Identificação de polímeros de microplásticos encontrados no trato digestivo de peixes do Lago de Amatitlán, Guatemala / Identification of microplastic polymers found in the digestive tract of fish from Lake Amatitlán, Guatemala

O objetivo desta pesquisa foi a identificação, por meio de espectroscopia no infravermelho com transformada de Fourier combinada com reflectância total atenuada (FTIR-ATR), de microplásticos extraídos do trato gastrointestinal de peixes coletados no Lago de Amatitlán, para determinar os principais polímeros e a possível origem da contaminação por esses materiais. Foram analisados 68 microplásticos, correspondendo a 10% do total de microplásticos extraídos. Estes originaram-se de 36 espécimes, sendo 35 da espécie Oreochromis niloticus e um de Parachromis managuensis, dos quais foram analisados de 1 a 5 microplásticos por espécime. Os polímeros identificados foram polipropileno (PP), nylon, polietileno de alta densidade (HDPE), tereftalato de polietileno (PET), látex, poliestireno (PE), polietileno de baixa densidade (LDPE) e poliuretano (PU). O polipropileno (32), o polietileno de alta densidade (13) e o nylon (10) foram os polímeros mais frequentes. Os possíveis itens plásticos que podem ter originado os microplásticos incluem brinquedos, equipamentos de laboratório, baldes, embalagens de alimentos, tubulações, isolamento para cabos, têxteis, cordas e móveis que são produzidos na indústria do plástico, localizada principalmente na vertente sul da cidade da Guatemala. Além disso, as espécies de peixes do presente estudo sustentam pescarias importantes, o que levanta problemas de saúde humana, uma vez que a ingestão de peixes que consomem plásticos tem o potencial de aumentar a carga corporal de substâncias químicas perigosas, pois estas aderem superficialmente aos plásticos no ambiente e são posteriormente bioacumuladas.

The objective of this research was the identification, through Fourier transform infrared spectroscopy combined with attenuated total reflectance (FTIR-ATR), of microplastics extracted from the gastrointestinal tract of fish collected in Lake Amatitlán, to determine the main polymers and the possible origin of contamination by these materials. 68 microplastics were analyzed, corresponding to 10% of the total microplastics extracted. These originated from 36 specimens, 35 of the species Oreochromis niloticus and one of Parachromis managuensis, of which 1 to 5 microplastics per specimen were analyzed. The polymers identified were polypropylene (PP), nylon, high-density polyethylene (HDPE), polyethylene terephthalate (PET), latex, polystyrene (PE), low-density polyethylene (LDPE) and polyurethane (PU). Polypropylene (32), high-density polyethylene (13) and nylon (10) were the most frequent polymers. Possible plastic items that may have caused microplastics include toys, laboratory equipment, buckets, food packaging, pipes, insulation for cables, textiles, ropes and furniture that are produced in the plastics industry, located mainly on the south side of Guatemala City. Furthermore, the fish species in the present study support important fisheries, which raises human health concerns, since the ingestion of fish that consume plastics has the potential to increase the body load of dangerous chemicals, as they adhere superficially to the plastics in the environment and are subsequently bioaccumulated.

Dietoterapia en artritis reumatoide: Revisión de la evidencia

La artritis reumatoide (RA), es una enfermedad crónica reumática, caracterizada por un daño articular progresivo y manifestaciones extraarticulares, que pueden desencadenar una discapacidad. La etiología de las patologías autoinmunes, incluyendo la RA, es compleja, abarcando factores de tipo genético, hormonal, dietarios y ambientales. Sin embargo, los mecanismos fisiológicos por los que estos agentes contribuyen a la patogenia aún no están definidos completamente. Estudios sugieren un impacto de la disbiosis del microbioma intestinal en la patogénesis de la artritis reumatoide sugiriendo también la alteración de la permeabilidad intestinal como una posible causa. Esta se puede relacionar con patrones dietarios influyentes en la prevención de esta patología así como una propuesta de tratamiento complementario al manejo farmacológico tradicional, considerando el riesgo aumentado de estos pacientes de desarrollar síndrome metabólico y "caquexia reumatoide", una acumulación de tejido adiposo acompañado de una disminución de tejido muscular debido a los cambios catabólicos debido a la inflamación crónica e inactividad física a consecuencia de las dificultades motoras. Ante evidencia reciente que propone patrones de alimentación e intervenciones dietarias como tratamiento complementario a la terapia farmacológica en el manejo de la RA, la siguiente revisión narrativa cualitativa se propone revisar la efectividad de intervenciones propuestas en términos de dolor y actividad de enfermedad, encontrando dentro de la amplia heterogeneidad de intervenciones propuestas, aquellos patrones dietéticos con efecto modulador de la microbiota intestinal como la dieta mediterránea y sus variaciones en contexto de la promoción de un estilo de vida serían positivas como terapia complementaria a esta patología.

Rheumatoid arthritis (RA) is a chronic rheumatic disease characterised by progressive joint damage and extra-articular manifestations that can lead to disability. The aetiology of autoimmune diseases, including RA, is complex, involving genetic, hormonal, dietary, and environmental factors. However, the physiological mechanisms by which these agents contribute to pathogenesis have not yet been fully defined. More recent studies suggest an impact of gut microbiome dysbiosis on the pathogenesis of autoimmune diseases in both animal and human models, including rheumatoid arthritis, also suggesting altered intestinal permeability as a possible cause. This modification of the gut microbiome may be related to influential diet patterns in the prevention of this pathology, as well as a proposed complementary treatment to traditional pharmacological treatment, also considering the increased risk for these patients of developing metabolic syndrome and "rheumatoid cachexia", an accumulation of adipose tissue accompanied by a decrease in muscle tissue due to catabolic changes due to chronic inflammation and physical inactivity as a consequence of motor difficulties in RA. With the emergence of recent evidence proposing dietary interventions and eating patterns as adjunctive treatment to drug therapy in the management of RA, the following narrative qualitative review proposes reviewing recent evidence on the effectiveness of various proposed dietary interventions in the treatment of rheumatoid arthritis in terms of pain and disease activity, finding between a high heterogeneity of proposed interventions, those dietary patterns with modulating effect on the gut microbiome as Mediterranean diet and its variations in the context of promoting a healthy lifestyle would be positive as a complementary therapy for this disease.

Description of the first global outbreak of mpox: an analysis of global surveillance data.

BACKGROUND: In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS: In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS: Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4%] of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9%] of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7%] of 21 749). 3927 (7·3%) of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95% CI 1·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], p<0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], p<0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION: Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING: WHO Contingency Fund for Emergencies. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

Open-label phase I/II clinical trial of SARS-CoV-2 receptor binding domain-tetanus toxoid conjugate vaccine (FINLAY-FR-2) in combination with receptor binding domain-protein vaccine (FINLAY-FR-1A) in children.

OBJECTIVES: To evaluate a heterologous vaccination scheme in children 3-18 years old (y/o) combining two SARS-CoV-2r- receptor binding domain (RBD)protein vaccines. METHODS: A phase I/II open-label, adaptive, and multicenter trial evaluated the safety and immunogenicity of two doses of FINLAY-FR-2 (subsequently called SOBERANA 02) and the third heterologous dose of FINLAY-FR-1A (subsequently called SOBERANA Plus) in 350 children 3-18 y/o in Havana Cuba. Primary outcomes were safety (phase I) and safety/immunogenicity (phase II) measured by anti-RBD immunoglobulin (Ig)G enzyme-linked immunoassay (ELISA), molecular and live-virus neutralization titers, and specific T-cells response. A comparison with adult immunogenicity and predictions of efficacy were made based on immunological results. RESULTS: Local pain was the unique adverse event with frequency >10%, and none was serious neither severe. Two doses of FINLAY-FR-2 elicited a humoral immune response similar to natural infection; the third dose with FINLAY-FR-1A increased the response in all children, similar to that achieved in vaccinated young adults. The geometric mean (GMT) neutralizing titer was 173.8 (95% confidence interval [CI] 131.7; 229.5) vs Alpha, 142 (95% CI 101.3; 198.9) vs Delta, 24.8 (95% CI 16.8; 36.6) vs Beta and 99.2 (95% CI 67.8; 145.4) vs Omicron. CONCLUSION: The heterologous scheme was safe and immunogenic in children 3-18 y/o. TRIAL REGISTRY: https://rpcec.sld.cu/trials/RPCEC00000374.

La pediatría social. Herramienta necesaria para combatir la pandemia de COVID-19 en Cuba / Social Pediatrics: A Necessary Tool to Combat the COVID-19 Pandemic in Cuba

Introducción: La pediatría social se orienta hacia la atención integral del niño. Estudia las causas sociales que alteran su salud y también los problemas de esta índole que repercuten en su entorno social. En el contexto de la actual pandemia, caracterizada por alta morbilidad y mortalidad, se produjeron significativas consecuencias psicosociales. Objetivo: Describir el impacto de la pediatría social sobre la salud infanto-juvenil durante la pandemia de COVID-19. Métodos: Se realizó una revisión en las bases de datos bibliográficas PubMed y BVS. Se empleó el Google Académico como motor de búsqueda. Se utilizaron, en español y en inglés, los siguientes descriptores: pediatría social, pandemia COVID-19, aislamiento social, bienestar psicológico, salud mental y población pediátrica. Análisis y síntesis de la información: Se expusieron argumentos desde la mirada psicosocial del pediatra, relacionados con el desarrollo y el bienestar socioemocional de los niños, y la repercusión sobre ellos del aislamiento social; además, se describió el impacto de la pandemia en la infancia, y el papel desempeñado por el especialista y otros profesionales vinculados con la atención pediátrica. Conclusiones: La pandemia se caracterizó por afectar todas las esferas de la vida del niño. La pediatría social resultó indispensable en el enfrentamiento de las consecuencias médico-biológicas, psicológicas y sociales que ocasionó el azote de la COVID-19, por lo que su rol influyó en el restablecimiento del equilibrio biopsicosocial de la población infantil(AU)

Introduction: Social pediatrics is oriented towards the comprehensive care of children. It studies the social causes that alter their health, and also the problems of this nature that affect their social environment. In the context of the current pandemic, characterized by high morbidity and mortality, there were significant psychosocial consequences. Objective: To describe the impact of social pediatrics on children and adolescents health during the COVID-19 pandemic. Methods: A review was conducted in the bibliographic databases PubMed and VHL. Google Scholar was used as a search engine. The following descriptors were used in Spanish and English: social pediatrics, COVID-19 pandemic, social isolation, psychological well-being, mental health and pediatric population. Analysis and synthesis of information: Arguments were presented from the psychosocial perspective of the pediatrician, related to the development and socio-emotional well-being of children, and the impact on them of social isolation. In addition, the impact of the pandemic on children was described, and the role played by the specialists and other professionals linked to pediatric care. Conclusions: The pandemic was characterized by affecting all spheres of the child's life. Social pediatrics was indispensable in confronting the medical-biological, psychological and social consequences caused by the scourge of COVID-19, so its role influenced the restoration of the biopsychosocial balance of the children population(AU)

Biomarcadores en la sepsis y su valor predictivo en pacientes pediátricos

RESUMEN Introducción: La sepsis en niños, es causa de gran preocupación entre los pediatras. La incorporación de nuevos biomarcadores posibilita la obtención de un diagnóstico rápido y preciso. Objetivo: Determinar la capacidad predictiva de mortalidad de un grupo de biomarcadores en pacientes pediátricos con sepsis. Métodos: Estudio multicéntrico descriptivo analítico, prospectivo y longitudinal en 60 pacientes ingresados en dos Unidades de cuidados intensivos: Hospital Dediátrico docente "Borrás-Marfán" y Hospital Pediátrico Universitario "William Soler" entre diciembre de 2016 y diciembre de 2018, con diagnóstico de sepsis severa y shock séptico. Se caracterizó la muestra según variables demográficas, origen y estadios de la sepsis y mortalidad; además se determinaron los biomarcadores más sensibles para el diagnóstico inicial y de mejor valor predictivo. Se empleó la estadística descriptiva y se realizaron pruebas diagnósticas con más de dos resultados (curva ROC). Resultados: Se observó una distribución similar de la muestra en cuanto sexo, con una media edad promedio de 5 años; dos tercios se diagnosticaron como sepsis graves y 23,3 % falleció El lactato fue el marcador con mayor sensibilidad. Conclusiones: Los biomarcadores más sensibles para el diagnóstico inicial de la sepsis fueron: lactato, proteína C reactiva y velocidad de sedimentación globular; los dos primeros junto a los leucocitos, neutrófilos y plaquetas, también resultaron buenos predictores de mortalidad. La velocidad de sedimentación globular fue el biomarcador predictor de mortalidad menos significativo.

ABSTRACT Introduction: Sepsis in children is a cause of great concern among pediatricians. New biomarkers makes it possible to obtain quick and accurate diagnosis. Objective: To determine the predictive capacity of mortality of a group of biomarkers in pediatric patients with sepsis. Methods: An analytical, prospective and longitudinal descriptive multicenter study was carried out in 60 patients admitted to two intensive care units at Borrás-Marfán Teaching Pediatric Hospital and William Soler University Pediatric Hospital from December 2016 to December 2018. These patients had a diagnosis of sepsis severe and septic shock. The sample was characterized according to demographic variables, origin and stages of sepsis and mortality. In addition, the most sensitive biomarkers for the initial diagnosis and the best predictive value were determined. Descriptive statistics were used and diagnostic tests were performed with more than two results (ROC curve). Results: A similar distribution of the sample was observed in terms of sex, with average age of 5 years; two thirds were diagnosed as severe sepsis and 23.3% died. Lactate was the marker with the highest sensitivity. Conclusions: The most sensitive biomarkers for the initial diagnosis of sepsis were lactate, C-reactive protein and erythrocyte sedimentation rate; the first two, together with leukocytes, neutrophils, and platelets, were also good predictors of mortality. Erythrocyte sedimentation rate was the least significant predictor of mortality biomarker.

The Efficiency of Different Priming Agents for Improving Germination and Early Seedling Growth of Local Tunisian Barley under Salinity Stress.

The current work aimed to investigate the effect of seed priming with different agents (CaCl2, KCl, and KNO3) on germination and seedling establishment in seeds of the barley species of both Hordeum vulgare (L. Manel) and Hordeum maritimum germinated with three salt concentrations (0, 100, and 200 mM NaCl). The results showed that under unprimed conditions, salt stress significantly reduced the final germination rate, the mean daily germination, and the seedling length and dry weight. It led to a decrease in the essential nutrient content (iron, calcium, magnesium, and potassium) against an increase in sodium level in both of the barley species. Moreover, this environmental constraint provoked a membrane injury caused by a considerable increase in electrolyte leakage and the malondialdehyde content (MDA). Data analysis proved that seed priming with CaCl2, KCl, and KNO3 was an effective method for alleviating barley seed germination caused by salt stress to varying degrees. Different priming treatments clearly stimulated germination parameters and the essential nutrient concentration, in addition to increasing the seedling growth rate. The application of seed priming reduced the accumulation of sodium ions and mitigated the oxidative stress of seeds caused by salt. This mitigation was traduced by the maintenance of low levels of MDA and electrolyte leakage. We conclude that the priming agents can be classed into three ranges based on their efficacy on the different parameters analyzed; CaCl2 was placed in the first range, followed closely by KNO3, while the least effective was KCl, which placed in the third range.

Microencapsulation Improved Fumaric Acid and Thymol Effects on Broiler Chickens Challenged With a Short-Term Fasting Period.

The first objective of this study was to demonstrate the usefulness of the microencapsulation technique to protect fumaric acid and thymol, avoiding their early absorption and ensuring their slow release throughout the gastrointestinal tract (GIT). For this purpose, the release of a lipid matrix microencapsulated brilliant blue (BB) was assessed in vitro, using a simulated broiler intestinal fluid, and in vivo. In vitro results showed that more than 60% of BB color reached the lower intestine, including 26.6 and 29.7% in the jejunum and ileum, respectively. The second objective was to determine the effects of microencapsulated fumaric acid, thymol, and their mixture on the performance and gut health of broilers challenged with a short-term fasting period (FP). One-day-old male ROSS 308 chickens (n = 280) were randomly distributed into seven treatments, with 10 replicates of four birds each. Dietary treatments consisted of a basal diet as negative control (NC), which was then supplemented by either non-microencapsulated fumaric acid (0.9 g/kg), thymol (0.6 g/kg), or a mixture of them. The same additive doses were also administered in a microencapsulated form (1.5 and 3 g/kg for the fumaric acid and thymol, respectively). At day 21, chickens were subjected to a 16.5-h short-term FP to induce an increase in intestinal permeability. Growth performance was assessed weekly. At day 35, ileal tissue and cecal content were collected from one bird per replicate to analyze intestinal histomorphology and microbiota, respectively. No treatment effect was observed on growth performance from day 1 to 21 (p > 0.05). Microencapsulated fumaric acid, thymol, or their mixture improved the overall FCR (feed conversion ratio) and increased ileal villi height-to-crypt depth ratio (VH:CD) (p < 0.001) on day 35 of the experiment. The microencapsulated mixture of fumaric acid and thymol increased cecal abundance of Bacteroidetes, Bacillaceae, and Rikenellaceae, while decreasing that of Pseudomonadaceae. These results indicate that the microencapsulation technique used in the current study can be useful to protect fumaric acid and thymol, avoiding early absorption, ensure their slow release throughout the GIT, and improve their effects on fasted broiler chickens.

Medicina convencional frente a medicina tradicional: preferencias de uso en una comunidad rural del Ecuador / Conventional medicine versus traditional medicine: preferences for use in a rural community in Ecuador

Objetivo: Analizar las preferencias del tratamiento convencional, frente al tratamiento con plantas medicinales en una comunidad rural del Ecuador. Métodos: Se realizó una investigación cuantitativa, no experimental, descriptiva, transversal. Se aplicó un cuestionario de 22 preguntas a 49 informantes, uno por cada hogar de la comunidad. Se cumplieron todas las consideraciones éticas en la obtención y manejo de la información. Resultados: Estas personas tienen una concepción de causalidad para diferenciar las enfermedades físicas de otras de origen sobrenatural, cuya curación corresponde exclusivamente a la medicina tradicional. Reconocen la efectividad de la medicina convencional para tratar problemas agudos de tipo somático y traumático, así como también, para curar y prevenir complicaciones de enfermedades crónicas. Sin embargo, en dolores viscerales la población prefiere el tratamiento con plantas medicinales, por su mayor accesibilidad y rapidez de acción. Conclusiones: La medicina convencional es elegida en la mayoría de los problemas físicos de salud, no obstante, se valora a la medicina tradicional para tratar problemas de origen sobrenatural y se promueve el respeto por las cosmovisiones del proceso salud enfermedad.

Overexpression of the vascular brassinosteroid receptor BRL3 confers drought resistance without penalizing plant growth.

Drought represents a major threat to food security. Mechanistic data describing plant responses to drought have been studied extensively and genes conferring drought resistance have been introduced into crop plants. However, plants with enhanced drought resistance usually display lower growth, highlighting the need for strategies to uncouple drought resistance from growth. Here, we show that overexpression of BRL3, a vascular-enriched member of the brassinosteroid receptor family, can confer drought stress tolerance in Arabidopsis. Whereas loss-of-function mutations in the ubiquitously expressed BRI1 receptor leads to drought resistance at the expense of growth, overexpression of BRL3 receptor confers drought tolerance without penalizing overall growth. Systematic analyses reveal that upon drought stress, increased BRL3 triggers the accumulation of osmoprotectant metabolites including proline and sugars. Transcriptomic analysis suggests that this results from differential expression of genes in the vascular tissues. Altogether, this data suggests that manipulating BRL3 expression could be used to engineer drought tolerant crops.

Hepatocyte-secreted extracellular vesicles modify blood metabolome and endothelial function by an arginase-dependent mechanism.

Hepatocytes release extracellular vesicles (EVs) loaded with signaling molecules and enzymes into the bloodstream. Although the importance of EVs in the intercellular communication is already recognized, the metabolic impact of the enzymes carried by these vesicles is still unclear. We evaluated the global effect of the enzymatic activities of EVs by performing untargeted metabolomic profiling of serum samples after their exposure to EVs. This approach revealed a significant change in the abundance of 94 serum metabolic signals. Our study shows that these vesicles modify the concentration of metabolites of different chemical nature including metabolites related to arginine metabolism, which regulates vascular function. To assess the functional relevance of this finding, we examined the levels of arginase-1 protein and its activity in the hepatic EVs carrying the exosomal markers CD81 and CD63. Remarkably, the arginase activity was also detected in EVs isolated from the serum in vivo, and this vesicular activity significantly increased under liver-damaging conditions. Finally, we demonstrated that EVs secreted by hepatocytes inhibited the acetylcholine-induced relaxation in isolated pulmonary arteries, via an arginase-dependent mechanism. In summary, our study demonstrates that the hepatocyte-released EVs are metabolically active, affecting a number of serum metabolites involved in oxidative stress metabolism and the endothelial function.

Metabolic Features Across the Female Life Span in Women with PCOS.

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine metabolic disorder and is presently considered a family pathology. It is associated with obesity, insulin resistance and metabolic syndrome. Racial, ethnic and environmental factors may be important in determining the clinical manifestations of this syndrome. Polycystic ovary syndrome is an exclusion diagnosis and, therefore, should be distinguished from the physiological changes typical for the age and from other hyperandrogenic disorders. Early diagnosis is important since this syndrome is associated with reproductive, oncologic and metabolic risks. Interestingly, the clinical features of this disorder may change throughout the lifespan of a PCOS woman, starting from adolescence to postmenopausal age. During the first decades of life the main features are in the reproductive area, while later in life metabolic abnormalities are more evident. While the assessment of insulin resistance is not part of the diagnosis of PCOS, it has been demonstrated that this metabolic component appears early in life and persists over time. Moreover during puberty and pregnancy, insulin resistance is exacerbated. Pregnancy represents an important stage, as the offspring of these patients may be reprogrammed and inherit some of the metabolic and reproductive features of their mothers. In the present review, we will focus on several metabolic aspects of the PCOS condition at different stages of life in a Chilean population.

El ácido láctico y la escala SEGRAV-23 como valores pronósticos de gravedad en niños críticos / Lactic acid and SEGRAV-23 scale as predictive values of severity in critically-ill children

INTRODUCCIÓN: los sistemas de valoración de la gravedad son medios para cuantificar objetivamente la situación clínica del paciente, determinar el pronóstico y evaluar la eficacia y eficiencia del tratamiento. El lactato es un biomarcador que ha demostrado su magnífica capacidad predictiva de mortalidad, lo que hace que se mantenga dentro de las recomendaciones de expertos y en todas las guías relevantes. OBJETIVO: determinar el pronóstico de gravedad del ácido láctico y del índice Sistema para evaluar la gravedad de las enfermedades (SEGRAV-23), en niños ingresados en la Unidad de Cuidados Intensivos Pediátricos en el periodo febrero de 2011 a febrero de 2013. MÉTODOS: se realizó un estudio observacional, analítico, longitudinal y prospectivo en el cual se estudiaron 208 pacientes ingresados en las unidades de cuidados intensivos pediátricos de los hospitales "Dr. Luis Díaz Soto" y "Juan Manuel Márquez", en el periodo de febrero de 2011 a febrero de 2013. Para determinar el grado de dependencia entre vivos y fallecidos en el índice SEGRAV-23 y los valores del lactato, se utilizó el chi cuadrado de Pearson con una p menor de 0,05 para garantizar una confiabilidad de un 95 %. RESULTADOS: con respecto al SEGRAV-23 y los valores de lactato se observó que el 32,3 % de los pacientes con lactato entre 5-7 mmol/L se mantuvo con el reporte de muy graves, y el 14,7 % críticos. El 43,7 % de los fallecidos presentaron SEGRAV-23 mayor de 21 puntos. El 35,3 % de los pacientes que presentaron cifras de lactato al ingreso entre 5-7 mmol/L fallecieron. A los 10 días de estadía se evidenció que el 72,7 % de los pacientes que presentaron cifras de lactato entre 5-7 mmol/L fallecieron, al igual que el 80 % de los que tuvieron una hiperlactoacidemia mayor de 7 mmol/L. CONCLUSIONES: el ácido láctico y la escala SEGRAV-23 tienen una aceptable capacidad pronóstica y son buenos indicadores de gravedad del paciente crítico.

INTRODUCTION: the severity scoring systems are means to objectively quantify the patient's clinical situation, to determine the prognosis and to evaluate the efficacy and efficiency of the treatment. Lactate is a biomarker that has demonstrated its great predictive capacity for mortality, which keeps it included in the experts' recommendation and in all relevant guidelines. OBJECTIVE: to determine the severity prognosis of the lactic acid and of the index System for Evaluating the Severity of Diseases (SEGRAV-23) in children admitted to the pediatric intensive care unit in the period of February 2011 to February 2013. METHODS: prospective, longitudinal, analytical and observational study of 208 patients admitted to the pediatric intensive care units in "Dr Luis Diaz Soto" and "Juan Manuel Márquez" hospitals, conducted from February 2011 to February 2013. For the purpose of determining the level of dependence between the living and dead people in the SEGRAV-23 index and the lactate values, Pearson's chi square with p< 0.05 was used to assure 95 % reliability. RESULTS: regarding SEGRAV-23 and the lactate values, it was observed that 32.3 % of patients with 5-7 mmol/L lactate continued to be reported as severely-ill and 14.7 % as critical patients. In the group of dead people, 43.7 % had a SEGRAV-23 index higher than 21 scores whereas 35.3 % of patients with lactate values of 5 to 7 mmol/L on admission died. After ten days of hospitalization, it was evinced that 72.7 % of patients who had 5-7 mmol/L lactate values died as it happened with 80 % of those with over 7 mmol/L hyperlactoacidemia. CONCLUSIONS: lactic acid and the SEGRAV-23 scale have acceptable prognostic capacity and are good severity indicators in critically-ill patients.

Casein glycomacropeptide in the diet may reduce Escherichia coli attachment to the intestinal mucosa and increase the intestinal lactobacilli of early weaned piglets after an enterotoxigenic E. coli K88 challenge.

Casein glycomacropeptide (CGMP), a glycoprotein originating during cheese manufacture, has shown promising effects by promoting the growth of some beneficial bacteria in vitro, although its activity has not been well explored. The present study was designed to evaluate the effects of CGMP against enterotoxigenic Escherichia coli (ETEC) K88 in vitro (Trial 1) and in vivo (Trial 2). In Trial 1, increasing concentrations of CGMP (0, 0.5, 1.5 or 2.5 mg/ml) were tested regarding its ability to block the attachment of ETEC K88 to ileal mucosa tissues obtained from piglets. Increasing the concentration of CGMP resulted in a gradual decrease in ETEC K88 attachment to the epithelial surface. In Trial 2, seventy-two piglets were distributed in a 2 × 2 factorial combination including or omitting CGMP in the diet (control diet v. CGMP) and challenged or not with ETEC K88 (yes v. no). Inclusion of CGMP increased crude protein, ammonia and isoacid concentrations in colon digesta. CGMP also increased lactobacilli numbers in ileum and colon digesta, and reduced enterobacteria counts in mucosa scrapings and the percentage of villi with E. coli adherence measured by fluorescence in situ hybridisation. The inclusion of CGMP in the diets of challenged animals also prevented the increase of enterobacteria in ileal digesta. We can conclude that CGMP may improve gut health by diminishing the adhesion of ETEC K88 to the intestinal mucosa, by increasing the lactobacilli population in the intestine and by reducing the overgrowth of enterobacteria in the digestive tract of piglets after an ETEC K88 challenge.

Meniscal repair using the inside-out technique with cross stitch.

The treatment of meniscal tears continues to evolve. A few years ago most tears were treated with total meniscectomy, which evolved to partial meniscectomy and then to meniscal repair. The purpose is to preserve as much of the menisci as possible, to maintain their potential biomechanical properties, and to preserve normal knee function. Different repair techniques have been used many of them involving both vertical and horizontal sutures. We are proposing an inside-out meniscal repair technique with cross-shaped stitches that provides a 4-point fixation construct.

[Dietary fats and cardiovascular health]. / Grasas de la dieta y salud cardiovascular.

Although dietary fat and its role in cardiovascular prevention has been one of the most extensively studied nutritional topics, it continues to be an ever-expanding research area. Particularly thanks to studies on Mediterranean diet, we now know that fat quality is more relevant than the amount of fat we eat in the diet. Thus, saturated and trans fats have been found to increase the risk of atherogenic disease. This is why it is recommended to substitute complex carbohydrates or unsaturated fat for unsaturated and trans fats with the aim of reducing saturated and trans fat intake to <10% and <1%, respectively, of the total calorie intake. Recent population studies, particularly that conducted in Kuopio, Finland, and those on Mediterranean diet, stress the important role of monounsaturated and polyunsaturated fats as key nutrients in preventing cardiovascular disease in modern societies. Furthermore, a special type of polyunsaturated fatty acids, i.e. those of the omega-3 (n-3) series, is increasingly becoming essential nutrients for a healthy diet, especially in the case of children. Therefore, there is a rationale for four the Scientific Societies that are strongly committed to disseminate the benefits of a healthy diet in preventing cardiovascular disease, and to prepare a joint statement with the purpose of spreading improved knowledge on the importance of changing to a healthy diet with a well-balanced fat intake for industrialized populations. Accordingly, a multidisciplinary panel of experts from the following institutions has developed the present joint statement targeted at both adults and children of different ages: Spanish Society of Arteriosclerosis, Spanish Society of Family and Community Medicine, Spanish Association of Paediatrics, Spanish Society of Gastroenterology, Hepatology and Paediatric Nutrition and Dietetics, and Spanish Society for Food Sciences.

Impact of pre-selected autochthonous starter cultures on the flavor quality of Iberian dry-fermented "salchichón" sausage with different ripening processes.

UNLABELLED: The purpose of this study was to investigate the impact on flavor quality of 2 autochthonous starter cultures in the manufacture of Iberian dry-fermented "sálchichón." A total of 2 strains of Pediococcus acidilactici (MS200 and MS198) were combined individually with a strain of Staphylococcus vitulus (RS34) to obtain 2 starter cultures: P200S34 and P198S34. The ability of both starter cultures to implant during 2 different manufacturing procedures of "salchichón" was evaluated by 16S rRNA gene sequence analysis. Changes due to starter culture inoculations on volatile compounds were determined by gas chromatography/mass spectrometry, and the impact on flavor quality evaluated by sensorial analysis. The implantation of starter cultures was adequate and did not significantly modify the flavor of the traditional Iberian dry-fermented "salchichón," while modulating the volatile compound profile with respect to that found in sausages with wild microbial populations. The influence of the starter cultures studied was more evident in the shorter sausage processing time. P198S34 was related with the increase in some volatile compounds deriving from lipid degradation. P200S34 contributed to the formation of several volatile compounds arising from lipid degradation, amino acid catabolism, and microbial esterase activity. PRACTICAL APPLICATION: P200S34 and P198S34 are autochthonous starter cultures for specific use in the processing of Iberian dry-fermented sausages. The application of these starters allows obtaining Iberian dry-fermented sausages with sensorial characteristics standardized. It is greatly interesting for processing and marketing industry of these high-quality meat products.

Transposição do enxerto vascularizado da fíbula pro fêmur diafisário sem microanastomoses / Vascularized fibular graft transposition to upper femur avoiding microsurgery

OBJETIVO: O estudo descreve uma maneira nova e simples de transplantar o enxerto ósseo vascularizado da fíbula pro fêmur diafisário sem necessidade de microcirurgia, demonstra o caso clínico operado com bom resultado quanto a vascularização e consolidação óssea e, por último, especula sobre possíveis outras aplicações dentro da cirurgia reconstrutiva. MÉTODOS: A fíbula vascularizada é transportada até o fêmur sem necessidade de microcirurgia, alcançando até sua metáfise proximal através das comunicações das perfurantes do músculo gêmeo lateral com as septais fibulares via retalho de pele póstero-lateral da perna que intersecciona os dois sistemas. RESULTADOS: O paciente operado evoluiu sem infecção. Cintilografia esquelética precoce demonstrou vascularização óssea. CONCLUSÃO: O retalho gêmeo fibular é nova arma no arsenal do cirurgião. Sua técnica é factível, reprodutível, seu tempo cirúrgico reduzido e o princípio de construção com ponte através de ilhas de pele e perfurantes poderá ser aplicado na construção de novos retalhos.

OBJECTIVE: The study describes a new and simple way to transplanttranspose a vascularized fibular graft from the fibula to the femur diaphysis without the need for microsurgery, demonstrates a successful clinical case with good results with regards to vascularization and osseous consolidation, and speculates about other applications of this flap procedure in reconstructive surgery. METHODS: A stalked vascularized fibular bone graft was transferred without microsurgery. The bone reached the proximal diaphysis of the femur. Communication between the lateral gastrocnemius arterial system and fibular artery through a skin flap and it's perforating arteries allowed good vascularization to the graft. The concept of "perforating artery-to-perforating artery" was established with their vascular territories intersecting the skin island flap. RESULTS: The patient operated on healed without infection. Bone scintigraphy showed periosteal bone vascularization. CONCLUSION: The Cutaneous Gastrocnemius-Fibular Flap is a new weapon for the reconstructive surgeon. Itïs practical and reliable, and its reduced surgery time and its principle of construction will be applicable to the creation of other flaps.

Relación entre electroencefalograma y neuroimagen en niños con epilepsia focal de difícil control / Relation between electroencephalogram and neuroimaging present in children with epilepsy of difficult control

Las epilepsias focales son las màs frecuentes en los niños, y la resistencia al tratamiento farmacológico puede estar presente hasta en el 30 por ciento de los pacientes. Se realizó este estudio con el objetivo de dirigir la atención hacia la coincidencia topográfica de los paroxismos electroencefalográficos, con lesiones estructurales demostrables por neuroimagen, para facilitar el diseño de estrategias terapéuticas futuras. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, con 44 niños con diagnóstico de epilepsia focal de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente Juan M Márquez, entre enero de 2003 y junio de 2007. Se realizaron estudios por electroencefalograma (EEG) al ingreso y videoelectroencefalograma, además de estudios de neuroimagen por tomografía axial o resonancia magnética nuclear. RESULTADOS. Los paroxismos en EEG involucraron el lóbulo frontal hasta en el 68 por ciento de los pacientes. En el 48 por ciento de los pacientes, los paroxismos electroencefalográficos coinciden con zonas de alteración estructural según neuroimagen, más frecuentes en el lóbulo frontal. En el 25 por ciento no hay coincidencia topográfica y en el 27 por ciento no se precisan alteraciones estructurales. CONCLUSIONES. En las epilepsias focales de difícil control se debe prestar especial atención a las zonas elocuentes con coincidencia entre el EEG y la neuroimagen, para evaluar de forma temprana las alternativas quirúrgicas de tratamiento.

Focal epilepsies are the more frequent conditions in children and a pharmacologic treatment resistance could be present up to 30 percent of patients. Aim of present paper was to direct the attention to topographic coincidence of electroencephalographic paroxysms with structural lesions by neuroimaging facilitating the future therapeutical strategies design. METHODS: A descriptive, longitudinal, prospective study was conducted in 44 children diagnosed with epilepsy of difficult control admitted in Neuropediatrics Service of Juan Manuel Marquez Teaching Children Hospital from January, 2003 to June, 2007. At admission, we made electroencephalogram (EEG) and videoelectroencephalogram (VEEG) studies as well as neuroimaging studies by axial tomography (AT) or nuclear magnetic resonance (NMR). RESULTS: Paroxysms in EEG involved frontal lobule up to the 68 percent of patients. In 48 percent, electroencephalographic paroxysms coincide with structural alteration zones according neuroimaging, more frequent in frontal lobule. In 25 percent there is not topographic coincidence, and in 27 percent there are not specified structural alterations. CONCLUSIONS: In focal epilepsies of difficult control, we must to take care of eloquent zones with coincident between EEG and neuroimaging to assess in time the surgical treatment options.