Más allá de los límites de la disciplina con niños prematuros: una reflexión holística / Beyond the Limits of Discipline with Premature Children: A Holistic Reflection / Além dos limites da disciplina com bebés prematuros: uma reflexão holística

Introducción. En este artículo se presenta una reflexión sobre la necesidad de tener una visión holística en la problemática de la prematurez, para que los equipos del área de salud puedan tener una comprensión de la multiplicidad de factores presentes en el parto prematuro, y sus consecuencias para el menor, la madre, los familiares y el personal de salud involucrado. Tema de reflexión. El tema se sustenta en dos investigaciones realizadas con las madres, los padres y los niños beneficiarios del Programa Madre Canguro en un hospital del Estado, en dos momentos, 2012 y 2014, con algunos de los autores del presente artículo. Conclusiones. Además de la revisión de la literatura científica relacionada con el tema y la problemática, se concluye que, bajo una mirada holística, se comprende de manera integral la problemática y se propicia una mejor comunicación con los padres; con el equipo de la atención en salud, se logra un manejo transdisciplinario, superando los objetos de estudios aislados. Se da así un abordaje integrador y significativo en la cotidianidad de cada actor, desde la piel, con el Programa Madre Canguro, hasta la racionalidad de la ciencia.

Introduction. This article presents a reflection on the need for a holistic view of the problem of premature births, so that healthcare teams can understand the multiplicity of factors present in premature births, and its consequences for the minor, the mother, the family members, and the healthcare staff involved. Topic of reflection. The topic is based on two investigations carried out with mothers, fathers, and children's beneficiaries of the Mother Kangaroo Program in a State hospital, at two moments, 2012 and 2014, with some of the authors of this article. Conclusions. In addition to the review of the scientific literature related to the topic and the problem, it is concluded that, under a holistic view, the problem is understood in a comprehensive way and better communication with the parents is encouraged. With the healthcare team, cross-disciplinary handling is achieved, overcoming the objects of isolated studies. As such, there is an integrative and significant approach in the daily life of each actor, from the skin, with the Mother Kangaroo Program, to the rationality of science.

Introdução. Este artigo apresenta uma reflexão sobre a necessidade de se ter uma visão holística da problemática da prematuridade, para que as equipes da área da saúde possam ter uma compreensão da multiplicidade de fatores presentes no parto prematuro, e suas consequências para a criança, a mãe, os familiares e o pessoal de saúde envolvido. Tópico de reflexão. O tema é baseado em duas pesquisas realizadas com mães, pais e filhos beneficiários do Programa Mãe Canguru em um hospital estadual, em dois momentos, 2012 e 2014, com alguns dos autores deste artigo. Conclusões. Além da revisão da literatura científica relacionada ao tópico e ao problema, conclui-se que, sob uma visão holística, o problema é plenamente compreendido e incentiva-se uma melhor comunicação com os pais; com a equipe de saúde, consegue-se uma gestão transdisciplinar, superando os objetos de estudos isolados. Isto proporciona uma abordagem integradora e significativa no cotidiano de cada ator, desde a pele, com o Programa Mãe Canguru, até a racionalidade da ciência.

Microalgal Peloids for Cosmetic and Wellness Uses.

Peloids have been used for therapeutic purposes since time immemorial, mainly in the treatment of locomotor system pathologies and dermatology. Their effects are attributed to their components, i.e., to the properties and action of mineral waters, clays, and their biological fraction, which may be made up of microalgae, cyanobacteria, and other organisms present in water and clays. There are many studies on the therapeutic use of peloids made with microalgae/cyanobacteria, but very little research has been done on dermocosmetic applications. Such research demonstrates their potential as soothing, regenerating, antioxidant, anti-inflammatory, and antimicrobial agents. In this work, a method for the manufacture of a dermocosmetic peloid is presented based on the experience of the authors and existing publications, with indications for its characterization and study of its efficacy.

Lack of benefit with omega-3 fatty acid supplementation in HIV patients: A randomized pilot study.

Objective: To assess the effect of omega-3 polyunsaturated fatty acids (n-3 PUFA) supplementation on bone metabolism in HIV-infected patients presenting with hypertriglyceridemia.Methods: Patients were randomized 1:1 to receive 2 g of n-3 PUFA or fenofibrate (FF). The primary endpoint was % change in bone mineral density (BMD) from baseline to month 24 in lumbar spine (LS) and femoral neck (FN). Secondary endpoints were changes in Z-score, calcitriol, calcitonin, parathyroid hormone, osteocalcin, and C-terminal telopeptide of type I collagen (CTX-I) at 12 and 24 months. Differences in continuous variables were evaluated using the t test or Mann-Whitney U-test for independent samples and differences in means of intra- and inter-subject continuous variables using a general linear model. Categorical variables were compared by the chi-squared or Fisher's exact test.Results: 30 patients were included in each arm; 23 in the n-3 PUFA arm and 22 in the FF arm completed follow-up. No significant differences between arms were observed after 24 months in either region (FN: -12.51% ± 7.89 in the n-3 PUFA arm and -8.18% ± 7.72 in the FF arm, p = .07; LS: 2.94% ± 6.63 in the n-3 PUFA arm, -3.07% ± 16.85 in the FF arm, p = .07), although the BMD reduction in the FN region after 24 months was noticeable in both arms (n-3 PUFA: -12.51% ± 7.89%, p =< .001; FF: -8.183% ± 7.72%, p =< .001). There was a significant difference in calcitriol changes between arms after 96 weeks. No differences in Z-score or bone turnover markers were observed between the two arms.Conclusions: Omega-3 fatty acid supplementation resulted in no beneficial changes in BMD or bone turnover markers. n-3 PUFA supplementation achieved similar reductions in triglyceride levels as FF.

Association between cognitive function and supplementation with omega-3 PUFAs and other nutrients in ≥ 75 years old patients: A randomized multicenter study.

A few studies have assessed the association between omega-3 polyunsaturated fatty acids (n-3 PUFA) and cognitive impairment (CI) in very old adults. The aim of this study was to evaluate the effect of a multinutrient supplementation rich in n-3 PUFA on the cognitive function in an institutionalized ≥75-year-old population without CI or with mild cognitive impairment (MCI). A multicenter placebo-controlled double-blind randomized trial was conducted between 2012 and 2013. Cognitive function was assessed at baseline and after one year using 4 neuropsychological tests. Nutritional status was assessed using Mini Nutritional Assessment (MNA). Interaction between Mini-Mental State Examination (MMSE) score and nutritional status were analyzed using linear regression models. A total of 99 participants were randomized to receive placebo or pills rich in n-3 PUFA. After 1-year follow-up, both groups decreased their MMSE score (-1.18, SD:0. 53 and -0.82, SD:0. 63, p = 0.67 for the control and the intervention group respectively). The memory subscale of the MMSE showed an improvement (+0.26, SD:0.18) in the intervention group against a worsening in the control group (-0.11, SD: 0.14; p = 0.09 for differences between groups). Patients at intervention group with normal nutritional status (MNA ≥24) showed an improvement in the MMSE (+1.03, p = 0.025 for differences between 1-y and baseline measurements) against a worsening in the group with malnutrition (MNA<24) (-0.4, p = 0.886 for differences between 1-y and baseline; p of interaction p = 0.05). Supplementation with n-3 PUFA did not show an improvement in the global cognitive function in institutionalized elderly people without CI or with MCI. They only suggest an apparent improvement in memory loss if previously they were well nourished.

Lipoprotein(a) concentrations in rheumatoid arthritis on biologic therapy: Results from the CARdiovascular in rheuMAtology study project.

BACKGROUND: Plasma concentrations of lipoprotein (a) (Lp(a)), a lipoprotein with atherogenic and thrombogenic properties, have a strong genetic basis, although high concentrations of Lp(a) have also been reported in the context of inflammation, as in rheumatoid arthritis (RA). Few studies evaluate the impact of biologic therapies (BT) on Lp(a) in RA, taking into account that with these new therapies a better control of inflammation is achieved. OBJECTIVE: The aim of the study was to evaluate the plasma concentrations of Lp(a) in Spanish RA patients on BT attending rheumatology outpatient clinics. METHODS: Baseline analysis of the CARdiovascular in rheuMAtology project, a 10-year prospective study, evaluating the risk of cardiovascular events in RA and other forms of inflammatory arthritis. RA patients were classified according to treatment: no biologic, anti-tumor necrosis factor, anti-interleukin-6 receptor tocilizumab (TCZ), and other biologic (rituximab or abatacept). A model of linear multivariate regression was built in which the dependent variable was Lp(a) concentration and the explanatory variable was BT. The model was adjusted for confounding factors. RESULTS: Seven hundred and seventy-five RA patients were analyzed. Plasma concentrations of total cholesterol and triglyceride were significantly higher in TCZ-treated patients. Nevertheless, no significant difference in the atherogenic index between TCZ-treated patients and patients without BT was found. After adjusting for confounding factors, patients with BT had lower concentrations of Lp(a) than those without BT; however, only TCZ-treated patients achieved statistically significant differences (ß: -0.303, 95% confidence interval: -0.558 to -0.047; P = .02). CONCLUSIONS: RA patients treated with TCZ show lower plasma concentrations of Lp(a) compared with patients without BT.

Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study).

OBJECTIVE: The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved. METHODS: We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment. RESULTS: The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of >180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P<.001). CONCLUSION: The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved.

High doses of vitamin E improve mitochondrial dysfunction in rat hippocampus and frontal cortex upon aging.

Rat aging from 4 to 12 mo was accompanied by hippocampus and frontal cortex mitochondrial dysfunction, with decreases of 23 to 53% in tissue and mitochondrial respiration and in the activities of complexes I and IV and of mitochondrial nitric oxide synthase (mtNOS) (P < 0.02). In aged rats, the two brain areas showed mitochondria with higher content (35-78%) of oxidation products of phospholipids and proteins and with higher (59-95%) rates of O(2)(-) and H(2)O(2) production (P < 0.02). Dietary supplementation with vitamin E (2.0 or 5.0 g/kg of food) from 9 to 12 mo of rat age, restored in a dose-dependent manner, the decreases in tissue and mitochondrial respiration (to 90-96%) and complexes I and IV and mtNOS activities (to 86-88%) of the values of 4-mo-old rats (P < 0.02). Vitamin E prevented, by 73-80%, the increases in oxidation products, and by 62-68%, the increases in O(2)(-) and H(2)O(2) production (P < 0.05). High resolution histochemistry of cytochrome oxidase in the hippocampal CA1 region showed higher staining in vitamin E-treated rats than in control animals. Aging decreased (19%) hippocampus mitochondrial mass, an effect that was restored by vitamin E. High doses of vitamin E seem to sustain mitochondrial biogenesis in synaptic areas.

Inserción laboral de las matronas graduadas entre los años 2001 y 2005 / Integration into the workforce of midwives graduated between 2001 and 2005

Objetivo: Conocer las características de la inserción laboral de las matronas que se graduaron entre los años 2001 y 2005. Personas y método: Estudio observacional, descriptivo y transversal. Se estudiaron todas las matronas que se graduaron en España entre los años 2001 y 2005, en 18 Unidades Docentes de Matronas pertenecientes a 15 Comunidades Autónomas. Se utilizó un cuestionario elaborado por el equipo investigador que se envió por correo postal o electrónico. Resultados: Se recibieron 328 cuestionarios cumplimentados, un 44,14% de los enviados. Todas las matronas que respondieron habían trabajado como matrona, y el 89,3% (293) consiguió trabajo en menos de un mes. Tenía un contrato fijo el 12,2% (38), lo tenía interino el 43,9% (136), y el resto tenía un contrato eventual. El 84,8 (263) desarrollaba su actividad asistencial en el hospital. Un 24,2% (74) estaba en situación de pluriempleo. El 5,4% (18) no trabajaban como matronas. El número de matronas que estaba trabajando en la misma CC.AA. que se había formado era inferior al 50% de las matronas formadas en Canarias, Castilla-La Mancha, Cataluña, Galicia y País Vasco. Conclusiones: La inserción laboral se realiza rápidamente y la situación de pluriempleo es alta, lo que indica escasez de profesionales. La mayoría de las matronas desarrolla su actividad asistencial en hospitales. Hay unidades que forman a más matronas procedentes de otra comunidad que de la propia, como consecuencia de esto son menos las matronas que trabajan en estas comunidades que las que se formaron en ellas (AU)

Objective: To characterize the integration into the workforce of midwives graduated between 2001 and 2005. Participants and method: A descriptive, observational, cross-sectional study was performed. It included all the midwives who graduated from 18 Midwifery Teaching Units in 15 Spanish autonomous communities from 2001 to 2005. A questionnaire prepared by the research team and distributed by postal or electronic mail was employed. Results: We received 328 completed questionnaires, 44.14% of those sent out. All the responders had worked as a midwife and 89.3% (293) had found work within less than a month. Thirty-eight (12.2%) had found permanent jobs, while 136 (43.9%) had substitute positions and the remainder had temporary jobs. In all, 84.8% (n=263) were working in a hospital. Seventy-four (24.2%) held more than one job. Eighteen (5.4%) were not working as midwives. The number of midwives who were working in the same autonomous community in which they had received their training was less. Than 50% among those who had studied in the communities of Canary Islands, Castilla La Mancha, Catalonia, Galicia and the Basque Country. Conclusions: Midwives are integrated rapidly into the workforce and many work in more than one place, an indication of the shortage of these professionals. Most of the midwives work in hospitals. There are units that train more midwives from outside their community. Consequently, the number of midwives working in these communities is lower than the number who studied midwifery there (AU)

Dietary thioproline decreases spontaneous food intake and increases survival and neurological function in mice.

Male mice on a diet supplemented with thioproline (l-thiazolidine-4-carboxylic acid), a physiological metabolite of 5-hydroxytryptamine, at 2.0 g/kg of food from 28 weeks of age and for their entire life, showed a 23-29% increased median and maximal life span. These survival increases were associated with improved neurological functions. Compared to control mice, thioproline-supplemented mice had a 20% lower integral spontaneous food intake, and 10% lower body weight at 100 weeks of age. Body weight showed a statistically significant inverse relationship with survival and neurological performances. Thioproline-supplemented mice exhibited a 58-70% decrease of the age-dependent oxidative damage in brain and liver mitochondria at 52 weeks (old mice) and 78 weeks (senescent mice) of age, respectively. The age-associated decrease of brain mitochondrial enzyme activities, NADH-dehydrogenase, cytochrome c oxidase, and mitochondrial nitric oxide synthase (mtNOS), in old and senescent mice were markedly prevented (51-74%) by thioproline. In vitro, thioproline neither exhibited direct antioxidant activity nor had any effect on the electron transfer or mtNOS functional activities of brain and liver mitochondria. It is surmised that thioproline induces an anorexic effect associated with improved survival and neurological function through a decreased oxidative damage and regulation that may involve hypothalamic appetite centers.

Vitamin E at high doses improves survival, neurological performance, and brain mitochondrial function in aging male mice.

Male mice receiving vitamin E (5.0 g alpha-tocopherol acetate/kg of food) from 28 wk of age showed a 40% increased median life span, from 61 +/- 4 wk to 85 +/- 4 wk, and 17% increased maximal life span, whereas female mice equally supplemented exhibited only 14% increased median life span. The alpha-tocopherol content of brain and liver was 2.5-times and 7-times increased in male mice, respectively. Vitamin E-supplemented male mice showed a better performance in the tight-rope (neuromuscular function) and the T-maze (exploratory activity) tests with improvements of 9-24% at 52 wk and of 28-45% at 78 wk. The rates of electron transfer in brain mitochondria, determined as state 3 oxygen uptake and as NADH-cytochrome c reductase and cytochrome oxidase activities, were 16-25% and 35-38% diminished at 52-78 wk. These losses of mitochondrial function were ameliorated by vitamin E supplementation by 37-56% and by 60-66% at the two time points considered. The activities of mitochondrial nitric oxide synthase and Mn-SOD decreased 28-67% upon aging and these effects were partially (41-68%) prevented by vitamin E treatment. Liver mitochondrial activities showed similar effects of aging and of vitamin E supplementation, although less marked. Brain mitochondrial enzymatic activities correlated negatively with the mitochondrial content of protein and lipid oxidation products (r2 = 0.58-0.99, P < 0.01), and the rates of respiration and of complex I and IV activities correlated positively (r2 = 0.74-0.80, P < 0.01) with success in the behavioral tests and with maximal life span.

Oral protein-energy supplements in peritoneal dialysis: a multicenter study.

BACKGROUND: Protein-energy malnutrition is prevalent in peritoneal dialysis (PD) patients and is associated with increased morbidity and mortality. OBJECTIVE: To evaluate the impact of prophylactic treatment with an oral protein-energy supplement (Protenplus; Fresenius AG, Bad Homburg, Germany) on nutritional parameters in patients starting PD. DESIGN: Prospective, multicenter, randomized study of group A patients (Protenplus, n = 35) and group B (controls, n = 30), with evaluations at baseline and at 6 and 12 months. STATISTICAL METHODS: Efficacy of factors by linear mixed model analysis for repeated measurements, chi-square, t-test, and Mann-Whitney test. OUTCOME PARAMETERS: Patient compliance, serum albumin, and other nutritional parameters. RESULTS: No significant differences were found at baseline evaluation. During follow-up, a significant number of group A patients abandoned intake of the supplement due to non-compliance (n = 7) or side effects (n = 8) (chi2 p < 0.01). Patients with lower residual renal function were less likely to comply. The mixed model in the "intention to treat" analysis showed a significant increase related to supplement intake only in total lymphocyte count in group A. The "as treated" analysis of the 29 patients who fulfilled the study (9 in group A, 20 in group B) disclosed that belonging to group A constituted an independent factor for increased lymphocyte count (p < 0.001), body weight (p < 0.03), tricipital skinfold thickness (p < 0.01), middle-arm muscle circumference (p < 0.025), lean body mass (LBM) (p < 0.002), creatinine LBM related to body surface area (p < 0.001), and creatinine generation rate (p < 0.002). However, these data may have been biased by the high rate of noncompliance in group A. CONCLUSIONS: Protenplus proved to be unsuitable as a long term, oral protein-energy supplement in PD patients due to a high rate of noncompliance and intolerance, primarily among patients with lower residual renal function. The question of whether other products, better-tolerated as nutritional supplements, could compensate for daily protein peritoneal losses in long-term PD remains open.

Toxicología aguda oral del Eucalyptus saligna Sm. por el método de las clases / Oral acute toxicology of Eucalyptus saligna Sm. by class method

El presente trabajo se desarrolló en la Unidad Provincial de Toxicología Experimental de Camagüey con el objeto de realizar el estudio toxicológico agudo del Eucalytus saligna Sm. Para el desarrollo del mismo se utilizó el método de las clases de toxicidad aguda, a partir de dosis prefijdas de 25, 200 y 2000 mg/kg PC. La especie empleada fue Rathus rathus, línea Wistar, con un peso corporal comprendido entre 150 y 200 g. Se observaron signos tóxicos en la dosis de 2 000 mg/kg PC tales como: letargo, somnolencia y disminución de la respuesta a estímulos; y en la dosis de 200 mg/kg PC no se observaron estos. Se pudo comprobar que la decocción de Eucalyptus saligna Sm. no es tóxica, al no ocurrir mortalidad a la dosis de 2 000 mg/kg que es la dosis límite según la norma utilizada (AU)

Toxicidad aguda oral del Xanthium stramarium L. (Guizazo de Caballo) / Acute oral toxicity from Santhium stramarium L. (Guizazo de caballo)

Se realizó un estudio experimental con el objetivo de evaluar el posible efecto tóxico del extracto fluido en solución hidroalcohólica al 65 porciento de Xanthium strumarium L. Para el desarrollo del mismo se utilizó el Método de las Clases de Toxicidad Aguda (CTA) a partir de dosis prefijadas de 25,200 y 200 mg/kg de peso corporal. Los animales seleccionados fueron ratas de la línea Wistar, con un peso corporal comprendido entre 150 y 200 g. Los resultados demostraron la inocuidad de la planta al no observarse signos clínicos que evidenciaran toxicidad y no ocurrir muertes con las dosis de 2 000 mg/Kg que es la dosis límite según la norma utilizada (AU)

Toxicidad aguda oral del Xanthium stramarium L (Guizazo de Caballo) / Acute oral toxicity from Santhium stramarium L (Guizazo de caballo)

Se realizó un estudio experimental con el objetivo de evaluar el posible efecto tóxico del extracto fluido en solución hidroalcohólica al 65 porciento de Xanthium strumarium L. Para el desarrollo del mismo se utilizó el Método de las Clases de Toxicidad Aguda (CTA) a partir de dosis prefijadas de 25,200 y 200 mg/kg de peso corporal. Los animales seleccionados fueron ratas de la línea Wistar, con un peso corporal comprendido entre 150 y 200 g. Los resultados demostraron la inocuidad de la planta al no observarse signos clínicos que evidenciaran toxicidad y no ocurrir muertes con las dosis de 2 000 mg/Kg que es la dosis límite según la norma utilizada

Cell-saver: hacia una cirugía sin transfusiones de sangre / Cell-saver towards a surgery system of autotransfusion blood

Es impensable la cirugía moderna sin transfusiones de sangre. Sin embargo las desventajas y limitaciones de depender de sangre homóloga son bien conocidas: escasez de tipos poco frecuentes, lentitud en la realización de pruebas cruzadas y de contaminación con enfermedades de transmisión hemática. De allí e interés de las técnicas de recolección, procesamiento y administración de sangre autóloga. Los autores presentan su experiencia con el Cell-Saver (Elmd-500, Electromedics, Inc), dispositivo versátil y rápido para el manejo de sangre autóloga en el ambiente quirúgico. Desde 1995 hasta noviembre de 1996, el sistema de autotransfusión Cell-Saver fue utilizado en 133 pacientes consecutivos en los siguientes procedimientos: cirugía cardíaca: 112, patología de la aorta abdominal: 14, cirugía ortopédica: 5, cardiopatía congénita: 1, disección óptica: 1, herida penetrante de tórax: 1. En todos los casos se utilizó el Elmd-500 para la sangre del campo operatorio y procesarla mediante lavado con solución salina normal en una campana de ultra centrifugación, obteniéndo de esta manera eritrocitos lavados, concentrados, libres de cualquier contaminante. En los casos de cirugía cardíaca, durante la inducción anestésica se obtienen por centrifugación concentrado globular, plasma rico en plaquetas y plasma pobre en plaquetas, para su reinfusión al finalizar el procedimiento. Los autores concluyen que la autotransfusión es un recurso extremadamente útil y aún subutilizado, en todos los casos de cirugía cardiovascular, torácica, ortopédica y/o de emergencia en los cuales se anticipa la necesidad de transfundir sangre