La Relación médico paciente y algunos aspectos transculturales de salud y enfermedad / Doctor patient comunication and transcultural aspects of health and disease

La orientación científica de la medicina ha sido determinante en el progreso que ha alcanzado, pero la consideración de la persona, la unificación del sujeto en el objeto, es fundamental en la clínica, en el acto médico. Necesitamos una antro-pología médica en la que lo principal es la relación entre ambas, enfermedad y enfermo, que puedan distinguirse, compararse y ser posible, que cada una de las dos funciones relacionadas se unifiquen en un punto medio.El entendimiento entre paciente y médico pueden verse perturbado por malen-tendidos del lenguaje y del bagaje cultural, así como exigimos al paciente que notifique con claridad sobre su enfermedad, el médico quien tiene la mayor res-ponsabilidad en la relación con el enfermo debe preocuparse, a su vez, de notifi-car claramente al paciente de su acontecer, de su diagnóstico y de su pronóstico. Así lo destaca Victor von Weizsacker que expresa claramente la orientación que significa la Antropología Médica, "El hombre es un objeto que contiene un sujeto, y este no está por fuera de los dominios de la ciencia, sino que pertenece a la misma".

The scientific direction of the medicine has been determining in the progress that has reached, but the consideration of the person, the unification of the subject in the object, is fundamental in the clinic, the medical act. We needed a medical anthropology in which the main thing is the relation between both, disease and patient, that they can be distinguished, be compared and to be possible, that each one of the two related functions is unified in a midpoint. The understanding between patient and doctor can be seen disturbed by misun-derstanding of the language and the cultural baggage, as well as we demanded the patient who notifies with clarity on his disease, the doctor that has the great-er responsibility in the relation with the patient must worry, as well, to notify clearly to the patient of his to occur, its diagnosis and its prognosis. Thus it honors Victor von Weizsacker that expresses clearly the direction that means the Medical Anthropology, "the man is an object that contains a subject, and this it is not in favor of outside the dominions of science, but that belongs to the same one".

Efecto del consumo de harina de maíz fortificada con acido fólico sobre los niveles de folatos sanguíneos en mujeres de edad fértil / Effect of fortified flour consumption on blood folate levels in women of childbearing age

Fortification of foods is now widely used to prevent folate deficiency. Folic acid has been added to corn flour and its efficacy in the prevention of NTD has been proved. The aim of this study was to compare the effect of the intake of fortified corn-flour versus non fortified flour and to folic acid supplement, on blood folate levels in women of childbearing age. Forty-five women were randomized into three groups according to: (A) use of fortified flour (n=18), (B) non-fortified flour (n=17); (C) supplementation with 5 mg of oralfolic acid (n=10). All females answer a dietary and anthropometric questionnaire applied once a month during three months. Blood red cell (IE) and plasmatic (P) folate were measured at the beginning and at the end of the study; also the DNA analysis for the 677T mutation was performed. The corn flour was provided to groups A and B during three months, to be consumed as eight tortillas daily. Group C received 5.0 mg tablet of folic acid (Valdecasas®), once per week, during three months. IE and P folate and hematocrito were significantly increased in women from group C (p<0.05). Only plasmatic folic acid levels were significantly increased in women from groups A and B. Genotype distribution was: 15.6 percent homozygous TT, 42.2 percent C/C and 42.2 percent CT. Weekly administration of 5.0 mg of folic acid is an effective way to increase blood folate levels and shows to be more efficient than fortified corn flour.

La fortificación de alimentos con ácido fólico puede ser efectiva en la prevención de los defectos del tubo neural, aunque no existen estudios que demuestren la eficacia de esta medida en la harina de maíz. El objetivo del estudio fue evaluar el efecto del consumo de harina de maíz vitaminada sobre los niveles de folatos sanguíneos, en comparación con la suplementación oral. Se incluyeron 45 mujeres en edad fértil aleatorizadas en tres grupos; grupo A (n=18) harina vitaminada, grupo B (n=17) harina sin vitaminas, grupo C (n=10) suplemento oral 5.0 mg de ácido fólico una vez por semana, durante tres meses. A las participantes se les aplicó una encuesta nutricional y se les midió por radioinmunoensayo el folato intraeritrocitario (FIE) y plasmático (FP) al inicio y final del estudio y se determinó la presencia del polimorfismo C677T del gen MTHFR. En las mujeres con suplemento oral los niveles FIE y FP y el hematocrito se incrementaron significativamente (p< 0.05), mientras que en los grupos A y B se registró un incremento significativo en los valores de FP pero no IE ni hematocrito. La ingesta de otras fuentes de ácido fólico se incrementó significativamente en los grupos A y B. El 15.6 por ciento de las mujeres fueron homocigotas TT, 42.2 por ciento homocigotas CC y 42.2 por ciento heterocigotas CT. La administración de 5 mg de ácido fólico por semana es una medida más eficiente que la ingesta de harina de maíz vitaminada para elevar los niveles de folatos.

Combined protocol of cell therapy for chronic spinal cord injury. Report on the electrical and functional recovery of two patients.

BACKGROUND: This is a preliminary report on successful results obtained during treatment of two patients with chronic spinal cord injury. The therapeutic approach was based on the generation of controlled inflammatory activity at the injury site that induced a microenvironment for the subsequent administration of autologous, BM-driven transdifferentiated neural stem cells (NSC). METHODS: BM mesenchymal stem cells (MSC) were cocultured with the patient's autoimmune T (AT) cells to be transdifferentiated into NSC. Forty-eight hours prior to NSC implant, patients received an i.v. infusion of 5 x 10(8) to 1 x 10(9) AT cells. NSC were infused via a feeding artery of the lesion site. Safety evaluations were performed everyday, from the day of the first infusion until 96 h after the second infusion. After treatment, patients started a Vojta and Bobath neurorehabilitation program. RESULTS: At present two patients have been treated. Patient 1 was a 19-year-old man who presented paraplegia at the eight thoracic vertebra (T8) with his sensitive level corresponding to his sixth thoracic metamere (T6). He received two AT-NSC treatments and neurorehabilitation for 6 months. At present his motor level corresponds to his first sacral metamere (S1) and his sensitive level to the fourth sacral metamere (S4). Patient 2 was a 21-year-old woman who had a lesion that extended from her third to her fifth cervical vertebrae (C3-C5). Prior to her first therapeutic cycle she had severe quadriplegia and her sensitive level corresponded to her second cervical metamere (C2). After 3 months of treatment her motor and sensitive levels reached her first and second thoracic metameres (T1-T2). No adverse events were detected in either patient. DISCUSSION: The preliminary results lead us to think that this minimally invasive approach, which has minor adverse events, is effective for the repair of chronic spinal cord lesions.

Laparoscopic esophagomyotomy and antireflux procedure with intraoperative manometry.

We have been routinely performing laparoscopic cholecystectomy and antireflux procedures. Having this experience, we decided to assess the feasibility and safety of performing a laparoscopic esophagomyotomy and antireflux procedure. Here we present a case of a 37-year-old man with a history of progressive dysphagia and a diagnosis of achalasia, made on the basis of clinical, endoscopic, and manometric studies. Preoperative manometry reported a pressure of 52 mm Hg (normal, 15-25 mm Hg) for 4.5 cm (normal, > 3 cm). Laparoscopic esophagomyotomy and anterior fundoplication were performed. The esophagomyotomy included a 6-cm segment of distal esophagus and 2 cm of stomach; postoperative manometry was 18 mm Hg for 3 cm. Eight months postoperatively, a barium swallow demonstrated no reflux. Laparoscopic esophagomyotomy and antireflux procedure can be performed with efficacy and safety, with the advantage of a shorter hospitalization and an early recovery compared with the traditional procedure. Also, we emphasize the importance of the intraoperative manometry in the relevance of a concomitant antireflux procedure.

Effect of olive and sunflower oils on low density lipoprotein level, composition, size, oxidation and interaction with arterial proteoglycans.

The atherogenicity of low density lipoproteins (LDL) may be modulated by its serum levels, structure and affinity for components of the intima, all properties that can be altered by diet. Linoleic acid-rich diets (n-G, 18:2) reduce the levels of LDL whereas those rich in oleic (n-9,18:1) are considered 'neutral'. However, LDL enriched in linoleic acid have been reported to be more vulnerable to free radical-mediated oxidation than those enriched in oleic, a potentially atherogenic property. The effect of dietary fats on other properties of LDL that may also modulate atherogenesis, such as size and capacity to interact with intima components, are not well established. We explored here how a change from an olive oil-rich diet (OO) to a sunflower oil-rich one (SFO) affects these parameters in a community with a traditional Mediterranean diet. Eighteen free-living volunteers were placed for 3 weeks on a diet with 31% of caloric intake as sunflower oil and then shifted for an additional 3 weeks to a diet in which OO provided 30.5% of the calories. The LDL after SFO had a fatty acids ratio of (18:2 + 18:3 + 20:4) to (16:0 + 16:1 + 18:0 + 18:1) of 1.06 +/- 0.11 compared to 0.73 +/- 0.06 after the OO period. Serum LDL was significantly lower after SFO than after OO. Unexpectedly, copper-catalyzed oxidation of LDL from the SFO period was significantly less than that of the particles from the OO period. The resistance to oxidation of LDL of the SFO and OO period related to alterations in content of the antioxidants alpha-tocopherol, beta-carotene and retinol, in addition to changes in size and fatty acids composition. In vitro binding of LDL to human arterial proteoglycans was also significantly lower for the SFO-LDL than the OO-LDL, a result that can also be attributed to the larger size of the SFO-LDL. Therefore, three properties of LDL: circulating levels, oxidizability, and affinity with intima proteoglycans, that may modulate its atherogenicity, were shifted in a favorable direction by diets rich in linoleic acid and natural antioxidants.

[A case control study of the relationship between diet and breast cancer in a sample from 3 Spanish hospital populations. Effects of food, energy and nutrient intake]. / Estudio caso-control de la relación dieta y cáncer de mama en una muestra procedente de tres poblaciones hospitalarias españolas. Repercusión del consumo de alimentos, energía y nutrientes.

A case-control study was conducted to analyze the possible role of diet on the incidence of breast cancer in a group of 275 women (139 cases and 136 controls) recruited from three hospital populations (Madrid, Mérida, and Santiago de Compostela). The retrospective intake of foods was studied by a modified dietary history; from this the intake of energy, nutrients, fiber, and alcohol was derived. Intake of oils and fats was significantly higher among cases, which translates into a higher intake of lipids and vitamin E. In contrast, intake of vitamin D and legumes was significantly lower. No differences were observed regarding other foods and nutrients between cases and controls. The estimate of the odds ratio as a relative risk measure for breast cancer, adjusted and unadjusted for total energy, indicates that intake of cereals and legumes, proteins, carbohydrates and fiber is apparently a protective factor, whereas an excessive intake of meat, oils and fats and a lipid intake higher than 46% of the total caloric intake or poly-unsaturated fatty acids higher than 15 g would be a risk factor for this pathology.

[The treatment of pneumothorax by small-caliber drainage without a water seal]. / Tratamiento del neumotórax con drenaje fino sin sello de agua.

The authors describe their experience in treating 72 patients with pneumothorax by placement of a drainage tube of 2.2 mm internal diameter equipped with a Heimlich valve. Full lung expansion was achieved with this method in 93% of the cases. Mean hospital stay was 4.05 days (Sx = 3.4, minimum 1, maximum 20). In 7 (10.7%) cases out of 64 who were discharged and followed as outpatients, there was recurrence of pneumothorax. With these results the authors conclude that the system used is valid for treating pneumothorax and that large drains and water seals are not necessary in most cases.

Several aspects of mineral/protein nutrition in relation to consumption of an oil involved in the toxic syndrome.

An oil involved in the 'toxic syndrome' and two similar mixtures of oils, one with and the other without added oleoanilides, were studied for their effects on the utilization of protein, calcium, magnesium, phosphorus, sodium, potassium and zinc. Forty-eight female Wistar rats initially weighing about 75 g were fed for 28 days on the same semi-synthetic diet containing: virgin olive oil, or a mixture of canbra oil (50%), refined olive-pomace oil (20%), grapeseed oil (20%) and animal fat (10%), or the same dietary mixture supplemented with either 700 ppm oleoanilides or the alleged toxic oil. Weight, food intake and nutritional balances were monitored. The food intake of the animals fed the toxic oil began to decrease at the end of the trial, producing a reduction in the amount of nutrients ingested, but no weight loss. This oil also negatively affected the digestion of protein, potassium, sodium and zinc, the mechanism of which, in the case of the first two, appears to be related to the source of the fat. It also decreased metabolic utilization while favouring protein catabolism and the elimination of phosphorus, magnesium and potassium. No substantial modifications were noted in the animals' bones.

[Physico-chemical changes in olive oil used in repeated frying and its impact on blood lipoproteins in rats]. / Alteraciones fisicoquímicas de un aceite de oliva empleado en frituras repetidas y su incidencia sobre la lipoproteinemia de ratas.

The effect of an olive oil used in repeated fryings on certain parameters of lipidic metabolism in rat has been studied. The control animals ingest a diet containing 15% raw olive oil, while in the experimental group the diet contains the same ratio of olive oil but used in repeated fryings. An increase in total esterified cholesterol and in cholesterol bound to HDL was observed in the experimental rats, while the levels of free cholesterol remained constant. Triglycerides decreased significantly. A tendency, non-significant, to decrease the percentage of VLDL was found. The lipidic and proteic composition of VLDL, LDL and HDL is very similar in both groups, although the phospholipid content of VLDL decreased significantly in the experimental group. Results indicate that, in the animals fed fried olive oil, their takes place an adaptation in the mechanisms related to the prevention of a rising of plasmatic cholesterol levels.

[Ca-P interaction at the nutritional and bone levels in male quail (Coturnix coturnix japonica)]. / La interacción Ca-P a nivel nutritivo y óseo en codornices machos (Coturnix coturnix japonica).

Five experiments were conducted in which various levels of calcium (Ca) and phosphorus (P) were fed to adult male quail (diets D-1: Ca = 1.54%, p = 0.80%; D-2: Ca = 3.20%, P = 0.81%; D-3: Ca = 1.57%, P = 1.66%; D-4: Ca = 3.40%, P = 1.71%; D-5: Ca - 2.20%, P = 0.81%). The interaction between Ca and P, and the effect on some nutritive hematic and osseous parameters were investigated for each diet. Feeding high P caused a body weight decrease in D-4 adult quail (P less than 0.05) and diminished food intake in the birds of trial D-3 (P less than 0.05). The results indicated that the excretion of Ca or P is a lineal function of its own intake. Neither the pattern of relationship between the intake and excretion of Ca was altered by the levels of phosphorus in the diets, nor the levels of calcium altered the pattern of P. With these levels of Ca and P interaction between both nutrients were not demonstrated. Plasma Ca levels and dry weight of femur as well as the ash content in them, were not significantly decreased, although the levels of the latter components were inferior in the groups fed non-adjusted diets in the Ca:P ratio (diets D-1, D-2, D-3 and D-4).

Dieldrin, Ca and P balance, and characteristics of the egg in the quail (Coturnix coturnix japonica).

A study was made of the Ca and P balance, Ca and P content in the femur, physical characteristics of the egg, mineral structure of the shell, and the number of eggs in quails treated with dieldrin (20 mg/kg of diet) for 48 days. The diet contained 3.24% Ca and 0.72% P. The Ca and P balance, the bone contents of Ca and P and the calcemia in the males were not changed by the pesticide. In the females, the pesticide decreased the amount of excreted Ca and Ca in the egg, for which reason the coefficient of nutritive utilization (CNU), the coefficient of corporal retention (CCR), and the Ca level in the femur were greater in treated laying quails. The calcemia remained stable, and the balance of P was not significantly modified by the dieldrin. The study of weight, size, and strength of the egg did not reveal any influence of the dieldrin, and egg production fluctuated throughout the test period.

[The effect of Ca/P relation on utilization of both nutrients in laying quails (author's transl)]. / Influencia de la relación Ca/P sobre la utilización de ambos nutrients en la codorniz en puesta.

The effect of two Ca/P relations (2.1 y 4.5) in the diet on nutritive utilization of both minerals, egg production and egg characteristics (weight, size, resistence and shell Ca content) was studied. Nutritive utilization and absolute body retention of Ca were higher with a Ca/P relation of 4.5, while the lower Ca/P relation (2.1) produced a greater utilization of P, without differences as high as in the case of Ca. As a whole, the diet with a Ca/p relation = 2.1 was more efficiently utilized but egg production did not rise optimal levels got on the diet with a Ca/P relation = 4.5 Egg characteristics were similar with both treatments.