Psoriasis induced by antiTNF therapy in inflammatory bowel disease: Therapeutic management and evolution of both diseases in a nationwide cohort study.

BACKGROUND: some patients with inflammatory bowel disease (IBD) treated with antiTNF develop drug-induced psoriasis (antiTNF-IP). Several therapeutic strategies are possible. AIMS: to assess the management of antiTNF-IP in IBD, and its impact in both diseases. METHODS: patients with antiTNF-IP from ENEIDA registry were included. Therapeutic strategy was classified as continuing the same antiTNF, stopping antiTNF, switch to another antiTNF or swap to a non-antiTNF biologic. IP severity and IBD activity were assessed at baseline and 16, 32 and 54 weeks. RESULTS: 234 patients were included. At baseline, antiTNF-IP was moderate-severe in 60 % of them, and IBD was in remission in 80 %. Therapeutic strategy was associated to antiTNF-IP severity (p < 0.001). AntiTNF-IP improved at week 54 with all strategies, but continuing with the same antiTNF showed the worst results (p = 0.042). Among patients with IBD in remission, relapse was higher in those who stopped antiTNF (p = 0.025). In multivariate analysis, stopping antiTNF, trunk and palms and soles location were associated with antiTNF-IP remission; female sex and previous surgery in Crohn´s disease with IBD relapse. CONCLUSION: skin lesions severity and IBD activity seem to determine antiTNF-IP management. Continuing antiTNF in mild antiTNF-IP, and swap to ustekinumab or switch to another antiTNF in moderate-severe cases, are suitable strategies.

Influence of familial forms of inflammatory bowel disease on the use of immunosuppressants, biological agents, and surgery in the era of biological therapies. Results from the ENEIDA project.

BACKGROUND AND AIMS: Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era. METHODS: Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes. RESULTS: A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31 months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC. CONCLUSIONS: In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.

Clinical Presentation, Management, and Evolution of Lymphomas in Patients with Inflammatory Bowel Disease: An ENEIDA Registry Study.

An increased risk of lymphoma has been described in patients with inflammatory bowel disease (IBD). The aims of our study were to determine the clinical presentation, the previous exposure to immunosuppressive and biologic therapies, and the evolution of lymphomas in patients with IBD. IBD patients with diagnosis of lymphoma from October 2006 to June 2021 were identified from the prospectively maintained ENEIDA registry of GETECCU. We identified 52 patients (2.4 cases of lymphoma/1000 patients with IBD; 95% CI 1.8-3.1). Thirty-five were men (67%), 52% had ulcerative colitis, 60% received thiopurines, and 38% an anti-TNF drug before lymphoma diagnosis. Age at lymphoma was lower in those patients treated with thiopurines (53 ± 17 years old) and anti-TNF drugs (47 ± 17) than in those patients not treated with these drugs (63 ± 12; p < 0.05). Five cases had relapse of lymphoma (1.7 cases/100 patient-years). Nine patients (17%) died after 19 months (IQR 0-48 months). Relapse and mortality were not related with the type of IBD or lymphoma, nor with thiopurines or biologic therapies. In conclusion, most IBD patients had been treated with thiopurines and/or anti-TNF agents before lymphoma diagnosis, and these patients were younger at diagnosis of lymphoma than those not treated with these drugs. Relapse and mortality of lymphoma were not related with these therapies.

Long-Term Outcomes of Biological Therapy in Crohn's Disease Complicated With Internal Fistulizing Disease: BIOSCOPE Study From GETECCU.

INTRODUCTION: The prevalence of penetrating complications in Crohn's disease (CD) increases progressively over time, but evidence on the medical treatment in this setting is limited. The aim of this study was to evaluate the effectiveness of biologic agents in CD complicated with internal fistulizing disease. METHODS: Adult patients with CD-related fistulae who received at least 1 biologic agent for this condition from the prospectively maintained ENEIDA registry were included. Exclusion criteria involved those receiving biologics for perianal disease, enterocutaneous, rectovaginal, anastomotic, or peristomal fistulae. The primary end point was fistula-related surgery. Predictive factors associated with surgery and fistula closure were evaluated by multivariate logistic regression and survival analyses. RESULTS: A total of 760 patients from 53 hospitals (673 receiving anti-tumor necrosis factors, 69 ustekinumab, and 18 vedolizumab) were included. After a median follow-up of 56 months (interquartile range, 26-102 months), 240 patients required surgery, with surgery rates of 32%, 41%, and 24% among those under anti-tumor necrosis factor, vedolizumab, or ustekinumab, respectively. Fistula closure was observed in 24% of patients. Older patients, ileocolonic disease, entero-urinary fistulae, or an intestinal stricture distal to the origin of the fistula were associated with a higher risk of surgery, whereas nonsmokers and combination therapy with an immunomodulator reduced this risk. DISCUSSION: Biologic therapy is beneficial in approximately three-quarters of patients with fistulizing CD, achieving fistula closure in 24%. However, around one-third still undergo surgery due to refractory disease. Some patient- and lesion-related factors can identify patients who will obtain more benefit from these drugs.

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn's Disease Patients: The SUSTAIN Study.

BACKGROUND: Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn's disease (CD) patients in real-world clinical practice. METHODS: A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. RESULTS: A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). CONCLUSIONS: Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice.

This large retrospective study demonstrated the short- and long-term effectiveness and safety of ustekinumab in patients with Crohn's disease in real-world clinical practice, including those with refractory disease.

Determinants of early antibody responses to COVID-19 mRNA vaccines in a cohort of exposed and naïve healthcare workers.

BACKGROUND: Two doses of mRNA vaccination have shown >94% efficacy at preventing COVID-19 mostly in naïve adults, but it is not clear if the second dose is needed to maximize effectiveness in those previously exposed to SARS-CoV-2 and what other factors affect responsiveness. METHODS: We measured IgA, IgG and IgM levels against SARS-CoV-2 spike (S) and nucleocapsid (N) antigens from the wild-type and S from the Alpha, Beta and Gamma variants of concern, after BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) vaccination in a cohort of health care workers (N=578). Neutralizing capacity and antibody avidity were evaluated. Data were analyzed in relation to COVID-19 history, comorbidities, vaccine doses, brand and adverse events. FINDINGS: Vaccination induced robust IgA and IgG levels against all S antigens. Neutralization capacity and S IgA and IgG levels were higher in mRNA-1273 vaccinees, previously SARS-CoV-2 exposed, particularly if symptomatic, and in those experiencing systemic adverse effects (p<0·05). A second dose in pre-exposed did not increase antibody levels. Smoking and comorbidities were associated with 43% (95% CI, 19-59) and 45% (95% CI, 63-18) lower neutralization, respectively, and 35% (95% CI, 3-57%) and 55% (95% CI, 33-70%) lower antibody levels, respectively. Among fully vaccinated, 6·3% breakthroughs were detected up to 189 days post-vaccination. Among pre-exposed non-vaccinated, 90% were IgG seropositive more than 300 days post-infection. INTERPRETATION: Our data support administering a single-dose in pre-exposed healthy individuals as primary vaccination. However, heterogeneity of responses suggests that personalized recommendations may be necessary depending on COVID-19 history and life-style. Higher mRNA-1273 immunogenicity would be beneficial for those expected to respond worse to vaccination and in face of variants that escape immunity such as Omicron. Persistence of antibody levels in pre-exposed unvaccinated indicates maintenance of immunity up to one year. FUNDING: This work was supported by Institut de Salut Global de Barcelona (ISGlobal) internal funds, in-kind contributions from Hospital Clínic de Barcelona, the Fundació Privada Daniel Bravo Andreu, and European Institute of Innovation and Technology (EIT) Health (grant number 20877), supported by the European Institute of Innovation and Technology, a body of the European Union receiving support from the H2020 Research and Innovation Programme. We acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the "Centro de Excelencia Severo Ochoa 2019-2023" Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. L. I. work was supported by PID2019-110810RB-I00 grant from the Spanish Ministry of Science & Innovation. Development of SARS-CoV-2 reagents was partially supported by the National Institute of Allergy and Infectious Diseases Centers of Excellence for Influenza Research and Surveillance (contract number HHSN272201400008C). The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.

Conocimientos, prácticas y valoraciones sobre manipulación de alimentos en hospitales públicos bonaerenses, Argentina, 2020 / Knowledge, practices, and appraisals on food handling in public hospital of Buenos Aires province, Argentina, 2020

INTRODUCCIÓN: La manipulación de alimentos dentro del ámbito hospitalario juega un papel crucial en la cadena causal de enfermedades transmitidas por alimentos. Actualmente no existe información sobre conocimientos, prácticas y valoraciones de los manipuladores de alimentos a nivel local. El objetivo de este estudio fue evaluar a los manipuladores de alimentos de hospitales públicos de la provincia de Buenos Aires y su asociación con características sociodemográficas, laborales y de capacitación. MÉTODOS: Se realizó un estudio transversal analítico. Se envió una encuesta virtual a los hospitales públicos de la provincia para que fuera distribuida a todos los manipuladores de alimentos. Se relevaron datos sociodemográficos, laborales y de capacitación. Se evaluaron conocimientos y prácticas mediante preguntas de opción múltiple y se indagaron valoraciones personales sobre su trabajo. RESULTADOS: La encuesta fue completada por 561 manipuladores de 56 hospitales. Más del 80% había recibido algún tipo de capacitación. El 22,9% presentó conocimientos suficientes y el 15,3%, prácticas adecuadas. La valoración de prácticas adecuadas se asoció a mayor antigüedad, servicios tercerizados y a la realización de 5 o más capacitaciones en servicio. La escasez de elementos de trabajo y la infraestructura inadecuada fueron las principales barreras. DISCUSIÓN: La realización de capacitaciones en servicio y la presencia de personal con mayor antigüedad podrían mejorar la manipulación de alimento.

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry.

BACKGROUND: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. METHODS: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. RESULTS: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. CONCLUSIONS: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response.

Economic Evaluation of Combining Pharmaco- and Behavioral Therapies for Smoking Cessation in an Occupational Medicine Setting.

OBJECTIVE: To estimate the budget impact (BI) of funding pharmaco+behavioral therapies for smoking cessation from an employer perspective. METHODS: A hybrid economic model was applied to estimate the BI, which considered up to four cessation attempts over a 3-year horizon. The model estimated the costs of funding a cessation programme, and the mean savings due to avoided loss of productivity and absenteeism because of smoking cessation. RESULTS: 53.8% of smokers quit smoking. The programme, which costs &OV0556;394,468, would generate earnings of &OV0556;1,342,133; with &OV0556;644,974 in incremental net savings. These mean &OV0556;1.64 in return per each euro invested. Results show net benefits from two cigarettes smoked while working every day. CONCLUSIONS: Considering the avoided costs of loss of productivity and absenteeism, funding a smoking cessation programme of pharmaco+behavioral therapies would produce substantial savings for the employer.

The increasing importance of environmental conditions in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is the most common neurodegenerative disease affecting motor neurons (MNs). Although a small percentage of ALS has a familial origin, the vast majority of cases are sporadic in which genetic factors and environment interact with each other leading to disease onset in genetically predisposed individuals. In the current model of the disease, each individual has a determined genetic load, some degree of cell degeneration related to age and several risky environmental exposures. In this scenario, MN degeneration would occur when the sum of these factors reach a certain threshold. To date, an extensive list of environmental factors has been associated to ALS, including different categories, such as exposure to heavy metals and other toxicants, cyanotoxins or infectious agents. In addition, in recent years, lifestyle and other demographic parameters are gaining relevance in the genesis of the disease. Among them, physical activity, nutrition, body mass index, cardiovascular risk factors, autoimmune diseases and cancer are some of the conditions which have been related to the disease. In this review, we will discuss the potential mechanisms of environmental conditions in motor neuron degeneration. Understanding the role of each one of these factors as well as their interactions appears as a crucial step in order to develop new preventive, diagnostic and therapeutic approaches for ALS patients.

A novel RMRP mutation in a Spanish patient with cartilage-hair hypoplasia.

Cartilage-hair hypoplasia (CHH), or McKusick type metaphyseal chondrodysplasia, was first recognized as a distinct entity in the Old Order Amish in the USA, but was later identified in other groups, and found to be unusually frequent among Finns. CHH is highly pleiotropic with manifestations that include short stature, defective cellular immunity and predisposition to several cancers. CHH is caused by mutations in the RNA component of RNase MRP (RMRP, ribonuclease mitochondrial RNA processing) and is transmitted as an autosomal recessive trait. In the present work, a Spanish CHH patient was extensively characterized at the immunological and molecular DNA level. Several parameters of cellular and humoral immunity were analyzed in this patient: lymphocyte subpopulation, proliferative responsiveness in mitogen stimulation and quantification of serum immunoglobulins. Sequencing of the RMRP gene allowed identification of two mutations in the patient: a +4 C>T substitution previously described on one allele, and a duplication of 15 nucleotides at position -11 on the other allele. This mutation has not previously been described.

Intoxicación aguda por carbamazepina: tratamiento por hemoperfusión y hemofiltración / Acute carbamazepine poisoning: treatment by means of hemoperfusion and hemofiltration

Intoxicación Aguda por Carbamazepina: Tratamiento por hemoperfusión y hemofiltración. Las intoxicaciones accidentales o intencionales por fármacos son una consulta habitual en Emergencia y origen de frecuentes ingresos en Unidades de Cuidados Intensivos. El manejo del paciente intoxicado involucra un equipo multidisciplinario donde el nefrólogo puede formar parte por las repercusiones de la intoxicación en sí y/o en la recuperación del tóxico de la sangre. El uso de las técnicas de depuración extracorpóreas en intoxicaciones ha sido muy limitado y depende de la severidad y farmacocinética del tóxico involucrado. La hemoperfusión con carbón activado ha sido de las técnicas más utilizadas en estos casos, así como la hemodiálisis convencional, pero hay escasos datos del uso de técnicas continuas como la hemofiltración en el tratamiento de intoxicaciones exógenas. En esta comunicación se analiza un paciente que presenta dos severos episodios de intoxicación intencional con Carbamazepina, en uno de los cuales se intentó la recuperación del fármaco con hemoperfusión con carbón activado con buenos resultados y en el segundo episodio se realizó hemofiltración. Se discute la farmacocinética del fármaco involucrado y las características de las técnicas utilizadas así como posibles indicaciones de cada una de ellas en este tipo de intoxicaciones

Factores clínicos en la progresión de la insuficiencia renal crónica / Clinical factors concerning progression of chronic kidney insufficiency

Se estudia la influencia de distintos factores clínicos en la progresión (pr) de la insuficiencia renal crónica (IRC), revisando retrospectivamente la historia clínica de 65 pacientes (ptes) con IRC desde una creatininemia (PCr) inicial (i) de 3.2 + 1.01 mg por ciento hasta su ingreso en hemodiálisis (38 hombres, 27 mujeres; edad 50.6+15.6 años; seguimiento de 38.2+26.6 meses).Se definió la progresión por la pendiente -b de la regresión lineal (rg) de los valores de 1/PCr en relación al tiempo (t) y se controló la linearidad de esa relación por un método estadístico que detecta puntos de quiebre en la rg.La rg de 1/PCr-t describió adecuadamente la progresión en 47 ptes (grupo A) y mal en 18 (grupo B).En el grupo A la progresión no varió según el sexo, PCri, medio asistencial (público o privado), tipo de nefropatía o frecuencia de controles de policlínica.Hubo mayor progresión en los ptes con presión arterial (PA) media (PAM) de toda la evolución (PAMt) mayor de 120 mmHg respecto a los de PAMt inferior a 100 mmHg (p< 0.05) y correlación (r: 0.36) entre la PAM luego de los 5 mg por ciento de PCr y la progresión de la IRC, lo que se confirmó en análisis multivariado. Hubo más ptes hipertensos en el grupo A que en el grupo B (p< 0.05). Nuestro estudio confirmala relación directa entre hipertensión arterial y progresión de la IRC

Utilización nutricional de una dieta baja en proteína, en ratas diabéticas por aloxana / Nutritional utilization of a low protein diet in alloxan diabetic rats

Considerando la influencia que el control de la dieta ejerce en el curso de la diabete, se estudió en ratas diabéticas por aloxana, las variaciones que en la utilización nutricional de la proteína tiene el aporte de dos niveles de este sustrato en la dieta [12%(lote 1) y 4%(lote2)]. cada lote se dividió a su vez en dos grupos: A) testigo y B) diabético. Se determinaron parámetros ponderales, ingesta, coeficientes de eficicencia alimentaria (CEA), de eficiencia digestiva (CED), y de utilización metabólica (CUM) así como la razón N retenido/N ingerido y glucemia al principio y final del experimento. Se observó una disminución en el peso, CEA, CED, y CUM en las ratas testigo del lote 2, frente a las del lote 1. La diabetes experimental produjo una elevación en el CEA en los animales del lote 1. Asimismo, en el lote 2 el peso y el CEA disminuyeron mientras aparecía un incremento en la ingesta y el CED, frente a los animales testigo del lote 2. La glucemia se agudizó en las ratas diabéticas, en contraste con las testigo, y en las ratas tratadas que ingerían la dieta baja en proteína, en relación a las alimentadas con la dieta control. Los datos sugieren una modulación, tanto de la utilización nutricional como del estado diabetógeno, por efecto de la cantidad de proteína ingerida en nuestras condiciones experimentales

Influencia del nivel proteinico dietario sobre el patron electroforetico y los niveles de IgG e IgM plasmaticos en ratas gestantes y sus neonatos / Influence of dietary protein level on electrophoretic pattern and IgG and IgM levels in plasma of pregnant rats and their offspring

En vista de la influencia que los estados nutricional y fisiológico tienen sobre la capacidad inmunológica del individuo, se llevó a cabo un estudio de las modificaciones que inducen tres niveles de proteína en la dieta: 4%, 10% (control) y 20% sobre la tasa de inmunoglobulinas G y M plasmáticas, así como los niveles de proteínas totales en plasma (PPT) y sus fracciones, en ratas no gestantes (NG) y gestantes (G) y sus neonatos. Efecto de la dieta en ratas adultas - En ratas no gestante aparece un incremento en la tasa de Ig G por acción de la dieta alta en proteína. Los niveles de PPT disminuyen con las dietas alta y baja en proteína. En animales G disminuyen ambas Ig con las dos dietas experimentales (4% y 20%), mientras la tasa de PPT se incrementa a medida que aumenta la cantidad de proteína ingerida. Efecto de la gestación - Los niveles de Ig G e Ig M se elevan con las dietas del 4% y 10%. Sin embargo, estos niveles sufren un descenso cuando las ratas ingieren la dieta del 20% de proteína. La tasa de PPT desciende con el déficit proteínico dietario y aumenta con la dieta más alta en proteína. Efecto de la dieta en neonatos - Los niveles de Ig M sólo se detectaron en la progenie de ratas alimentadas con las dietas alta y baja en proteína. Por su parte, la tasa de PPT se incrementa en función directa de la ingesta proteínica dietaria

Efectos aditivos de la malnutrición proteínica y del cortisol en las proteínas plasmáticas e inmunoglobulinas de ratas gestantes, y sus neonatos / Additive effects of protein malnutrition and cortisol on plasma proteins and immunoglobulins of pregnant rats, and their affsprings

La presente investigación se llevó a cabo con el objeto de determinar las consecuencias de la adición de dos mecanismos inmunosupresores: malnutrición proteínica y cortisol, en la unidad materno-fetal. Se estudiaron así los niveles plasmáticos de Ig G e Ig M en ratas gestantes malnutridas y tratadas con cortisol (0.5 mg/100 g de peso) durante la gestación, así como en sus neonatos. Por otro lado y con el fin de evaluar el estado nutricional, se determinaron también los parámetros ponderales, juntamente con las proteínas plasmáticas y sus fracciones en las madres y en sus crías. El déficit nutricional plasmáticas en las madres y en sus neonatos. El cortisol disminuyó los parámetros ponderales en los animales control e incremento las proteínas plasmáticas en el grupo malnutrido. Al parecer, la malnutrición protepinica determina una menor funcionalidad delos linfocitos B, puesto que se produjo un descenso en las tasa de Ig G e Ig M plasmáticas. Sin embargo, la Ig M neonatal se incrementó, lo que aparentemente pudo ser consecuencia de la aparición de infecciones concomitantes. Por su parte, el cortisol indujo una deficiencia inmune humoral, tanto en las ratas madres control como en las malnutridas, con descenso en los niveles plasmáticos de Ig G e IG M. No obstante, la hormona pareció aumentar la susceptibilidad a la infección en lso recién nacidos, especialmente en los procedentes de madres malnutridas, ya que en estas condiciones se suscitó un aumento de Ig G e Ig M

Nivel proteínico dietario durante la gestación: su influencia sobre el reparto materno-fetal de sustratos / Dietary protein level during pregnancy: its influence on maternal-fetal exchange of substrates

En vista de la influencia que la concentración proteínica de la dieta materna tiene en el desarrollo del proceso gestacional y sus consecuencias sobre el crecimiento neonatal, se estudiaron, en ratas, las variaciones que el aporte de distintos niveles de proteína dietaria, 10%, 4% y 20% durante la gestación, ejerce en la eficiencia de utilización del alimento y en el reparto materno-fetal de sustratos. Con este propósito, se hicieron comparaciones entre las tres situaciones dietarias, y el efecto de la gestación se observó comparando las ratas gestantes con las no gestantes, con cada una de las dietas sometidas a estudio. Se determinó la ingesta, parámetros ponderales y eficiencia de conversión alimentaria (ECA) en ratas adultas, así como los parámetros ponderales de los neonatos. Según se pudo apreciar, tanto en los animales gestantes como en los no gestantes la ECA varió en función directa a la cantidad de proteína ingerida, mientras que durante la gestación se elevó en todas las situaciones dietarias. Por otra parte, la variabilidad ponderal de madres y neonatos, consecutiva a los cambios de proteína en la dieta, afectó también el reparto materno-fetal de sustratos. Este último fue modificado en los animales sometidos a las dietas que contenían 4% y 20% de proteína, dando lugar a una retención de sustratos en los tejidos maternos, en perjuicio del desarrollo neonatal