[FAMILY EATING HABITS AND PERCEPTION OF RISK IN EATING DISORDERS]. / ALIMENTACIÓN FAMILIAR Y PERCEPCIÓN DE RIESGO EN TRASTORNOS DE LA CONDUCTA ALIMENTARIA.

INTRODUCTION: factors related to food, shape, weight and exercise, transmitted from parents to children, and media sociocultural factors, such as social networks, also influence the development of Eating Disorders (ED). OBJECTIVES: to analyse the influence of family eating habits and the parents perception about the influence of social networks on the development and maintenance of ED. METHOD: 30 parents of ED patients participated voluntarily in this study fulfilling a series of questionnaires, as well as reporting their weight and height. RESULTS: it is observed an underestimation of weight in the case of overweight (33.33%) and obesity (35%) without considering the fact of going on diet in the future (χ2 = 11.31; p < 0.01). It must be noted that it exists an excessive consumption of meats, snacks and sweets. During weekends it is observed an increased intake of calories and sugar (p < 0.01) and cholesterol (p < 0.05), while the intake of fibre, iron, zinc and magnesium is reduced (p < 0.01). In addition, the consumption of water and bread decreases and other habits seem to be more relevant (e.g. snacking, intake of a single dish) (p < 0.05). DISCUSSION AND CONCLUSIONS: eating habits of ED patients' families improve by means of the nutrition education included in the treatment. Relatives do not perceive adequately the risk of the social networks in their children, which might contribute to the maintenance and future relapses of ED.

Introducción: los aspectos relacionados con la comida, la figura, el peso y el ejercicio físico, transmitidos de padres a hijos, y los factores socioculturales de índole mediática, como las redes sociales, pueden influir en el desarrollo de Trastornos de la Conducta Alimentaria (TCA). Objetivos: analizar la influencia de la alimentación familiar y la percepción de esta sobre la influencia de las redes sociales en el inicio y mantenimiento del TCA. Método: 30 padres de pacientes con TCA participaron voluntariamente en este estudio cumplimentando una serie de cuestionarios, y recogiéndose su peso y talla. Resultados: se observa una subestimación del peso en casos de sobrepeso (33,33%) y obesidad (25%), ya que ni siquiera se plantean realizar una dieta futura (91,67% y 25%, respectivamente) (2 = 11,31; p < 0,01). Destaca un exceso en el consumo de carnes, snacks y dulces. Durante el fin de semana hay un incremento en el consumo de kcal y azúcar (p < 0,01) y colesterol (p < 0,05), disminuyendo la ingesta de fibra, Fe, Zn y Mg (p < 0,01). Asimismo, se consume menos agua y pan, aumentando el picoteo (p < 0,01) y la frecuencia de aparición de un único plato (p < 0,05). Discusión y conclusiones: los hábitos alimentarios de estos familiares mejoran gracias a la educación nutricional incluida en el tratamiento. Los familiares no perciben adecuadamente el riesgo de las redes sociales en sus hijos, pudiendo contribuir al mantenimiento y a futuras recaídas del TCA.

[EATING HABITS, EXCESS WEIGHT AND WEIGHT SELF-PERCEPTION AT SCHOOL]. / HÁBITOS ALIMENTARIOS, SOBRECARGA PONDERAL Y AUTOPERCEPCIÓN DEL PESO EN EL ÁMBITO ESCOLAR.

INTRODUCTION: in the last years the rates of overweight and obesity in adolescents have been increasing simultaneously with a progressive abandon of the Mediterranean dietary patterns. In addition many adolescents misperceive their weight. OBJECTIVES: to analyse the prevalence of overweight/ obesity, to assess the self-perception of weight and to explore the eating habits in a child and adolescent sample. The relationship among these variables and the influence on the psychosocial wellbeing are also analysed. METHOD: a total of 87 secondary school students participated in this project. Weight and height were obtained, the self-perceived weight was assessed and a series of questionnaires were applied in order to explore the participants´ wellbeing. RESULTS: 28.73% of the sample had overweight and 9.19% obesity, 27.48% of the students misperceived their weight and only a quarter of the sample had a proper Mediterranean dietary pattern. The frequency of weight control was related positively with a higher weight perception. DISCUSSION AND CONCLUSIONS: many participants underestimated their weight and a possible association between overweight/obesity and skipping breakfast was observed. A progressive increase in the prevalence of overweight and obesity in adolescents is confirmed and the need to implement nutrition education programs after analyzing the eating habits is proposed.

Introducción: en los últimos tiempos se ha observado un aumento exponencial de las tasas de sobrepeso y obesidad en la población infanto-juvenil, a la vez que un abandono del patrón alimentario mediterráneo. Además, gran parte de la población adolescente autopercibe erróneamente su peso. Objetivos: analizar la prevalencia de exceso de peso, la autopercepción del peso y los hábitos alimentarios en una muestra infanto-juvenil. Buscar relaciones entre dichas variables y el bienestar psicosocial. Método: 87 alumnos de la ESO participaron voluntariamente en el proyecto mediante la cumplimentación de cuestionarios y la recogida de peso y talla tanto reales como autopercibidos. Resultados: un 28,73% de la muestra presentaba sobrepeso y un 9,19% obesidad. El 27,48 % del total de los encuestados autopercibía erróneamente su peso y únicamente la cuarta parte de la muestra presentó un patrón alimentario mediterráneo correcto. Se obtiene una mayor frecuencia de control del peso a medida que la autopercepción de este aumenta. Discusión y conclusiones: gran parte de la muestra subestima su peso y existe una posible asociación entre la ausencia de desayuno y mayores tasas de exceso de peso infanto-juvenil. Se observa un aumento progresivo de la prevalencia de sobrepeso y obesidad en adolescentes, así como la necesidad de implementar labores de educación nutricional tras analizar sus hábitos alimentarios.

[One year prognosis after suffering the onset of cerebrovascular disease in patients from a public hospital in Lima, Peru]. / Pronóstico al año tras sufrir el debut de enfermedad cerebrovascular en pacientes de un hospital nacional de Lima, Perú.

In Latin America, there is almost nonexistense information about the prognosis of patients with stroke. We tried to find one- year vital and functional prognosis from patients with "first-ever stroke". We did a prospective cohort study, recruiting patients in the medicine service of a public hospital, and follow them up to one year after their first-ever stroke. We collected baseline data, such as previous medical history and information about their stroke. We found mortality proportions, differences among subgroups, and compared their actual and initial functionality. We included 101 patients, 20.8% of whom died during the follow-up, with higher mortality in people over 65 years old and those severely disabled after the stroke. The functionality did not improve after one year. One out of five patients with a first-ever stroke dies a year after it, with higher mortality in elders and in people with severe disability. We conclude it is mandatory to develop a follow-up and support program to prevent unfavorable outcomes in patients who suffer stroke.

Pronóstico al año tras sufrir el debut de enfermedad cerebrovascular en pacientes de un hospital nacional de Lima, Perú / One year prognosis after suffering the onset of cerebrovascular disease in patients from a public hospital in Lima, Peru

En Latinoamérica la información del pronóstico de pacientes con enfermedad cerebrovascular (ECV) es limitada. Por ello, se buscó determinar el pronóstico vital y funcional al año, de pacientes con debut de ECV. Se desarrolló un estudio de cohorte prospectivo, con seguimiento al año a pacientes con primer evento cerebrovascular reclutados en el servicio de medicina de un hospital nacional. Se recolectó datos sociodemográficos, antecedentes patológicos e información del evento. Se halló proporciones de mortalidad, diferencias entre subgrupos y se comparó la funcionalidad inicial y al año. Se incluyó 101 pacientes, 20,8% falleció durante el seguimiento, encontrándose mayor mortalidad en los mayores de 65 años y en aquellosseveramente discapacitados tras el evento. La funcionalidad no mejoró al año. Se concluye que uno de cinco pacientes que debuta con ECV fallece al año, con mayor mortalidad en ancianos y en pacientes gravemente discapacitados. Es pertinente crear un sistema de seguimiento y soporte para prevenir evolución desfavorable en pacientes que sufren ECV.

In Latin America, there is almost nonexistense information about the prognosis of patients with stroke. We tried to find oneyear vital and functional prognosis from patients with ôfirst-ever strokeõ. We did a prospective cohort study, recruiting patients in the medicine service of a public hospital, and follow them up to one year after their first-ever stroke. We collected baseline data, such as previous medical history and information about their stroke. We found mortality proportions, differences among subgroups, and compared their actual and initial functionality. We included 101 patients, 20.8% of whom died during the follow-up, with higher mortality in people over 65 years old and those severely disabled after the stroke. The functionality did not improve after one year. One out of five patients with a first-ever stroke dies a year after it, with higher mortality in elders and in people with severe disability. We conclude it is mandatory to develop a follow-up and support program to prevent unfavorable outcomes in patients who suffer stroke.

[Three-month life prognosis and associated factors in patients with altered mental status admimtted to the emergency room of a national hospital in Peru]. / Pronóstico de vida a tres meses y factores asociados de pacientes con alteración del estado mental en emergencia de medicina de un hospital nacional en Perú

OBJECTIVES: Determine the prognosis at three months and associated factors of patients with altered mental status (AMS). MATERIALS AND METHODS: Cross-sectional study that included patients over 18 years of age admitted to the emergency room in a national hospital, with AMS, within twenty-four hours of onset and that required observation. The demographic, clinical and functional assessment information were taken from the medical record. A follow-up was made at three months by telephone. RESULTS: The study included 290 patients, representing 4.1% of the total patients in the emergency room. Overall mortality was 24.2%, whereas in the subgroup of older adults was 28.1%; 19.3% in adults and 15.2% in young adults. The average age was 63.5 years and the elderly group constituted nearly two thirds of the population. 51% were males. The average hospital stay was 7 days. The most frequently associated causes were infectious diseases (44.1%), neurological (40.3%), respiratory (28.3%), metabolic (18.6%), and cardiovascular (17.2%) disorders. Mortality was associated with a) GCS levels <7 (OR 2.9, p<0.001) and b) functionality score of 5 on the modifi Rankin scale (OR 8.2, p=0.03). CONCLUSIONS: AMS, present in 4% of emergency admissions, is associated with mortality in one in four people. The predominant cause infectious diseases. The commitment of the functionality was the main predictor of mortality.

Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study.

AIM: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. METHODS: Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. RESULTS: DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07-1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02-1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001). CONCLUSION: DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin.

Adherence to reduced-polluting biomass fuel stoves improves respiratory and sleep symptoms in children.

BACKGROUND: Symptoms of sleep apnea are markedly increased in children exposed to smoke from biomass fuels and are reduced by kitchen stoves that improve indoor biomass pollution. However, the impact of adherence to the use of improved stoves has not been critically examined. METHODS: Sleep-related symptom questionnaires were obtained from children <15 years of age in 56 families residing in the communities of Lliupapuquio, Andahuaylas province in Peru before and 2 years after installation of less-polluting Inkawasi cooking stoves. RESULTS: 82 children with lifetime exposures to indoor fuel pollution were included. When compared to those alternating between both types of stoves or those using traditional stoves only, those children who exclusively used Inkawasi cooking stoves showed significant improvements in sleep and respiratory related symptoms, but some minor albeit significant improvements occurred when both stoves were concomitantly used. CONCLUSIONS: Improvements in respiratory and sleep-related symptoms associated with elevated indoor biomass pollution occur only following implementation and exclusive utilization of improved kitchen stoves.

[Identification of tachypnea and subcostal retractions as clinical signs for the diagnosis of community-acquired pneumonia among children: systematic review and meta-analysis]. / Precisión de la taquipnea y las retracciones subcostales como signos clínicos para diagnóstico de neumonía adquirida en la comunidad en niños: revisión sistemática y metaanálisis.

OBJECTIVES: Determine whether tachypnea and subcostal retractions can be efficient predictors for the diagnosis of Community-Acquired Pneumonia (CAP) among children. MATERIALS AND METHODS: These were the databases used: PubMed, LILACS, The African Journal Database and The Cochrane Central Library. Original studies were included which assessed the diagnostic performance of the clinical criteria for tachypnea or subcostal retraction defined in accordance with the criteria of the World Health Organization (OMS) for CAP diagnosis in children ≤ 5 with cough and fever. The likelihood ratio (LR), the diagnosis odds ratio (DOR), and their respective confidence intervals at 95% (IC95%) were estimated for each clinical test. RESULTS: 975 studies were found, eight were included in the review. 4740 patients were enrolled and 3584 (75%) were analyzed, 916 (19%) of which had a CAP diagnosis. When data were combined, tachypnea had a positive LR of 3.16, (95% CI 2.11-4.73) and a negative LR of 0.36 (95% CI 0.23-0.57). The DOR was 10.63 (95% CI 4.4-25.66, I2=93%). When subcostal retractions were analyzed, a positive LR of 2.49 (95%CI 1.41-4.37) and a negative LR of 0.59 (95%CI 0.4-0.87) were obtained. The DOR was 5.32 (95%CI 1.88-15.05, I2=89%). CONCLUSIONS: The presence or absence of tachypnea and subcostal retractions can be used in CAP diagnosis; it is worth considering the relative uncertainty in its diagnostic power and relatively modest LR. The confidence of these results is low due to the inadequate quality of the related evidence.

[Secondary vasculitis to infection by Fasciola hepatica]. / Vasculitis secundaria a infección por Fasciola hepática.

There is a case of a 38 year-old male patient coming from an area where hepatic fascioliasis is endemic in Peru. He was hospitalized because he showed 4 weeks of symptoms like fever, intense myalgias, erythematous and painful injuries on limb extensions. The electromyography and nerve conduction velocity showed a global inflammatory myopathy. A skin biopsy showed polyarteritis nodosa-type vasculitis. During the evaluation process prior to the immunosuppressive therapy, hepatic Fasciola eggs were found in the parasitological examination of stools. The fascioliasis diagnosis was confirmed by fas2-ELISA: 0.46 (VN <0.20). Clinical symptoms started to subside after treatment with ticlabendazol. Contact with the patient was maintained for a year and there was no evidence of disease recurrence, and he was asymptomatic.

Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study.

BACKGROUND: Depressive disorders are leading contributors to burden of disease in developing countries. Research aiming to improve their diagnosis and treatment is fundamental in these settings, and psychometric tools are widely used instruments to support mental health research. Our aim is to validate and compare the psychometric properties of the Spanish versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Zung Self-Rating Depression Scale (ZSDS). METHODOLOGY/PRINCIPAL FINDINGS: A Spanish version of the CES-D was revised by 5 native Spanish speaking psychiatrists using as reference the English version. A locally standardized Spanish version of the ZSDS was used. These Spanish versions were administered to 70 patients with a clinical diagnosis of DSM-IV Major Depressive Episode (MDE), 63 without major depression but with clinical diagnosis of other psychiatric disorders (OPD), and 61 with no evidence of psychiatric disorders (NEP). For both scales, Cronbach's alpha (C-α) and Hierarchical McDonald Omega for polychoric variables (MD-Ω) were estimated; and receiver operating characteristics (ROC) analysis performed. For the CES-D and ZSDS scales, C-α was 0.93 and 0.89 respectively, while MD-Ω was 0.90 and 0.75 respectively. The area under the ROC curve in MDE+OPD was 0.83 for CES-D and 0.84 for ZSDS; and in MDE+NEP was 0.98 for CES-D and 0.96 for ZSDS. Cut-off scores (co) for the highest proportions of correctly classified (cc) individuals among MDE+OPD were ≥29 for CES-D (sensitivity (ss) = 77.1/specificity (sp) = 79.4%/(cc) = 78.2%) and ≥47 for ZSDS (ss = 85.7%/sp = 71.4%/cc = 78.9%). In the MDE+NEP, co were ≥24 for the CES-D (ss = 91.4%/sp = 96.7%/cc = 93.9%) and ≥45 for the ZSDS (ss = 91.4%/sp = 91.8%/cc = 91.6%). CONCLUSION: Spanish versions of the CES-D and ZSDS are valid instruments to detect depression in clinical settings and could be useful for both epidemiological research and primary clinical settings in settings similar as those of public hospitals in Lima, Peru.

Precisión de la taquipnea y las retracciones subcostales como signos clínicos para diagnóstico de neumonía adquirida en la comunidad en niños: revisión sistemática y metaanálisis / Identification of tachypnea and subcostal retractions as clinical signs for the diagnosis of community-acquired pneumonia among children: systematic review and meta-analysis

Objetivos. Evaluar si la taquipnea y las retracciones subcostales son predictoras eficientes para el diagnóstico de neumonía adquirida en la comunidad (NAC) en niños. Materiales y métodos. Se revisaron las bases de datos: PubMed, LILACS, The African Journal Database y The Cochrane Central Library. Se incluyeron estudios originales que evaluaron el rendimiento diagnóstico de los criterios clínicos de taquipnea o retracciones subcostales, definidos según los criterios de la Organización Mundial de la Salud (OMS) para el diagnóstico de NAC en niños de hasta cinco años de edad con tos y fiebre. Se estimaron las razones de probabilidades (LR), el odds ratio diagnostico (DOR) y sus respectivos intervalos de confianza al 95% (IC95%) para cada prueba clínica evaluada. Resultados. Se encontraron 975 estudios, incluyendo ocho en la revisión. Se enrolaron 4740 pacientes y analizaron 3584 (75%), de los cuales 916 (19%) tuvieron el diagnóstico de NAC. Al combinar los datos, la taquipnea obtuvo una LR positiva de 3,16, (IC95% 2,11-4,73) y una LR negativa de 0,36 (IC95% 0,23-0,57). El DOR fue de 10,63 (IC95% 4,4-25,66, I2=93%). Al realizar el análisis para retracciones subcostales se obtuvo un LR positivo de 2,49 (IC95% 1,41-4,37) y un LR negativo de 0,59 (IC95% 0,4-0,87). El DOR fue de 5,32 (IC95% 1,88-15,05, I2=89%). Conclusiones. Se puede tomar en cuenta la presencia o ausencia de taquipnea y retracciones subcostales en el diagnóstico de NAC, cabe considerar la incertidumbre relativa en su poder diagnóstico y los LR relativamente modestos. La confianza en estos resultados es baja por la inadecuada calidad de la evidencia en este tema.

Objectives. Determine whether tachypnea and subcostal retractions can be efficient predictors for the diagnosis of Community-Acquired Pneumonia (CAP) among children. Materials and methods. These were the databases used: PubMed, LILACS, The African Journal Database and The Cochrane Central Library. Original studies were included which assessed the diagnostic performance of the clinical criteria for tachypnea or subcostal retraction defined in accordance with the criteria of the World Health Organization (OMS) for CAP diagnosis in children ≤ 5 with cough and fever. The likelihood ratio (LR), the diagnosis odds ratio (DOR), and their respective confidence intervals at 95% (IC95%) were estimated for each clinical test. Results. 975 studies were found, eight were included in the review. 4740 patients were enrolled and 3584 (75%) were analyzed, 916 (19%) of which had a CAP diagnosis. When data were combined, tachypnea had a positive LR of 3.16, (95% CI 2.11-4.73) and a negative LR of 0.36 (95% CI 0.23-0.57). The DOR was 10.63 (95% CI 4.4-25.66, I2=93%). When subcostal retractions were analyzed, a positive LR of 2.49 (95%CI 1.41-4.37) and a negative LR of 0.59 (95%CI 0.4-0.87) were obtained. The DOR was 5.32 (95%CI 1.88-15.05, I2=89%). Conclusions. The presence or absence of tachypnea and subcostal retractions can be used in CAP diagnosis; it is worth considering the relative uncertainty in its diagnostic power and relatively modest LR. The confidence of these results is low due to the inadequate quality of the related evidence.

Vasculitis secundaria a infección por Fasciola hepática / Secondary vasculitis to infection by Fasciola hepatica

Se presenta el caso de un paciente varón de 38 años, procedente de una zona endémica para fascioliasis hepática en el Perú. Fue hospitalizado por presentar un cuadro de cuatro semanas de evolución; con fiebre, mialgias intensas, lesiones eritematosas y dolorosas en las regiones de extensión de las extremidades. La electromiografía y la velocidad de conducción nerviosa mostraron una miopatía inflamatoria global. La biopsia de piel evidenció una vasculitis de tipo poliarteritis nodosa. En el proceso de evaluación previa a la terapia inmunosupresora, se hallaron huevos de Fasciola hepática en el examen coproparasitológico. El diagnóstico de fascioliasis se confirmó con fas2-ELISA: 0,46 (VN <0,20). El cuadro clínico remitió luego del tratamiento con ticlabendazol. Se mantuvo contacto con el paciente durante un año y no se evidenció recurrencia de la enfermedad, manteniéndose asintomático.

There is a case of a 38 year-old male patient coming from an area where hepatic fascioliasis is endemic in Peru. He was hospitalized because he showed 4 weeks of symptoms like fever, intense myalgias, erythematous and painful injuries on limb extensions. The electromyography and nerve conduction velocity showed a global inflammatory myopathy. A skin biopsy showed polyarteritis nodosa-type vasculitis. During the evaluation process prior to the immunosuppressive therapy, hepatic Fasciola eggs were found in the parasitological examination of stools. The fascioliasis diagnosis was confirmed by fas2-ELISA: 0.46 (VN <0.20). Clinical symptoms started to subside after treatment with ticlabendazol. Contact with the patient was maintained for a year and there was no evidence of disease recurrence, and he was asymptomatic.

[Fulminant myocarditis and acute gastroenteritis due to Coxsackie virus B6]. / Miocarditis fulminante y enfermedad diarreica aguda por Coxsackie virus B6.

We present the case of a young woman who suffered cardiogenic due to by Coxsackie virus B6. The patient attended a private clinic with an acute gastroenteritis and after one hour of receiving hydratation,she developed hypotension and shock, severe hypoxemia and bilateral lung infiltrate. The patient entered the Intensive Care Unit, where she received hemodynamic support. Due to the clinical picture and cardiac enzymes increase, a cardiac failure was suspected and the echocardiographic findings suggested "myocarditis". The evolution was successful and Coxsackie B6 virus infection diagnosis was made during the follow up by increase of the levels of antibodies for virus Coxsackie B6.

Miocarditis fulminante y enfermedad diarreica aguda por Coxsackie virus B6 / Fulminant myocarditis and acute gastroenteritis due to Coxsackie virus B6

Presentamos el caso de una paciente joven que presentó choque cardiogénico por virus Coxsakie B6. La paciente acudió a una clínica particular con un cuadro clínico compatible con gastroenterocolitis aguda a la que después de una hora de estar recibiendo hidratación y manejo del cuadro diagnosticado, se agregó hipotensión que llegó al estado de choque, hipoxemia severa y compromiso pulmonar bilateral intersticial por lo que ingresó a Unidad de Cuidados Intensivos, donde recibió manejo de soporte. Debido al cuadro clínico y elevación de enzimas cardiacas se sospechó de compromiso cardiaco, la ecocardiografía evidenció cambios sugerentes de miocarditis. La evolución fue favorable y se le pudo dar de alta después de una semana. El diagnóstico etiológico del cuadro se hizo en el seguimiento, presentando serología con elevación de títulos para virus Coxsakie B6.

We present the case of a young woman who suffered cardiogenic due to by Coxsackie virus B6. The patient attended a private clinic with an acute gastroenteritis and after one hour of receiving hydratation,she developed hypotension and shock, severe hypoxemia and bilateral lung infiltrate. The patient entered the Intensive Care Unit, where she received hemodynamic support. Due to the clinical picture and cardiac enzymes increase, a cardiac failure was suspected and the echocardiographic findings suggested "myocarditis". The evolution was successful and Coxsackie B6 virus infection diagnosis was made during the follow up by increase of the levels of antibodies for virus Coxsackie B6.

Elevada frecuencia de dislipidemia y glucemia basal alterada en una población Peruana de altura / High frequency of dyslipidemia and impaired fasting glycemia in a high altitude Peruvian population

Se realizó un estudio transversal en la comunidad altoandina de Lari (3600 msnm) en Arequipa, Perú. Se evaluó el índice de masa corporal (IMC), niveles de glucosa y perfil de lípidos en 74 pobladores mayores de 18 años. La edad promedio fue de 51,7 ± 18,0 años, 62,2 por ciento fueron mujeres, el IMC promedio fue de 25,6 ± 3,7. Se encontró una prevalencia de hipercolesterolemia de 40,6 por ciento, "HDL anormalmente bajo" en 77 por ciento de la población (93,5 por ciento en mujeres frente a 50 por ciento en varones; p<0,001) y niveles elevados de LDL en el 71,7 por ciento. La prevalencia de glucemia basal alterada fue del 27 por ciento y valores de glucosa >126 mg/dL de 1,3 por ciento. En conclusión, esta población altoandina tiene niveles elevados de glucemia basal alterada en ayunas, hipercolesterolemia y HDL anormalmente bajo. Se deben tomar en cuenta estos hallazgos para realizar intervenciones en poblaciones de altura para evitar futuras complicaciones cardiovasculares.

We performed a cross sectional study in Lari (3600 m), a highland rural community from Arequipa, Peru. We evaluated a body mass index (BMI), glycemia and lipid profile in 74 over 18 year persons. The mean age was 51.7 ± 18.0 years, 62.2 percent were women, mean of BMI was 25.6 ± 3.7. Prevalence of hypercholesterolemia was 40.6 percent, "low HDL" in 77 percent of the population (93.5 percent in women vs 50 percent in men, p <0.001) and elevated level of LDL was 71.7 percent. The prevalence of impaired fasting glycemia was 27 percent. In conclusion, we found high prevalence of impaired fasting glycemia, hypercholesterolemia and especially "low HDL" in high altitude rural natives. These findings must be considered to realize interventions in high altitude populations to avoid future cardiovascular complications.

[High frequency of dyslipidemia and impaired fasting glycemia in a high altitude Peruvian population]. / Elevada frecuencia de dislipidemia y glucemia basal alterada en una población Peruana de altura.

We performed a cross sectional study in Lari (3600 m), a highland rural community from Arequipa, Peru. We evaluated a body mass index (BMI), glycemia and lipid profile in 74 over 18 year persons. The mean age was 51.7 ± 18.0 years, 62.2% were women, mean of BMI was 25.6 ± 3.7. Prevalence of hypercholesterolemia was 40.6%, "low HDL" in 77% of the population (93.5% in women vs 50% in men, p <0.001) and elevated level of LDL was 71.7%. The prevalence of impaired fasting glycemia was 27%. In conclusion, we found high prevalence of impaired fasting glycemia, hypercholesterolemia and especially "low HDL" in high altitude rural natives. These findings must be considered to realize interventions in high altitude populations to avoid future cardiovascular complications.

Analysis of the association of preeclampsia with polymorphisms of the INS, INSR and IRS1 genes in Mexican women.

BACKGROUND/AIMS: It has been proposed that preeclampsia is a metabolic syndrome of pregnancy. The polymorphisms PstI and MaeIII of INS, NsiI of INSR and Ala513Pro and Gly972Arg of IRS1 have been associated with metabolic syndrome; moreover, the products of these genes are functionally contiguous during insulin signaling. The aim of this study was to assess whether these polymorphisms are associated with preeclampsia. METHODS: 46 normotensive pregnant women and 43 preeclamptic patients were included in the study to develop a clinical, biochemical and genotypic profile of preeclampsia. Clinical evaluation consisted of measurement of blood pressure, height and weight. Peripheral blood samples were collected for determination of fasting glucose and insulin concentrations and for extraction of genomic DNA. Proteinuria was determined. Polymorphisms were detected using PCR-RFLP. RESULTS: The normotensive and preeclampsia groups did not differ significantly in clinical and biochemical traits, except for systolic and diastolic blood pressure (p < 0.0001). Polymorphisms previously associated with metabolic syndrome in Mexican populations were not associated with preeclampsia in Mexican women (p > 0.05). CONCLUSION: The lack of an association between preeclampsia and the polymorphisms studied suggests that other genes whose products do not have direct functional interaction with metabolic syndrome or epigenetic factors may play a role in preeclampsia.

El estado periodontal y la higiene bucal en los pacientes cardiópatas del Policlínico Plaza de la Revolución / The periodontal state and the oral hygiene in cardiopathy patients at Plaza de la Revolución Polyclinic

La enfermedad periodontal se relaciona con las enfermedades cardiovasculares, ya que los microorganismos del surco gingival y de las bolsas periodontales pueden agravar el inicio y curso de estas afecciones cardiovasculares. Se efectuó un estudio descriptivo y transversal, a una muestra no probabilística de 210 cardiópatas del Policlínico Plaza de la Revolución en el mes de febrero del 2003, a los que se les aplicó el índice de higiene bucal revisado (IHB-R) de Greene y Vermillion, y el índice periodontal revisado de Russell (IP-R). Las variables del estudio fueron: la edad, el sexo, el estado periodontal y el grado de higiene bucal. Se pudo constatar que el 91 por ciento de estos pacientes presentó algún grado de afección periodontal, y fueron los adultos jóvenes los de mayor prevalencia en cuanto a enfermedad gingival crónica, con el 83,3 por ciento. La gravedad de las periodontopatías aumentó con la edad; no hubo diferencias significativas en canto al sexo. Solo el 8 por ciento de estos pacientes tuvo buena higiene bucal; en el grupo estudiado predominó la higiene deficiente. Se evidenció que a medida que la higiene bucal fue más deficiente, el grado de afección periodontal aumentó, por lo cual resulta importante aplicar medidas preventivo-curativas, para mejorar la salud periodontal y así disminuir los riesgos en este grupo de pacientes dispensarizados(AU)

The periodontal disease is related to the cardiovascular diseases, since the microorganisms of the gingival sulcus and of the periodontal pockets may aggravate the beginning and the course of these cardiovascular affections. A descriptive and cross-sectional study was conducted in a non-probabilistic sample of 210 cardiopathy patients of Plaza de la Revolución Polyclinic in February 2003. They were applied the revised oral higiene index (R-OHI) of Greene and Vermillion, and the revised periodontal index of Russell (R-PI).The following variables were studied: age, sex, periodontal state, and oral hygiene degree. It was confirmed that 91 percent of these patients presented some periodontal affection degree, and that the young adults had the highest prevalence of chronic gingival disease, accounting for 83.3 percent. The severity of the periodontopathies increased with age. There were no significant differences by sex. Only 8 percent of these patients had a good oral hygiene. The inadequate hygiene prevailed in the studied group. It was evidenced that as the oral hygiene was more deficient, the degree of periodontal affection grew. That's why, it is important to take preventive and curative measures to improve the periodontal health and to reduce the risks in this group of categorized patients(AU)