[Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023]. / Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023.

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.

Sperm selection by thermotaxis improves ICSI outcome in mice.

The ejaculate is a heterogeneous pool of spermatozoa containing only a small physiologically adequate subpopulation for fertilization. As there is no method to isolate this subpopulation, its specific characteristics are unknown. This is one of the main reasons why we lack effective tools to identify male infertility and for the low efficiency of assisted reproductive technologies. The aim of this study was to improve ICSI outcome by sperm selection through thermotaxis. Here we show that a specific subpopulation of mouse and human spermatozoa can be selected in vitro by thermotaxis and that this subpopulation is the one that enters the fallopian tube in mice. Further, we confirm that these selected spermatozoa in mice and humans show a much higher DNA integrity and lower chromatin compaction than unselected sperm, and in mice, they give rise to more and better embryos through intracytoplasmic sperm injection, doubling the number of successful pregnancies. Collectively, our results indicate that a high quality sperm subpopulation is selected in vitro by thermotaxis and that this subpopulation is also selected in vivo within the fallopian tube possibly by thermotaxis.

Two cases of atypical hemolytic uremic syndrome (aHUS) and eosinophilic granulomatosis with polyangiitis (EGPA): a possible relationship.

Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by hemolysis, thrombocytopenia, and renal failure. It is related to genetic mutations of the alternative complement pathway and is difficult to differentiate from other prothrombotic microangiopathies. Eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss syndrome, CSS) is a systemic ANCA-associated vasculitis and a hypereosinophilic disorder where eosinophils seem to induce cell apoptosis and necrosis and therefore, vasculitis. Here, we report the case of two CSS patients with a genetic complement disorder consistent with aHUS diagnosis. Both patients showed histologic features that supported the diagnosis of CSS, and a genetic complement study confirmed the suspected aHUS diagnosis. In the case where eculizumab was administered, the global response was excellent. There is very limited understanding of the genetics and epidemiology of both, atypical HUS and EGPA, but considering our two patients we suggest that an etiopathogenic link exists among patients diagnosed with both entities.

Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges.

While multi-detector cardiac computed tomography angiography (MDCCTA) prior to reoperative cardiac surgery (RCS) has been associated with improved clinical outcomes, its impact on hospital charges and length of stay remains unclear. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure. The primary clinical endpoint was the composite of perioperative death, myocardial infarction (MI), stroke, and hemorrhage-related reoperation. Secondary clinical endpoints included surgical procedural variables and the perioperative volume of bleeding and transfusion. Length of stay was determined using the hospital's electronic medical record. Cost data were extracted from the hospital's billing summary. Analysis was performed on individual categories of care, as well as on total hospital charges. Data were compared between subjects with and without MDCCTA, after adjustment for the Society of Thoracic Surgeons score. Baseline characteristics were similar between the two groups. MDCCTA was associated with shorter procedural times, shorter intensive care unit stays, fewer blood transfusions, and less frequent perioperative MI. There was additionally a trend towards a lower incidence of the primary endpoint (17.5 vs. 24.2 %, p = 0.13) primarily due to a lower incidence of perioperative MI (0 vs. 5.7 %, p = 0.002). MDCCTA was also associated with lower median recovery room [$1,325 (1,250-3,302) vs. $3,217 (1,325-5,353) p < 0.001] and nursing charges [$6,335 (3,623-10,478) vs. $6,916 (3,915-14,499) p = 0.03], although operating room charges were higher [$24,100 (22,300-29,700) vs. $23,500 (19,900-27,700) p < 0.05]. Median total charges [$127,000 (95,000-188,000) vs. $123,000 (86,800-226,000) p = 0.77] and length of stay [9 days (6-19) vs. 11 days (7-19), p = 0.21] were similar. Means analysis demonstrated a strong trend towards lower mean total hospital charges [$163,000 (108,426) vs. $192,000 (181,706), p = 0.06] in the MDCCTA group. In conclusion, preoperative MDCCTA is associated with a number of improved perioperative outcomes and does not significantly effect the length of stay or total hospital charges during the index hospitalization.

[Macrocytosis without anaemia in an urban population]. / Estudio de macrocitosis sin anemia en una población urbana.

OBJECTIVE: Observational study on a group of patients with macrocytosis without anaemia. The probable relationship of cause and effect between Helicobacter pylori and macrocytosis. METHODS AND MATERIAL: An observational and cross-sectional study. MAIN MEASUREMENTS: The measured variables were: personal data, medical and analytical history in relation to macrocytosis, alcohol and smoking habits and drug use. This information was taken from the medical history of the patient. RESULTS: The prevalence of macrocytosis without anaemia was 7.12%. The main cause found was hypothyroidism in 37/234 (15.8%) patients, followed by alcoholism in 34/234 (14.5%) patients. The most frequent association was alcohol and tobacco in 9/234 (3.8%) patients. It was not possible to find a cause of the increased mean corpuscular volume (MCV) in 87/234 (37.18%) patients. Out of 37 tests conducted for Helicobacter pylori, 23 of them were positive. DISCUSSION: Macrocytosis without anaemia has a high prevalence. Finding the most frequent causes could help in the early diagnosis and treatment. H. pylori currently appears to be associated to different digestive tract and non-digestive tract diseases.It could be a cause of increased MCV, but this study was unable demonstrate this.

Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.

BACKGROUND: Preoperative evaluation with contrast-enhanced multidetector computed tomographic angiography (MDCTA) is considered an "appropriate" indication based on expert consensus. We aimed to evaluate how the presurgical evaluation with MDCTA impacts the outcomes after reoperative cardiac surgery (RCS). METHODS: We retrospectively studied 364 patients undergoing RCS between 2004 and 2008, including 137 referred for MDCTA. High-risk CT findings were defined as the presence of right ventricle or aorta <10 mm from the sternum or a bypass graft <10 mm from the sternum crossing the midline. The primary clinical end point was the composite of perioperative death, myocardial infarction (MI), stoke, and hemorrhage-related reoperation. Secondary end points included surgical procedural variables and the perioperative volume of bleeding and of red blood cell (RBC) transfusion. RESULTS: Baseline clinical characteristics were similar between the 2 groups. Individuals referred for MDCTA showed a trend toward a lower incidence of the composite primary end point (17.5% vs 24.2%, P = .13), primarily related to a significantly lower incidence of perioperative MI (0% vs 5.7%, P = .002). Multidetector computed tomographic angiography was also associated with shorter perfusion (90 vs 110 minutes, P = .002), cross clamp time (63 vs 75 minutes, P = .003), and total time in intensive care unit (103 vs 148 hours, P = .04), and a lower volume of postoperative RBC transfusion (627 vs 824 mL, P = .09). These differences remained significant after adjustment for the Society of Thoracic Surgeons score and the performing surgeon. CONCLUSION: The use of MDCTA before RCS was associated with shorter perfusion and cross clamp time, shorter intensive care unit stays, and less frequent perioperative MI.

Espolón calcáneo de la adolescencia / Calcaneal spur in adolescence

Se presentó un paciente adolescente portador de espolones calcáneos bilateral, rara patología a esta edad en nuestro país. Se expuso el cuadro clínico y la terapéutica adecuada. Se revisó la literatura.

An adolescent patient presented with bilateral calcareal spurs, which is very rare pathology at this age in our country. The clinical chart was exponed and the therapy was carried out. The literatura was consulted.

Identificação e concentração das antocianinas durante a ontogenia foliar de Hevea brasiliensis Muell. Arg. (IAN 873) e H. pauciflora Muell. Arg. submetidas a dois regimes hídricos

Pigments of rubber tree leaves were identified by means of descending paper chromatography, using three solvent systems. Analysis of the chromatograms and Rf values indicated the presence of two anthocyanins, pelargonidin and cyanidin. A yellow spot, with Rf value greater than 0.90, was probably kaempferol.The anthocyanin level was influenced in rubber tree seedlings subjected to water stress, showing a drastic reduction in the first ten days of leaf ontogeny. Leaves older than 20 days showed no significant difference under diferent water stress treatments. Clone IAN 873 progeny more strongly affected by water stress than that of H. pauciflora.

Através de cromatografia descendente em papel, com a utilização de três sistemas de solventes, indentificaram-se os pigmentos presentes nas folhas de seringueira. Por meio das análises dos cromatogramas e dos RF encontrados, verificou-se a presença de duas antocianinas, a pelargonidina e a cianidina. Foi observada a presença de uma mancha amarela, com RF acima de 0,90, provavelmente o quempferol. O teor de antocianina foi influenciado pelo déficit hídrico em plântulas de serigueira, com drástica redução nos primeiros dez dias de antogenia foliar. Após o vigésimo dia de idade, não houve diferença significativa entre os tratamentos. A progênie do clone IAN 873 de Hevea brasiliensis foi mais influenciada pela deficiência hídrica que a de H. pauciflora.

Desenvolvimento morfológico de folhas de Hevea brasiliensis Muell. Arg. e H. pauciflora Muell. Arg. submetidas a dois regimes hídricos

In rubber trees the morphological characteristics related to foliar ontogeny were influenced by a water stress regime. For Hevea brasiliensis and H. pauciplora water stress provoked a significant reduction in 1) number of leaves, 2) lenght of the central leaflet, 30) leaf dry wight., 4) leaf wet weight, 5) class of angle, between petiole and leaflet and 5) grafted sprout size. Under the two different experimental water regimes little difference was found in thickness of leaf anatomical tissues, probably because the water stress was applied for a short period and because ambient conditions have little effect on development of the these tissues. Nonetheless, H. pauciflora tends to show greater resistance to water loss in comparison with H. brasillensis (clone IAN 873), and also has more xeromorphic leaver. Physiologic age of rubber tree leaves did not correlate well with either the class of angle between petiole and leaflet or the plastochron index. It was possible, however, to determine the reference value (R = 50.0 mm) for the rubber tree. Plants under water stress showed a lower rate of leaf emergence as the graft sprouted. The class of angle between the petiole and leaflet was significantly affected by ambient conditions.

As características morfológicas relacionadas com a ontogenia foliar das espécies de seringueira foram influenciadas pela deficiência hídrica. O déficit hídrico provocou redução significativa no número de folhas, no comprimento do folíolo central, na matéria seca foliar, na matéria fresca foliar, na classe do ângulo folíolo-pecíolo e no tamanho da brotação em H. brasiliensis e H. pauciflora. A espessura dos tecidos anatômicos das folhas foi pouco modificada cm ambos os tratamentos, provavelmente devido ao pequeno efeito do curto período de aplicação do estresse hídrico e das condições do ambiente sobre a formação desses tecidos. No entanto, H. pauciflora tende a apresentor maior resistência à perda de água, quando comparada com H. brasiliensis (IAN 873), visto apresentar folhas com características mais xeromórficas. A classe do ângulo folíolo-pecíolo e o índice plastocrono não foram adequados para representar a idade fisiológica das folhas da seringueira. No entanto, foi possível determinar o valor de referência (R = 50,0 mm) para a seringueira. Verificou-se que as plantas com déficit hídrico apresentaram menor taxa de emergência de folhas durante o desenvolvimento do lançamento. A classe do ângulo folíolo-pecíolo foi significativamente influenciada pelas condições do ambiente.

Fruticultura Tropical no Acre: implantação e resultados preliminares

Summary In Rio Branco, Acre, by the convention INPA/BANACRE, was started in 1978 the installation of a project of tropical fruit culture. There were selected 10 small scale farmers with low income and were selected also the follewing fruit species: Annona muricata L., Rollinia mucosa (Jacq.) Baill., Matisia cordata (H.B.K.) = Quararibea cordata (Humb. & Bonpl.) Vischer, Arthocarpus incisa L., Pourouma cecropiaefolia Mart., Euterpe oleracea Mart., Bactris gasipaes H.B.K. = Guilielma gasipaes (H.B.K.) Bailey, Achras sapota L. = Manilkara zapota (L.) van Royen, Pouteria caimito (Ruiz & Pav.) Radlk and Theobroma grandiflorum (Willd & Spreng) Schum. These species were collected in several regions in the Amazon basin. There is being made a constant evaluation of several characters to form an information bank and to evaluate the adaptation of the species. In the period of November/78 to February/80, were planted 49 ha on 6 properties, and until March/81 there will be planted more 51 ha, to reach the ideal of 10 ha 10 properties (100 ha).