[Analysis of hospital technical efficiency during 2011]. / Análisis de la eficiencia técnica hospitalaria 2011.

BACKGROUND: Efficiency in the use of resources in health systems and hospitals has been a matter of interest for administrators as well as for policy makers. The growing costs due to higher levels of demand from the population require a better use and allocation of such costs. AIM: To assess the technical efficiency in 28 hospitals in Chile, considering the period from May to October, 2011. MATERIAL AND METHODS: The average number of available beds, the number of staff and the expenses on consumer and service goods were used as production inputs and, on the other hand, the expenditures adjusted by the Diagnosis-Related Groups (IR-DRG) were used as producís. To assess the technical efficiency, the Data Envelopment Analysis technique was used. RESULTS: The levéis of inefficiency fluctuóte from 20 to 23.3%. In other words, with a 20% increase in hospital discharges and maintaining fixed inputs, hospitals could become efficient. CONCLUSIONS: The incorporation of methodologies to determine efficiency allows gathering new knowledge for people who manage resources as well as for policy makers by optimizing practices and having better allocation criteria.

[Analysis of hospital efficiency determinants in Chile]. / Análisis de los determinantes de la eficiencia hospitalaria: el caso de Chile.

BACKGROUND: The knowledge of variables influencing hospital efficiency is of paramount importance to carry out initiatives of management improvement and optimization. AIM: To explore on the hospital technical efficiency factors. MATERIAL AND METHODS: Data from 255,439 hospital discharges from 28 hospitals from May to October 2011 were analyzed. The efficiency index developed by Santelices et al was calculated. Proxy variables of hospital practices, human resource productivity, strategic performance, financing mechanisms, geographical territory and specialization, were considered. The analysis was carried out estimating econometric models. RESULTS: The most significant variables to explain efficiency are the length of stay adjusted by complexity, the discharges per nurse and midwife and the performance of the Hospital Balancea Score Card. CONCLUSIONS: The suggested analysis contributes to identify hospital efficiency causes. The results suggest ways to improve performance of hospitals.

Chromatin Immunoprecipitation of Low Number of FACS-Purified Epidermal Cells.

Chromatin immunoprecipitation followed by sequencing (ChIP-seq) is a method designed to detect interactions between chromatin and the proteins bound to it. This method has been widely used for characterizing epigenetic landscapes in many cell types; however, a limiting factor has been the requirement of a high number of cells. Here, we describe a protocol for ChIP in epidermal cells from a newborn mouse, purified by fluorescence-activated cell sorting (FACS). This protocol has been optimized specifically for prefixed, low cell numbers, resulting in enough immunoprecipitated DNA suitable for genome-wide analysis.

Geomorphology applied to landscape analysis for planning and management of natural spaces. Case study: Las Batuecas-S. de Francia and Quilamas natural parks, (Salamanca, Spain).

Geomorphology is fundamental to landscape analysis, as it represents the main parameter that determines the land spatial configuration and facilitates reliefs classification. The goal of this article is the elaboration of thematic maps that enable the determination of different landscape units and elaboration of quality and vulnerability synthetic maps for landscape fragility assessment prior to planning human activities. For two natural spaces, the final synthetic maps were created with direct (visual-perceptual features) and indirect (cartographic models and 3D simulations) methods from thematic maps with GIS technique. This enabled the creation of intrinsic and extrinsic landscape quality maps showing sectors needing most preservation, as well as intrinsic and extrinsic landscape fragility maps (environment response capacity or vulnerability towards human actions). The resulting map shows absorption capacity for areas of maximum and/or minimum human intervention. Sectors of high absorption capacity (minimum need for preservation) are found where the incidence of human intervention is minimum: escarpment bottoms, fitted rivers, sinuous high lands with thick vegetation coverage and valley interiors, or those areas with high landscape quality, low fragility and high absorption capacity, whose average values are found across lower hillsides of some valleys, and sectors with low absorption capacity (areas needing most preservation) found mainly in the inner parts of natural spaces: peaks and upper hillsides, synclines flanks and scattered areas. For the integral analysis of landscape, a mapping methodology has been set. It comprises a valid criterion for rational and sustainable planning, management and protection of natural spaces.

[Analysis of obstetric-pediatric care in the perinatal period. Are births before 31 weeks' gestation in level 2B maternity units avoidable?] / Analyse des parcours de soins en périnatalité. Les naissances avant 31 SA en maternité de type 2B sont-elles évitables ?

INTRODUCTION: Regionalization of perinatal care has been developed to improve the survival of preterm babies. The mortality rate is higher among very premature infants born outside level-3 maternity units. The objective of this study was to evaluate the preventability of these very premature births occurring outside recommendations within level-2B maternity units. The secondary objective was to describe the care of premature infants between 23 and 24 weeks. METHODS: This is a single-center retrospective qualitative study of the care delivery pathways. Thirty-one deliveries in which the fetus was alive between 23 and 30 weeks+6 days occurred in a level-2B maternity unit in Thionville, France, between 1 January 2013 and 31 December 2015. After oral presentation of the cases, a level 2-3 multidisciplinary committee of experts in Lorraine evaluated the preventability criteria and reasons, and divided the deliveries into three groups: (i) birth in level-2B institutions avoidable, (ii) inevitable with factors related to the mother or the organization of care, (iii) with no inevitable factors. RESULTS: Out of the 31 deliveries included, the committee classified six deliveries as preventable, 14 as inevitable with factors, and 11 as inevitable with no factors. The criteria for preventability of birth in a level-2B unit were underestimation of maternal and fetal risk, an erroneous initial estimate of term or preterm labor, and two births in the upper limits of the French recommendations for in utero transfer. Nineteen of the 35 premature infants before 31 weeks' gestation died, 16 children were transferred to a level-3 maternity ward, and 16 children were allowed to go home. CONCLUSION: Analysis of the obstetrical-pediatric care course by an expert committee determined the preventability of the average birth and prematurity in level-2B maternity units in Lorraine for a small but significant number of cases. The local regionalization of neonatal care could be improved by the application of this method of analysis to other maternity wards in the Lorraine network.

[Intraoperative transesophageal echocardiography to guide removal of a hypernephroma with vena cava and right atrial extension]. / Ecocardiografía transesofágica intraoperatoria en el manejo de resección de hipernefroma con compromiso de vena cava y aurícula derecha.

We describe the case of a 70-year-old man who underwent resection of a right hypernephroma with vena caval and right atrial extension with continuous monitoring by transesophageal echocardiography. The monitoring technique brought important advantages, providing images that facilitated anatomical and functional evaluation of cardiac structures without obstructing the surgical field. Images of the heart and great vessels obtained in real time allowed the surgeon to make operative decisions based on accurate assessment of the cephalad extension of the tumor to the right chambers. Transesophageal echocardiography also allowed the anesthesiologist to monitor hemodynamic status throughout surgery and watch for tumoral emboli. The imaging technique proved to be highly useful for both anesthetic and surgical management of the patient.

COVID 19 y embarazo en Chile: Informe preliminar del estudio multicéntrico GESTACOVID / COVID-19 and pregnancy in Chile: preliminary report of the GESTACOVID multicenter study

INTRODUCCIÓN: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. MÉTODOS: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. RESULTADOS: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5-6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3-7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 - 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. CONCLUSIONES: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.

INTRODUCTION: In Chile, effects of the SARS-CoV-2 infection in pregnant women are unknown. GESTACOVID is a multicenter collaborative study including pregnant women and those in the postpartum period (until 42 days) who have had COVID-19. The purpose of this study is to report our preliminary results describing the clinical impact of COVID-19 in pregnant women, the associated risk factors and perinatal results. METHODS: Descriptive cohort study including 661 patients between April 7th and July 6th, 2020, in 23 hospitals. Demographical, comorbidities, clinical and diagnostic characteristics of COVID-19 disease and maternal and perinatal outcomes were analyzed. RESULTS: Pregnant women with COVID-19 admitted to the hospital were more likely to have chronic hypertension [10% vs 3%; OR=3.1 (1.5-6.79); p=0,003] and diabetes type 1 and 2 [7% vs 2%; OR=3.2 (1.3-7.7); p=0.009] than those with outpatient management. A body mass index of >40 kg/mt2 was associated with two-fold higher risk of hospitalization [OR=2.4 (1.2-4.6); p=0.009]. Almost half of patients (54%) were delivered by cesarean section, and 8% of the medically indicated deliveries were due to COVID-19. So far, 38% of the patients are still pregnant. Among 316 newborns, there were 21 positive PCR tests (6.6%), mostly from asymptomatic mothers undergoing universal screening. CONCLUSIONS: Pregnant women with COVID-19 and comorbidities such as diabetes, chronic hypertension and morbid obesity need a close follow up and should be a matter for further research. Vertical transmission of COVID-19 should be thoroughly studied to define the mechanisms and type of infection involved.

The efficacy of the lactational amenorrhea method (LAM) among working women.

The purpose of this study was to assess the efficacy of the lactational amenorrhea method (LAM) for family planning among mothers who are separated from their infants by work. The study population, 170 urban middle class women who planned to return to work before 120 days postpartum, were interviewed monthly for 6 months postpartum and contacted at 12 months. The study population received clinical support for expressing their milk and exclusively breast-milk feeding the infants and for the use of LAM for birth spacing. The cumulative life table pregnancy rate by 6-month was 5.2%, with 3 pregnancies, one at each of months 4, 5, and 6. LAM for working women, as described in this article, might be associated with a higher pregnancy risk than LAM use among non-working women. Therefore, women using LAM should be informed that separation from the infant might increase their risk of pregnancy.

Sister-chromatid exchange frequencies induced by metrifonate in mammalian in vivo and in vitro systems.

Metrifonate is a drug widely used to cure several helminthiases in man including cysticercosis. In this study we determine its capacity to induce SCEs in vivo and in vitro using the fluorescence-plus-Giemsa technique. In the human lymphocyte system we tested 10, 20, 30, 40, 50 and 60 micrograms/ml added at 24 h of culture with a duration of 72 h. The results showed a SCE inducing effect with the exception of the first tested dose (10 micrograms/ml), but without a dose-response expression. A cell cycle progression delay was seen with the three highest dosages. In the mouse bone marrow we tested 30, 60 and 120 mg/kg in a 24-h experiment, and the results indicated an SCE increase only with the highest dose. No modification of the cell proliferation kinetics was observed.

Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?

A control/intervention study carried out in Santiago, Chile assessed the impact of five interventions on breastfeeding patterns and duration, and demonstrated a significant increase in full breastfeeding at six months (32 percent to 67 percent). Fifty-nine of 422 post-intervention women were included in a sixth intervention: prenatal group educational sessions emphasizing the skills necessary to initiate and maintain breastfeeding past the neonatal period. A significantly higher percentage of this subset of women were fully breastfeeding at six months compared to those who received only the five basic interventions (80 percent and 65 percent, respectively). The effect was greater among primiparous women. We conclude that prenatal group education with hands-on skills reinforcement is a significant and additive component of breastfeeding support, especially among those who have no previous breastfeeding experience.

The effects on professional practices of a three-day course on breastfeeding.

This study assessed reported changes in clinical breastfeeding support practices following a three-day (approximately 24 hour) course. The course, presented at the Catholic University in Santiago, Chile, included the physiology of lactation and lactational infertility, related policy, clinical skills, the Lactational Amenorrhea Method (LAM), and program-related findings. A questionnaire was sent to all participants and an additional systematic sample was telephoned to assure a statistically valid sample. Sixty-nine percent of respondents reported changes in clinical practices resulting from attendance at the course. The results support the concept, now being advanced by the Baby-Friendly Hospital Initiative, that an 18-24 hour course can change clinical practices.

Hot sand burns on the sole of a patient with diabetes.

A patient with diabetes who burnt his feet by walking on hot sand was treated with an amorphous hydrogel, which resulted in full wound healing within four weeks. These patients should avoid walking barefoot on sand whenever possible.

[Chronic atrophic gastritis, hypergastinemia and gastric carcinoid tumor]. / Gastritis crónica atrófica, hipergastrinemia y tumor carcinoide gástrico.

We report a case of a gastric carcinoid tumor in an anemic woman with chronic atrophic gastritis and hypergastrinemia. An antrectomy with excision of a carcinoid tumor was performed; afterwards, gastrinemia was normal. Gastric carcinoids were considered uncommon gastric cancers; however, in recent years they have been studied with increasing interest because, as in chronic atrophic gastritis, it has been suggested that they might be produced by prolonged hypergastrinemia associated with therapeutic use of gastric acid supressors. We discuss the gastrin hypothesis, the different clinical types of gastric carcinoids and its therapeutical management.

[Massive fetomaternal transfusion after induction of labor by oxytocin]. / Transfusion foetomaternelle massive au décours de l'induction du travail par ocytocique.

UNLABELLED: Severe fetomaternal transfusions are seldom, but may lead to neonatal morbidity or death. CASE REPORT: We report a case of lethal fetomaternal transfusion in which a failure to induce labour, at term, can be suspected. COMMENTS: We emphasize the need of a close monitoring of the fetal well-being in cases of failed induced labour at term.

Sulfonylurea receptor 1 contributes to the astrocyte swelling and brain edema in acute liver failure.

Astrocyte swelling (cytotoxic brain edema) is the major neurological complication of acute liver failure (ALF), a condition in which ammonia has been strongly implicated in its etiology. Ion channels and transporters are known to be involved in cell volume regulation, and a disturbance in these systems may result in cell swelling. One ion channel known to contribute to astrocyte swelling/brain edema in other neurological disorders is the ATP-dependent, nonselective cation (NCCa-ATP) channel. We therefore examined its potential role in the astrocyte swelling/brain edema associated with ALF. Cultured astrocytes treated with 5 mM ammonia showed a threefold increase in the sulfonylurea receptor type 1 (SUR1) protein expression, a marker of NCCa-ATP channel activity. Blocking SUR1 with glibenclamide significantly reduced the ammonia-induced cell swelling in cultured astrocytes. Additionally, overexpression of SUR1 in ammonia-treated cultured astrocytes was significantly reduced by cotreatment of cells with BAY 11-7082, an inhibitor of NF-κB, indicating the involvement of an NF-κB-mediated SUR1 upregulation in the mechanism of ammonia-induced astrocyte swelling. Brain SUR1 mRNA level was also found to be increased in the thioacetamide (TAA) rat model of ALF. Additionally, we found a significant increase in SUR1 protein expression in rat brain cortical astrocytes in TAA-treated rats. Treatment with glibenclamide significantly reduced the brain edema in this model of ALF. These findings strongly suggest the involvement of NCCa-ATP channel in the astrocyte swelling/brain edema in ALF and that targeting this channel may represent a useful approach for the treatment of the brain edema associated with ALF.

Carcinoma de células escamosas de piel: serie de casos / Carcinoma of squamous cells of skin: series of cases

Resumen Introducción: El cáncer de células escamosas (CCE) es el segundo cáncer de piel más frecuente. Sin embargo, no hay publicaciones en Chile sobre el tema. Objetivo: Investigar características sociodemográficas y clínicas del CCE en la Región de Coquimbo, Chile. Material y Métodos: Serie de casos de pacientes con diagnóstico de CCE de piel tratados en el hospital de Coquimbo, entre enero de 2006 y diciembre de 2015. Criterios de inclusión: diagnóstico histológico definitivo de CCE de piel. Criterio de exclusión: 1.- seguimiento posoperatorio menor de 12 meses; 2.- operado en otro hospital; 3.- sometido a otro tratamiento previo a la cirugía; 4.- metástasis cutáneas de un CCE mucoso; 5.- CCE con metástasis a distancia. Variables independientes: edad, género, localización, tamaño, linfonodos comprometidos, residencia costera-interior. Variables dependientes: recurrencia, factores de recurrencia, letalidad. Análisis estadístico: descriptivo y analítico con el programa SSPS. Resultados: Se registraron 2.202 casos de cáncer de piel, 1.487 basocelular (67,5%), 181 melanomas (8,2%) y 534 CCE (24,2%). 236 pacientes tienen datos completos y constituyen el informe, 153 hombres (64,8%) y 83 mujeres (35,2%). Edad: 75,5 años ± 11,7 (extremos 46-94). La localización es: cabeza 158 casos (66,9%), otras áreas expuestas 47 (20%) y no expuestas 31 (14,1%). En cabeza la localización más frecuente es mejilla 40 casos (25%), frente 29 casos (12,3%). En 119 casos (50,4%) el cáncer se presenta ulcerado y en 117, no ulcerado (49,6%); diámetro del tumor 22 milímetros (rango 3-100 mm). En 10 casos hay linfonodos clínicos (4,2%). En 12 casos (5,9%) se extirpa LNC, 2 positivos. 201 casos presentan bordes histológicos libres (85,2%) y en 35 casos, borde comprometido (14,8%). Tasa de recurrencia local 8,5% (20 casos) y ganglionar 2,1% (5 casos). Recidiva del cáncer se asocia a borde histológico comprometido: P = 0,001, IC 95% 3,12-12,19 y ulceración p = 0,01, OR 4,63; IC 1,59-13,50. Seguimiento de 36 meses (rango 12-228). Letalidad 2,56%. Conclusión: El CCE de piel extirpado precozmente con confirmación histológica de erradicación tiene buen pronóstico.

Introduction: Squamous skin cancer (SSC) is the second most frequent skin cáncer, nevertheless reports about this issue are not published in Chile. Objetive: To investigate social, demographics, and clinic characteristics of SSC in semidesertic Coquimbo Region, Chile. Material and Methods: serie of patients diagnosed and treated in Coquimbo hospital between January 2006 and December 2015. Inclussion criteria: 1.- histopathological confirmation of SSC. Exclusion criteria: 1.- follow up lesser than 12 months; 2.- operated in another hospital; 3.- submitted to another treatment prior to surgery; 4.- skin metastasis of mucous squamous carcinoma; 5.- patients with distant metástasis. Independent variables: age, gender, tumor site, tumor size, clinical lymph nodes, shore or valley residency. Dependent variable: recurrency frecuence, factors of recurrency, letality. Statistical analysis: descriptive and analytical by SSPS program. Results: 2.202 skin cancer cases were registered, 1.487 basal cells carcinoma (67.5%), 181 melanoma (8.2%) and 534 squamous cells carcinoma (24.2%). 236 patients with complete data are included in this report. There were 153 men (64.8%), and 83 women (35.2%). Mean age was 75.5 years old ± 11.7 (range 46-94). Primary site was: head 158 patients (66.9%), other sun exposed areas 47 patients (20%), and non exposed areas 31 patients. Cheek and front were the most frequents head site with 40 cases (25%) and 29 cases (12.3%), respectively. In 119 cases (50.4%) SCC was ulcerated, and 117 cases was not; primary tumor diameter was 22 millimeters (range 3-100). Clinical lymph nodes were primarily positives in 10 patients, (4.2%). In 12 cases with negative lymph nodes, sentinel limph node was resected. 2 were positives. Histological borders were tumor free in 201 patients (85.2%) and, 35 cases (14.8%) had positive histological borders. Local recurrence incidence was 8.5% (20 cases). Limph nodes recurrence was 2.1% (5 cases). Cancer recurrence was associated with histological positive borders P = 0.001, IC 95% 3.12-12.19, and ulcerated tumor p = 0.01, OR 4.63; IC 1.59-13.50. Letality was 2.56%. Mean follow up was 36 months (range 12-228 months). Conclusions: SSC has a good prognosis when primary tumor is resected early, with free histological borders resection.

[Congenital toxoplasmosis due to maternal reinfection during pregnancy]. / Toxoplasmose congénitale secondaire à une réinfection maternelle pendant la grossesse.

Reinfection with Toxoplasma gondii is exceptional but can lead to transmission to the fetus when it occurs during pregnancy. We present a case of congenital toxoplasmosis in a young baby born to an immunocompetent mother who had been immunized against toxoplasmosis before pregnancy. The presence of residual IgG-specific antibodies does not always mean an absolute protection against a new toxoplasma infection. During the pregnancy, the patient was advised to follow the hygienic and dietary preventive measures even though the previous test results were consistent with past toxoplasma infection.

Descripción del somatotipo y cualidades físicas de varones surfistas experimentados chilenos / Description of somatotype and physical qualities of experienced Chilean men surfers

El surf es un deporte que ha incrementado su número de adeptos en Chile. Sin embargo, existen pocos estudios que describan las características antropométricas y físicas de estos deportistas en el medio nacional. Este estudio observacional descriptivo transversal, tuvo por objetivo describir las características antropométricas y físicas de surfistas experimentados chilenos. En 15 surfistas chilenos experimentados (edad: 27,1±5,2; talla: 1,77±0,04; peso: 74,1±6,3) se evaluó el somatotipo, control postural, los saltos Squat Jump (SJ) y Counter Movement Jump (CMJ), y el consumo máximo de oxígeno (VO2 Max.). El somatotipo promedio de la muestra fue endomorfo (2,7±0,5), mesomorfo (4,6±0,7) y ectomorfo (2,3±0,6). En la prueba de estabilidad postural se obtuvo un promedio de la velocidad y de área de desplazamiento del centro de presión de 7,2±1,3 mm/seg y 68,1±18,4 mm2 respectivamente. La altura promedio de los saltos SJ fue 33,2±5,3 cm y para el CMJ 35,8±5,1 cm. La media del VO2 Max. alcanzó los 47,2±5,6 (mL·min)/kg. Esta descripción reveló que el somatotipo de la muestra fue mesomórfico balanceado y que la capacidad aeróbica de estos deportistas fue alta en relación a la población general, pero intermedia en comparación a la de deportistas. Los surfistas de la muestra no presentan un gran desarrollo de la fuerza y fuerza-explosiva de los miembros inferiores, pero poseen un buen control postural.

Surfing is a sport that has been growing rapidly in popularity throughout Chile. However, there are very few studies that describe the anthropometric and physical characteristics of these athletes in this country. The objective of this study was to describe anthropometric and physical characteristics in Chilean surfers. The study design is a descriptive observational cross study. Somatotype, postural stability, Squat Jump (SJ) and Counter Movement Jump (CMJ) and maximal oxygen uptake (VO2 max) were evaluated in 15 experienced, Chilean surfers (age: 27.1±5.2; height: 1.77±0.04; weight: 74.1±6.3). Somatotype sample average was: endomorphism: 2.7±0.5, mesomorphism: 4.6±0.7 and ectomorphism: 2.3±0.6. In postural stability test, the average of the center of pressure displacement of speed and area was 7.2±1.3 mm/sec and 68.1±18.4 mm2 respectively. The height average of the jumps was 33.2±5.3 cm for SJ and 35.8±5.1 cm for CMJ. The average of VO2 max reached 47.2±5.6 (mL·min)/kg. This description reflects the sample´s somatotype was balanced mesomorph, their aerobic capacity was high-level in relation to the general population, but is middle level in comparison to other athletes. Surfers of this sample didn´t show a large force development or explosive strength in their lower limbs and hold a good postural control.

[Gender-dependent differences in glutathione (GSH) metabolism in very preterm infants]. / Différences liées au sexe dans le métabolisme du glutathion (GSH) du grand prématuré

BACKGROUND: Gender differences in mortality and morbidity are often reported in very preterm infants. In studies aiming to understand the underlying mechanisms, better protection against oxidative stress in baby girls has been suggested. OBJECTIVES: Shortly after birth, we compared glutathione (GSH) metabolism in female and male preterm infants and its relationship with prenatal and postnatal parameters. METHODS: We took the opportunity of a prospective randomised controlled trial evaluating the safety-efficacy balance of inhaled nitric oxide (Hamon and al., 2005) [12] to assess, in vivo, the antioxidant defences within the first 48 h of life in 240 premature infants less than 32 weeks gestational age (GA). We measured total plasmatic GSH level (nmol/L), intraerythrocyte glutathione peroxidase (GPX, µmol/min/g haemoglobin) and intraerythrocyte glutathione reductase (GR, µmol/min/g haemoglobin) from venous blood samples withdrawn through central lines. RESULTS: Expressed as mean ± standard error of the mean: soon after birth (at 24h median), plasmatic GSH was not different between females (n=123) and males (n=117): 0.932 ± 0.016 vs 0.956 ± 0.012 nmol/L. However, at the same time, GPX, the enzyme involved in GSH synthesis, was at a significantly higher level in baby girls (p<0.001): 11.63 ± 0.25 vs 10.21 ± 0.24 µmol/min/g haemoglobin, as was GR, the enzyme responsible for GSH regeneration (p=0.02): 12.18 ± 0.23 vs 11.22 ± 0.21 µmol/min/g haemoglobin. We observed no significant correlation between GSH levels, GPX, or GR activities with prenatal steroids, GA, birth weight, severity of respiratory disease, and oxygen requirements for the entire population or between the two genders. CONCLUSION: Whereas the level of glutathione, a key molecule in the defence against oxidative stress in humans, appears to be identical in preterm females and males soon after birth, the enzymes involved in its synthesis (GPX) and regeneration (GR) are higher in females. SPECULATION: Study of the sequential progression of GSH, GPX, and GR with regard to prolonged oxidative stress exposure in preterm females and males is needed to better evaluate their potential clinical relevance.

Evaluación nutricional de personas con VIH/SIDA / Nutritional status of people living with HIV-AIDS

Introduction: At present, the relationship between diet, nutrition and HIV infection has been demonstrated. The scientific community recognizes that knowledge and nutritional care can help maintain health and reduce the effects of the infection. Objective: To assess the nutritional status of people living with HIV-AIDS treated in out-patient clinics of Plaza County. Subjects and Methods: A descriptive cross-sectional study in 87 people infected with HIV (66 males and 21 females). Fifty four asymptomatic infected people and 33 AIDS patients were studied. Nutritional assessment consisted of anthropometric measurements: weight, height, triceps skinfold and arm circumference to calculate the body mass index, and fat and arm muscle area; dietary assessment with frequency questionnaires and food consumption by food groups; measurement of biochemical parameters: hemoglobin, triglycerides, blood sugar and cholesterol. Values were compared with the Student t test and Spearman correlation. Results: The largest group was asymptomatic male between 30-49 years. Few cases of anemia were detected. Hypertriglyceridemia and discrete reductions in fat reserves were predominant. Half of people with AIDS presented bad eating habits. More than half presented sufficient level of knowledge and attitude. Conclusion: It is necessary to increase the attitude of these patients in relation to the care of their nutrition.

Está demostrada la relación entre la alimentación, la nutrición y la infección por VIH. La comunidad científica reconoce que los conocimientos y el cuidado nutricional pueden contribuir a mantener la salud y a disminuir los efectos de la infección. Objetivo: Evaluar el estado nutricional de las personas con VIH-sida atendidas en la consulta de descentralización del municipio Plaza. Sujetos y Métodos: Se realizó un estudio descriptivo transversal en 87 personas infectados con el VIH, 66 del sexo masculino y 21 femenino. 54 portadores asintomáticos del virus y 33 pacientes sida. La evaluación nutricional consistió en mediciones antropométricas: peso, talla, pliegue tricipital, circunferencia braquial para calcular el índice de masa muscular, área grasa y muscular del brazo; evaluación dietética con encuestas de frecuencia de consumo de alimentos y por grupo de alimentos; medición de parámetros bioquímicos: hemoglobina, triglicéridos, glicemia y colesterol. Se comparó con la prueba t de Student así como correlación de Spearman entre indicadores. Resultados: Predominaron los asintomáticos masculinos entre 30-49 años. Se detectaron pocos casos de anemia. Predominó la hipertrigliceridemia y disminuciones discretas de las reservas de grasas. La mitad de personas con sida presentó comportamiento alimentario inadecuado. Más de la mitad presentó nivel de conocimientos y actitud suficiente. Conclusión: Es necesario incrementar la actitud de estos pacientes en relación al cuidado de su nutrición.