feature had significantly lower brain activation compared to traditional manual control only for novices. Expertise led to a lower brain activation pattern within the middle frontal gyrus, complemented by performance metrics that involve lower cognitive workload. Results here confirm the potential of the Neuroergonomic approach and that direct neural activity measures can complement and enhance task performance metrics. We conclude that the cognitive workload benefits of PowerAssist are more directed to new users and difficult settings. The approach demonstrated here can be utilized in future studies to enable greater personalization and understanding of mobility interfaces within real-world dynamic environments.

Clinical Taste Perception Test for Patients With End-Stage Kidney Disease on Dialysis.

OBJECTIVE: The aim of this study was to validate a direct taste perception test (TPT) and evaluate its performance in patients on dialysis. METHODS: This cross-sectional study was carried out in a tertiary-care hospital. A TPT was validated on 112 healthy subjects and applied on 43 patients on hemodialysis and 32 patients on peritoneal dialysis. All participants were presented a 10-mL sample to identify and rate intensity of primary tastes: sweet (sucrose 2%), sour (citric acid 0.1%), bitter (caffeine 0.06%), salty (sodium chloride 0.5%), and umami (sodium glutamate 0.25%). The internal consistency and repeatability of TPT was assessed by Cronbach's alpha and intraclass correlation coefficient. Chi-square and Mann-Whitney U tests were used to compare groups. RESULTS: TPT had Cronbach's alpha of 0.77. Intraclass correlation coefficient was 0.74 for sweet, P < .0001; 0.57 for salty, P = .001; 0.62 for sour, P < .0001; 0.78 for bitter, P < .0001; and 0.76 for umami, P < .0001. Compared with controls, patients on peritoneal dialysis were less able to identify sweet and umami tastes (P < .05) and marginally (P = .06) sour taste, whereas patients on hemodialysis were marginally (P = .06) less able to identify sweet and salty tastes. Bitter was not differently identified between groups. According to the visual analog scale (0-10), all patients on dialysis perceived sour taste less intensely than control subjects (P < .05). CONCLUSIONS: This TPT for patients on dialysis had adequate reliability to identify five primary tastes in a clinical setting. Except for bitter taste, perception of all the primary tastes was altered in patients on dialysis compared with control subjects. A broader use of this test would help identify taste alterations and implement strategies for malnutrition.

Pica en enfermedad renal crónica avanzada: revisión de la literatura / Pica in end-stage chronic kidney disease: Literature review

La pica como entidad individual en el paciente con enfermedad renal crónica (ERC) no ha sido ampliamente estudiada, a pesar de que se ha reportado una alta prevalencia en esta población, y de que las complicaciones propias de la pica (anemia, alteración en electrolitos, mala absorción de micro y macronutrientes y desnutrición) podrían verse exacerbadas en la ERC, lo cual limitaría alcanzar una mejor calidad de la terapia de remplazo renal. La ingesta de sustancias no calóricas y no nutricionales podría ser perjudicial por los efectos en la saciedad y en el descontrol metabólico/electrolítico, y por afectar la biocompatibilidad de los micronutrientes, toxinas y patógenos, lo que finalmente puede empeorar el estado de salud. En la práctica diaria es posible que la pica resulte subreportada debido a la vergüenza del paciente a reconocerlo, o el miedo a que dicho comportamiento pueda influir en su tratamiento. Adicionalmente, los clínicos, al no investigar la presencia de pica o sus complicaciones contribuyen a la falta de información acerca de la magnitud y la relevancia de este trastorno de la conducta alimentaria en la ERC

Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD

Pica in end-stage chronic kidney disease: Literature review. / Pica en enfermedad renal crónica avanzada: revisión de la literatura.

Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD.

Model of chronic kidney disease care in primary health care / Modelo de atención de la enfermedad renal crónica en la atención primaria de la salud

Multidisciplinary attention models include the joined and coordinated participation of different professionals within the health team (physicians, nurses, social workers, dietitians, physical trainers, among others). A multidisciplinary approach facilitates and improves management of patients from early chronic kidney disease (CKD) in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients and should be adapted to the resources and health systems; its systematic implementation can help to improve patient care and prevent/slow the progression of CKD.

Los modelos de atención multidisciplinaria incluyen la participación conjunta y coordinada de diferentes profesionales miembros del equipo de salud (médicos, enfermeras, trabajadoras sociales, nutriólogas, entrenadores físicos, entre otros). Un abordaje multidisciplinario facilita y mejora el manejo de los pacientes con enfermedad renal crónica (ERC) en el primer nivel de atención médica. Este abordaje es una estrategia para mejorar el cuidado de una forma más completa, iniciando y manteniendo conductas saludables, promoviendo el trabajo en equipo, eliminando barreras para alcanzar objetivos y mejorando los procesos de la atención. Una intervención multidisciplinaria puede incluir procesos educativos guiados por profesionales, el empleo de grupos de autoayuda y el desarrollo de un plan de manejo de la ERC. La atención actual de los pacientes con ERC, fragmentada y compleja, asociada con los malos resultados frecuentemente observados, pone de manifiesto la importancia de la implementación de un abordaje multidisciplinario desde las etapas más tempranas de la enfermedad. Las estrategias multidisciplinarias deben enfocarse en las necesidades de los pacientes y deben ser adaptadas a los recursos disponibles en los sistemas de salud; su implementación sistematizada podrá ayudar a mejorar el cuidado del paciente y prevenir y/o retrasar el avance de la ERC.

Role of dietitian in prevention and treatment of early chronic kidney disease / El rol del nutriólogo en la prevención y tratamiento temprano de la enfermedad renal crónica

Mexico occupies one of the first places worldwide in terms of incidence and prevalence of end-stage renal disease (ESRD). As renal function decreases, morbi-mortality increases; therefore, early interventions could more positively influence on the evolution of disease and delay/avoid fatal outcome. Unfortunately, dietitian´s participation in treatment of patients with chronic kidney disease (CKD) has been mainly focused on the late stages, when the goal of nutritional care is to manage complications, and preparation of patients to initiate dialysis. Notwithstanding, it is worthy to remark that, within the multidisciplinary team of the primary health-care, dietitian is the professional on charge of the nutritional care of patients with early CKD, or without CKD but at high risk to develop it; therefore, dietitian is responsible to promote and strength healthy eating habits. Strengthening the role of the dietitian in the prevention and treatment of early CKD must be an outstanding activity in the agenda to fight against the epidemics of ESRD in our country and the world.

México ocupa uno de los primeros lugares a nivel mundial en incidencia y prevalencia de enfermedad renal crónica terminal (ERCT). A medida que la función renal disminuye, la morbimortalidad aumenta, por lo que las intervenciones tempranas pueden influir más satisfactoriamente en el curso de la enfermedad y retrasar/evitar sus desenlaces fatales. Desafortunadamente, la participación del nutriólogo en el tratamiento de pacientes con enfermedad renal crónica (ERC) se ha enfocado principalmente en las etapas avanzadas de la enfermedad, cuando el objetivo del cuidado nutricional es el manejo de las complicaciones y la preparación para el inicio de diálisis. Por lo tanto, es indispensable recalcar que, dentro del equipo multidisciplinario del primer nivel de atención, el nutriólogo es el profesional de la salud a cargo de la atención nutricional del paciente con ERC temprana, o aun sin ella, pero con factores de riesgo para desarrollarla, y por lo tanto, es el responsable de promover y fortalecer hábitos saludables de alimentación. Fortalecer el rol del nutriólogo en la prevención y tratamiento de la ERC temprana debería ser una actividad a destacar en la agenda para disminuir la epidemia de la ERCT en nuestro país y en el mundo.

[Clinical and biochemical characteristics of patients with morbid obesity at the time of hospital admission and one year after undergoing bariatric surgery]. / Características clínicas y bioquímicas de pacientes con obesidad extrema al ingreso y un año después de someterse a cirugía bariátrica.

BACKGROUND: Three percent of Mexicans suffer from morbid obesity. Comorbidities associated to this condition diminish quality of life, increase mortality and health care costs. Despite bariatric surgery has specific indications and risks, it is the only treatment with effective long-term results. The aim of the study was to evaluate biochemical and clinical patient characteristics, both preoperatively and a year after they underwent bariatric surgery. METHODS: We carried out a quasi-experimental study that evaluates a sample of patients in the Clínica de Obesidad at Hospital de Especialidades (a third level hospital) between March 2011 and October 2015. RESULTS: A total of 150 patients were analyzed (60 % were women). Mean age was 41 ± 9 years and mean body mass index (BMI) was 48 kg/m2 (42-53 kg/m2). Before surgery, type 2 diabetes mellitus (T2DM) was present in 31 %, hypertension in 60 % and 30 % of the patients were "metabolically healthy obese". A year after surgery, the percentage of excess body weight loss was 66 %, T2DM and hypertension remission was 70 % and 50 %, respectively. CONCLUSION: Bariatric surgery is an effective treatment to reduce excess weight. It improves biochemical, and clinical parameters in extreme obese patients.

Introducción: el 3 % de la población mexicana padece obesidad extrema. Sus comorbilidades disminuyen la calidad de vida, aumentan la mortalidad y los costos de atención médica. El único tratamiento con resultados a largo plazo es la cirugía bariátrica, aunque tiene indicaciones y riesgos específicos. Buscamos evaluar las características de los pacientes de cirugía bariátrica al inicio y un año después del tratamiento quirúrgico. Métodos: estudio cuasi experimental con los datos antropométricos, clínicos y bioquímicos de una muestra de pacientes operados en la Clínica de Obesidad del Hospital de Especialidades del Centro Médico Nacional de marzo del 2011 a octubre del 2015. Resultados: fueron analizados 150 pacientes (60 % mujeres), la media de edad fue de 41 ± 9 años y el índice de masa corporal (IMC) de 48 kg/m2 (42-53 kg/m2). Previo a la cirugía, 31 % tenía diabetes mellitus tipo 2 (DM2) y 62 % hipertensión arterial (HAS). El 30 % eran obesos "metabólicamente sanos". Un año después de la cirugía el porcentaje del exceso de peso perdido fue de 66 %. La remisión de DM2 y HAS fue de 70 y 50 %, respectivamente. Conclusión: la cirugía bariátrica es efectiva en la pérdida de peso y en la mejoría de parámetros bioquímicos y clínicos en pacientes con obesidad extrema.

[Complications of endoscopic nasal and sinus surgery: experience in 150 patients]. / Cirugía endoscópica de nariz y senos paranasales. Complicaciones en 150 pacientes.

BACKGROUND: Endoscopic nasal and sinus surgery has been used greatly for the treatment of inflammatory and neoplasm pathology, as well as for the approach of the extrasinus structures. Although it has proven to be a very successful method, it is not exempt of complications. Our objective was to identify the frequency of complications in patients with sinus and nasal pathology that underwent an endoscopic surgery of the nose and sinuses. METHODS: A total of 150 patients who underwent endoscopic sinus surgery, 75 women and 75 men, in a specialties hospital of the Instituto Mexicano del Seguro Social (IMSS). The type of pathology, surgical technique done, major and minor adverse event presented were recorded. RESULTS: We observed an overall complication rate of 18 %: 2.7 % corresponded to major, and 15.3 % to minor. The main pathologies were chronic rhinosinusitis without polyps (24.7 %) and sinus nasal tumors (22 %). CONCLUSIONS: The overall complications and the major rates were similar to those reported in the literature. On the other hand, the minor adverse events were slightly higher. Still, endoscopic surgery has become a safe surgical treatment option.

INTRODUCCIÓN: la cirugía endoscópica de la nariz y senos paranasales ha tenido un gran auge para tratar la patología inflamatoria y tumoral, y para abordar estructuras extrasinusales. Aunque ha demostrado ser un método muy exitoso, no deja de ser motivo de complicaciones. El objetivo de esta investigación fue identificar la frecuencia de complicaciones en los pacientes con patología nasosinusal sometidos a cirugía endoscópica de nariz y senos paranasales. MÉTODOS: se evaluaron 150 pacientes operados por vía endoscópica, 75 mujeres y 75 hombres, en un hospital de especialidades del Instituto Mexicano del Seguro Social. Se registró tipo de patología, tipo de cirugía endoscópica realizada y sus complicaciones mayores y menores. RESULTADOS: se observó 18 % de complicaciones globales: 2.7 % mayores y 15.3 %, menores. Las principales patologías fueron rinosinusitis crónica sin pólipos (24.7 %) y tumores nasosinusales (22 %). CONCLUSIONES: la frecuencia de complicaciones totales, y de estas las mayores, fueron similares a las reportadas en la literatura mundial. En cuanto a las complicaciones menores, estas presentaron mayor frecuencia. Aun así, la cirugía endoscópica se ha convertido en una opción segura de tratamiento quirúrgico en problemas de nariz y senos paranasales.

Anemia in children under five years old in Eastern Cuba, 2005-2011.

INTRODUCTION: Anemia is the main nutritional problem in Cuban preschool children, prompting several interventions to prevent and control it. An enhanced national strategy was established in 2008, and particular attention paid to the eastern provinces, the region with greatest challenges in social determinants of health. OBJECTIVE: Determine anemia prevalence in children aged 6-59 months in Cuba's five eastern provinces in three separate years within a decade, as well as association of anemia with epidemiological and nutritional factors, to assess impact of Cuba's Comprehensive Plan for Prevention and Control of Iron-Deficiency Anemia in Cuba. METHODS: Cross-sectional studies of children aged 6-59 months (completed) were conducted in 2005, 2008 and 2011. Hemoglobin levels were measured to diagnose anemia (hemoglobin <110 g/L) and data were collected on independent variables such as age, sex, area of residence (urban or rural), daycare center enrollment, birth weight, breastfeeding history, and maternal anemia during pregnancy. Frequency distributions were created and comparisons tested with the chi square, and odds ratios calculated with 95% confidence intervals. RESULTS: Anemia prevalence in the region fell from 31.8% in 2005 to 26% in 2011; most of cases were mild (hemoglobin: 100-109 g/L). Prevalence was higher in children aged 6-23 months than in those aged 24-59 months throughout. No significant differences were found in anemia prevalence between boys and girls. Prevalence was higher in rural than in urban areas in 2005 (p = 0.026) and 2011 (p = 0.012). Daycare enrollment emerged as a protective factor in all three years. Low birth weight was associated with anemia only in 2011 (OR 1.74, CI 1.04-2.92). Prevalence of exclusive breastfeeding for six months increased over the study period; lack of breastfeeding was found to be associated with anemia in 2005 (OR 1.57, CI 1.05-2.34). Maternal anemia at onset of and during pregnancy was a significant risk factor in 2005 (OR 1.98, CI 1.27-3.10) and 2011 (OR 1.43, CI 1.05-1.94). CONCLUSIONS: Although anemia prevalence steadily decreased over the study period, it continues to be a public health problem in Cuba and anemia prevention and control measures should be maintained and strengthened: interventions for women of childbearing age, fostering exclusive breastfeeding of infants through their sixth month, and encouraging compliance with recommendations on complementary feeding per Cuba's nutritional guidelines for children aged <2 years. Further evaluation is needed to identify the causes of anemia in the population of preschool children.

Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005-2010 period.

BACKGROUND: Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistance to Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. METHODS: Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with country's Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory. RESULTS: Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines from seven AMI countries was evaluated, mostly collected from the public sector, 1,445/1,663 (86.9%). Results indicate that 193/1,663 (11.6%) were found not to meet quality specifications. Most failures were reported during visual and physical inspection, 142/1663 (8.5%), and most of these were due to expired medicines, 118/142 (83.1%). Samples failing TLC accounted for 27/1,663 (1.6%) and those failing disintegration accounted for 24/1,663 (1.4%). Medicines quality failures decreased significantly during the last two years. CONCLUSIONS: Basic tests revealed that the quality of medicines in the public sector improved over the years, since the implementation of this type of quality monitoring programme in 2005. However, the lack of consistent confirmatory tests in the quality control (QC) laboratory, utilizing methods that can also evaluate additional quality attributes, could still mask quality issues. In the future, AMI countries should improve coordination with their health authorities and their QC lab consistently, to provide a more complete picture of malaria medicines quality and support the implementation of corrective actions. Facilities in the private and informal sectors also should be included when these sectors constitute an important source of medicines used by malaria patients.

Policondritis recidivante. Manifestaciones otorrinolaringológicas y reporte de un caso / Relapsing polychcondritis: ear, nose throat symptoms

La policondritis recidivante (PR) es una enfermedad multisistémica rara que produce un síndrome clínico característico consistente en episodios recurrentes, progresivos, de inflamación cartilaginosa, particularmente de pabellones auriculares, nariz, laringe, tráquea, articulaciones costocondrales y anillos valvulares cardiacos; puede asociarse con afecciones sistémicas como vasculitis, escleritis, epiescleritis, glomerulonefritis; alteraciones de grandes vasos, oído medio e interno y alteraciones del funcionamiento hepático. Se presenta un caso de PR en el que las manifestaciones iniciales, de igual manera que en la mayoría de las series reportadas, involucra oídos, nariz y vías respiratorias altas, con una revisión bibliográfica enfocada principalmente al área otorrinolaringológica

Micetoma de nariz y senos paranasales: informe de un caso / Nasal and paranasal sinuses' mycetoma: report of a case

El micetoma es una enfermedad crónica, localizada, lentamente progresiva, caracterizada por formación de fístulas cutáneas que drenan material purulento con los característicos "granos de azufre". Existen dos tipos de micetomas, los producidos por eumicetos y los producidos por actinomicetos. Se presenta el caso de un paciente masculino que acude a consulta por obstrucción nasal constante, rinorrea mucopurulenta y fétida, así como por epistaxis. La tomografía computarizada y los estudios de patología determinaron rinosinusitis crónica por Actinomyces species. Hasta donde conocemos, éste es el primer caso informado en la literatura mundial de un micetoma por Actinomyces species de nariz y senos paranasales (maxilar y etmoidal).