Estudios clinicos controlados aleatoreos, en la pediatria de Latino America ( 1996-2005) / Randomized controlled trials in pediatric Latin America (1996-2005)

Los estudios controlados aleatoreos (ECR) están entre los métodos más adecuados para evaluar la efectividadde intervenciones en Salud, pero hay grandes dificultades para efectuar este tipo de investigaciones en Latino América. Objetivo: Analizar la producción de ECR en países de Latino América en niños o adolescentes, en el período 1996-2005.

El zinc en la salud humana -1 / Zinc in human health - I

Zinc Is a divalent cation with multiple functions In the human body. Zinc absorption occurs In the small Intestine and, together with zinc excretion via feces, is the point of control for zinc homeostasis. Zinc Is an essential nutrient with a specific role In more than 300 enzymes, which participate In all Important biochemical reactions of the human body. Therefore, zinc status has a direct effect In growth, neurological and behavioral development and In the Immune system. The diagnosis of zinc deficiency In Individuals Is difficult given that there Is still no Indicator with adequate sensitivity. Nevertheless, It Is acceptable to use serum zinc to evaluate populations. Finally, Intervention strategies such as supplementation, food fortification and/or dietary modification can be used to control and/or prevent zinc deficiency.

El zinc es un catión divalente con múltiples funciones en el cuerpo humano. La absorción de zinc ocurre en el intestino delgado y es junto con la excreción de zinc vía heces, los puntos de control de la homeostasis de zinc. El zinc es un nutriente esencial con un rol específico en más de 300 enzimas, las cuales participan en todas las reacciones bioquímicas importantes del cuerpo humano. Por ende, el estado de zinc tiene un efecto directo en el crecimiento, el desarrollo neurológico y de comportamiento y en el sistema inmune. El diagnóstico de deficiencia de zinc en individuos no es posible pues aun no existe un marcador lo suficientemente sensible. Sin embargo, el zinc sérico es aceptable para evaluar a poblaciones. Finalmente, se pueden usar las estrategias de suplementación, fortificación y/o modificación alimentaria para controlar y/o prevenir la deficiencia de zinc.

El zinc en la salud humana - II / Zinc in human health - II

Zinc is a divalent cation with multiple functions in the human body. Zinc absorption occurs in the small intestine and is, together with its excretion via faeces, the point of control for zinc homeostasis. Zinc is an essential nutrient with a specific role in more than 300 enzymes, which participate in all important biochemical reactions of the human body. Therefore, zinc status has a direct effect in growth, neurological and behavioral development and in the immune system. The diagnosis of zinc deficiency in individuals is not yet possible given that there still is no indicator with adequate sensitivity. Nevertheless, it is acceptable to use serum zinc levels to evaluate populations. Finally, intervention strategies such as supplementation, food fortification and/or dietary modification can be used to control and/or prevent zinc deficiency.

El zinc es un catión divalente con múltiples funciones en el cuerpo humano. La absorción de zinc ocurre en el intestino delgado y es junto con la excreción de zinc por las heces, uno de los dos puntos de control de la homeostasis de zinc. El zinc es un nutriente esencial con un rol específico en más de 300 enzimas, las cuales participan en todas las reacciones bioquímicas importantes del cuerpo humano. Por ende, el estado de la nutrición de zinc tiene un efecto directo en el crecimiento, el desarrollo neurológico y de comportamiento y en el sistema inmune. El diagnóstico de deficiencia de zinc en seres humanos no es posible pues aun no existe un marcador lo suficientemente sensible. Sin embargo, el zinc sérico es aceptable para evaluar poblaciones. Finalmente, se pueden usar las estrategias de suplementación, fortificación y/o modificación alimentaria para controlar y/o prevenir la deficiencia de este elemento.

Modificaciones a la leche del Programa Nacional de Alimentación Complementaria (PNAC) en Chile. 2009 / Changing the quality of milk of the National Complementary Food Program in Chile, 2009

The National Complementary Food Programs have been one of the stratregies applied for preventing the protein-energy undernutrition and some specific nutrient deficiencies, during the last decades in Chile. To provide a powdered cow's milk to the underprivileged families has been one targets for the first years of life, which includes the fortification with iron, zinc, copper and vitamin C. The evident improvement in recent years of nutritional markers (prevalence of protein- malnutrition, deficiencies of Fe, Zn and Cu) requires to reassess the Programs. Some possible ways for improving the quality of milk to be provided are discussed, on the basis of avoiding the interference of exclusive breast milk.

Los Programas de Alimentación Complementaria para enfrentar la desnutrición y carencias nutricionales específicas de la población más vulnerable, tienen varias décadas de desarrollo en Chile. La entrega de una leche de vaca en polvo (PuritaR) ha sido uno de los pilares en los primeros años de vida, estando fortificada en la última década con hierro, zinc, cobre y vitamina C. La evidente mejoría en años recientes de los indicadores nutricionales para estas edades (prevalencia de desnutrición, deficiencia de hierro, zinc y cobre) exige revisar esta parte del Programa. Se discuten aquí algunas formas de mejorar la calidad de la leche a entregar, manteniendo la premisa de no interferir con la promoción de la lactancia materna exclusiva.

Ta'ta', Huayani: perception of leishmaniasis and evaluation of medicinal plants used by the Chayahuita in Peru. Part II.

AIM OF THE STUDY: A knowledge attitude and practice study centred on leishmaniasis and its treatment was performed among the Chayahuita, an Amazonian Peruvian ethnic group living in an endemic area. This study documents traditional Chayahuita plant's use and disease concepts. Also, activity of some medicinal plants used by the Chayahuita is highlighted and discussed. MATERIALS AND METHODS: Ninety-three Chayahuita people were interviewed, following a semi-structured questionnaire focussed on disease knowledge and perception, personal attitude and healing practices. Simultaneously, a collection of plants was performed in different ecotopes, in order to make an extensive inventory of the pharmacopoeia. RESULTS: For the Chayahuita, cutaneous (CL) and muco-cutaneous leishmaniasis (MCL) are considered as diseases of their own, with specific names, aetiologies, mode of transmission. Regarding CL, Chayahuita people consider that the humid characteristic of the skin ulcer is a discriminative fact orienting the diagnostic forTa'ta' (leishmaniasis). Forty-six different species were designated useful against LC and /or MCL (29 species by means of the questionnaire and 27 species when collecting in different ecotopes). Thirty-seven extracts corresponding to 31 species used medicinally were screened in vitro against Leishmania amazonensis axenic amastigotes, assessing their viability by the reduction of tetrazolium salt (MTT). Six species displayed a good activity (10 microg/ml

Evaluation of the leishmanicidal activity of plants used by Peruvian Chayahuita ethnic group.

AIM OF THE STUDY: A total of 27 ethanolic plant extracts from 27 species were screened for leishmanicidal activity in vitro against Leishmania amazonensis. Most of the selected species (19) are traditionally used by the Chayahuitas, an Amazonian Peruvian ethnic group, to treat skin affections and/or leishmaniasis. MATERIAL AND METHODS: A colorimetric method based on the reduction of tetrazolium salt (MTT) was used to measure the viability of Leishmania amazonensis promastigote and amastigote stages. RESULTS AND CONCLUSIONS: Only the leaves of two species of the Piperaceae family (Piper hispidum Sw., and Piper strigosum Trel.) showed good leishmanicidal activities (IC(50)<10 microg/ml against amastigotes). Roots of Tabernaemontana sananho Ruiz & Pav. (Apocynaceae), together with bark of Vismia tomentosa Ruiz & Pav. (Clusiaceae), fruits of Solanum straminifolium var straminifolium Jacq. (Solanaceae), and stems of Zamia lindenii Regel ex André (Cycadaceae) showed low activity against amastigote stage (IC(50) around 50 microg/ml). Of those only Tabernaemontana sananho displayed also good activity on promastigotes (IC(50)<10 microg/ml). Results are discussed herein, in relation with the traditional use of the plants and compared with other data from the relevant literature.

Spirolactone iridoids might be responsible for the antileishmanial activity of a Peruvian traditional remedy made with Himatanthus sucuuba (Apocynaceae).

Extracts of seven medicinal plants used specifically against cutaneous leishmaniasis in the Madre de Dios region of Peru were evaluated in vitro against promastigote and axenic amastigote forms of Leishmania amazonensis. One of them showed interesting leishmanicidal activities (IC(50)=5 microg/ml in amastigotes). Bio-guided isolation of the stem bark's ethanol extract of Himatanthus sucuuba (Spruce ex Müll. Arg.) Woodson (Apocynaceae) afforded the spirolactone iridoids isoplumericin and plumericin. The latter showed a reduction of macrophage infection similar to that of the reference drug Amphotericin B (IC(50)=0.9 and 1 microM, respectively). These findings validate the traditional use of Himatanthus sucuuba in the treatment of cutaneous leishmaniasis (Uta) in Peru.

Alimentación del niño menor de 2 años: recomendaciones de la rama de nutrición de la Sociedad Chilena de Pediatría / Alimentation in children under 2 years: recommendations of the nutritional section of the Chilean Pediatric Society

Los patrones de alimentación adquiridos durante los primeros años son importantes en el crecimiento y desarrollo y pueden afectar las preferencias alimentarias en etapas posteriores. Los problemas nutricionales en Chile han cambiado en los últimos años, la prevalencia de obesidad infantil ha aumentado. Por otro lado, con la información científica disponible los organismos internacionales han propuesto modificaciones a los requerimientos de energía y de otros nutrientes para las distintas edades. Este artículo actualiza y propone nuevas recomendaciones de alimentación para población chilena durante los primeros dos años de vida.

Evaluation of the effectiveness of Rosmarinus officinalis (Lamiaceae) in the alleviation of carbon tetrachloride-induced acute hepatotoxicity in the rat.

The effect of oral administration of Rosmarinus officinalis L. (Lamiaceae) on CCl(4)-induced acute liver injury was investigated. Rats were daily treated with the plant extract at a dose of 200 mg/kg corresponding to 6.04 mg/kg of carnosol as determined by reverse phase high-performance liquid chromatography. The treatment was initiated 1 h after CCl(4) administration and Rosmarinus officinalis fully prevented CCl(4) effect on hepatic lipid peroxidation after 24 h of CCl(4) administration. The increase in bilirubin level and alanine aminotransferase activity in plasma induced by CCl(4) was completely normalized by Rosmarinus officinalis. The treatment also produced a significant recovery of CCl(4)-induced decrease in liver glycogen content. CCl(4) did not modify the activity of liver cytosolic glutathione S-transferase (GST) compared with that of control groups. However, Rosmarinus officinalis increased liver cytosolic GST activity and produced an additional increment in plasma GST activity in rats treated with CCl(4). Histological evaluation showed that Rosmarinus officinalis partially prevented CCl(4)-induced inflammation, necrosis and vacuolation. Rosmarinus officinalis might exert a dual effect on CCl(4)-induced acute liver injury, acting as an antioxidant and improving GST-dependent detoxification systems.

Wernicke's syndrome after bariatric surgery.

Two young females with severe morbid obesity presented with Wernicke's syndrome after Roux-en-Y gastro-jejunum bypass had been performed. The first patient had recurrent vomiting and dyplopia two months post-surgery. Physical examination indicated bilateral ophthalmoparesia with conserved convergence and ataxia. The second patient had frequent vomiting episodes over the previous three months together with lower limb hypotonia, myoclonia and generalised tonicoclonic seizures on two occasions within one year of surgery. In both cases routine blood test, ion levels (sodium, potassium, calcium, phosphates), electroencephalogram and CT scan were normal. Thiamine therapy was instigated on the basis of clinical intuition and the first patient achieved complete remission within 24 hours while the second improved gradually in that two years later only mild lower limb hypotonia and a slight cognitive deficit remains. Erythrocyte transketolase activity determinations were abnormal on two separate occasions for this second patient. Vitamin B1 determinations were not available for the first patient. In conclusion, the restriction in energy intake and the persistent vomiting together with malabsorption induced by the surgical intervention could explain the vitamin deficiency causing Wernicke's encephalopathy. This indicates a need for close monitoring and systematic vitamin supplementation in those patients who undergo bariatric surgery.

Inhibition of hepatic cell nuclear DNA fragmentation by zinc in carbon tetrachloride-treated rats.

BACKGROUND/AIMS: The aims of this study were to ascertain: 1) whether hepatic cell DNA fragmentation is increased in rats with early stages of liver disease induced by carbon tetrachloride; 2) whether the inhibition of DNA cleavage is involved in the hepatoprotective effects of zinc; and 3) if relationships exist between DNA fragmentation and the onset of fibrosis in this experimental model. METHODS: Twenty-one treated rats and 23 controls were divided into two groups to receive either a standard diet or one supplemented with zinc. All the animals were sacrificed 1 week later for histological and biochemical assessments, which included a DNA fragmentation index, hepatic zinc and metallothionein concentrations, fibrosis measured by hepatic hydroxyproline concentration and plasma alanine aminotransferase activity. RESULTS: Hepatic cell DNA fragmentation was increased in rats with early hepatic fibrosis and the increase was independent of hepatocytolysis, as measured by alanine aminotransferase activity. Oral zinc administration inhibited hepatic cell DNA fragmentation in the treated rats and was proportional to the hepatic concentration of the metal. The mechanism of the zinc-mediated decrease in DNA cleavage was related to an increase in the hepatic metallothionein concentration. Hepatic cell DNA fragmentation was related to hydroxyproline concentration. CONCLUSIONS: Our results suggest that apoptosis may be involved in the early transformations occurring in the liver and which can lead to the initiation of cirrhosis. As such, the potential therapeutic use of zinc supplementation would warrant further investigation.

Traumatismos duodenales / Duodenal traumas

Aunque los traumatismos abdominales constituyen un importante motivo de consulta en servicios de urgencia, las lesiones duodenales son relativamente infrecuentes, constituyendo un verdadero desafío diagnóstico y terapéutico para médicos y cirujanos de urgencia. A pesar de las modernas técnicas de reanimación; de los cuidados intensivos de pacientes críticos y de prácticas quirúrgicas expertas, las lesiones duodenales se siguen asociando a elevada morbimortalidad. Se presenta una revisión actualizada del tema, tratando aspectos relevantes a su cuadro clínico, clasificación, diagnóstico y tratamiento. Finalmente se revisan brevemente algunos aspectos de la fístula duodenal, que constituye la complicación más temida de estos traumatismos

Diagnóstico bacteriológico de un caso de botulismo infantil y primer aislamiento de C. botulinum en Chile / Bacteriological diagnosis of an infant botulism case and first isolation of C. botulinum in Chile

En noviembre de 1994 se recibió, en el Laboratorio de Anaerobicos del Instituto de Salud Pública de Chile, una muestra de deposición de una lactante de dos meses de edad con el diagnóstico presuntivo de botulismo infantil. La muestra fus sembrada en los medios de cultivo correspondientes y en atmósfera anaerobia hasta obtener un cultivo puro. Este fue sometido a diferentes pruebas bioquímicas, las cuales fueron coincidentes con Clostridium botulinum grupo I. POsteriormente se procedió a confirmar el diagnóstico realizando el test de patogenicidad y neutralización en ratones CF-1. En base a los resultados observados se concluyó que la cepa aislada correspondía a clostridium botulinum grupo I tipo A, lo cual fue confirmado por el Centers for Disease Control de Atlanta. Este fue el primer aislamiento de C. botulinum a partir de una muestra clínica en Chile