Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions.

BACKGROUND: Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM: Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS: From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION: In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

Transoperative Magnetic Resonance Imaging in Awake Glioma Surgery: Experience in a Latin American Tertiary-Level Center.

OBJECTIVE: Analyze the usefulness, efficacy, and safety of transoperative magnetic resonance imaging (tMRI) in glioma surgery in awake patients. METHODS: Retrospective, single-center, analytical study of a cohort of patients who underwent awake surgery for gliomas by the same surgeon in a third-level Argentine center, in the period between 2012 and 2022. Only patients with pathology-confirmed gliomas, with 6-month follow-up, who had preoperative and postoperative volumetric magnetic resonance imaging, were included in this sample. Subsequently, we analyzed which patients received surgery with the tMRI protocol and the results using multivariate regression analysis. RESULTS: A total of 71 patients were included. A tMRI study was performed on 22 (31%) of these patients. The use of tMRI increased the percentage of resection by 20% (P = 0.03), thereby increasing the possibility of gross total resection. However, using tMRI significantly extended surgical time by 84 minutes (P < 0.001). In 55% of the patients in whom tMRI was performed, the resection was continued after it. The use of tMRI did not increase the rate of infections or the development of surgically associated neurological deficits in the long term, despite the fact that 47% of the patients showed the development of a new deficit or worsening of a previous one during the intraoperative period. CONCLUSIONS: The use of tMRI in awake glioma surgery proved to be a safe tool that contributes to increasing the degree of tumor resection, compared to the use of neurophysiological mapping and neuronavigation, at the expense of increased surgical times and costs. We consider tMRI in awake glioma surgery should be used in properly selected cases.

Changes in energy expenditure and physical activity over 15 years of environmental changes: The Maycoba project.

OBJECTIVE: This work aimed to parse out the role of changing environments on body composition, total energy expenditure, and physical activity in the Mexican Pima, a population experiencing rapid industrialization. METHODS: Using doubly labeled water, we compared energy expenditure and physical activity in a longitudinal cohort of Mexican Pima (n = 26; female: 12) in 1995 and 2010. Body mass and composition were assessed by bioimpedance analysis. To determine the effects of environmental factors on body weight independent of age, we compared the 1995 longitudinal cohort with an age- and sex-matched cross-sectional cohort (n = 26) in 2010. RESULTS: Body mass, fat mass, and fat-free mass all significantly increased between 1995 and 2010. Despite a 13% average increase in body weight, weight-adjusted total daily energy expenditure decreased significantly. Measured physical activity levels also decreased between 1995 and 2010, after we adjusted for weight. CONCLUSIONS: Our results suggest that the recent industrialization of the Maycoba region in Sonora, Mexico, has contributed to a decrease in physical activity, in turn contributing to weight gain and metabolic disease among the Mexican Pima.

A monthly gridded burned area database of national wildland fire data.

We assembled the first gridded burned area (BA) database of national wildfire data (ONFIRE), a comprehensive and integrated resource for researchers, non-government organisations, and government agencies analysing wildfires in various regions of the Earth. We extracted and harmonised records from different regions and sources using open and reproducible methods, providing data in a common framework for the whole period available (starting from 1950 in Australia, 1959 in Canada, 1985 in Chile, 1980 in Europe, and 1984 in the United States) up to 2021 on a common 1° × 1° grid. The data originate from national agencies (often, ground mapping), thus representing the best local expert knowledge. Key opportunities and limits in using this dataset are discussed as well as possible future expansions of this open-source approach that should be explored. This dataset complements existing gridded BA data based on remote sensing and offers a valuable opportunity to better understand and assess fire regime changes, and their drivers, in these regions. The ONFIRE database can be freely accessed at https://zenodo.org/record/8289245 .

Multifaceted strategy based on automated text messaging after a recent heart failure admission: the MESSAGE-HF Randomized Clinical Trial

IMPORTANCE: Readmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem. OBJECTIVE: To evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022. INTERVENTION: Participants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team. MAIN OUTCOMES AND MEASURES: The primary end point was change in N-terminal pro-brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed. RESULTS: Of 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, -2.21; 95% CI, -3.67 to -0.74; P = .001; score difference at 180 days, -2.08; 95% CI, -3.59 to -0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26). CONCLUSIONS and relevance: An intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome.

Descompresión microvascular endoscópica versus microscópica en neuralgia trigeminal en un centro Argentino / Endoscopic vs. microscopic techniques for the treatment of trigeminal neuralgia. Our experience at an Argentine care center

Resumen Introducción: La descompresión microvascular (DMV) en la neuralgia trigeminal es una técnica quirúrgica cuyo objetivo es revertir la compresión a la que se ve someti do un nervio por una estructura vascular. El objetivo de este estudio fue realizar una comparación directa entre la descompresión microvascular endoscópica (DMV-E) y la misma a través del uso del microscopio (DMV-M) en el tratamiento de la neuralgia del trigémino. Métodos: Se realizó un estudio de cohorte retrospec tivo de pacientes operados de neuralgia de trigémino, por un mismo cirujano, entre 2015 y 2021 en nuestra institución, tanto por técnica microquirúrgica como endoscópica. Resultados: Se obtuvieron un total de 31 pacientes divididos en dos grupos: Grupo M correspondiente a 15 (49%) pacientes abordados con técnica microscópica y Grupo E, con 16 (51%) pacientes intervenidos con técnica endoscópica. Se identificaron diferencias en el tamaño de la cra niectomía, más pequeña en el grupo E (2.50 cm vs 3.70 cm grupo M); y en el tiempo de internación, de 2.43 días en el grupo E vs. 4.46 días en el grupo M. El tiempo de cirugía fue similar para ambas técnicas quirúrgicas La principal compresión fue dada por la arteria ce rebelosa superior (ACS) en ambos grupos. Todos los pacientes presentaron mejoría del Barrow Neurological Institute Pain Intensity Score (BNI) en el postoperatorio en ambos grupos. Discusión: La DMV-E constituye una alternativa qui rúrgica interesante a la ya conocida DMV-M para el tratamiento de la neuralgia trigeminal, por requerir menores dimensiones en la incisión cutánea y tamaño de la craniectomía, acortando el tiempo de internación, lo cual no solo implica un beneficio para el paciente, sino que también representa menor costo de internación.

Abstract Introduction: Trigeminal neuralgia is a highly invali dating pathology, whose natural course has been modi fied thanks to decompressive microvascular surgery. The intervention can be carried out either with a microscope or via an endoscopic technique. Our goal was to compare these two techniques for the treatment of this complex pathology. Methods: Retrospective, analytical study of a cohort of patients treated by a single surgeon at our institution, in the period between 2015 and 2021. Results: We identified 31 patients and divided them into two groups: 15 (49%) treated using the microscopic technique (group M), and 16 (51%) exclusively via an endoscopic one (group E). Differences were observed between the means of the size of the craniectomy in group M (3.7 cm) compared to group E (2.5 cm); The mean length of hospital stay for patients in group E was shorter (4.46 days compared to that of patients in group M, whose hospital stay averaged 2.43 days). There were no differences between the two groups regarding the length of the procedure. In both groups, the predomi nant compression was due to the superior cerebellar artery (SCA). Pain outcomes were equivalent, with every patient in both groups having an improved postoperative Barrow Neurological Institute Pain Intensity Score (BNI). Discussion: Endoscopic microvascular decompression is an attractive option for the resolution of neurovas cular conflict as it provides functional results similar to the microscope technique, without requiring an exten sive craniectomy and associated to shorter in-hospital stay, which is beneficial for both the patient and the institution.

Encuesta sobre usos y prácticas de Doppler transcraneal en pacientes neurocríticos en unidades de cuidados intensivos pediátricos de Argentina / Survey on the use and practice of transcranial Doppler ultrasound in neurocritical patients in pediatric intensive care Units in Argentina

Introducción. El uso del Doppler transcraneal (DTC) en pacientes neurocríticos se reporta cada vez más en las terapias intensivas pediátricas. El objetivo de esta encuesta es conocer los usos y prácticas del DTC en la atención neurocrítica y el proceso de formación del personal que realiza el estudio. Materiales y métodos. Encuesta a profesionales de 23 unidades de terapia intensiva pediátrica de Argentina. Resultados. Porcentaje de respuesta del 86 %. Se utilizó en sospecha de muerte encefálica (n = 20), trauma de cráneo (n = 16) y accidente cerebrovascular (n = 16). El intensivista pediátrico es quien realiza los estudios (n = 13/20). Los encuestados utilizan el Doppler para decidir conductas y tratamientos, comenzar el proceso de evaluación de muerte encefálica, solicitar tomografía de cerebro y manejar la presión de perfusión cerebral con vasopresores. Conclusión. Todos los encuestados utilizan los hallazgos del DTC para guiar tratamientos o conductas. La mitad de los encuestados está poco conforme con la capacitación recibida.

Introduction. The use of transcranial Doppler (TCD) ultrasoundin neurocritical patients is reported to be increasingly common in pediatric intensive care units. The objective of this survey was to know about the use and practice of TCD ultrasound in neurocritical care and the training process of staff members performing it. Materials and methods. Survey administered to providers from 23 pediatric intensive care units of Argentina. Results. The percentage of response was 86%. TCD ultrasound was used for suspected brain death (n = 20), head injury (n = 16), and stroke (n = 16). Pediatric intensivists perform the test (n = 13/20). Surveyed participants use TCD ultrasound to decide on treatment and management, start brain death assessment, request brain computed tomography, and manage cerebral perfusion pressure with vasopressors. Conclusion. All surveyed participants use TCD ultrasound findings to guide management or treatments. Half of surveyed participants are little satisfied with their training.

Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach / Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.

Microcirugía de las fístulas durales arteriovenosas espinales, más un repaso de la anatomía vascular vertebromedular / Microsurgery of spinal dural arteriovenous fistulas, plus a review of the vertebromedullary vascular anatomy

Introducción: la fístula dural arteriovenosa espinal (FDAVE) es una enfermedad vascular rara, de etiología desconocida y frecuentemente subdiagnosticada. El tratamiento puede ser microquirúrgico o endovascular. Material y Método: Análisis retrospectivo de una serie de 8 pacientes consecutivos con FDAVE tratados por microcirugía entre 2010 y 2020. Fueron evaluados parámetros como edad, sexo, cuadro clínico pre y postoperatorio medido con las escalas de Aminoff-Logue y Rankin modificada. Los estudios diagnósticos con RMN (Resonancia Magnética Nuclear), ARM (Angio Resonancia Magnética) y ADM (Angiografía Digital Medular) se utilizaron para determinar nivel lesional y resultados quirúrgicos. Resultados: Fueron operados 8 pacientes (7 masculinos y 1 femenino) con un promedio de edad de 58 años. El tiempo de evolución del cuadro clínico al diagnóstico fue menor a 12 meses salvo un caso de 32 meses. Las FDAVE fueron localizadas en: 6 a nivel dorsal entre D6 y D12, una en L2 y la última en S1 (5 derechas y 3 izquierdas). La arteria de Adamkiewicz se identificó en: 4 casos en L1, 2 en D12, 1 en D10 y un caso en D7 (6 izquierdas y 2 derechas). De los 8 pacientes operados, 3 fueron embolizados previamente. La evolución postoperatoria del cuadro neurológico fue: 2 de 8 permanecieron estables y 6 de 8 mejoraron uno o más puntos en la escala de Rankin modificada; no hubo complicaciones en el postoperatorio. Todos los pacientes mejoraron las imágenes en RMN diferida y la ADM luego de los 6 meses fue negativa. El seguimiento promedio fue de 48 meses con un rango de 11 a 116 meses, ningún paciente presentó recidiva de la FDAVE. Conclusiones: El tratamiento quirúrgico de las FDAVE es un método muy eficaz, de baja morbilidad y menor tasa de recurrencia comparado con el tratamiento endovascular.

Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare vascular disease, of unknown etiology and frequently underdiagnosed. Treatment can be microsurgical or endovascular. Material and Method: Retrospective analysis of a series of 8 SDAVF patients treated by microsurgery between 2010 and 2020. Parameters including age, sex, pre and postoperative clinical condition were analyzed according to modified Aminoff-Logue and modified Rankin scales. Diagnostic studies such as MRI (Magnetic Resonance Imaging), MRA (Magnetic Resonance Angiogram) and spinal DSA (Digital Subtraction Angiography), were evaluated for lesion level, as were surgical results. Results: Eight patients (7 male and 1 female), average age of 58 years were operated. The interval from symptom onset to diagnosis was less than 12 months in all cases except one (32 months). SDAVF locations were thoracic in 6 cases between T6 and T12, at L2 in one and at S1 in one case (5 on the right and 3 on the left). The Adamkiewicz artery was identified in: 4 cases at L1, 2 at D12, 1 at D10 and in one case at D7 (6 left-sided and 2 right-sided). Three of the 8 patients operated had undergone prior embolization. Postoperative neurological outcomes showed: 2 patients remained stable and 6 had improved one or more points on the modified Rankin scale; no postoperative complications were observed. Follow-up MRI images improved in all cases and spinal DSA was negative at six months. Average follow-up was 48 months (range 11 to 116 months), no patient presented recurrence. Conclusions: Microsurgical treatment of SDAVF proved to be efficient, with low morbidity and lower recurrence rates compared to endovascular results.

Epidemiologic study of cluster headache prevalence in a medium-size city in Brazil / Estudo epidemiológico da prevalência da cefaleia em salvas em uma cidade de médio porte do Brasil

ABSTRACT To determine the prevalence of cluster headache (CH) in Barbacena, a medium-size city in the State of Minas Gerais, Brazil. Methods The total population of Barbacena is 126,284 inhabitants and the Family Health Strategy Program covers 84,610 of them. In order to identify patients with cluster headache, 36,145 of these inhabitants were screened, following which, a questionnaire was completed by 181 health agents distributed throughout the 28 health posts belonging to the Family Health Strategy network. The completed questionnaires were selected based on the clinical criteria established by the International Headache Society, and those patients (18 years of age or older) with a possible CH diagnosis were later assessed by a headache specialist. This was an observational, cross-sectional study. Results In all, 15 patients were diagnosed as having CH, comprising a prevalence of 0.0414%; or 41.4/100,000 inhabitants. Conclusion The prevalence of cluster headache in Barbacena was lower than that observed in many locations worldwide.

RESUMO Determinar a prevalência de cefaléia em Salvas (CS) em Barbacena, uma cidade de tamanho médio do Estado de Minas Gerais, Brasil. Métodos A população total de Barbacena, totaliza 126.284 habitantes e o Programa de Estratégia de Saúde da Família cobre 84.610 deles. A fim de identificar pacientes com Cefaléia em Salvas, 36.145 deles foram rastreados através de um questionário que foi completado por 181 agentes de saúde, distribuídos entre os 28 postos de saúde pertencentes à rede de Estratégia de Saúde da Família. Os questionários preenchidos foram selecionados com base nos critérios clínicos estabelecidos pela International Headache Society, e aqueles pacientes (com idade igual ou maior de 18 anos) com um possível diagnóstico de CH foram posteriormente avaliados por um especialista em dor de cabeça. Este é um estudo observacional, transversal. Resultados No total, 15 pacientes foram diagnosticados com CH, compreendendo uma prevalência de 0,0414%; ou 41,4 / 100,000 habitantes. Conclusão A prevalência de Cefaleia em Salvas em Barbacena foi menor do que a observada em muitos locais do mundo.

WHO body mass index for age charts overestimate thinness and overweight compared to international and US charts applied to indigenous and non-indigenous Mexican children

Assessments of whether children are thin (low body mass index for age) or overweight are based on body mass index (BMI for age and sex) charts published by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control and Prevention (CDC). We aimed to determine whether these charts indicated different prevalence of thinness and overweight (obesity included) in indigenous and non-indigenous school aged children from different regions and ethnic groups in Mexico. A probability proportional to size, cluster sampling method was employed in four regions of the country. We recruited 1,731 children aged 7.0-9.9 (507 indigenous from six ethnic groups and 1,224 non-indigenous). BMI was calculated according to age, and thinness and overweight classifications were compared according to cutoff values in the WHO, IOTF, and CDC references. The WHO reference generated the highest rates for thinness (12.5%) and overweight (30%) in children across regions and ethnic groups. The CDC reference estimated the lowest rates of thinness in children (5.5%), and the IOTF reference estimated the lowest rates of overweight (24.7%). Estimates of both thinness (8.3%) and overweight (13.4%) rates were lower in indigenous than non-indigenous groups (14.3% and 37.5%, respectively). The WHO BMI for age chart estimated higher rates of thinness and overweight in children compared to the CDC and IOTF charts. Because thinness as indicator of undernutrition status is relatively new, differences in body composition among indigenous and non-indigenous children may justify the need for more appropriate screening criteria to compare the growth status(AU)

La clasificación del estado nutricio de los niños con delgadez o con sobrepeso se realiza empleando el índice de masa corporal (IMC para la edad y el sexo) con las tablas de la OMS, IOTF y CDC. El objetivo de esta investigación fue determinar si estas referencias resultan en diferentes prevalencias de delgadez y sobrepeso (obesidad incluida) en niños escolares indígenas y no indígenas de diferentes regiones de México. Se empleó un muestreo por conglomerados en cuatro regiones del país. Se reclutaron 1,731 niños con edades entre 7,0-9,9 (507 indígenas de cinco grupos étnicos y 1,224 no indigenas) durante 2006 y 2008. El IMC se calculó y se clasificó como delgadez y sobrepeso con los puntos de corte sugeridos por las referencias internacionales. Cuando se compararon las clasificaciones, la referencia de OMS generó la prevalencia más alta de delgadez (12,5%) y sobrepeso (30%) en niños de todas las regiones y grupos étnicos. La referencia de los CDC estimó las prevalencias más bajas de delgadez (5,5%) y la referencia IOTF produjo las proporciones más bajas de sobrepeso (24,7%). Las proporciones de delgadez (8,3%) y sobrepeso (13,4%) fueron más bajas en niños indígenas que en los no indígenas (14.3% y 37.5%, respectivamente). La referencia de la OMS del IMC para la edad produjo las prevalencias más altas de delgadez y sobrepeso en comparación con los estándares de CDC y IOTF. Dado que la delgadez como indicador de desnutrición en niños es de uso reciente, las diferencias encontradas entre indígenas y mestizos pueden justificar el contar con mejores herramientas de tamizaje en estudios de crecimiento(AU)

Modelo para la estimación de la talla de pie en adultos mexicanos de 20-59 años basado en la longitud rodilla-talón / Model for estimating standing height in Mexican adults for 20-59 years, based on knee length

Actualmente las distancias óseas se utilizan para predecir la talla en adultos que no pueden tener una adecuada bipedestación o no cumplen con la posición adecuada para la obtención de la talla. Existen algoritmos para la estimación de la talla basados en la longitud rodilla-talón, diseñados para poblaciones específicas; sin embargo, existen poblaciones que aún no cuentan con esta herramienta, por lo que se usan ecuaciones ya existentes, que no necesariamente reflejan los factores genético-ambientales para la población de interés. El objetivo de este estudio fue desarrollar y validar modelos predictivos para la talla de pie en adultos mexicanos, con antropómetro de diseño propio y cinta métrica. Se midieron 240 adultos de 20 a 59 años, de ambos sexos, sin problemas aparentes en la columna vertebral. Se midió el peso, la talla de pie y la longitud rodilla-talón. Se desarrolló un modelo predictivo para cada instrumento de medición. La selección de modelos y el desarrollo de las ecuaciones se llevó a cabo mediante los métodos de 'Todas las Regresiones Posibles' y 'Regresión Múltiple'. Se obtuvieron dos algoritmos que no mostraron diferencias significativas entre la talla medida y estimada tras un proceso de validación cruzada. Las R2 para los modelos fueron de 0,93 y 0,92, con un error estándar del estimador (EE) de 2,30 y 2,40 cm, para el antropómetro y la cinta respectivamente. Ambos métodos resultaron aceptables en términos de concordancia, exactitud y precisión. A tallas extremas (altas o bajas), ambos modelos presentaron sesgo, lo cual debe considerarse al aplicar estos algoritmos (AU)

Currently, bone distances are used to predict standing height in adults that might not be able to achieve a correct standing position. Knee length based algorithms for estimating standing height have been proposed and designed for specific populations. However, equations for other populations may not necessarily reflect environmental and genetic factors for the group of interest. The aim of this study was to develop and validate predictive models for standing height in Mexican adults. For this purpose, 240 male and female adults aged 20 to 59 years, with no apparent spine problems were measured. We measured weight, height and knee length, using an anthropometer of our own design and a glass fiber metric measuring tape. A predictive model for each measuring instrument was developed. Model selection and development of equations were carried out by 'all possible regressions and multiple regression' procedures. The predictive models for standing height by the anthropometer and by the measuring tape did not show significant differences between measured and estimated height. The R2 for the two models were 0.93 and 0.92, with a standard error of the estimator (EE) of 2.30 and 2.40 cm, for the anthropometer and the measuring tape, respectively. Both methods were acceptable in terms of concordance, accuracy and precision; however, at very high and low predicted height values, both models showed significant bias, which should be considered when applying these algorithms in different populations (AU)

Impacto del tratamiento antineoplásico en el estado nutricional en pacientes con cáncer de mama / Antineoplastic treatment impact on nutritional status in patients with breast cancer

Introducción: El cáncer de mama es la neoplasia más diagnosticada en mujeres en México y también la de mayor mortalidad. Aunque el tratamiento ha mejorado, puede afectar de forma importante el estado nutricio de quienes lo reciben. Objetivo: Evaluar el impacto del tratamiento antineoplásico sobre el estado nutricio en pacientes con cáncer de mama. Pacientes y métodos: Se aplicó un diseño cuasiexperimental, antes y después de seis meses del inicio del tratamiento quimioterapéutico. Participaron 40 pacientes con diagnóstico primario de cáncer de mama invasivo. Se tomaron medidas antropométricas, de composición corporal mediante absorciometría dual de rayos X (DEXA) así como análisis de la dieta mediante recordatorio de 24 horas y cuestionario de frecuencia de consumo. Además, se cuantificaron los biomarcadores séricos, retinol y Beta-caroteno. El efecto del tratamiento se estimó utilizando regresión linear mixta para mediciones repetidas. Resultados: Se registró una pérdida de tejido magro (p=0.03). Además se encontró interacción del climaterio sobre los parámetros de peso, IMC y grasa corporal; solo en las pacientes preclimatéricas aumentaron estas medidas (p=0.005, 0.006 y 0.001 respectivamente). El retinol sérico disminuyó (p=0.049) pese al incremento en el Beta-caroteno (p=0.030). También se incrementó el consumo de vegetales y hubo una reducción en el consumo de alimentos de origen animal. Conclusión: El tratamiento antineoplásico para cáncer de mama afectó negativamente al peso y grasa corporal, principalmente en las mujeres jóvenes. Pese a las modificaciones dietarias, el consumo promedio de vegetales aún es insuficiente, lo cual se reflejó también en los biomarcadores séricos (AU)

Background: Breast cancer is the most commonly diagnosis malignancy in women in Mexico and also has the highest mortality. Although treatment has improved significantly, it can affect the nutritional status of the recipients. Objective: The aim of this study was to assess the impact of the initial phase of antineoplastic therapy on the nutritional status in patients with breast cancer. Methods: Forty subjects with primary diagnosed of invasive breast cancer were study in a before and after intervention (six months apart) using a quasi-experimental design. Basal and six month after intervention measurements included were anthropometry, body composition by dual X-ray absorptiometry (DEXA), diet by 24-hour recall and food frequency questionnaire, as well as serum Beta-carotene and retinol. The therapy effect was analyzed using repeated measurements mixed linear regression. Results: Lean tissue decreased after the studied period (p=0.032).Addicionally, there was an interaction between weight, BMI and body fat parameters with menopausal status, increasing in these variables due to therapy only premenopausal patients (p=0.005, 0.006 and 0.001, respectively). Serum retinol decreased (p=0.049) despite the improvement in Beta-carotene status (p=0.03). In general there was an increase the consumption of vegetables food products whilst a decrease in animal foods products. Conclusion: The breast cancer antineoplasic treatment had a negative effect on weight and body fat, especially in young women. Although there were some positive dietary changes, vegetables consumption remained insufficient, which was also reflected in serum biomarkers (AU)

Estimación de la masa grasa por DXA y el modelo de cuatro compartimentos en púberes mexicanos de 9 a 14 años / Estimation of body fat by DXA and the four compartment model in Mexican youth

Se evaluó la precisión y exactitud en la estimación de la grasa corporal (%) por absorciometría dual de rayos X (DXA Lunar-DPX-MD) comparado con el modelo de cuatro compartimentos (4C) en 32 púberes (F=16) de 9 a 14 años. El sesgo entre la DXA y el modelo de 4C fue de -3.5% de grasa (r=0.25; p=0.171) con un intervalo de confianza de -1.9 a -5.1 (p=0.050). Los límites de concordancia al 95% fueron de +5% a -12% de grasa. El coeficiente de correlación de concordancia fue de pc=0.85. La prueba de exactitud por análisis de regresión mostró que el intercepto y la pendiente de las estimaciones de grasa corporal por DXA fueron diferentes al modelo de 4C (p>0.05). La precisión evaluada con el valor de R2 mostró que la DXA explicó el 83% de la varianza de la grasa corporal por el modelo de 4C con un error de 4.1%. El error total como medida de exactitud fue de 5.6%. La exactitud grupal evaluada por análisis de varianza no mostró interacción entre el método (DXA-4C) y el análisis por separado del sexo, el estado puberal y la presencia de sobrepeso. No obstante, hubo efecto del método (p=0.043) en presencia de sobrepeso (p<0.001). En conclusión, los resultados muestran que el uso de la DXA comparado con el modelo de 4C no es equivalente en púberes mexicanos. Sin embargo, estos datos no limitan el uso de la DXA en estudios de composición corporal y su relación con anormalidades metabólicas.

The objective of this study was to validate the estimation of body fat (%BF) by DXA (Dual-Energy X-Ray AbsorciomDPX-MD) against the four compartment model (4C) of body composition in 32 Mexican pubertal girls and boys (aged 9 - 14y; F=16). The mean of the difference between DXA and 4C model was -3.5 %BF (p=0.171). The limits of agreement (95% ± 2 SD) were +5% to -12%BF. The precision of estimated limits of y the confidence intervals were -1.9% to -5.1%BF (P=0.050). The concordance correlation coefficient was pc= 0.85. The test of accuracy for coincidence of slop intercepts between DXA and the 4C model showed no coincidence (p< 0.05). The precision by R2 explained 83% of the variance (SEE, 4.1 %). The individual accuracy assess by the total error was 5.6%. The group mean accuracy by two way analysis of variance of body fat did not show interaction between method (DXA-4C model) and separate analysis of gender and overweight. However, there was an effect of method (p=0.043) in the presence of overweight (p<0.001). In conclusion, the estimation of percent of body fat by DXA was not precise and accurate in a group of Mexican children. However, results do not limit the utility of DXA for the measurements of body composition and its relation with health outcomes, especially in follow up studies.

Prevalencia de deficiencia de hierro y de anemia por deficiencia de hierro en adolescentes embarazadas del noroeste de México 2007-2008 / Prevalence of iron deficiency and iron deficiency anemia in pregnant adolescents from northwest Mexico 2007-2008

La anemia por deficiencia de hierro (Fe) es un problema de salud pública mundial, principalmente en niños y en mujeres en edad fértil. Las adolescentes requieren cubrir las demandas de Fe propias del crecimiento acelerado y del inicio de la menstruación y en adolescentes embarazadas se agrega el crecimiento de los tejidos fetales. El objetivo de este estudio fue determinar la prevalencia de deficiencia de Fe y de anemia por deficiencia de Fe en adolescentes embarazadas del noroeste de México. Participaron 186 mujeres menores de 19 años de edad, comprendidas en el primer o segundo trimestre del embarazo y atendidas en Centros de Salud Públicos de la ciudad de Hermosillo, Sonora. Se aplicaron cuestionarios sobre el nivel socioeconómico e información dietaria mediante la aplicación de recordatorio de 24 horas. Se cuantificó hemoglobina (Hb), hematocrito, ferritina y protoporfirina eritrocitaria. De acuerdo a los valores de Hb y ferritina, se agruparon como normales (37.4 por ciento de las voluntarias), como deficientes de Fe sin anemia (55.5 por ciento) y con anemia por deficiencia de Fe (7.1 por ciento). En este último grupo, seis participantes clasificaron con anemia moderada y siete con anemia ligera. Las variables que se asociaron con indicadores de Fe, en al menos dos grupos de mujeres fueron la ingesta de Fe y de fibra y las semanas de embarazo. El elevado porcentaje de mujeres con reserva deficiente de Fe demanda la identificación y atención de factores maternos y de hábitos de consumo de alimentos que afectan el estado de Fe en las adolescentes embarazadas.

Iron deficiency anemia (IDA) remains a word public health problem, particularly in children and child-bearing-age women. Iron demands need to be covered by adolescent women due to the increased physical growing, menstruation, pregnancy and fetal growing tissues at this life stage. This study was proposed to investigate the prevalence of iron deficiency and IDA in pregnant adolescent women from Northwestern Mexico. Participated 186 women under 19 years old during the first or second trimester of pregnancy who attended the local health institutions in Hermosillo Sonora. Questionnaires and 24 hr recalls were administered to collect socioeconomic and dietary information respectively. Hemoglobin (Hb), hematocrit, ferritin and eritrocytic protoporphyrin were measured. Hb and ferritin values were used to categorize the recruited women into normal (37.4 percent), iron deficient (55.5 percent) and IDA (7.1 percent) groups. Six and seven women showed moderated and light anemia status in the IDA group. Fe and fiber intake and weeks of pregnancy were associated with the biochemical indicators of iron at least in two women groups. The high percentage of iron deficient women in this study is demanding the identification and attention of maternal factors and food habits that are risk of iron deficiency in pregnant women.

Lesão renal aguda após revascularização do miocárdio com circulação extracorpórea / Lesión renal aguda post-revascularización del miocardio con circulación extracorpórea / Acute kidney injury after on-pump coronary artery bypass graft surgery

FUNDAMENTO: A lesão renal aguda (LRA) é uma doença complexa para a qual, atualmente, não há uma definição padrão aceita. A AKIN (Acute Kidney Injury Network) representa uma tentativa de padronização dos critérios para diagnóstico e estadiamento da LRA, baseando-se nos critérios RIFLE (risk, injury, failure, loss, e end-stage kidney disease), publicados recentemente. OBJETIVOS: Avaliar a incidência e mortalidade associada à LRA em pacientes submetidos à revascularização do miocárdio (RM) com circulação extracorpórea (CEC). MÉTODOS: O total de 817 pacientes foi dividido em dois grupos: LRA negativa (-), com 421 pacientes (51,5 por cento), e LRA positiva (+), com 396 pacientes (48,5 por cento). Foi considerado LRA a elevação da creatinina em 0,3 mg/dl ou aumento em 50 por cento da creatinina em relação a seu valor basal. RESULTADOS: A mortalidade em 30 dias dos pacientes com e sem LRA foi de 12,6 por cento e 1,4 por cento, respectivamente (p < 0,0001). Em um modelo de regressão logística multivariada, LRA após RM com CEC foi preditora independente de óbito em 30 dias (OR 6,7 - p = 0,0002). Esse grupo de pacientes teve maior tempo de permanência em UTI [mediana 2 dias (2 a 3) vs. 3 dias (2 a 5) - p < 0,0001)] e uma maior proporção de pacientes com permanência prolongada na terapia intensiva (> 14 dias) - 14 por cento vs. 2 por cento; p < 0,0001. CONCLUSÃO: Na população estudada, mesmo uma discreta alteração da função renal baseada nos critérios do "Acute Kidney Injury Network - AKIN" foi preditora independente de óbito em 30 dias após RM com CEC.

BACKGROUND: The acute kidney injury (AKI) is a complex disease for which there is no accepted standard definition nowadays. The Acute Kidney Injury Network (AKIN) represents an attempt to standardize the criteria for diagnosis and staging of acute renal dysfunction based on recently published RIFLE criteria, that means, (Risk, Injury, Failure, Loss, and End-stage kidney disease). OBJECTIVES: To evaluate the incidence and associated mortality of AKI in patients submitted to on-pump coronary artery bypass graft surgery (on-pump CABG). METHODS: A total of 817 patients were divided into two groups: negative AKI (-), with 421 patients (51.5 percent), and positive AKI (+), with 396 patients (48.5 percent). Increase of 0.3 mg/dL in creatinine or of 50 percent in creatinine's basal value was considered as AKI. RESULTS: The rate of patient's mortality with or without AKI within 30 days after cardiac surgery was 12.6 percent and 1.4 percent, respectively (p<0.0001). In a multivariate logistic regression model, AKI after on-pump CABG was an independent predictor of death within 30 days (OR=6.7; p=0.0002). This group of patients presented a longer period of permanency in intensive care unit (ICU) [median 2 days (2 to 3) versus 3 days (2 to 5); p=0.0001] and a bigger proportion of patients with prolonged permanence in intensive care (>14 days) (14 versus 2 percent; p=0.0001). CONCLUSION: In the studied population, even a discrete alteration in renal function, based on AKIN criteria, was an independent predictor of death in 30 days after on-pump CABG.

FUNDAMENTO: Lesión renal aguda (LRA) es una compleja enfermedad, la que, actualmente, no tiene definición patrón acepta. AKIN (Acute Kidney Injury Network) representa una tentativa de estandardización de criterios para el diagnostico y estadiamiento de LRA basado en los criterios RIFLE (risk, injury, failure, loss, y end-stage kidney disease) publicados recientemente. OBJETIVO: Evaluar la incidencia y mortalidad asociada a LRA en pacientes sometidos a revascularización del miocardio (RM) con circulación extracorpórea (CEC). MÉTODOS: El total de 817 pacientes fueron divididos en dos grupos: LRA negativa (-), con 421 pacientes (51,5 por ciento), y LRA positiva (+), con 396 pacientes (48,5 por ciento). LRA fue considerada la elevación de creatinina en 0,3 mg/dl el aumento en 50 por ciento de creatinina en relación a su valor basal. RESULTADOS: La mortalidad dentro de 30 días de los pacientes con y sin LRA ha sido de 12,3 y 1,4 por ciento, respectivamente (p<0,0001). En un modelo de regresión logística multivariado, LRA tras RM con CEC fue predictora independiente de óbito en 30 días (OR=6,7; p=0,0002). Ese grupo de pacientes tuvo el mayor tiempo de permanencia en unidad de cuidados intensivos (UCI) (6,0±9,5 días versus 3,4±4,0 días; p<0,0001) y una proporción de pacientes con permanencia prolongada en la terapia intensiva (>14 días), 14 versus 2 por ciento; p<0,0001. CONCLUSIÓN: En la población estudiada, mismo una discreta alteración de la función renal basada en los criterios AKIN ha sido predictora independiente de óbito, en 30 días tras RM con CEC.

Validez de una ecuación basada en antropometría para estimar la grasa corporal en adultos mayores / Validity of an equation based on anthropometry to estimate body fat in older adults

Se diseñó y validó una ecuación de predicción basada en antropometría para estimar la masa grasa en adultos mayores, usando como método de referencia el modelo de 4 compartimientos (AC). Se incluyeron 202 sujetos = 60 años. Se midió el agua corporal total por dilución con oxido de deuterio, contenido mineral óseo por DEXA y la densidad corporal por pletismografñia de desplazamiento de aire. Para el diseño y validación la muestra se dividió aleatoriamente. En la sub-muestra uno se generaron los modelos de predicción de la masa grasa, los cuales se aplicaron en la sub-muestra dos. La exactitud y precisión se probó por análisis de regresión simple y el sesgo mediante la prueba de Bland y Atman y regresión lineal simple. La ecuación incluyó peso corporal, sexo, pliegue del tríceps y pantorrilla; con una R², un error estándar del estimador y el estadístico de Mallow (Cp) de 0.86,3.2, respectivamente. En la sub-muestra dos se observó equivalencia entre los métodos, con un intercepto no estadísticamente diferente de cero (p>0.05) y pendiente diferente de cero (p<0.05) o similar a 1. La ecuación explicó un 86 por ciento de la varianza de la media de la masa grasa determinada por el modelo de 4C, asimismono presentó sesgo significativo tanto en la muestra total y por sexo. La ecuación generada puede ser de gran utilidad para estimar la composición corporal de adultos mayores con características similares al grupo estudiado, utilizando mediciones antropométricas simples de medir. Así mismo puede ser aplicada en estudio clínicos y epidemiológicos en este grupo poblacional.

Edad de la menarquia en adolescentes del noroeste de México / The Menarche Age in Teenagers of the Northwest of Mexico

El inicio de la maduración sexual en los individuos es un parámetro utilizado para conocer la calidad de vida de una población. En mujeres, el indicador más utilizado es la edad de la menarquia. Considerando que en esta región no existen estudios que muestren esta información, los objetivos del presente trabajo fueron obtener la edad de la menarquia en mujeres escolares del Noroeste de México y establecer la relación de ésta con el nivel socioeconómico, el peso y la talla. Se seleccionó al azar una muestra de 857 mujeres escolares de 7 a 17 años de edad, a las cuales se les determinó la edad de la menarquia por medio del método statu quo. Para la menarquia el valor encontrado fue de 12.06 ± 0.44 años, encontrándose una relación significativa con la talla (p < 0.01) y con el nivel socioeconómico (p < 0.01). En conclusión, el valor encontrado en este estudio es semejante al reportado en otras poblaciones latinoamericanas. Por otra parte, considerando que alrededor del 70 por ciento de la población mexicana tiene un nivel socioeconómico bajo, es posible que la edad de la menarquia sea el resultado de interacciones genéticas y ambientales

Immunomodulatory effects of crotoxin isolated from Crotalus durissus terrificus venom in mice immunised with human serum albumin

Crotalus durissus terrificus venom and its main component, crotoxin (CTX), have the ability to down-modulate the immune system. Certain mechanisms mediated by cells and solublefactors of the immune system are responsible for the elimination of pathogenic molecules to ensure the specific protection against subsequent antigen contact. Accordingly, weevaluated the immunomodulatory effects of CTX on the immune response of mice that had been previously primed by immunisation with human serum albumin (HSA). CTX inoculationafter HSA immunisation, along with complete Freund’s adjuvant (CFA) or Aluminium hydroxide (Alum) immunisation, was able to suppress anti-HSA IgG1 and IgG2a antibodyproduction. We showed that the inhibitory effects of this toxin are not mediated by necrosis or apoptosis of any lymphoid cell population. Lower proliferation of T lymphocytesfrom mice immunised with HSA/CFA or HSA/Alum that received the toxin wasobserved in comparison to the mice that were only immunised. In conclusion, CTX is able to exert potent inhibitory effects on humoural and cellular responses induced by HSAimmunisation, even when injected after an innate immune response has been initiated.