Response to oral sucrosomial iron supplementation in patients undergoing bariatric surgery. The BARI-FER study / Respuesta a la suplementación oral con hierro sucrosomado en pacientes sometidos a cirugía bariátrica. Estudio BARI-FER

Background: Chronic intravenous iron administration is often required after bariatric surgery. Oral sucrosomial iron has a particular form of absorption and may represent an alternative treatment. Objective: To assess the effect of switching to oral sucrosomial iron in patients receiving intravenous iron supplementation after bariatric surgery. Patients and methods: A case-control study was conducted on 40 women of childbearing age, of whom 20 were switched to oral sucrosomial iron, while 20 patients continued on intravenous iron sucrose every three months. Results: No significant differences were seen in Hb, ferritin, and TSI levels before and after three months of treatment with sucrosomial iron. Conclusion: Oral sucrosomial iron could be an alternative in patients who require parenteral treatment with iron after bariatric surgery (AU)

Antecedentes: A menudo es necesaria la administración intravenosa crónica de hierro después de la cirugía bariátrica. El hierro sucrosomado oral tiene una forma especial de absorción y es un posible tratamiento alternativo. Objetivo: Valorar el efecto del cambio al hierro sucrosomado oral en los pacientes que reciben suplementos de hierro por vía intravenosa después de cirugía bariátrica. Pacientes y métodos: Se realizó un estudio de casos y controles que incluyó a 40 mujeres en edad fértil, de la que 20 se cambiaron a hierro sucrosomado oral, mientras que las 20 restantes siguieron recibiendo hierro sacarosa cada tres meses. Resultados: No se observaron diferencias importantes en los niveles de Hb, ferritina ni TSI hallados antes y después de tres meses de tratamiento con hierro sucrosomado. Conclusión: El hierro sucrosomado oral puede ser una alternativa en los pacientes que necesitan tratamiento parenteral con hierro después de cirugía bariátrica (AU)

Bellagio Report on Healthy Agriculture, Healthy Nutrition, Healthy People / Informe Bellagio sobre la actividad agropecuaria y la nutrición para la salud de las personas

The Bellagio Report on Healthy Agriculture, Healthy Nutrition, Healthy People is the result of the meeting held at the Rockefeller Foundation Bellagio Center in Lake Como, Italy 30 October-1 November, 2012. The meeting was science-based but policy-oriented. The role and amount of healthy and unhealthy fats, with attention to the relative content of omega-3 and omega-6 fatty acids, sugar, and particularly fructose in foods that may underlie the epidemics of non-communicable diseases (NCDs) worldwide were extensively discussed. The report concludes that sugar consumption, especially in the form of high energy fructose in soft drinks, poses a major and insidious health threat, especially in children, and most diets, although with regional differences, are deficient in omega-3 fatty acids and too high in omega-6 fatty acids. Gene-nutrient interactions in growth and development and in disease prevention are fundamental to health, therefore regional Centers on Genetics, Nutrition and Fitness for Health should be established worldwide. Heads of state and government must elevate, as a matter of urgency, nutrition as a national priority, that access to a healthy diet should be considered a human right and that the lead responsibility for nutrition should be placed in Ministries of Health rather than agriculture so that the health requirements drive agricultural priorities, not vice versa. Nutritional security should be given the same priority as food security.

El Informe Bellagio sobre la actividad agropecuaria y la nutrición para la salud de las personas es el resultado de la reunión celebrada del 30 de octubre al 1 de noviembre del 2012 en el Centro Bellagio de la Fundación Rockefeller, ubicado a orillas del lago de Como (Italia). La reunión se basó en datos científicos, pero estuvo orientada a cuestiones de política. Se trataron ampliamente los temas de la función y la cantidad de las grasas saludables y las grasas poco saludables en los alimentos, con atención especial a su contenido relativo de ácidos grasos omega-3 y omega-6, y de azúcar, en particular fructosa, que pueden ser la causa de la epidemia de enfermedades no transmisibles en el mundo. El informe concluye que el consumo de azúcares, sobre todo en la forma de fructosa de alto contenido energético contenida en las bebidas gaseosas, supone una amenaza grave e insidiosa para la salud, especialmente en la niñez, y que la mayoría de los regímenes alimentarios, aunque con diferencias regionales, contienen cantidades insuficientes de ácidos grasos omega-3 y cantidades demasiado elevadas de ácidos grasos omega-6. Dado que las interacciones entre los genes y los nutrientes durante el crecimiento y el desarrollo, así como en la prevención de las enfermedades, son fundamentales para la salud, deben establecerse en todo el mundo centros regionales de genética, nutrición y buena condición física para promover la salud. Los jefes de Estado y de gobierno deben elevar la nutrición, con carácter de urgencia, al nivel de prioridad nacional, lograr que el acceso a un régimen alimentario saludable se considere un derecho humano, y hacer que la responsabilidad principal en materia de nutrición recaiga en los ministerios de salud, en lugar de en los ministerios de agricultura y ganadería, a fin de que las necesidades de salud orienten las prioridades agropecuarias, y no a la inversa. Debe asignarse a la seguridad nutricional la misma prioridad que a la seguridad alimentaria.

A review on gastric leptin: the exocrine secretion of a gastric hormone / 대한해부학회지

A major advance in the understanding of the regulation of food intake has been the discovery of the adipokine leptin a hormone secreted by the adipose tissue. After crossing the blood-brain barrier, leptin reaches its main site of action at the level of the hypothalamic cells where it plays fundamental roles in the control of appetite and in the regulation of energy expenditure. At first considered as a hormone specific to the white adipose tissue, it was rapidly found to be expressed by other tissues. Among these, the gastric mucosa has been demonstrated to secrete large amounts of leptin. Secretion of leptin by the gastric chief cells was found to be an exocrine secretion. Leptin is secreted towards the gastric lumen into the gastric juice. We found that while secretion of leptin by the white adipose tissue is constitutive, secretion by the gastric cells is a regulated one responding very rapidly to secretory stimuli such as food intake. Exocrine-secreted leptin survives the hydrolytic conditions of the gastric juice by forming a complex with its soluble receptor. This soluble receptor is synthesized by the gastric cells and the leptin-leptin receptor complex gets formed at the level of the gastric chief cell secretory granules before being released into the gastric lumen. The leptin-leptin receptor upon resisting the hydrolytic conditions of the gastric juice is channelled, to the duodenum. Transmembrane leptin receptors expressed at the luminal membrane of the duodenal enterocytes interact with the luminal leptin. Leptin is actively transcytosed by the duodenal enterocytes. From the apical membrane it is transferred to the Golgi apparatus where it binds again its soluble receptor. The newly formed leptin-leptin receptor complex is then secreted baso-laterally into the intestinal mucosa to reach the blood capillaries and circulation thus reaching the hypothalamus where its action regulates food intake. Exocrine-secreted gastric leptin participates in the short term regulation of food intake independently from that secreted by the adipose tissue. Adipose tissue leptin on the other hand, regulates in the long term energy storage. Both tissues work in tandem to ensure management of food intake and energy expenditure.

Cervical cancer prevention program in Jakarta, Indonesia: See and Treat model in developing country / 부인종양

OBJECTIVE: The purpose of this study was to describe the implementation of single visit approach or See-visual inspection of the cervix with acetic acid (VIA)-and Treat-immediate cryotherapy in the VIA positive cases-model for the cervical cancer prevention in Jakarta, Indonesia. METHODS: An observational study in community setting for See and Treat program was conducted in Jakarta from 2007 until 2010. The program used a proactive and coordinative with VIA and cryotherapy (Proactive-VO) model with comprehensive approach that consists of five pillars 1) area preparation, 2) training, 3) awareness, 4) VIA and cryotherapy, and 5) referral. RESULTS: There were 2,216 people trained, consist of 641 general practitioners, 678 midwives, 610 public health cadres and 287 key people from the society. They were trained for five days followed by refreshing and evaluation program to ensure the quality of the test providers. In total, 22,989 women had been screened. The VIA test-positive rate was 4.21% (970/22,989). In this positive group, immediate cryotherapy was performed in 654 women (67.4%). CONCLUSION: See and Treat program was successfully implemented in Jakarta area. The Proactive-VO model is a promising way to screen and treat precancerous lesions in low resource setting.

Efeitos da ingestão de chás de Camellia sinensis em parâmetros ósseos de ratos machos jovens, tratados ou não com sacarose / Effects of ingestion of tea Camellia sinensis on bone parameters in young male rats, treated or not with sucrose

Os chás verde e branco obtidos a partir das folhas de Camellia sinensis, possuem elevadas concentrações de polifenóis, principalmente catequinas, aos quais são atribuídos inúmeros efeitos benéficos. Em alguns países a ingestão desses chás por seres humanos é próxima à ingestão de água, e em todo o mundo é cada vez maior a oferta de bebidas e outros preparados a base desses chás, para a população de diversas faixas etárias. Através de diferentes mecanismos os chás reduzem o sobrepeso, os depósitos de lipídeos, além de promoverem melhoras no perfil lipídico plasmático e na glicemia. O consumo de chás de C. sinensis, ou dos polifenóis obtidos a partir dos chás, vem sendo associado à melhora na qualidade óssea de animais e humanos em diversas situações. Por mecanismos diretos e indiretos, os chás promovem aumento na formação óssea por estimular a diferenciação em osteoblastos inibindo ainda a apoptose dessas células, além de reduzir a osteoclastogênese e a atividade de osteoclastos. Essas ações resultam em aumento da densidade mineral óssea, melhora da microarquitetura e da resistência óssea às fraturas. Durante a fase de crescimento, porém, os dados da literatura são ainda insuficientes para comprovar a segurança dos chás em relação à qualidade e crescimento ósseo. O consumo excessivo de carboidratos simples, que muitas vezes resulta em sobrepeso e obesidade, modifica de forma negativa parâmetros ósseos, por mecanismos que envolvem adipocinas, vias hipotalâmicas e metabolismo energético. Neste estudo foram analisados os efeitos da ingestão de chás verde e branco na estrutura óssea de animais em fase de crescimento, e a possibilidade dos chás reverterem ou minimizarem alterações na estrutura resultantes do excessivo consumo de carboidratos. Sessenta ratos Wistar machos, com 40 dias de idade foram subdividos nos grupos controle (C), sacarose (S), sacarose e chá verde (SCV), sacarose e chá branco (SCB), chá verde (CV) e chá branco (CB). Infusões de chás foram...

White and green teas obtained from Camellia sinensis leaves have high concentrations of polyphenols, mainly catechins, to which innumerable beneficial effects are contributed. In some countries, ingestion of these teas by human beings is close to that of water ingestion, and worldwide, there is an increasing offer of beverages and other preparations based on these teas for different age-ranges of the population. By means of different mechanisms teas reduce overweight, lipid deposits, in addition to promoting improvements in the plasma lipid profile and glycemia. Consumption of C. sinensis teas, or the polyphenols obtained from them, has been associated with improvement in bone quality of animals and humans in various situations. By direct and indirect mechanisms, the teas promote increased bone formation by stimulating differentiation into osteoblasts, as well as inhibiting apoptosis of these cells, in addition to reducing osteoclastogenesis and osteoclast activity. These actions result in increased bone mineral density, improve bone microarchitecture and fracture resistance. During the growth phase, however, there are still insufficient data in the literature to prove the safety of teas in relation to bone quality and growth. Excessive simple carbohydrate consumption frequently results in overweight and obesity, negatively modifies bone parameters by mechanisms that involve adipokines, hypothalamic pathways and energy metabolism. In this study the effects of green and white tea ingestion on the bone structure of animals in the growth stage were analyzed, as well as the possibility of the teas reverting or minimizing alterations in structure resulting from excessive carbohydrate consumption. Sixty male Wistar rats, 40 days if age were subdivided into the following groups: Control (C), Sucrose (S), Sucrose and green tea (SCV), Sucrose and white tea (SCB), green tea (CV) and white tea (CB). Tea infusions were administered daily for 8 weeks, at a dose of...

Influência do ganho de massa corporal, induzido por dieta rica em sacarose, em parâmetros biométricos, bioquímicos e biofísicos de ratos Wistar / Influence of body mass gain induced by sucrose-rich diet in biometric, biochemical and biophysical parameters of Wistar rats

Obesidade e osteoporose são doenças crônicas de saúde pública que compartilham características e prevalência cada vez mais relevantes. Com a finalidade de analisar a influência da obesidade induzida por dieta rica em sacarose em parâmetros biométricos, bioquímicos e biofísicos, ratos Wistar machos com 3 meses de idade, foram divididos em grupo C -Controle (n=10), com livre acesso à ração e água e grupo S -Sacarose (n=10), submetidos às mesmas condições do grupo 1 controle e suplementados com sacarose a 30% (p/v). O período experimental foi de 8 semanas. Foram mensurados também massa corporal, ingestão de líquidos, consumo de ração, glicemia, tecido adiposo abdominal, concentrações de cálcio, fósforo, fosfatase alcalina, leptina e insulina. As tíbias foram desarticuladas e dissecadas para análises biofísicas. A densidade mineral óssea foi, avaliada por densitômetro ósseo padrão; a densidade radiográfica por meio do programa computacional de. análise de imagens - lMAGE J; a resistência óssea foi determinada por ensaio mecânico destrutivo; a quantidade de material mineral ósseo por meio da calcinação e a conectividade trabecular foi analisada por microtomografia óssea. Durante o período experimental os animais do grupo C consumiram quantidade maior de água e ração, porém a massa corporal final foi menor que a do grupo S. Neste grupo, a sobrecarga calórica oferecida aos animais, durante oito semanas, resultou em aumento no consumo energético, massa corporal, glicemia, concentração plasmática de leptina e de tecido adiposo abdominal. Entretanto, não apresentou diferença significativa na concentração plasmática de insulina. Na análise biofísica do tecido ósseo foi evidenciada menos densidade óssea (DXA) para o grupo S quando realizada a comparação inicial vs final no mesmo grupo. Entretanto, não foi observada diferença significante na comparação final entre o grupo C e S. A densidade radiográfica evidenciou menor densidade (mmAL) no grupo S. Não foram observadas...

Obesity and osteoporosis are chronic diseases of public health importance that share characteristics and increasingly and relevant prevalence. In order to analyze the influence of obesity induced by sucrose- rich diet in biometric, biochemical and biophysical parameters Wistar rats at 3 months of age were divided into two group: C - ControI (n = 10), with free access to food and water and S -Sucrose (n = 10) subjected to the same conditions of control group and supplemented with 30% sucrose (p/v), during 8 weeks. Measures of body mass, fluid intake, feed intake, blood glucose, abdominal adipose tissue, concentrations of calcium, phosphorus, alkaline phosphatase, leptin and insulin were taken. The tibias were disarticulated and dissected for biophysical analysis. Bone mineral density was assessed by standard bone densitometer; the radiographic image by the computer program of image analysis -IMAGE J; bane strength was determined by destructive mechanical testing; quantification of bone mineral material by calcination and trabecular connectivity was analyzed by microtomography bone. During the experimental period, animaIs in the control group (C) consumed higher amounts of food and water, but the body mass was smaller than the group receiving sucrose (S). In this group, the caloric load given to the animaIs for eight weeks resulted in increased energy consumption, body mass, glycemia, leptin plasmatic and abdominal faro However, the plasma insulin concentration was not altered. Biophysical analysis of bone tissue revealed lower bane density (DXA) for the group S when compared to the initial density within the same group. However, there was no significant difference in the final comparison between group C and S. Radiographic density showed lower density (mmAL) in the group S. There were no significant differences between mechanical tests parameters and calcium, phosphorus or alkaline phosphatase plasmatic concentration. However, the amount of bone mineral...

Comparative Study on the Efficacy of Different Cycloplegic Agents in Myopic Adults

PURPOSE: To evaluate the efficacy of 3 cycloplegic regimens in adults with myopia. METHODS: Refraction, accommodation amplitude, residual accommodation and biometric findings were assessed before and after instillation of regimen I (tropicamide 0.5% and phenylephrine 0.5%), regimen II (cyclopentolate 1.0%), and regimen III (combination of regimen I and II). RESULTS: In myopic adults aged 22 to 26 years, cycloplegic refraction revealed less myopia than manifested refraction. Although there was no difference in residual accommodation among the 3 regimens, regimen II and III were more effective in reducing myopia, accommodation, and axial length. The difference in cycloplegic refraction between regimen I and II was more prominent in patients who had larger amplitude of accommodation and residual accommodation with regimen I. CONCLUSIONS: Cycloplegic refraction should be used even in adult myopes. For patients with stronger accommodation and larger residual accommodation with tropicamide, cycloplegic refraction with cyclopentolate may be used to ensure relaxation.

Usefulness of Awake Anesthesia in Flexor Tendon Surgery

PURPOSE: According to various medical publications, it is believed that epinephrine should not be injected in fingers. However numerous articles show the successful use of local anesthetic with epinephrine in the digits. Epinephrine-mixed lidocaine solution enables to maintain a bloodless field for operation and provides long duration of local anesthesia when patient was wide awake. METHODS: From May 2009 to December 2009, ten patients underwent flexor tendon reconstruction with local anesthesia using epinephrine. No tourniquet was necessary. Before operation, all patients were injected with local anesthetics using 1% lidocaine 20 mL and 0.1% epinephrine 0.1 mL. RESULTS: There was no case of digital necrosis nor gangrene in the epinephrine injection. All 10 patients actively could move the finger through a full range of motion. All procedures were performed without sedation nor tourniquet and we could obtain a good vision of operative field and patients were comfortable. The patient make his or her fingers move through a full range of active motion before the skin is closed. Phentolamine was not required to reverse the vasoconstriction in any patients. CONCLUSION: The assertation that epinephrine should not be injected into the fingers is clearly no longer valid. The epinephrine injection allowed the authors to adjust flexor tendon surgery without risks associated with general anesthesia. It also enables to ensure longer anesthetic duration and bloodless operative field, and prevent post operative complications. In case of flexor tendon surgery, the use of epinephrine injection is recommended because of the advantages of local anesthesia.

Physiology of Lactation / 한양의대학술지

To produce milk, four secretory processes are synchronized in the alveolar cell of the mature, functional mammary gland: (1) exocytosis, (2) fat synthesis and secretion, (3) secretion of ions and water, and (4) transcytosis of immunoglubulins and other substances from the interstitial space. Milk is synthesized continuously into the alveolar lumen, where it is stored until milk removal from the breast is initiated. Prolactin mediates the central nervous system regulation of milk secretion, but its influence is modified greatly by local factors that depend on milk removal from the breast. Oxytocin mediates milk let-down by stimulating the contraction of myoepithelial cells that surround the alveoli and ducts. Lactogenesis includes all the processes necessary to go from the undifferentiated mammary gland in the early pregnant animal to full lactation sometime after parturition. The most important factors in initiation of lactogenesis stage II appear to be progesterone withdrawal. The metabolic demands of breastfeeding require an increase in maternal metabolism. Postpartum suppression of fertility is thought to be the result of an alteration in pulsatile gonadotropin releasing hormone secretion from the hypothalamus. Women who wish to ensure against pregnancy during lactation usually are advised to use other contraceptive means.

Treatment of chronic kidney disease in children / 소아과

The treatment of pediatric patients with chronic renal disease comprises management of nutritional imbalance, fluid, electrolyte, and acid-base disturbances, mineral bone disease, anemia, hypertension, and growth retardation. The treatment also includes administration of appropriate renal replacement therapy, if required. Adequate dietary intake of carbohydrates, fats, and proteins and caloric intake must be encouraged in such patients to ensure proper growth and development. In addition, fluid, electrolyte, and acid-base status must be regularly monitored and should be well maintained. Serum calcium, phosphorus, and parathyroid hormone levels must be maintained at their target range, which are determined on the basis of the glomerular filtration rate, to avoid the development of mineral bone disease. This can be achieved by using phosphorus binders and vitamin D analogues. An erythropoiesis-stimulating agent must be administered along with iron supplementation to maintain the hemoglobin level of the patients between 11-12 g/dL. Hypertension must be controlled with adequate water and sodium balance and appropriate antihypertensive agents. Administration of recombinant human growth hormone is recommended to improve the final adult heights.

Iron Intake During Pregnancy on Serum Concentrations of Trace Minerals in Mothers and Neonates

It is a common clinical practice to recommend taking iron supplements for pregnant women during gestation. Although it is required to ensure adequate iron stores during pregnancy, there has been some debate over the interference effects of excessive iron load, because it is possible to compete in the transport in the intestine and placenta and in binding to serum proteins of other trace minerals. In this study, maternal and neonatal serum concentrations of Fe, Zn, Cu, Se, Cr, Mn, and Co were assessed along with maternal Fe intakes. A total of 124 pregnant women and their term neonates participated voluntarily in this research. The women were divided into one of the three groups {high Fe intake (HFI), median Fe intake (MFI), and low Fe intake (LFI)} by their total Fe intakes and one of the two groups (Anemic and Normal) by their Fe nutritional status. All the data were compared among the three groups and between the two groups also. Total Fe intakes of HFI, MFI, and LFI groups were 140.8 +/- 76.1, 68.0 +/- 11.2, and 30.2 +/- 8.6 mg/day, respectively. Those of Anemic and Normal groups were 90.1 +/- 74.8 and 86.6 +/- 46.8 mg/day, respectively. Maternal Hb concentration and Hct were not significantly different among HFI, MFI, and LFI groups but those were significantly different between Anemic and Normal groups. However, neonatal Hb concentration was not significantly different among HFI, MFI, and LFI groups and between Anemic and Normal groups either. Maternal serum Fe concentrations of the three groups, HFI, MFI, and LFI, were similar but that of Anemic group was significantly lower compared to Normal group. However, there was no significant difference in neonatal serum Fe concentrations among the three groups and between the two groups either. Serum concentrations of the other trace minerals in both mothers and neonates were not significantly different among HFI, MFI, and LFI groups and between Anemic and Normal groups. In addition, in the maternal serum, Fe concentration was positively correlated to Zn and Se concentration, respectively. As for the neonatal serum, Fe concentration showed a positive correlation to Zn, Cu, Mn, Se, and Co concentration, respectively. No trace mineral concentration was found to correlate negatively to Fe concentration in both maternal and neonatal serum, The results in this study indicate that Fe intakes of pregnant women, even if it is considerably above the level of estimated average requirement (EAR), may not affect serum Fe concentration in both mothers and neonates. In addition it might not influence adversely on the availability of other trace minerals including Zn and Cu in both mothers and neonates.

Innovative Medical Education at Witten/Herdecke University: Its Idea of Alternative Education and Curriculum / 한국의학교육

PURPOSE: Witten/Herdecke University, Germany, is the only private medical school and university that has offered a wide range of new curricula in the early age of innovation in medical education. The aim of the study is to review how the educational goal of this institution is realized in its curriculum. METHODS: Descriptive study of the educational goal, foundation history, and structure of Witten-Herdecke University's curriculum, as well as its organizational style, through analysis of the literature and publications. RESULTS: Witten/Herdecke University provides an integrated education that ranges from medicine and music therapy to economics and art. This structure is intended to ensure that students receive the broadest education possible to build their own humanity. The results of its innovative education have been recognized as admirable in recent objective publications. CONCLUSION: Through its curriculum, Witten/Herdecke University uses a unique approach in educating its students to become sentient, compassionate human beings. Their program shows us that the direction of innovative medical education in recent decades is justified.

The Efficacy of Bipolar Transurethral Resection of the Prostate in Patients with Large Prostates(>80g) and Analysis of the Postoperative Results Based on the Resection Ratio / 대한비뇨기과학회지

PURPOSE: We evaluated the efficacy of bipolar transurethral resection of the prostate(TURP) in patients with large prostates(>80g) and determined the postoperative results based on the transitional zone resection ratio. MATERIALS AND METHODS: Thirty patients with benign prostatic hyperplasia (BPH)>80g(group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score(IPSS), maximum urinary flow rate (Qmax), post-void residual urine(PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume(RV) to the transitional zone volume(TZV). RESULTS: In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased. CONCLUSIONS: Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result.

Línea de acción: prevención y control de las carencias de micronutrientes. Fortificación del azucar con vitamina A / Line of action: prevention and control of the micronutrient deficiencies. Sugar fortification with vitamin A

El objetivo del documento es evaluar el desarrollo del proceso de fortificación del azucar con vitamina A a traves de la fortificación de 85.000 qq de azucar con palmitato de retinol en el Ingenio UNAGRO,su comercialización en el departamento de Oruro,para poder medir la aceptabilidad de nuevo producto y el impacto