Uncovering NDVI time trends in Spanish high mountain biosphere reserves: A detailed study.

Global warming is increasing the vulnerability of ecosystems, especially in peninsular Spain. Biosphere Reserves are internationally protected areas that seek to protect biodiversity and, at the same time, promote sustainable development. Evaluating these protected areas is essential to verify environmental changes and establish priorities in their management. In this work, we have studied the time trends of NDVI in the high mountain Biosphere Reserves of Spain from 2001 to 2016 to check if the trend patterns are associated with some environmental variables. Significant differences were found between NDVI trends and high mountain Biosphere Reserves. Firstly, significant positive trends in NDVI were observed when analysing both reserves together. However, significant differences were found between the two reserves. The Ordesa-Viñamala Reserve shows higher positive NDVI trends and lower negative trends, while this pattern is reversed in Sierra Nevada. We observed how the fluctuations in temperature and drought due to climate change have already negatively affected the Mediterranean reserve (Sierra Nevada). In contrast, the alpine reserve (Ordesa-Viñamala) maintains positive NDVI trends. This study helps to close the gap in information related to Biosphere Reserves, which gives value to the work that is being carried out by the local communities that make up them, generating statistically significant results that Biosphere Reserves are protected areas that help us understand how to manage and govern socioecological systems sustainably.

Modelling and testing forest ecosystems condition account.

We developed an application model based on the System of Environmental Economic Accounting-Ecosystem Accounting (SEEA-EA) framework, endorsed by the United Nations Statistical Commission in 2021. This model enables mapping condition accounts for forest ecosystems using automated computation. We applied the model nationally in Spain between 2000 and 2015 to test its effectiveness. Our model follows five methodological steps to generate forest condition accounts: (i) definition and spatial delimitation of forest ecosystem types; (ii) selection of variables using the ecosystem condition typology encompassing physical, chemical, compositional, structural, functional, and landscape characteristics; (iii) establishment of reference levels, including lower (collapse) and upper (high ecosystem integrity) thresholds; (iv) aggregation of variables into condition index; and (v) calculation of a single condition index by rescaling the aggregated indicators between 0 and 1. The results obtained from the model provide valuable insights into the status and trends of individual condition indicators, as well as aggregated condition index values for forest ecosystems, in a spatially explicit manner. Overall, the condition of the forest ecosystems in Spain showed a slight increase, from 0.56 in 2000 to 0.58 in 2015. However, distinct trends were observed for each ecosystem type. For example, mixed Alpine and Macaronesia forests exhibited a significant improvement, while the continental Mediterranean coniferous forests did not show any change. This innovative approach to monitoring forest condition accounts has important potential applications in policy and decision-making processes. It can contribute to effective evidence-based nature conservation, ecosystem service management, and identifying restoration areas.

Estado de salud y nutrición del adulto mayor que concurre al Hospital Geriátrico del Seguro Social en la Asunción. Paraguay / Health status of older adults attending the Geriatric Hospital of the Social Security, in Asunción, Paraguay

Resumen El aumento de la población de adultos mayores y su mayor demanda de atención en salud en Paraguay, requiere de una evaluación multidimensional que identifique sus condiciones de riesgo o deterioro. El objetivo de esta investigación, fue evaluar el estado de salud y nutrición de una muestra de adultos mayores que acudieron a la consulta ambulatoria del Hospital Geriátrico de la Previsional, en la Asunción, Paraguay. La investigación tuvo un diseño observacional, descriptivo y de corte transverso, de 108 adultos mayores a quienes se les realizó la Valoración Geriátrica Integral (VGI) y se evaluaron parámetros nutricionales. La edad promedio fue de 71 años con predominio del sexo femenino. De acuerdo al IMC, el 64% presentó sobrepeso u obesidad. De acuerdo a la VGI, 18% presentó riesgo nutricional, 43% dependencia leve para las actividades de la vida diaria y 12% para las actividades instrumentales. El 18% mostró déficit cognitivo, el 6% depresión y el 30% riesgo social. La población se caracterizó por presentar altas frecuencias de exceso de peso e hipertensión, con una baja frecuencia de riesgo de desnutrición, las mayores limitaciones se dieron en las actividades básicas de la vida diaria y en el riesgo social. El ser mujer y el exceso de peso se asociaron significativamente con las limitaciones básicas funcionales. Este trabajo constituyó uno de los primeros en el país sobre adultos mayores ambulatorios, permitiendo configurar una línea de base de las áreas comprometidas o en riesgo de declinación y desarrollar estrategias y acciones preventivas para promover un envejecimiento saludable.

Abstract The increase in the population of older adults and their more significant demand for health care in Paraguay requires a multidimensional evaluation to identify risks or deteriorating conditions. The objective of this research was to evaluate the health and nutrition status of a sample of older adults who attended the Geriatric Hospital of the Social Security for outpatient consultation. The research had a cross-sectional descriptive observational design, which included 108 older adults who underwent the Comprehensive Geriatric Assessment (CGA) and whose nutritional parameters were evaluated. Their average age was 71 years, with a predominance of females. According to their BMI, 64% were overweight or obese. As for the CGA, 18% presented a nutritional risk, 43% had mild dependence on activities of daily living and 12% on instrumental activities, 18% had a cognitive deficit, 6% had depression, and 30% had social risk. The population was characterized by a high prevalence of overweight and hypertension and a low frequency of risk of malnutrition. The most significant limitations were in the basic activities of daily life and social risk. Being female and being overweight were significantly associated with basic functional limitations. This work was one of the first in the country on ambulatory older adults, allowing the establishment of a baseline for areas where health is compromised or at risk of decline and the development of preventive strategies and actions to promote healthy aging.

How the ecosystem extent is changing: A national-level accounting approach and application.

Assessing the spatial and temporal changes in ecosystems is essential to account for natural capital contribution to human well-being. However, various methods to quantify these changes challenge the development of reliable values which can be integrated into national statistical accounts. Following the international system of environmental-economic accounting framework, which recently adopts an ecosystem accounting standard. We present a novel approach to develop an ecosystem extent account from existing ecosystem classifications. This study shows the spatial and statistical extent account of 26 ecosystems (i.e. forests, grasslands, croplands, and urban, among others) between 1970 and 2015 at the national scale. Extent accounts were developed at a resolution of 25 m and provided reliable information on how ecosystem types have changed over time in Spain. Our results reflect three main patterns in the extension account: (i) an increase in forest ecosystems, (ii) a considerable decrease in agroecosystems (especially annual croplands), and (iii) substantial development of urban areas. To the best of our knowledge, this method is the first attempt to develop a robust methodology to measure the extent of ecosystems at the national level. The proposed approach is crucial for a strong knowledge of ecosystem dynamics and their implications for ecosystem conditions and services at a national level. This has potential applications in urban planning, green infrastructure development, and multiple uses for territory management and policies, integrating natural capital into official statistics and mainstreaming ecosystems into national-level planning and monitoring processes.

Integration of Vulnerability and Hazard Factors for Landslide Risk Assessment.

Among the numerous natural hazards, landslides are one of the greatest, as they can cause enormous loss of life and property, and affect the natural ecosystem and their services. Landslides are disasters that cause damage to anthropic activities and innumerable loss of human life, globally. The landslide risk assessed by the integration of susceptibility and vulnerability maps has recently become a manner of studying sites prone to landslide events and managing these regions well. Developing countries, where the impact of landslides is frequent, need risk assessment tools that enable them to address these disasters, starting with their prevention, with free spatial data and appropriate models. Our study shows a heuristic risk model by integrating a susceptibility map made by AutoML and a vulnerability one that is made considering ecological vulnerability and socio-economic vulnerability. The input data used in the State of Guerrero (México) approach uses spatial data, such as remote sensing, or official Mexican databases. This aspect makes this work adaptable to other parts of the world because the cost is low, and the frequency adaptation is high. Our results show a great difference between the distribution of vulnerability and susceptibility zones in the study area, and even between the socio-economic and ecological vulnerabilities. For instance, the highest ecological vulnerability is in the mountainous zone in Guerrero, and the highest socio-economic vulnerability values are found around settlements and roads. Therefore, the final risk assessment map is an integrated index that considers susceptibility and vulnerability and would be a good first attempt to challenge landslide disasters.

Landslide Susceptibility Assessment Using an AutoML Framework.

The risks associated with landslides are increasing the personal losses and material damages in more and more areas of the world. These natural disasters are related to geological and extreme meteorological phenomena (e.g., earthquakes, hurricanes) occurring in regions that have already suffered similar previous natural catastrophes. Therefore, to effectively mitigate the landslide risks, new methodologies must better identify and understand all these landslide hazards through proper management. Within these methodologies, those based on assessing the landslide susceptibility increase the predictability of the areas where one of these disasters is most likely to occur. In the last years, much research has used machine learning algorithms to assess susceptibility using different sources of information, such as remote sensing data, spatial databases, or geological catalogues. This study presents the first attempt to develop a methodology based on an automatic machine learning (AutoML) framework. These frameworks are intended to facilitate the development of machine learning models, with the aim to enable researchers focus on data analysis. The area to test/validate this study is the center and southern region of Guerrero (Mexico), where we compare the performance of 16 machine learning algorithms. The best result achieved is the extra trees with an area under the curve (AUC) of 0.983. This methodology yields better results than other similar methods because using an AutoML framework allows to focus on the treatment of the data, to better understand input variables and to acquire greater knowledge about the processes involved in the landslides.

Alteraciones urinarias en niños litiásicos paraguayos según estado nutricional / Urinary alterations in Paraguayan lithiasic children according to nutritional status

La urolitiasis es una enfermedad multifactorial. En los últimos años se ha observado un incremento a nivel mundial de la incidencia de la litiasis urinaria tanto en adultos como en niños. Los cambios en los hábitos alimentarios y un aumento en la prevalencia de exceso de peso podrían asociarse a este fenómeno. El objetivo del trabajo fue describir la frecuencia de alteraciones urinarias presentes en niños con urolitiasis según estado nutricional. En este trabajo observacional transversal se incluyeron 104 niños litiásicos de ambos sexos divididos en dos grupos según estado nutricional: 68 niños con peso adecuado y 36 niños con sobrepeso u obesidad considerando criterios de la OMS. Se determinaron en orina de 24 horas calcio, fósforo, sodio, ácido úrico, citrato y magnesio. Del total de pacientes participantes 54 (51.9%) fueron niñas y 50 (48,1%) fueron niños. El 65,4% de los niños presentó peso normal y el 34,6% de los niños sobrepeso u obesidad con edades medias de 10±4 años y 8±4 años respectivamente. El 80% de los niños presentó al menos una alteración urinaria, siendo las más frecuentes en ambos grupos la hipocitraturia e hiperuricosuria. Es llamativa la elevada frecuencia de alteraciones en las concentraciones de promotores e inhibidores de cristalización, en ambos grupos, indicando un riesgo aumentado de recidivas(AU)

Urolithiasis is a multifactorial disease. Recently the incidence of urolithiasis in adults and children is increasing worldwide. Changes in eating habits and an increase in the prevalence of overweight could be associated with this phenomenon. The objective was to describe the frequency of urinary alterations according to nutritional status in children with urolithiasis. This cross-sectional observational study included 104 lithiasic boys and girls divided into two groups: 68 children with normal weight and 36 children with overweight or obesity considering WHO criteria. Calcium, phosphorus, sodium, uric acid, citrate and magnesium levels were determined in 24-hour urine. The frequency of boys and girls was 51.9% and 48.1% respectively. Sixty five percent of the children presented normal weight and 34.6% of the children were overweight or obese with mean ages of 10±4 years and 8±4 years respectively. Eighty percent of the children had at least one urinary disorder, the most frequent being hypocitraturia and hyperuricosuria in both groups. The high frequency of alterations in the concentrations of urinary promoters and inhibitors of crystallization in both groups was remarkable, indicating an increased risk of recurrence(AU)

Evaluación de anemia post intervención nutricional en niños de comunidades rurales de Caazapá, Paraguay

Introducción: Se ha descrito la heterogeneidad del impacto de la anemia según el área geográfica; en el sector rural se ve agravado afectando a la población más vulnerable. Objetivo: evaluar el efecto del suplemento nutricional en niños anémicos menores de cinco años indígenas y no indígenas, en comunidades rurales del Departamento de Caazapá. Materiales y métodos: Estudio observacional transversal. Fueron estudiados una cohorte de 109 niños menores de cinco años indígenas y no indígenas cuyos padres brindaron su consentimiento informado, a quienes se les suministró sulfato ferroso según edad y peso. Resultados: Se encontró un aumento significativo de las medianas de hemoglobina, después de la intervención, de 5,0 g/L en el grupo anémico de indígenas y en los no indígenas de 6,0 g/L; el 31% de los niños indígenas y el 84% de los no indígenas dejaron de ser anémicos, post intervención. Conclusión: Ambas poblaciones de niños anémicos indígenas y no indígenas presentaron un aumento significativo de los niveles medios de hemoglobina post tratamiento con suplemento con hierro y una mayoría presentó una mejoría a un estado no anémico o del grado de la anemia.

Introduction: The heterogeneity of the impact of anemia has been described according to geographic area; in rural areas the impact is greater, affecting the most vulnerable populations. Objective: to evaluate the effect of nutritional supplementation in anemic children, both indigenous and non-indigenous, under five years of age, in rural communities in the Department of Caazapá. Materials and methods: This was a cross-sectional, observational study. We studied a cohort of 109 indigenous and non-indigenous children under five years of age whose parents gave their informed consent and were given ferrous sulfate based on age and weight. Results: There was a significant increase in hemoglobin medians, after the intervention, of 5.0 g / L in the anemic group of indigenous children and of 6.0 g / L in the non-indigenous children; 31% of indigenous children and 84% of non-indigenous children ceased to be anemic after the intervention. Conclusion: Both the indigenous and non-indigenous populations of anemic children showed a significant increase in their average levels of hemoglobin after iron supplementation and a majority improved to a milder degree of anemia or to a resolution of their anemia.

Albedo estimated from remote sensing correlates with ecosystem multifunctionality in global drylands.

Monitoring ecosystem functioning is a significant step towards detecting changes in ecosystem attributes that could be linked to land degradation and desertification in drylands worldwide. Remote sensing-based vegetation indices (VIs) and land surface albedo are two favorite indicators to monitor desertification process due to their close relationship with ecosystem status and to their increasing applicability over multiple spatiotemporal scales. While VIs are routinely used to monitor ecosystem attributes and functions such as vegetation cover and productivity, no previous study has evaluated whether remote sensing-measured albedo is related to the simultaneous provision of multiple ecosystem functions (multifunctionality) in global drylands. In this study, we evaluated the correlation of six albedo metrics (shortwave black-sky albedo, shortwave white-sky albedo, visible black-sky albedo, visible white-sky albedo, near-infrared black-sky albedo and near-infrared white-sky albedo) and two VIs (Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI)) with multifunctionality indices related to carbon, nitrogen and phosphorus cycling measured in 61 dryland ecosystems from all continents except Antarctica. We found a negative relationship between land surface albedo and multifunctionality. Black-sky albedo had a stronger correlation with multifunctionality than white-sky albedo. Visible black-sky albedo showed the strongest correlation with multifunctionality (MUL, -0.314), as well as with functions related to carbon (CCY, -0.216) and nitrogen cycling (NCY, -0.410), while near-infrared (-0.339) and shortwave black-sky albedo (-0.325) showed stronger correlations with functions related to phosphorus cycling (PCY) than visible black-sky albedo (-0.233) did. VIs showed significant positive correlations with MUL, CCY, and NCY, and the magnitudes were higher than those observed between albedo metrics and the multifunctionality indices. However, VIs were not correlated with PCY, which had significant correlations with both shortwave and near-infrared albedo. Though the magnitudes of the correlations observed were not high, which may result from the wide variability in soil and vegetation types in our dataset, our findings indicate that remotely sensed albedo correlates to multifunctionality, which has been linked to alternative states in global drylands. As such, albedo has the potential to monitor changes in dryland ecosystem functioning, which can inform us about the onset of desertification in these areas.

Reporte de un caso de Cistinuria: Uso de herramientas de diagnóstico a nivel nacional / Report of a case of cystinuria: Use of diagnostic tools at national level

La cistinuria es una enfermedad genética que se engloba dentro de alteraciones congénitas del transporte de aminoácidos con formación de cálculos en las vías urinarias, si bien es poco frecuente se caracteriza por su elevada recurrencia. En este trabajo presentamos el caso de una paciente de 34 años, con antecedentes de haber perdido un riñón por episodios anteriores de litiasis y con múltiples recidivas que es diagnosticada mediante la detección de cistina por espectroscopía infrarroja como componente único de 96 fragmentos de cálculos removidos mediante nefrolitotomía percutánea. La paciente fue evaluada laboratorialmente mediante el perfil metabólico y la cristaluria. Las indicaciones de tratamiento específicas incluyeron la administración de agentes alcalinizantes, régimen nutricional, y entrenamiento para control de pH urinario. Es importante señalar la agresividad de la litiasis de cistina con las consecuencias que puede tener la calidad de vida del paciente, y por tanto la importancia de contar con capacidades instaladas a nivel país para el diagnóstico y seguimiento de litiasis genéticas como la causada por la cistinuria(AU)

Cystinuria is a genetic disease that is included among congenital defects of renal amino acids transport that causes urinary stone formation. Although it is rare, it is characterized by its high recurrence. We present the case of a 34-year-old patient that lost one of her kidney because of recurrent episodes of lithiasis, and that was diagnosed by the detection of cystine with infrared spectroscopy as the sole component of 96 stone fragments removed by percutaneous nephrolithotomy. The patient was evaluated by metabolic profile and crystalluria. The specific treatment indications included the administration of alkalinizing agents, nutritional regimen, and training for personal measurement of urinary pH. This case highlights the aggressiveness of cystine stones with the consequences that may have on the quality of the patient life, and therefore the importance of having installed proper diagnostic capacities at national level to detect and monitor treatment efficacy in genetic lithiasis such as cystinuria(AU)

Estado nutricional-hematológico y parasitosis intestinal de niños escolares de 5 a 12 años de cuatro localidades rurales de Paraguay / Nutritional-hematological status and intestinal parasitosis of school children aged 5 to 12 years in four rural localities of Paraguay

El mundo, actualmente se enfrenta a una doble carga de malnutrición que incluye la desnutrición y la alimentación excesiva. A ello se suman las parasitosis intestinales que es una enfermedad frecuente con importante morbimortalidad en la población infantil, ligadas a la pobreza y malas condiciones higiénico-sanitarias. El objetivo de este trabajo fue describir el estado nutricional-hematológico y parasitológico de niños escolares de cuatro comunidades rurales de Paraguay. Estudio observacional descriptivo de corte transverso en el que participaron 102 niños de ambos sexos de 5 a 12 años de edad. Se realizó medición de peso y talla, utilizando balanza calibrada, y un altímetro fijado a la pared. Toma de muestra sanguínea por punción venosa para determinación de parámetros hematológicos, procesados en contador hematológico por impedancia. Muestras de heces de una sola toma fueron recogidas en frascos apropiados con formol al 10%, utilizándose 4 métodos: directo, flotación de Willis, Graham y de concentración. En relación al estado nutricional-hematológico se encontró que el 3,9% de los niños estaba con desnutrición moderada y el 9,8% presentó riesgo de desnutrición; anemia se observó en el 38,2% de los niños. En relación a la parasitosis, el estudio diagnóstico se realizó a 94 niños y se encontró que el 72,2% estaba parasitado, siendo Blastocystis hominis el más frecuente. Tanto la frecuencia de anemia como de parasitosis es alta en esta población, sin embargo no se pudo establecer una relación entre ellas(AU)

[Lithogenic risk index in urinary lithiasis patients and their evolution after treatment.] / Índices de riesgo litogénico de pacientes litiásicos y su evolución post tratamiento.

OBJECTIVE: To determine the lithogenic risk index and its evolution after treatment of paraguayan lithiasic patients. METHODS: This experimental study of temporal series included 28 lithiasic patients of both sexes that attended to the Instituto de Prevision Social in 2012. Basal evaluation included metabolic study and urinary saturation indexes determined by EQUIL software. With this data, a specific treatment was selected for each patient. The follow up included a medical consultation monthly and the metabolic evaluation after 6 month. The study was approved by an ethical committee. RESULTS: Basal evaluation showed hypocitraturia, hypercalciuria and hyperoxaluria in 50%, 46.4% and 14.3% of patients, whereas 42.9% showed diuresis lower than 2 L/day. Crystallization risk for calcium oxalate, sodium urate, hidroxiapatite and uric acid was observed in 1,3, 12 and 12 patients respectively. After treatment, a decrease in the frequency of hypercalciuria and hypocitraturia was observed, just like the urinary saturation risk for all types of crystals studied. Statistical analysis showed a significant variation of diuresis (p 0,0001) and uric acid urinary saturation (p 0,002) after treatment. CONCLUSIONS: The lithogenic risk factors more frequently detected were hipocitraturia and hypercalciuria. Therapeutic measures achieved the decrease of saturation risk indexes for all the crystals analyzed, registering significant effects in the increase of diuresis and uric acid saturation decrease. The use of software tools for the calculation of crystallization risk is an important innovation in Paraguay.

[Lithogenic risk in patients from Paraguay with urolithiasis]. / Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay.

UNLABELLED: The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. AIM: To determine the lithogenic risk profile in patients with urolithiasis. MATERIAL AND METHODS: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. RESULTS: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. CONCLUSIONS: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Análisis morfológico de cálculos urinarios voluminosos y coraliformes / Morphologic analysis of voluminous and staghorn kidney stones

La formación de cálculos en el sistema urinario es característica de la urolitiasis. Cuando los cálculos son mayores de 20 mm de largo se consideran voluminosos y coraliformes cuando llenan la pelvis renal y se ramifican en uno o más cálices. Los cálculos urinarios frecuentemente pueden comprometer la integridad y funcionalidad renal. Este estudio descriptivo y retrospectivo tiene como objetivo describir la composición de cálculos voluminosos y coraliformes obtenidos de 67 pacientes que concurrieron al IICS de marzo del 2007 a abril del 2011 y cumplieron con los criterios de inclusión. El análisis morfológico de los cálculos se realizó aplicando criterios mineralógicos y morfológicos descritos por Daudon et al. dando diferentes tipos morfológicos, cada uno con una composición dominante y una causa etiológica probable para la formación del cálculo. Los tipos más frecuentes en el núcleo fueron IVa1 y IIa compuestos respectivamente de carbapatita (fosfato de calcio) y Weddellita (oxalato de calcio dihidratado), mientras que Ia compuesto por Whewhellita (oxalato de calcio monohidratado) fue el tipo más frecuente en sección y superficie. En el 87% de los cálculos se detectó la presencia de 2 o más tipos morfológicos asociados, mostrando la etiología multifactorial de la urolitiasis. La cirugía abierta fue la técnica más frecuentemente empleada para remover el cálculo, 5 pacientes perdieron un riñón como consecuencia de la litiasis. Estos resultados apuntan a la importancia de la identificación correcta de la causa que genera los cálculos para seleccionar medidas apropiadas para evitar la recurrencia y las complicaciones severas.

The formation of stones in the urinary system is characteristic of urolithiasis. When thestones are bigger than 20 mm long they are considered voluminous and staghorn whenthey fill the renal pelvis and branch into one or more of the calices. Urinary stones could frequently compromise renal integrity and functionality. This descriptive and retrospective study aimed to describe the composition of voluminous and staghorn stones obtained from 67 patients who attended IICS from March, 2007 to April, 2011 and complied with the inclusion criteria. Morphological analysis of kidney stones was made by applying mineralogical and morphological criteria described previously by Daudon et al. giving different morphological types, each one with a dominant composition and a probable etiological cause of the stone formation. The more frequent types in the nucleus were IVa1 and IIa composed respectively of carbapatite (calcium phosphate) and weddellite (calciumoxalate dihidrated) while Ia composed of Whewhellite (calcium oxalate monohydrated) wasthe more frequent type in section and surface. The presence of 2 or more morphological types associated was detected in 87% of the stones, showing the multifactorial etiology of urolithiasis. Open surgery was the more frequent technique to remove the stones 5 patientslost one kidney as an outcome of lithiasis. This results point the importance of the correct identification of the cause that generates the stones to select proper measures to avoid recurrence and severe complications.

Malnutrición en niños menores de 5 años indígenas y no indígenas de zonas rurales, Paraguay / Malnutrition in indigenous and non-indigenous children under five years of age in rural areas, Paraguay

Los menores de cinco años de edad se afectan por la falta de alimentos adecuados mucho más rápido que a edades superiores por las demandas del crecimiento. El objetivo fue evaluar la situación nutricional de niños menores de cinco años de comunidades rurales, indígenas y no indígenas. Previo consentimiento informado de los padres o tutores, fueron evaluados 226 niños menores de cinco años de ambos sexos, 117 indígenas y 109 no indígenas según indicadores antropométricos de malnutrición por defecto y por exceso. Se aplicó una encuesta para obtener información de las características sociodemográficas y hábitos alimentarios. En niños indígenas y no indígenas la prevalencia de desnutrición global fue de 2,4 % y 2,6 %, riesgo de desnutrición 22% y 5,1%, desnutrición crónica 35,9% y 12,8%, sobrepeso 28,9% y 12,9%, respectivamente. Se observó un consumo frecuente de frutas en ambas poblaciones, seguida del consumo de proteína vegetal en población indígena y de proteína animal en los no indígenas. El 69,2% de los niños indígenas y el 3,7% de los niños no indígenas vivían en la pobreza extrema. Los principales problemas nutricionales encontrados fueron la desnutrición crónica, el riesgo de desnutrición y el sobrepeso. Los niños más fuertemente afectados son los indígenas, que sobreviven en difíciles condiciones socioeconómicas.

Children under five years of age are affected by the lack of adequate food faster thanolder individuals due to growth demands. The objective was to evaluate the nutritional situation of indigenous and non-indigenous children under five years living in rural communities. After obtaining the informed consent of their parents, 226 boys and girls under five years, 117 indigenous and 109 non-indigenous children, were evaluated using nutritional indicators of malnutrition by defect and excess. A questionnaire was applied toobtain information about social-demographic characteristics and dietary habits. Inindigenous and non-indigenous children, the prevalences of global malnutrition were 2.4% and 2.6%, malnutrition risk 22% and 5.1%, chronic malnutrition 35.9% and 12.8%,overweight 28.9% and 12.9%. Frequent consumption of fruits was observed in both populations, followed by consumption of vegetable protein in indigenous population and animal protein in non-indigenous. 69.2% of indigenous children and 3.7% of non-indigenous children living in extreme poverty. The main nutritional problems found were chronic malnutrition, malnutrition risk and overweight. The most strongly affected children were theindigenous, who survive in difficult socio-economic conditions.

Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay / Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Enteroparasitosis en niños bajo 5 años de edad, indígenas y no indígenas, de comunidades rurales del Paraguay / Enteric parasitic disease in children under 5 years of age, indigenous and non-indigenous, from rural communities in Paraguay

Background: Official figures of mortality in children under five years of age in the Americas, report that infectious and parasitic diseases caused most of the deaths. Objective: To evaluate the frequency of intestinal parasites in vulnerable children, indigenous and non-indigenous, and their socio-environmental characteristics. Patients and Methods: We evaluated 247 children under five years of age, of both sexes. Descriptive study with an analytical component, transverse cutting. Copro-parasitological examinations were carried out and semi-structured interviews to collect socio-demographic data were conducted. Results: The frequency of intestinal parasitic diseases was 56.1% and 35.5% in indigenous and non-indigenous children, respectively. In both populations, the most common pathogens were Blastocystis hominis and Giardia lamblia. Conclusion: We found a high frequency of parasitism in indigenous children at the expense of protozoa. Non-indigenous children still present the same parasitic species found in previous studies, suggesting the need to implement more control and prevention. The poor conditions in which they live favor the development of these diseases.

Introducción: Cifras oficiales de mortalidad en niños bajo 5 años de edad, en las Américas, refieren que la mayor parte de las defunciones fueron causadas por enfermedades infecciosas incluyendo las parasitarias. Objetivo: Evaluar la frecuencia de enteroparasitosis en población infantil vulnerable, indígenas y no indígenas, y sus características socio-ambientales. Pacientes y Métodos: Se evaluaron 247 niños bajo 5 años de edad, de ambos sexos. Estudio descriptivo con componente analítico, de corte transverso. Se realizaron exámenes copro-parasitológicos y se aplicaron encuestas semi-estructuradas para recoger datos socio-demográficos. Resultados: la frecuencia de enteroparasitosis en los niños indígenas fue de 56,1% y en los niños no indígenas de 35,5%. En ambas poblaciones los patógenos más frecuentes fueron Gardia lamblia y Blastocystis hominis. Conclusión: Encontramos una elevada frecuencia de parasitosis en la población infantil indígena, a expensas de los protozoarios. Los niños no indígenas siguen portando las mismas especies parasitarias encontradas en estudios anteriores, sugiriendo la necesidad de implementar un mayor control y prevención. Existen escasos estudios en nuestro país sobre parasitosis en edades tempranas y no se cuentan con datos en la niñez indígena. Las pobres condiciones en las que viven favorecen el desarrollo de estas enfermedades.

[Enteric parasitic disease in children under 5 years of age, indigenous and non-indigenous, from rural communities in Paraguay]. / Enteroparasitosis en niños bajo 5 años de edad, indígenas y no indígenas, de comunidades rurales del Paraguay.

BACKGROUND: Official figures of mortality in children under five years of age in the Americas, report that infectious and parasitic diseases caused most of the deaths. OBJECTIVE: To evaluate the frequency of intestinal parasites in vulnerable children, indigenous and non-indigenous, and their socio-environmental characteristics. PATIENTS AND METHODS: We evaluated 247 children under five years of age, of both sexes. Descriptive study with an analytical component, transverse cutting. Copro-parasitological examinations were carried out and semi-structured interviews to collect socio-demographic data were conducted. RESULTS: The frequency of intestinal parasitic diseases was 56.1% and 35.5% in indigenous and non-indigenous children, respectively. In both populations, the most common pathogens were Blastocystis hominis and Giardia lamblia. CONCLUSION: We found a high frequency of parasitism in indigenous children at the expense of protozoa. Non-indigenous children still present the same parasitic species found in previous studies, suggesting the need to implement more control and prevention. The poor conditions in which they live favor the development of these diseases.

Litiasis por cistina: Reporte de un caso / Cystine lithiasis: Case report

La cistinuria es una enfermedad genética cuya expresión clínica es la formación de cálculos en las vías urinarias. Si bien este tipo de litiasis es poco frecuente se caracteriza por un elevado número de recidivas. En este trabajo, presentamos el caso de una paciente de 24 años con litiasis por cistina, en la que el diagnóstico se logró mediante el hallazgo de cristales de cistina en muestras de orina y la presencia de cistina como único componente de los cálculos expulsados espontáneamente en dos ocasiones y removidos por nefrolitotomía percutánea en una ocasión en un lapso de 6 meses. El tratamiento instaurado consistió en aumento de la ingesta de líquido, dieta con restricción de sodio y proteínas y administración de agentes alcalinizantes para aumentar el pH de la orina. Así mismo queremos mostrar la disponibilidad y el uso a nivel nacional de técnicas laboratoriales especializadas para el diagnóstico y seguimiento de pacientes con cistinuria.

Cystinuria is a genetic disease which clinical expression is the formation of stones in theurinary tract.Even though this kind of lithiasis is rare, it is characterized by a highrecurrence rate. In this work,we present the case of a 24-year-old female patient withcystine lithiasisin whom the diagnosis was made by detection of cystine crystals in urinesamples and the presence of cystine as the only component of kidney stonesspontaneously passed in two episodes and removed by percutaneous nephrolithotomyoncein a period of six months. The treatment measures established were increase of thefluid intake,restricted protein and sodium diet and administrationofalkaline agents toincreaseurinary pH. Wealsoshow the availability and use at national level of specializedlaboratory techniques for the diagnosis and follow-up of cystinuric patients.

Frecuencia de dislipidemia y estado nutricional de escolares de áreas rurales paraguayas / Frequency of dislipidemia and nutritional state in schoolchildren of P a raguayan rural areas

Mundialmente la prevalencia de dislipidemias ha crecido en la última década en niños y adultos. En nuestro país las enfermedades circulatorias son la primera causa de muerte. Se determinó la frecuencia de dislipidemia, estado nutricional y factores asociados a dislipidemia en escolares de cuatro escuelas rurales públicas. Estudio observacional descriptivo de corte transverso en una población de escolares de 5 a 13 años de edad, de ambos sexos, con muestreo de casos consecutivos, realizado entre abril de 2008 a setiembre de 2009. Se determinó el estado nutricional por IMC según CDC 2000 y los niveles de colesterol y triglicéridos en sangre por métodos enzimáticos. A través de una encuesta, se consultaron los antecedentes familiares de dislipidemia, actividad física y hábitos alimentarios. El 59% de los 182 escolares incluidos en el estudio presentaron dislipidemia, 33% niveles de colesterol de riesgo moderado o alto, 41% niveles de triglicérido de riesgo moderado o alto. El 8% de los escolares mostró sobrepeso u obesidad. En cuanto a factores de riesgo asociados a dislipidemia, el 60% consumía carnes no magras al menos dos o tres veces por semana y el 56% de los niños que poseían padres con antecedentes de dislipidemia presentaban hipercolesterolemia de riesgo. La prevalencia de dislipidemia en esta población es preocupante y por ello, es necesario introducir estrategias dirigidas a mejorar los hábitos alimenticios en las instituciones educativas.

The worldwide prevalence of dislypidemiain children and adults has increased in the lastdecade.In our country, circulatory diseases are the first cause of death. The frequency ofdislypidemia, nutritional state and factors associated to dislypidemias in schoolchildren offour public rural schoolswas determined. This was a cross-sectional descriptiveobservational studywith consecutive samplingcarried out in a population of schoolboysand girlsaged5to13years oldfrom April 2008 to September 2009.The nutritional statewas determined by BMI according toCDC 2000and colesterol and triglycerides bloodlevels by enymatic methods. A survey collected family backgrounds about dislypidemia,physical activity and food habits.Fifty nine percent of the 182schoolchildren included inthe study presented dislypidemia, 33%had moderated or high risk for colesterol levelsand41%moderated or high risk for triglycerids levels while8%had overweight orobesity. In relation to risk factors associated to dislypidemia,60%ate lean meatat leasttwo to three times a week and56%of the children, who had parents with dislypidemiabackgrounds,showed risk hipercholesterolemia.The prevalence of dislypidemiafoundin this population is worrisomeshowing that it is necessary to introduce educationalstrategies aimed at improving food habits in the educational institutions.