Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas.

Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures. A workshop was designed to assess member states' regulatory capacity. A thematic analysis was conducted to analyze regional needs, successes and challenges. Thereafter, the Government Capacity-Building Framework for the prevention and control of NCDs was used to examine findings. The findings were organized in two sets: (i) PAHO/WHO actions to support member states and (ii) key actors' actions to advance regulatory policies. The results show notable regulatory progress across the Region of the Americas. However, progress differs between countries, with opportunities to strengthen measures in most countries, mainly in conflict of interest management. The results identified important actions to strengthen the regulatory capacity of PAHO/WHO member states. To maximize momentum for these actions, timelines must be identified, and political commitment can be boosted by applying human rights-based and food system-wide approaches.

Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico.

We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.

microbeMASST: a taxonomically informed mass spectrometry search tool for microbial metabolomics data.

microbeMASST, a taxonomically informed mass spectrometry (MS) search tool, tackles limited microbial metabolite annotation in untargeted metabolomics experiments. Leveraging a curated database of >60,000 microbial monocultures, users can search known and unknown MS/MS spectra and link them to their respective microbial producers via MS/MS fragmentation patterns. Identification of microbe-derived metabolites and relative producers without a priori knowledge will vastly enhance the understanding of microorganisms' role in ecology and human health.

Assessing transnational spillover effects of Mexico's front-of-package nutritional labeling system among Mexican Americans in the US.

OBJECTIVE: In 2020, Mexico implemented innovative front-of-package nutrition warning labels (FoPWLs) for packaged foods to increase the salience and understanding of nutrition information. This study evaluated Mexican Americans' self-reported exposure to Mexican FoPWLs and self-reported effects of FoPWLs on purchasing behavior. METHODS: The 2021 International Food Policy Study surveyed online panels of adult Mexican Americans in the US (n = 3361) to self-report on buying food at Mexican-oriented stores, noticing Mexican FoPWLs, and being influenced by FoPWLs to purchase less of eight different unhealthy foods (each assessed separately). After recoding the frequency of buying foods in Mexican stores and noticing FoPWLs (i.e., "often" or "very often" vs. less often), logistic models regressed these outcomes on sociodemographics, adjusting for post-stratification weights. RESULTS: Most participants (88.0%) purchased foods in Mexican stores. Of these, 64.1% reported noticing FoPWLs, among whom many reported that FoPWLs influenced them to buy fewer unhealthy foods (range = 32% [snacks like chips] - 44% [colas]). Participants were more likely to buy foods in Mexican stores and notice FoPWLs if they were younger, had ≥two children at home vs no children (AOR = 1.40, 95%CI = 1.15-1.71; AOR = 1.37, 95%CI = 1.03-1.80, respectively), and more frequently used Spanish (AOR = 1.91, 95%CI = 1.77-2.07; AOR = 1.87, 95%CI = 1.69-2.07). Also, high vs. low education (AOR = 1.51, 95%CI = 1.17-1.94) and higher income adequacy (AOR = 1.37, 95%CI = 1.25-1.51) were positively associated with noticing FoPWLs. Being female and more frequent Spanish use were consistently associated with reporting purchase of fewer unhealthy foods because of FoPWLs. CONCLUSIONS: Many Mexican Americans report both exposure to Mexican FOPWLs and reducing purchases of unhealthy foods because of them.

A Taxonomically-informed Mass Spectrometry Search Tool for Microbial Metabolomics Data.

MicrobeMASST, a taxonomically-informed mass spectrometry (MS) search tool, tackles limited microbial metabolite annotation in untargeted metabolomics experiments. Leveraging a curated database of >60,000 microbial monocultures, users can search known and unknown MS/MS spectra and link them to their respective microbial producers via MS/MS fragmentation patterns. Identification of microbial-derived metabolites and relative producers, without a priori knowledge, will vastly enhance the understanding of microorganisms' role in ecology and human health.

Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance.

BACKGROUND: Animal studies have shown that isoflurane and propofol have differential effects on Alzheimer's disease (AD) pathology and memory, although it is unclear whether this occurs in humans. METHODS: This was a nested randomised controlled trial within a prospective cohort study; patients age ≥60 yr undergoing noncardiac/non-neurological surgery were randomised to isoflurane or propofol for anaesthetic maintenance. Cerebrospinal fluid (CSF) was collected via lumbar puncture before, 24 h, and 6 weeks after surgery. Cognitive testing was performed before and 6 weeks after surgery. Nonparametric methods and linear regression were used to evaluate CSF biomarkers and cognitive function, respectively. RESULTS: There were 107 subjects (54 randomised to isoflurane and 53 to propofol) who completed the 6-week follow-up and were included in the analysis. There was no significant effect of anaesthetic treatment group, time, or group-by-time interaction for CSF amyloid-beta (Aß), tau, or phospho-tau181p levels, or on the tau/Aß or p-tau181p/Aß ratios (all P>0.05 after Bonferroni correction). In multivariable-adjusted intention-to-treat analyses, there were no significant differences between the isoflurane and propofol groups in 6-week postoperative change in overall cognition (mean difference [95% confidence interval]: 0.01 [-0.12 to 0.13]; P=0.89) or individual cognitive domains (P>0.05 for each). Results remained consistent across as-treated and per-protocol analyses. CONCLUSIONS: Intraoperative anaesthetic maintenance with isoflurane vs propofol had no significant effect on postoperative cognition or CSF Alzheimer's disease-related biomarkers within 6 weeks after noncardiac, non-neurological surgery in older adults. CLINICAL TRIAL REGISTRATION: NCT01993836.

Soil resistance and recovery during neotropical forest succession.

The recovery of soil conditions is crucial for successful ecosystem restoration and, hence, for achieving the goals of the UN Decade on Ecosystem Restoration. Here, we assess how soils resist forest conversion and agricultural land use, and how soils recover during subsequent tropical forest succession on abandoned agricultural fields. Our overarching question is how soil resistance and recovery depend on local conditions such as climate, soil type and land-use history. For 300 plots in 21 sites across the Neotropics, we used a chronosequence approach in which we sampled soils from two depths in old-growth forests, agricultural fields (i.e. crop fields and pastures), and secondary forests that differ in age (1-95 years) since abandonment. We measured six soil properties using a standardized sampling design and laboratory analyses. Soil resistance strongly depended on local conditions. Croplands and sites on high-activity clay (i.e. high fertility) show strong increases in bulk density and decreases in pH, carbon (C) and nitrogen (N) during deforestation and subsequent agricultural use. Resistance is lower in such sites probably because of a sharp decline in fine root biomass in croplands in the upper soil layers, and a decline in litter input from formerly productive old-growth forest (on high-activity clays). Soil recovery also strongly depended on local conditions. During forest succession, high-activity clays and croplands decreased most strongly in bulk density and increased in C and N, possibly because of strongly compacted soils with low C and N after cropland abandonment, and because of rapid vegetation recovery in high-activity clays leading to greater fine root growth and litter input. Furthermore, sites at low precipitation decreased in pH, whereas sites at high precipitation increased in N and decreased in C : N ratio. Extractable phosphorus (P) did not recover during succession, suggesting increased P limitation as forests age. These results indicate that no single solution exists for effective soil restoration and that local site conditions should determine the restoration strategies. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.

Unraveling the genetic complexities of combined retinal dystrophy and hearing impairment.

Usher syndrome, the most prevalent cause of combined hereditary vision and hearing impairment, is clinically and genetically heterogeneous. Moreover, several conditions with phenotypes overlapping Usher syndrome have been described. This makes the molecular diagnosis of hereditary deaf-blindness challenging. Here, we performed exome sequencing and analysis on 7 Mexican and 52 Iranian probands with combined retinal degeneration and hearing impairment (without intellectual disability). Clinical assessment involved ophthalmological examination and hearing loss questionnaire. Usher syndrome, most frequently due to biallelic variants in MYO7A (USH1B in 16 probands), USH2A (17 probands), and ADGRV1 (USH2C in 7 probands), was diagnosed in 44 of 59 (75%) unrelated probands. Almost half of the identified variants were novel. Nine of 59 (15%) probands displayed other genetic entities with dual sensory impairment, including Alström syndrome (3 patients), cone-rod dystrophy and hearing loss 1 (2 probands), and Heimler syndrome (1 patient). Unexpected findings included one proband each with Scheie syndrome, coenzyme Q10 deficiency, and pseudoxanthoma elasticum. In four probands, including three Usher cases, dual sensory impairment was either modified/aggravated or caused by variants in distinct genes associated with retinal degeneration and/or hearing loss. The overall diagnostic yield of whole exome analysis in our deaf-blind cohort was 92%. Two (3%) probands were partially solved and only 3 (5%) remained without any molecular diagnosis. In many cases, the molecular diagnosis is important to guide genetic counseling, to support prognostic outcomes and decisions with currently available and evolving treatment modalities.

How Having a Clear Why Can Help Us Cope With Almost Anything: Meaningful Well-Being and the COVID-19 Pandemic in México.

Background: Coronavirus disease 2019 (COVID-19) has resulted in an increase in known risk factors for mental health problems. Mexico adopted lockdown and physical distancing as a containment strategy with potential consequences on day to day life, such as social isolation, loss of income and loneliness that can have important consequences in terms of mental health. Objective: We aimed to examine the effect of the initial phases of the COVID-19 pandemic on psychological distress, well-being and perceived physical health among Mexican-base respondents and to examine whether coping strategies would play a potential intermediating role in relation to these variables. Under the Existential Positive Psychology perspective, an emphasis was made on meaning-centered coping. Methods: A cross-sectional study was conducted between April 30 and June 16th 2020 among 604 Mexicans-base respondents of which 471 were women and 132 men. Data was collected by using online questionnaires. Psychological distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). The Brief COPE Inventory was used to assess problem-focused and emotion-focused coping strategies. We also used the Meaning-Centered Coping Scale (MCCS). PERMA-Profiler was used to assess well-being, perceived physical health, and loneliness. Profiler and Descriptive analyses and bivariate linear regression were performed to examine the association of variables. Results: 45.9% of the participants reported moderate to extremely severe psychological distress. Our results demonstrate that problem-focused and emotion-focused coping were positively related to psychological distress, whereas meaning-centered coping was negatively associated with distress. Furthermore, psychological distress played a potential negative role in the perceived physical health, while meaning-centered coping and well-being buffered the negative influence of psychological distress on perceived physical health (completely standardized indirect effect = -0.01, SE: 0.012, 95% CI [-0.065; -0.017]. Conclusion: Meaning-centered coping was found to suppress the negative influence of psychological distress on sensation of decreased physical health corroborating the critical role of meaning in life in promoting well-being. Future studies can further examine the value of the critical role of meaning in life in promoting well-being as a protective factor against severe distress during traumatic events. Findings of this study can be used to orient policies and interventions aimed to alleviate suffering in the midst of the COVID-19 pandemic.

Lockdown measures and their impact on single- and two-age-structured epidemic model for the COVID-19 outbreak in Mexico.

The role of lockdown measures in mitigating COVID-19 in Mexico is investigated using a comprehensive nonlinear ODE model. The model includes both asymptomatic and presymptomatic populations with the latter leading to sickness (with recovery, hospitalization and death as possible outcomes). We consider situations involving the application of social-distancing and other intervention measures in the time series of interest. We find optimal parametric fits to the time series of deaths (only), as well as to the time series of deaths and cumulative infections. We discuss the merits and disadvantages of each approach, we interpret the parameters of the model and assess the realistic nature of the parameters resulting from the optimization procedure. Importantly, we explore a model involving two sub-populations (younger and older than a specific age), to more accurately reflect the observed impact as concerns symptoms and behavior in different age groups. For definiteness and to separate people that are (typically) in the active workforce, our partition of population is with respect to members younger vs. older than the age of 65. The basic reproduction number of the model is computed for both the single- and the two-population variant. Finally, we consider what would be the impact of partial lockdown (involving only the older population) and full lockdown (involving the entire population) on the number of deaths and cumulative infections.

Characterizing a two-pronged epidemic in Mexico of non-communicable diseases and SARS-Cov-2: factors associated with increased case-fatality rates.

BACKGROUND: People with a previous diagnosis of non-communicable diseases (NCDs) are more likely to develop serious forms of COVID-19 or die. Mexico is the country with the fourth highest fatality rate from SARS-Cov-2, with high mortality in younger adults. OBJECTIVES: To describe and characterize the association of NCDs with the case-fatality rate (CFR) adjusted by age and sex in Mexican adults with a positive diagnosis for SARS-Cov-2. METHODS: We studied Mexican adults aged ≥20 years who tested positive for SARS-Cov-2 during the period from 28 February to 31 July 2020. The CFR was calculated and associations with history of NCDs (number of diseases and combinations), severity indicators and type of institution that treated the patient were explored. The relative risk (RR) of death was estimated using Poisson models and CFR was adjusted using logistic models. RESULTS: We analysed 406 966 SARS-Cov-2-positive adults. The CFR was 11.2% (13.7% in men and 8.4% in women). The CFR was positively associated with age and number of NCDs (p trend <0.001). The number of NCDs increased the risk of death in younger adults when they presented three or more NCDs compared with those who did not have any NCDs [RR, 46.6; 95% confidence interval (CI), 28.2, 76.9 for women; RR, 16.5; 95% CI, 9.9, 27.3 for men]. Lastly, there was great heterogeneity in the CFR by institution, from 4.6% in private institutions to 18.9% in public institutions. CONCLUSION: In younger adults, higher CFRs were associated with the total number of NCDs and some combinations of type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease.

Usos clínicos de los probióticos: malabsorción de lactosa, cólico del lactante, enfermedad inflamatoria intestinal, enterocolitis necrotizante, Helycobacter pylori / Probiotics in lactose malabsortion, colic, inflammatory bowel disease, necrotizing enterocolitis, Helicobacter pylori

El potencial terapéutico de los probióticos, como agentes capaces de alterar la microbiota intestinal y ofrecer efectos benéficos a la salud, han llevado a su uso en patologías frecuentes en la edad pediátrica, sin embargo los resultados han sido heterogéneos. Se ha descrito una mayor eficacia en la prevención de manifestaciones clínicas de la intolerancia a la lactosa y del cólico del lactante, así como también en la enterocolitis necrotizante, además del mantenimiento de la fase de remisión en colitis ulcerativa. Su eficacia es menor, aunque es recomendable su uso, en el manejo del cólico del lactante. En la actualidad no se recomienda su uso para Enfermedad de Crohn ni tratamiento de la enterocolitis necrotizante. Aunque hay resultados satisfactorios, aún no existen recomendaciones firmes en infección por H. pylori. Todas las recomendaciones deben ser para cepas específicas de probióticos en cada enfermedad.

The therapeutic potential of probiotics, as agents capable of altering the intestinal microbiota and provide beneficial health effects have led to its use in common diseases in children, but the results have been mixed. It seems to be more effective in preventing clinical manifestations of lactose intolerance and prevention of colic and necrotizing enterocolitis, as well as maintenance of remission in ulcerative colitis. Although its effectiveness is lower, it is recommended the use in the management of colic. At present its use for treating Crohn's disease or necrotizing enterocolitis is not recommended. Although there are successful results, there are still no firm recommendations H. pylori infection. All recommendations must be for specific strains of probiotics in each disease.

[Preoperative evaluation and predictors of mortality in lung cancer resection]. / Evaluación preoperatoria y predictores de morbimortalidad en resección de cáncer de pulmón.

Surgical resection of lung cancer, the only available curative option today, is strongly associated with mortality. The goal during the perioperative period is to identify and evaluate appropriate candidates for lung resection in a more careful way and reduce the immediate perioperative risk and posterior disability. This is a narrative review of perioperative risk assessment in lung cancer resection. Instruments designed to facilitate decision-making have been implemented in recent years but with contradictory results. Cardiovascular risk assessment should be the first step before a potential lung resection, considering that most of these patients are old, smokers and have atherosclerosis. Respiratory mechanics determined by postoperative forced expiratory volume in the first second (FEV1), the evaluation of the alveolar-capillary membrane by diffusing capacity of carbon monoxide and cardiopulmonary function measuring the maximum O2 consumption, will give clues about the patient's respiratory and cardiac response to stress. With these assessments, the patient and its attending team can reach a treatment decision balancing the perioperative risk, the chances of survival and the pulmonary long-term disability.

Enfermedad de Caroli: Presentación de un caso / Caroli's Disease: Presentation of a case

La enfermedad de Caroli es una condición congénita poco frecuente, cuya incidencia se estima en 1 caso por millón. Se caracteriza por dilataciones saculares o fusiformes de las vías biliares. Entre las manifestaciones clínicas se encuentran dolor en hipocondrio derecho, fiebre e ictericia, estas crisis de colangitis secundarias a estasis biliar, y sepsis. Su diagnóstico se basa en el hallazgo de lesiones quísticas en árbol biliar, pueden observarse por ecografía, tomografía computarizada. Presentamos a paciente femenino de 37 años, acude a emergencia de Medicina Interna del Hospital Escuela, de la ciudad deTegucigalpa, Honduras, manifestando signos y síntomas de colangitis aguda e ictericia. Al examen físico presenta abdomen globoso y doloroso a expensas de una hepatomegalia marcada. Nuestra paciente presento episodios de colangitis recurrente. La tomografía computarizada revela múltiples espacios quísticos en ambos lóbulos hepáticos y se encontró lesiones quísticas en el árbol biliar. Excluyendo, colangitis esclerosante, quiste hidatídico, quiste del colédoco y dilatación ductal hereditaria, y confirmando la sospecha diagnostica de enfermedad de Caroli.

Caroli disease is a rare congenital condition, which incidence is estimated at 1 case per million. Characterized by saccular or fusiform dilation of the bile. Clinical manifestations include right upper quadrant pain, fever and jaundice, these crisis of cholangitis are secondary to biliary stasis, and sepsis. Diagnosis is based on the discovery of cystic lesions in biliary tree, it may be seen by ultrasound, computed tomography. We present a case of female patient with 37-year-old, who attends to the emergency service of internal medicine of the Hospital Escuela Universitario of the city ofTegucigalpa, Honduras, manifesting signs and symptoms of acute cholangitis and jaundice. Physical examination reveals globose and painful abdomen at the expense of a marked he-patomegaly. Our patient presented episodes of recurrent cholangitis, the computed tomography reveals multiple cystic spaces in both lobes and was found lesions in the biliary tree. Excluding, sclerosing cholangitis, hydatid cyst, bile duct and hereditary ductal dilatation, and confirmed the suspected diagnosis of Caroli's disease.

Alimentación del paciente con diarrea aguda

El manejo nutricional es un aspecto importante del tratamiento del niño con diarrea aguda. Se ha demostrado que: el ayuno, la desnutrición y la alteración de la microbiota intestinal, disminuyen: masa intestinal, actividad enzimática y tasa de recambio celular. Los objetivos fundamentales están dirigidos a evitar mayor deterioro de la salud y la evolución de la enfermedad hacia la cronicidad. Está demostrado lo beneficioso de continuar la alimentación durante el proceso diarreico, unida a la terapia de rehidratación oral, ya que disminuye el déficit de proteína y energía, evita el catabolismo, estimula la función intestinal y permite el mantenimiento de enzimas digestivas, ejerciendo efecto trófico sobre la mucosa del intestino delgado para reducir las pérdidas fecales y disminuir la hipotrofia funcional y anatómica asociada con el "reposo del intestino". La realimentación debe ser gradual, oportuna, precoz, completa y adecuada, a fin de ofrecer el aporte necesario de calorías, proteínas, lípidos y carbohidratos. El niño debe continuar con lactancia materna, en caso de recibir fórmula láctea, no se requiere su dilución ni el uso de fórmulas especiales. Se recomiendan: alimentos absorbentes o astringentes que contienen polisacáridos con propiedades coloidales como pectina y dextrina que disminuyen número de deposiciones y aumentan su consistencia; evitar consumo de alimentos ricos en fibra insoluble; consumir fuente proteica de alto valor biológico e hipoalergénica; administrar los vegetales y frutas en sopas espesas, puré, jugos o compotas naturales, y fortificarlos con harina de maíz o arroz sin agregado de azúcar.

Nutritional management is an important aspect of the treatment of children with acute diarrhea. It has been shown that fasting, malnutrition, and alteration of the intestinal microbiota, decrease: intestinal mass, enzyme activity and cell turnover rate. The fundamental objectives are directed to avoid further deterioration of the health and the progression of the disease towards chronicity. Benefits of continuation of feeding during diarrhoea, coupled with oral rehydration therapy has been demonstrated, since it decreases the deficit of protein and energy, prevents catabolism, stimulates intestinal function and allows the maintenance of digestive enzymes exerting trophic effect on the mucosa of the small intestine, which in turn reduces fecal losses, functional and anatomical hypotrophy associated with the "rest of the intestine". Refeeding should be gradual, timely, early, complete and adequate, in order to provide the necessary contribution of calories, proteins, lipids and carbohydrates. The child should continue breastfeeding. In case of receiving milk formula, this requires no dilution or special formulas. Recommended: absorbent or astringent foods that contain polysaccharide with colloidal properties such as pectin and dextrin which decrease number of bowel movements and increase its consistency; avoid consumption of foods high in insoluble fibre; protein source of high biological value and hypoallergenic type; preparation of vegetables and fruit as thick soups, puree, juice or natural jams, and fortify them with corn or rice flours without added sugar.

Nutrición en recién nacidos a término y en niños de 1 a 6 meses / Nutrition in newborn term and the infant up to 6 months of age

La adecuada nutrición durante la infancia y niñez temprana garantiza el completo desarrollo del potencial humano de todo niño en cualquier parte del mundo, así como la prevención de la aparición de enfermedades crónicas relacionadas con la nutrición en la edad adulta. Las prácticas de alimentación correctas son fundamentales para lograr una salud óptima. La alimentación con leche humana de forma exclusiva cubre todos los requerimientos nutricionales los primeros seis meses de vida para luego ser continuada conjuntamente con la alimentación complementaria hasta los dos años. Las fórmulas artificiales se administran cuando la alimentación con leche humana no es posible ya sea por causas médicas inherentes a la madre o al niño. La alimentación con leche humana ejerce un efecto protector para la prevención de deficiencias de micronutrientes principalmente de hierro y vitamina A en los primeros seis meses de vida. La suplementación de la madre embarazada y durante la lactancia en riesgo de deficiencia es importante para el estado nutricional del niño en estas edades.

Nutrition in newborn term and the infant up to 6 months of age Adequate nutrition during infancy and early childhood ensures the full development of the human potential of every child in any part of the world, as well as the prevention of chronic diseases related to nutrition in adulthood. They are fundamental power of good practices to achieve optimal health. The human feeding exclusively covers all nutritional requirements during the first six months of life and to be then continued together with the complementary feeding up to two years. Artificial formulas are used when human milk feeding is not possible either by medical causes inherent to the mother or the child. Human milk feeding exerts protective effect for the prevention of micronutrient deficiencies mainly of iron and vitamin A to the first six months of life. The pregnant mother and supplementation during lactation at risk of deficiency is important to the nutritional status of the child at this age.

Abscesos hepáticos en pacientes pediátricos: estudio multicéntrico / Liver abscesses in pediatric patients: multicenter study

El absceso hepático (AH) sigue siendo causa de alta mortalidad y morbilidad en el mundo relacionadas con las condiciones sociodemográficas de los países en desarrollo. Analizar las características epidemiológicas, clínicas, diagnósticas y terapéuticas de los AH en pacientes pediátricos en nueve centros asistenciales del país. Estudio descriptivo, retrospectivo, donde se revisaron las historias clínicas en pacientes menores de 17 años de edad con diagnóstico de AH ingresados entre Enero-1998 a Mayo-2011. Se incluyeron 161 pacientes: predominaron los masculinos 59,01% (95/161), preescolares 42,24% (68/161), procedencia tipo urbana: 68,33% (110/161). Tiempo promedio de enfermedad prehospitalaria: 10 días y de hospitalización: 22 días. Los principales hallazgos fueron: fiebre: 96,27% (155/161), dolor abdominal 88,19% (142/161), leucocitosis: 91,30% (147/161) con neutrofilia 86,34% (139/161), comorbilidades por migración errática por Ascaris lumbricoides 19,88% (32/161), desnutrición 15,13% (23/152), AH único: 77,64% (125/161), lóbulo derecho: 82,61% (133/161), tipo piógeno 62,9% (56/89). El 96,89% recibieron Metronidazol (156/161) asociado en su mayoría con cefalosporina de tercera generación más aminoglicósido 24,22% (39/161). Se les realizó drenaje del AH 28,57% (46/161). La Mortalidad fue: 1,86%. Los hallazgos clínicos-epidemiológicos y estudios imagenológicos permiten establecer el diagnóstico preciso e instaurar la antibioticoterapia ideal, reduciendo significativamente su morbilidad y mortalidad

Liver abscess (AH) remains a leading cause of mortality and morbidity in the world related to the sociodemographic conditions of developing countries. To analyze the epidemiological, clinical, diagnostic and treatment of AH in pediatric patients in nine centers throughout the country. A descriptive, retrospective, which reviewed the medical records for patients under 17 years of age diagnosed with AH admitted between January 1998 to May-2011. Results: We included 161 patients: male predominance of 59.01% (95/161), preschool 42.24% (68/161), urban-type origin: 68.33% (110/161). Average time of prehospital illness: 10 days, and hospitalization: 22 days. The main findings were: fever: 96.27% (155/161), abdominal pain 88.19% (142/161), leukocytosis: 91.30% (147/161) with neutrophilia 86.34% (139/161), comorbidities by erratic migration Ascaris lumbricoides 19.88% (32/161), malnutrition 15.13% (23/152), AH only: 77.64% (125/161), right lobe: 82.61% (133/161), pyogenic type 62.9% (56/89). The 96.89% received metronidazole (156/161) associated mostly with third-generation cephalosporin, aminoglycoside 24.22% (39/161). Underwent drainage of AH 28.57% (46/161). Mortality was: 1.86%. The clinical-epidemiological and imaging studies allow us to establish accurate diagnosis and institute the perfect antibiotic, significantly reducing morbidity and mortality

Evaluación del estado nutricional en pacientes pediátricos institucionalizados con VIH/SIDA / Assessment of nutritional status in institutionalized pediatric patients with HIV/AIDS

Introducción. La inmunosupresión progresiva y profunda generada por el VIH/SIDA hace que el organismo sea más vulnerable a las infecciones oportunistas, así como también a los episodios clínicos y complicaciones asociadas, que con frecuencia tienen un enorme efecto en el estado nutricional del individuo. Nuestro objetivo fue determinar el estado nutricional de los pacientes pediátricos con VIH/SIDA. Metodología. El estudio fue descriptivo y transversal, donde participaron 60 pacientes con edades comprendidas entre 1-13 años, de ambos sexos, atendidos por la Fundación Innocens de Maracaibo. Se realizó una evaluación nutricional con la toma de medidas antropométricas, y se registraron los valores de hematología, bioquímica sanguínea y evaluación dietética. Resultados. El análisis nutricional antropométrico según el IMC arrojó que el 60% de los niños tiene un diagnóstico normal, con mayor prevalencia en los varones. Los niveles plasmáticos de triacilglicéridos (134,43 ± 66,04mg/dl) fueron más altos que los valores deseables para los grupos etarios, mientras que los valores de HDL-c (34,12 ± 12,22 mg/dl) fueron más bajos. Así mismo los valores de hemoglobina fueron bajos en todos los grupos de edades (11,25 ± 1,26, g/dL). El estudio dietético evidenció una baja adecuación de calorías y de nutrientes para todos los grupos etarios. Conclusión. Un importante número de los pacientes pediátricos con SIDA atendidos por la Fundación Innocens tienen un deterioro del estado nutricional, lo que amerita la implementación de un programa de atención nutricional integral, a fin de contribuir con el mejoramiento de la calidad de vida de estos pacientes.

Introduction: Progressive and profound immunosuppression caused by HIV/AIDS makes the body more vulnerable to opportunistic infections as well as the associated clinical events and complications that often have a huge effect on the nutritional status of the individual. Our objective was to determine the nutritional status of pediatric patients with HIV/AIDS. Methodology: We conducted a descriptive cross-sectional study that included 60 patients aged 1-13 of both sexes who received care from the Fundación Innocens in Maracaibo, Venezuela. Nutritional assessment was done by anthropometric measurement while hematology, blood biochemistry, and dietary assessment data were also recorded. Results:Anthropometric nutritional analysis by BMI diagnosed 60% of children as normal, with higher prevalence in males. Plasma levels of triglycerides (134.43 ± 66.04 mg/dl) were higher than values desirable for the relevant age groups while HDL-C levels (34.12 ± 12.22 mg/dl) were lower. Hemoglobin levels were also low in all age groups (11.25 ± 1.26 g/dL). The dietary study showed a low dietary adequacy of calories and nutrients for all age groups. Conclusion: A significant number of pediatric AIDS patients cared for by the Fundación Innocens show impaired nutritional status that warrants the implementation of a comprehensive nutritional care program to help improve the quality of life of these patients.

Depressive symptoms among poor older adults in Mexico: prevalence and associated factors.

OBJECTIVE: To describe the presence of depressive symptoms (DS) and factors associated with them among poor Mexican older male and female adults (OA). METHODS: A survey was conducted among OA enrolled in a governmental poverty relief program (Oportunidades) in Mexico. Participants completed a short version of the Center for Epidemiologic Studies Depression Scale and answered questions about health and life conditions. RESULTS: The prevalence of DS over the cutoff point was 43% (confidence interval (CI) 39.5-46.4). DS were associated with different variables among male and female participants. For men, difficulties in performing daily life activities were associated with DS over the cutoff point (odds ratio (OR) 2.62, CI 1.58-4.34) and literacy was associated with less DS (OR 0.46, CI 0.31-0.68). For women, difficulties with daily life activities were associated with more DS (OR 2.50, CI 1.57-3.97), and being head of the family was also positively associated (OR 1.81, CI 1.11-2.93). CONCLUSIONS: DS were frequent among this sample of poor OA. The differences between men and women in variables associated with DS highlight the importance of considering the gendered aspects of growing old.