[Real-world efficacy of switching to bictegravir/ emtricitabine/tenofovir alafenamide in pretreated patients with triple therapy containing rilpivirine]. / Eficacia en vida real del cambio a bictegravir/ emtricitabina/tenofovir alafenamida en pacientes previamente tratados con pautas triples que contienen rilpivirina.

OBJECTIVE: To analyze the efficacy and tolerability of the strategy to change from rilpivirine (RPV) based regimens to bictegravir / emtricitabine / tenofovir alafenamide (B/F/TAF). METHODS: Single-center, observational and retrospective study. Patients who made the change to B/F/TAF before February 2020 were selected, analyzing the results after 24 and 48 weeks. The percentage that remained with an undetectable viral load was determined, as well as the changes in CD4 + lymphocytes, metabolic parameters and renal function. RESULTS: A total of 42 patients were included. Thirty-two of the 35 patients (91.4%) who completed the 48 weeks of follow-up had an undetectable viral load. The CD4 + lymphocyte count remained stable at 24 and 48 weeks. The response to B/F/TAF was not influenced by the two analogs previously received. CONCLUSIONS: Switching from triple therapy with RPV to B/F/TAF is a safe and effective strategy in real life.

Systematic training in master swimmer athletes increases serum insulin growth factor-1 and decreases myostatin and irisin levels.

During ageing, anabolic status is essential to prevent the decrease in quantity and quality of skeletal muscle mass (SMM). Exercise modulates endocrine markers of muscle status. We studied the differences of endocrine markers for muscle status in 62 non-sarcopenic Mexican swimmer adults aged 30-70 y/o, allocated into two groups: the systematic training (ST) group including master athletes with a physical activity level (PAL) >1.6, and the non-systematic training group (NST) composed by subjects with a PAL <1.5. Body composition, diet, biochemical and endocrine markers were analyzed. The ST group showed lower myostatin (MSTN) and irisin (IRI) levels, two strong regulators of SMM. The insulin growth factor-1 (IGF-1) was higher in the ST. This is consistent with most of the evidence in young athletes and resistance training programs, where IGF-1 and IRI seem to play a crucial role in maintaining anabolic status in master athletes.

End-of-life transfusions in patientswith an oncological diagnosis / Transfusiones al final de la vida en pacientes con diagnóstico oncológico

Introduction: Cancer patients in terminal stages present symptoms related to anemia, other cytopenias, and coagulopathies that deteriorate the quality of life. These symptoms can be multicausal and do not improve in most cases. Objective: Describe the use of blood transfusions in the six months before death as an alternative palliative treatment in patients with an oncological diagnosis in the city of Medellin during the period 2013-2018. Methods: Retrospective cohort, in patients with a cancer diagnosis who received transfusions in the last six months of life, a non-probabilistic sampling of consecutive cases was executed. The analysis was carried out in SPSS, estimating absolute and relative frequencies and median with interquartile ranges. Results: Out of 3,254 medical records of cancer pa­tients, 151 were included. The time to oncological diagnosis had a median of 2 years (IQR 1 and 3). The symptoms observed in patients before and after the first transfusion were pain, present in 32.1 % (46) and 16.9 % (25) respectively, besides drowsiness was distinguished in 25 % (36) before transfusion and 14.3 % (21) after. Finally, the clinical outcomes before and after the last transfusion prior to death, were a decrease in pain, asthenia/adynamia, drowsiness, among others. Conclusions: The findings of this research allow us to appreciate the current panorama in the institutions in which palliative care medical services are being provided and consider when to offer the blood products to a patient at the end of life as a therapeutic measure in the context of a human being cared by physicians.(AU)

Introducción: Los pacientes con cáncer en fase terminal presentan síntomas relacionados con la anemia, otras citopenias y coagulopatías que deterioran la calidad de vida. Estos síntomas pueden ser multicausales y no mejoran en la mayoría de los casos. Objetivo: Describir el uso de transfusiones sanguíneas en los seis meses previos a la muerte como alternativa de tratamiento paliativo en pacientes con diagnóstico oncológico en la ciudad de Medellín durante el periodo 2013-2018. Métodos: Cohorte retrospectiva, en pacientes con diagnóstico de cáncer que recibieron transfusiones en los últimos seis meses de vida, se ejecutó un muestreo no probabilístico de casos consecutivos. El análisis se realizó en SPSS, estimando frecuencias absolutas y relativas y mediana con rangos intercuartílicos.Resultados: De 3254 historias clínicas de pacientes con cáncer, 151 fueron incluidas. El tiempo hasta el diagnóstico oncológico tuvo una mediana de 2 años (IQR 1 y 3). Los síntomas observados en los pacientes antes y después de la primera transfusión fueron el dolor, presente en el 32,1 % (46) y el 16,9 % (25) respectivamente, además de la somnolencia que se distinguió en el 25 % (36) antes de la transfusión y el 14,3 % (21) después. Finalmente, los resultados clínicos antes y después de la última transfusión antes de la muerte, fueron una disminución del dolor, astenia/adinamia, somnolencia, entre otros. Conclusiones: Los hallazgos de esta investigación permiten apreciar el panorama actual en las instituciones en las que se prestan servicios médicos de cuidados paliativos y considerar cuándo ofrecer los hemoderivados a un paciente al final de la vida como medida terapéutica en el contexto de un ser humano atendido por los médicos.(AU)

Association of cagA+ Helicobacter pylori strains with high urease activity and dyspepsia in Mexican adults. / Asociación de cepas de Helicobater pylori cagA+ con alta actividad de ureasa y dispepsia en adultos mexicanos.

INTRODUCTION AND AIMS: Helicobacter pylori (H. pylori) is associated with a higher risk of peptic ulcer and gastric cancer. The sole presence of the bacterium is not a determinant of clinical outcome, but rather the interaction of strain type and host factors determines the risk of disease. Our aim was to study the association between bacterial load, strain type, and gastric symptoms in H. pylori-positive subjects. MATERIALS AND METHODS: In a community survey, a diagnostic 13C-urea breath test for H. pylori was performed on 302 volunteers that were not taking antibiotics, antacids, or proton pump inhibitors one month prior to the test. The breath test produced 25 H. pylori-positive subjects, between 25-74 years of age, who then took a gastric symptoms survey and were tested for the presence of the cagA genotype in gastric juice, using the Entero-test®. Bacterial load was determined as a measure of urease activity, utilizing the delta over baseline value, obtained in the 13C-urea breath test. RESULTS: A total of 48% of the H. pylori-positive subjects were cagA+. A positive association was found between cagA status and high gastric urease activity (P<.0001) and the latter was significantly associated with the presence of symptoms (P<.0001). CONCLUSION: Gastric urease activity was strongly associated with dyspeptic symptoms and cagA+ H. pylori. Elevated 13C-delta over baseline values could be used as indicators of a higher risk for gastric disease.

[Helicobacter pylori infection in the HIV + population: a comorbidity to think about]. / Infección por Helicobacter pylori en la población VIH+: una comorbilidad en la que pensar.

OBJECTIVE: Gastrointestinal disorders are frequent in HIV+. Helicobacter pylori may be an underdiagnosed cause. METHODS: Patients with HIV and H. pylori were described since January 1998 up to December 2017. RESULTS: A total de 132 patients were included. The most frequent symptom was dyspepsia. 88.5% had chronic atrophic gastritis. Eradication was achieved in 102 (77.3%). Healing was more frequent with quadruple regimen (p=0.004) and in the youngest (p=0.041). CONCLUSIONS: H. pylori infection could be responsible for nonspecific digestive manifestations in HIV + patients.

[X isochromosomes: delayed diagnosis of Turner's syndrome]. / Isocromosomas X: diagnóstico tardío de síndrome de Turner.

Turner syndrome is diagnosed by the combination of certain phenotypic characteristics with the absence of one of the X chromosome. This absence may be total or partial, as occurs in isochromosomes Xq. The phenotypic consequences of these depend on two factors: the characteristics of the lost genes and the percentage of cells 45, X in mosaicisms. The clinical features also change with the cytogenetic pattern. Short stature is the most common phenotypic manifestation, as it is due to the haploinsufficiency of the SHOX gene on the short arm of X chromosomes. Thus, when there is isochromosomes on the long arms, short stature is always present. However, the typical features of this syndrome could be absent, and the diagnosis can be delayed. This occurred in our patients, who will not be able to obtain optimum benefits with growth hormone treatment.

Body composition prediction equations based on deuterium oxide dilution method in Mexican children: a national study.

BACKGROUND/OBJECTIVES: Obesity and undernutrition co-exist in many regions of Mexico. However, accurate assessments are difficult because epidemiological data on body composition are not available. The aim of this study was to facilitate assessments of body composition in Mexican school children of different geographical regions and ethnicity by developing equations for bioelectrical impedance and anthropometry based on deuterium oxide dilution. SUBJECTS/METHODS: We evaluated 336 subjects (143 belonged to six major indigenous groups) from Northern, Central and Southern Mexico. We measured height (Ht), weight (Wt), tricipital skinfold (Tricp-SKF) and resistance (R) based on a bioimpedance analysis (BIA). Fat-free mass (FFM) and fat mass (FM) were estimated from measurements of total body water with the deuterium dilution technique. RESULTS: The final BIA equation was FFM (kg)=0.661 × Ht²/R+0.200 × Wt-0.320. The R² was 0.96; the square root of the mean square error (SRMSE) was 1.39 kg. The final anthropometric equation was FM (kg)=-1.067 × sex+0.458 × Tricp-SKF+0.263 × Wt-5.407. The R² was 0.91; SRMSE was 1.60 kg. The BIA equation had a bias of 0.095 kg and precision of 1.43 kg. The anthropometric equation had a bias of 0.047 kg and precision of 1.58 kg. CONCLUSIONS: We validated two equations for evaluating body composition in Mexican indigenous and non-indigenous children and youth from three main regions of the country. These equations provided reliable estimates and will promote a better understanding of both obesity and undernutrition.

[Coinfection with HIV and HCV: abacavir and ribavirine, why not?]. / Coinfección por VIH y VHC: abacavir y ribavirina, ¿por qué no?

A 48-year old male coinfected by human immunodeficiency virus and hepatitis C virus (HCV) genotype 3a. The patient was under clinically and virologically effective treatment with Trizivir (zidovudine, lamivudine and abacavir) when it was decided to initiate treatment for the chronic HCV infection with peginterferon and ribavirin. Should the ongoing antiretroviral treatment be adjusted?

[Improvement of insulin sensitivity after an intensive lifestyle program for youth's weight management in the primary care]. / Mejora en la sensibilidad a la insulina con un programa intensivo de cambio en el estilo de vida para control de obesidad en niños y adolescentes en el primer nivel de atención.

The aim of this study was to evaluate an intensive lifestyle intervention for weight management among youth in a primary care setting on insulin sensibility, compared to a control group. The study included 42 youths 9-17 years old (n=23 intensive lifestyle intervention, n=19 control group) who completed a randomized trial for weight management in a primary care setting which included an oral glucose tolerance test. The intensive lifestyle intervention included monthly consultations with the primary care physician, nutrition counseling with a registered dietitian (weekly first 3 months and then monthly) and 12 group sessions in a behavioral change protocol. The control group attended monthly consultations with the primary care physician. Insulin sensitivity was estimated by the Insulin Sensitivity Index ISI(0,120) at baseline and 6 months posttreatment. At 6 months, the mean +/- DE, increase in insulin sensitivity was greater in the intensive lifestyle intervention than the control group (+46.8 +/- 56 vs. +5.6 +/- 47, between-group difference 41.2 [CI 95%, 8.5, 73.9], p = 0.01): Sixty five percent of youths on the intensive lifestyle intervention increased insulin sensitivity over 9 units vs. 32% in the control group (p=0.03). This study shows preliminary evidence that an intensive lifestyle intervention program can be an alternative model to improve insulin sensitivity among youths in the primary care setting.

Cuantificación de huevo en fideos secos según método electroforético (SDS PAGE) / Quantification of egg in dried noodles by electrophoretic methods (SDS PAGE)

El objetivo del trabajo fue utilizar la metodología SDS-PAGE para la cuantificación de huevo en fideos secos elaborados con harina y agregado de huevo. Se analizaron 6 sistemas modelos (SM) de fideos que contenían 0,0; 1,0; 2,5; 4,0; 6,0 y 8,0% de huevo en polvo. Se extrajeron proteínas totales con un buffer que contiene dodecilsulfato de sodio (SDS) y 2-Mercaptoetanol y se realizó electroforesis en gel de poliacrilamida con SDS. Se establecieron las relaciones de las áreas de los picos de los densitogramas (de huevo y de trigo) que permiten una correcta cuantificación del porcentaje de huevo agregado. Se analizaron 11 muestras comerciales en las cuales se realizó la cuantificación de huevo, obteniéndose valores comprendidos entre <1,0% y 8,8% de huevo en polvo. En los SM analizados y en las muestras comerciales se determinó además el contenido de colesterol (método enzimático) y el contenido de huevo por un método de ELISA. Los valores de colesterol en los SM se incrementaron con el aumento de huevo en polvo agregado, mientras que en las muestras se observaron valores bajos de colesterol para los niveles mas bajos de huevo y valores altos para los niveles mas altos de huevo. Con el método de ELISA se logró una correcta cuantificación de huevo en los SM hasta 4,0%, pero se obtuvieron resultados bajos en los sistemas mas altos (6,0 y 8,0%). Esto podría deberse a la importante dilución que debe realizarse de los extractos de las muestras para poder determinar su contenido. Con respecto a las muestras comerciales en 8 se obtuvieron valores similares a los de electroforesis mientras que en otras 3 los valores fueron diferentes. La metodología electroforética resulta una herramienta útil para la detección y la cuantificación de huevo en este tipo de muestras cuando se cuenta con SM de concentración de huevo en polvo conocida.

Trichuriasis and low-iron status in schoolchildren from Northwest Mexico.

BACKGROUND/OBJECTIVES: The aim of this study was to investigate the association between trichuriasis and iron status in rural schoolchildren from Northwest Mexico. SUBJECTS/METHODS: A total of 73 schoolchildren (37 boys, 36 girls) between the ages of 6 and 10 years were voluntarily recruited from the public primary school of the rural community of El Higueral in Culiacan, Sinaloa (Northwest Mexico) for a cross-sectional study with a longitudinal follow-up of 5 weeks. Data were collected on socioeconomic status, anthropometry, haematological and biochemical indices of iron status, daily iron intake, and prevalence and intensity of trichuriasis. Multiple regression models, independent t-test and paired t-test were used to analyse the association between trichuriasis and iron status in cross-sectional and longitudinal samples, respectively. Adjusted models were tested for linear regression assumptions using residual plots. RESULTS: The mean age of the Trichuris-free and Trichuris-infected groups was 7.7±1.3 and 7.7±1.5 years respectively (P=0.92). The height for age was significantly higher in the Trichuris-free group than the Trichuris-infected group (P=0.02). No differences were found in the socioeconomic variables between the two groups. At baseline, significantly higher concentrations of haemoglobin, haematocrit, blood cell count (RBC) and serum iron were measured in the Trichuris-free group compared with the Trichuris-infected children (P<0.05). An association was found between trichuriasis and haemoglobin adjusted for socioeconomic variables, age and sex. Haemoglobin, RBC and serum ferritin concentrations were significantly increased in the infected children 5 weeks after treatment (P<0.05). CONCLUSIONS: Trichuriasis could be a risk factor for low-iron status in the schoolchildren of Northwest Mexico.

Prediction of fat-free mass by bioelectrical impedance analysis in older adults from developing countries: a cross-validation study using the deuterium dilution method.

OBJECTIVE: Several limitations of published bioelectrical impedance analysis (BIA) equations have been reported. The aims were to develop in a multiethnic, elderly population a new prediction equation and cross-validate it along with some published BIA equations for estimating fat-free mass using deuterium oxide dilution as the reference method. DESIGN AND SETTING: Cross-sectional study of elderly from five developing countries. METHODS: Total body water (TBW) measured by deuterium dilution was used to determine fat-free mass (FFM) in 383 subjects. Anthropometric and BIA variables were also measured. Only 377 subjects were included for the analysis, randomly divided into development and cross-validation groups after stratified by gender. Stepwise model selection was used to generate the model and Bland Altman analysis was used to test agreement. RESULTS: FFM = 2.95 - 3.89 (Gender) + 0.514 (Ht2/Z) + 0.090 (Waist) + 0.156 (Body weight). The model fit parameters were an R2, total F-Ratio, and the SEE of 0.88, 314.3, and 3.3, respectively. None of the published BIA equations met the criteria for agreement. The new BIA equation underestimated FFM by just 0.3 kg in the cross-validation sample. The mean of the difference between FFM by TBW and the new BIA equation were not significantly different; 95% of the differences were between the limits of agreement of -6.3 to 6.9 kg of FFM. There was no significant association between the mean of the differences and their averages (r= 0.008 and p= 0.2). CONCLUSIONS: This new BIA equation offers a valid option compared with some of the current published BIA equations to estimate FFM in elderly subjects from five developing countries.

Impact of Giardia intestinalis on vitamin a status in schoolchildren from northwest Mexico.

We conducted a cross-sectional study in northwest Mexico in order to investigate the association between giardiasis and serum vitamin A in 40 Giardia-infected and 70 Giardia-free schoolchildren who were covered by a regional school breakfast program. There were no significant differences in age, Z-scores for nutritional indices of height for age, weight for age, or weight for height, socioeconomic conditions (employment and education of the parents, household conditions, sanitation facilities, type of drinking water, and family income), and mean daily intakes of vitamin A in the Giardia-free (899 +/- 887 microg) and the Giardia-infected (711 +/- 433 microg) groups. A higher concentration of serum retinol was found in the Giardia-free group than in the Giardia-infected group (0.75 micromol/L versus 0.61 micromol/L, respectively; p < 0.0001). Giardia-infected children were more likely to be vitamin A-deficient than the Giardia-free children (OR = 3.2; 95% CI = 1.2-8.5). Although 95% of the children met the daily-recommended intakes of vitamin A, half of them showed subclinical vitamin A deficiency. It is recognized that vitamin A deficiency is multifactorial and giardiasis was a factor significantly associated with this deficiency in this study. Mexican program developers and policymakers should be aware about the distinction between dietary deficiencies and deficiency diseases when current national program strategies for parasitic control and vitamin A supplementation are redesigned.

Composición y aporte potencial de hierro, calcio y zinc de panes y fideos elaborados con harinas de trigo y amaranto / Composition and potential contribution of iron, calcium and zinc of bread and pasta made with wheat and amaranth flours]

Amaranth, a traditional american crop that is nowadays given renewed importance, has good food potential value. The minerals contributed by the grain are quantitatively important. However, as the flour is obtained by total grinding of the grain, this process leads to the presence of anti-nutritional components, such as fitates, and therefore, the evaluation of the actual availability of the minerals of nutritional interest becomes necessary. The process of bread fermentation, plus the addition of fitases and enhancers of mineral availability such as citric and ascorbic acid, might improve mineral bioavailability. The objective of this work was to assess protein, ash, lipids and total dietary fiber content and evaluate the concentration and dialyzability of Fe, Zn and Ca (as mineral bioavailability indicator) in bread and pasta 100% wheat, and bread and pasta obtained by replacing 20% wheat flour (WF) with whole amaranth flour (WAF). Ascorbic acid (AA), citric acid (CA) and fitase were used as mineral bioavailability enhancers. The potential contribution of each mineral (PC) was calculated as each mineral concentration times its dialyzability. In 80:20 bread an increase of total dietary fiber and minerals, compared to 100% wheat products was observed. A maximum FePC in 80:20 bread was obtained with CA and fitase (0.55mg%). In pasta, the maximum effect was observed with CA (0.07 mg%). The CaPC was maximum in 80:20 pasta with CA (16.72 mg%). The greatest ZnPC was found in 80:20 bread with CA and fitase (0.40 mg%). The introduction of the WAF in fermented baked products with addition of CA and fitase allows to obtain nutritional advantages.

El amaranto es un cultivo americano autóctono actualmente revalorizado por su elevado potencial alimentario. Los minerales aportados por el grano son cuantitativamente importantes. Sin embargo, la presencia de fitatos en los tegumentos externos del grano hace necesaria la evaluación de la biodisponibilidad de los minerales de interés nutricional pues la harina se obtiene por molienda integral. El proceso de fermentación del pan, sumado al agregado de fitasas y promotores de la dializabilidad mineral, podría mejorar la biodisponibilidad mineral. El objetivo del trabajo fue establecer el porcentaje de proteínas, cenizas, lípidos, fibra dietaria total (FDT), Fe, Zn y Ca y estudiar la dializabilidad de esos minerales - como indicadora de su biodisponibilidad - en panes y fideos elaborados con 100% harina de trigo (HT) y con 20% de reemplazo de HT por harina integral de amaranto (HIA). Como promotores de la biodisponibilidad mineral se utilizaron ácidos ascórbico (AA) y cítrico (AC) y fitasa. Se estableció el aporte potencial (AP) de cada mineral como el producto de su concentración y dializabilidad. En los panes 80:20 se observó un incremento sustancial del contenido de FDT y minerales. El máximo APFe se obtuvo en panes 80:20 con AC y fitasa (0,55 mg%). En fideos, el máximo efecto se observó con AC (0,07 mg%). El APCa fue máximo en fideos 80:20 con AC (16,72 mg%). El mayor APZn se evidenció en pan 80:20 con AC y fitasa (0,40 mg%). La introducción de la HIA en productos panificados fermentados con adición de AC y fitasas permite obtener ventajas nutricionales.