Differences in response of the proximal esophagus to wet swallows in patients of Chagas' disease and idiopathic achalasia.

Chagas' disease and idiopathic achalasia have similar esophageal manifestations such as absent or incomplete lower esophageal sphincter relaxation and aperistalsis in the esophageal body (alterations seen mainly in the distal esophageal body). Our aim in this paper was to study the response of the proximal esophageal body to wet swallows in patients with Chagas' disease and patients with idiopathic achalasia. We retrospectively analyzed the time interval between the onset of the pharyngeal contractions 1 cm proximal to the upper esophageal sphincter, as well as 5 cm distal to the pharyngeal measurement. Amplitude, duration and area under the curve of contractions in the proximal esophagus were also determined in 42 patients with Chagas' disease (15 with associated esophageal dilatation), 21 patients with idiopathic achalasia (14 with concomitant esophageal dilatation) and 31 control subjects. The time between the onset of pharyngeal and proximal esophageal contractions was longer in patients with Chagas' disease and in those with esophageal dilatation (1.39 +/- 0.16 s) than in control subjects (0.86 +/- 0.04 s, P < 0.01). The amplitude of proximal esophageal contractions was lower in patients with idiopathic achalasia and esophageal dilatation (60.9 +/- 16.3 mmHg) than in control subjects (89.7 +/- 6.9 mmHg, P = 0.06). The authors conclude that in patients with advanced esophageal disease, the proximal esophageal contractions in Chagas' disease have a delayed response to wet swallows when compared with controls, and that the amplitude of proximal esophageal contractions was lower than expected in patients with idiopathic achalasia.

[Validation of global nutrition assessment in elders]. / Validación del criterio de evaluación nutricional global del adulto mayor.

BACKGROUND: The Chilean Ministry of Health proposed the use of "Mini Nutritional Assessment", to identify elders at nutritional risk. This score considers anthropometric, dietary and quality of life items. AIM: To assess the concordance of the mini nutritional assessment with body mass index and dietary parameters in Chilean free living elders. MATERIAL AND METHODS: Subjects aged 70 years old or more, coming from four public outpatient clinics were studied. In all, the mini nutritional assessment, dietary intake using 24 h recalls and anthropometric parameters, were measured. Energy intake was evaluated using FAO/WHO/UNU guidelines. Micronutrient intake was evaluated using the Dietary Recommended Intakes (DRI) from USA. Kappa index was used to determine diagnostic concordance. RESULTS: Forty three percent of subjects were overweight or obese. There was a substandard intake of calcium, folate, zinc, vitamin A, C, E, B6, B12 and energy. Seventy nine percent of subjects had a deficient or regular food intake. Mini nutritional assessment score was normal in 66% of subjects. Fifty eight percent of those with a deficient food intake had a normal mini nutritional assessment. On the other hand, 73% of those considered at nutritional risk, had a normal or excessive weight. CONCLUSIONS: Mini nutritional assessment did not identify elders at nutritional risk in this sample.

[Experiences in community participation to promote nutritional education]. / Experiencias en participación comunitaria para promover la educación en nutrición.

This paper presents several experiences obtained in the Rural Research Center of the Solís Valley in relation to community participation programs. The main objective of these projects was to improve the nutritional practices of children in the rural areas of highland Mexico. As first experience, small groups were formed with mothers, fathers, married couples and teenagers. Each of these groups started a project oriented to promote nutritional self-sufficiency. One group of mothers was successful in assuring the provision of government subsidized milk in their community. A second group of mothers started a chicken-raising farm, but the project failed because all the chicken died in an epidemic. The group of fathers started a sheep-raising project as the first step to get a milk-producing cow. The sheep-raising was successful, but when the sheep were sold each man in the group kept the revenue to himself and the group disappeared. The married couples were successful both in a home-gardening project and in a chicken-raising farm. The teenagers were also successful with their home-gardening project and acted as "injection groups" to spread the project in other communities. As a second experience in community participation, community health workers taught mothers how to use locally available food to improve their diets, preparing culturally acceptable food recipes. This intervention was successful in increasing mother's awareness of a balanced diet. A second intervention combined the presentation of a drama ("peasant's theater") in order to increase mother's participation in these projects.(ABSTRACT TRUNCATED AT 250 WORDS)