Venous congestive encephalopathy secondary to arteriovenous fistula aggravated by cerebrospinal fluid shunt.

We present a unique clinical case of venous congestive encephalopathy in the context of a cerebral arteriovenous fistula with clinical worsening secondary to valvular overdrainage. ICP monitoring, the different pressure settings of the programable CSF shunt and the detailed clinical description that is carried out offer us enough data to understand that this case provides important pathophysiological knowledge to a little-known disease.

Risk factors for shunt-dependent hydrocephalus after spontaneous subarachnoid hemorrhage.

INTRODUCTION: Subarachnoid haemorrhage (SAH) is one of the most frequent neurosurgical emergencies, most of them due to intracranial aneurysm rupture. Hydrocephalus is a prevalent complication with a high rate of complications. The aims of this study are to identify predictors of shunt-dependent hydrocephalus following aneurysmal SAH and to quantify the complications arising from ventriculoperitoneal shunts. METHODS: This study is about an observational retrospective analytic study of the patients with spontaneous SAH admitted to Miguel Servet Universitary Hospital between 2017 and 2022. Patients' clinical and radiological characteristics, type of treatment, diagnoses and treatment of hydrocephalus, complications of ventriculoperitoneal shunts and mortality are some of the data achieved in this study. A descriptive study of these variables has been done and, subsequently, the most relevant variables have been statistically analysed to identify patients with increasing risk of shunting for hydrocephalus. This study was authorized by the Ethics Committee prior to its elaboration. RESULTS: A total of 359 patients with spontaneous SAH were admitted to Miguel Servet Universitary Hospital between 2017 and 2022, with an intrahospitalary death rate of 25.3%. 66.3% of the total of patients with SAH were due to intracranial aneurysm rupture (n = 238). 45.3% of the patients with aneurysmal SAH required an external ventricular drain (EVD) to treat acute hydrocephalus. 11.7% (n = 28) developed a shunt-dependent hydrocephalus. Statistical significance was found between shunt-dependent hydrocephalus and the following: high score in modified Fisher scale and placement of EVD. The mean interval from EVD to ventriculoperitoneal shunt placement was 26.1 days. The mean rate of reoperation of patients after shunt was 17.7%, mostly due to infection. CONCLUSIONS: The most significant risk factor for shunt-dependent hydrocephalus after aneurysmal SAH was high Fisher grade and previous need of EVD. Shunt infections is the main cause of shunt reoperation. Early shunt placement in selected patients might reduce the rate of infectious complications.

Optimal PHASES Scoring for Risk Stratification of Surgically Treated Unruptured Aneurysms.

OBJECTIVE: The PHASES (Population, Hypertension, Age, Size, Earlier subarachnoid hemorrhage, Site) score was developed to facilitate risk stratification for management of unruptured intracranial aneurysms (UIAs). This study aimed to identify the optimal PHASES score cutoff for predicting neurologic outcomes in patients with surgically treated aneurysms. METHODS: All patients who underwent microneurosurgical treatment for UIA at a large quaternary center from January 1, 2014, to December 31, 2020, were retrospectively reviewed. Inclusion criteria included a modified Rankin Scale (mRS) score of ≤2 at admission. The primary outcome was 1-year mRS score, with a "poor" neurologic outcome defined as an mRS score >2. RESULTS: In total, 375 patients were included in the analysis. The mean (SD) PHASES score for the entire study population was 4.47 (2.67). Of 375 patients, 116 (31%) had a PHASES score ≥6, which was found to maximize prediction of poor neurologic outcome. Patients with PHASES scores ≥6 had significantly higher rates of poor neurologic outcome than patients with PHASES scores <6 at discharge (58 [50%] vs. 90 [35%], P = 0.005) and follow-up (20 [17%] vs. 18 [6.9%], P = 0.002). After adjusting for age, Charlson Comorbidity Index score, nonsaccular aneurysm, and aneurysm size, PHASES score ≥6 remained a significant predictor of poor neurologic outcome at follow-up (odds ratio, 2.75; 95% confidence interval, 1.42-5.36, P = 0.003). CONCLUSIONS: In this retrospective analysis, a PHASES score ≥6 was associated with significantly greater proportions of poor outcome, suggesting that awareness of this threshold in PHASES scoring could be useful in risk stratification and UIA management.

Mortality After Microsurgical Treatment of Unruptured Intracranial Aneurysms in the Modern Era.

BACKGROUND: The incidence of mortality after treatment of unruptured intracranial aneurysms (UIAs) has been described historically. However, many advances in microsurgical treatment have since emerged, and most available data are outdated. We analyzed the incidence of mortality after microsurgical treatment of patients with UIAs treated in the past decade. METHODS: The medical records of all patients with UIAs who underwent elective treatment at our large quaternary center from January 1, 2014, to December 31, 2020, were reviewed retrospectively. We analyzed mortality at discharge and 1-year follow-up as the primary outcome using univariate to multivariable progression with P < 0.20 inclusion. RESULTS: During the 7-year study period, 488 patients (mean [SD] age = 58 [12] years) had UIAs treated microsurgically. Of these patients, 61 (12.5%) had a prior subarachnoid hemorrhage. One patient (0.2%) with a dolichoectatic vertebrobasilar aneurysm died while hospitalized, and 7 other patients (8 total; 1.6%) were determined to have died at 1-year follow-up (1 trauma, 2 myocardial infarction, 2 cerebrovascular accident, 1 pulmonary embolism, and 1 subdural hematoma complicated by abscess). On univariate analysis, significant risk factors for mortality at follow-up included diabetes mellitus, preoperative anticoagulant or antiplatelet use, aneurysm calcification, nonsaccular aneurysm, and higher American Society of Anesthesiologists grades (all P < 0.03). On multivariable logistic regression analysis, only nonsaccular aneurysms and higher American Society of Anesthesiologists grades were predictors of mortality. CONCLUSIONS: A low mortality rate is associated with recent microsurgical treatment of UIAs. However, nonsaccular aneurysms and higher American Society of Anesthesiologists grades appear to be predictors of mortality.

Changes in skinfolds and mid-upper arm circumference during pregnancy in Argentine women.

This investigation describes the pattern of changes in mid-upper arm circumference (MUAC), triceps, biceps and subscapular skinfold thicknesses during the course of pregnancy, and its relationship with maternal and newborn outcomes. A prospective cohort of 1066 pregnant women were selected in seven different urban regions in Argentina. Measurements of MUAC were carried out at 16, 28 and 36 gestational weeks. In a subsample of 488 women, triceps, biceps and subscapular skinfold thicknesses were measured. Mean total increase in subscapular, tricipital and bicipital skinfolds from 16 to 36 weeks of gestation were 4.5, 3.6 and 2.6 mm, respectively. MUAC showed a mean increase of 1.7 cm in the same period. Overweight or obese women at the start of pregnancy had lower increases in all measurements compared with women with normal or low body mass index. Maternal anthropometry was related to birthweight; women who gave birth to infants of less than 3000 g had lower average values in all measurements than those who had normal birthweight infants. LMS curves for MUAC and skinfolds by gestational age are presented, which can be used as a reference to assess maternal nutrition status during pregnancy. MUAC, tricipital and subscapular skinfold for gestational age curves are proposed for monitoring maternal nutritional status during pregnancy. MUAC cut-off points of 24.5, 25.5 and 26.5 cm for 16, 28 and 36 weeks of gestation, respectively, are also proposed as a proxy to detect low birthweight.

Repair of internal carotid artery injury with aneurysm clip during endoscopic endonasal surgery: illustrative case.

BACKGROUND: One of the most feared and dangerous scenarios that can appear during an endoscopic endonasal surgery (EES) is the iatrogenic injury of the internal carotid artery (ICA). Several methods, along with a variety of outcomes, have been described to deal with this complication. To the authors' knowledge, this is the first report on the use of a Yasargil-type aneurysm clip to solve an ICA injury, preserving the artery's patency and having a long-term follow-up. The authors discuss the advantages and disadvantages of other vessel preservation techniques compared with clipping. OBSERVATIONS: A visually impaired 56-year-old woman was diagnosed with a giant nonfunctional pituitary tumor that invaded the sphenoidal sinus, anterior and posterior ethmoidal cells, and both cavernous sinuses, with suprasellar extension and optochiasmatic compression. The patient underwent EES, and during the final resection phase her left ICA was injured, with massive hemorrhage. LESSONS: ICA injury during endoscopic skull base surgery carries high mortality and morbidity; it is essential to maintain carotid flow when possible to avoid short-term and long-term consequences. There are several techniques depicted in the literature to deal with this situation. The authors report the use of a Yasargil mini-clip to deal with the injury for a positive outcome: primary hemostasis, vessel preservation, and no postoperative complications.

Supracerebellar transtentorial approach for left parahippocampal cavernous malformation.

BACKGROUND: Lesions in the temporomesial region can be reached by various approaches: subtemporal, transsylvian, transcortical, interhemispheric parieto-occipital, or supracerebellar transtentorial (SCTT). The choice varies according to the characteristics of the lesion and neighboring structures. CASE DESCRIPTION: In this clinical case, it is presented a 56-year-old man with long-term evolution of drug-resistant epilepsy secondary to a cavernoma in the left parahippocampal gyrus. After assessing the lesion, it was decided a SCTT approach for its resection in a semi-sitting position, to avoid language disorders or visual damage. The surgery was uneventful and the patient did not present epileptic seizures during 6-month follow-up. CONCLUSION: Performing a SCTT is safe and feasible option for resection of lesions located in the basal temporomesial region without causing damage to neighboring structures, especially those located in the middle and posterior two-thirds of temporal region.

Metabolic Syndrome Among Young Health Professionals in the Multicenter Latin America Metabolic Syndrome Study.

Background: Metabolic syndrome (MS) and its components increase the risk of a number of chronic diseases. Evidence regarding its prevalence among health professionals, particularly in Latin America, is limited. The purpose of this study was to assess the overall prevalence of MS and its components among health professionals and students from five Latin American countries. Methods: A cross-sectional multicenter study entitled LATIN America METabolic Syndrome (LATINMETS) was conducted on five groups of apparently healthy volunteer subjects. Sociodemographic factors, lifestyle variables (smoking and physical activity), anthropometric measurements (weight, height, and waist circumference), standard biochemical analyses [triglycerides, glucose, and high-density lipoprotein cholesterol (HDL-C)], and blood pressure measurements were assessed. MS was diagnosed based on internationally harmonized criteria. Associations between MS components and sociodemographic, lifestyle, and anthropometric variables were analyzed using multivariate logistic regression. Results: A total of 1,032 volunteers (n = 316-Mexico, n = 285-Colombia, n = 223-Brazil, n = 132-Paraguay, and n = 76-Argentina) were recruited. The majority of them were women (71.9%), students (55.4%), and younger than 28 years (67.2%). The overall prevalence of age-standardized MS was 15.5% (23.1% men and 12.2% women). The majority (59.3%) presented at least one MS component, mainly abdominal obesity (29.7%) and low HDL-C levels (27.5%). After adjusting for age and sex, MS and its components were positively associated with being overweight or obese. Conclusions: MS prevalence in this study was similar to that generally found among young populations in Latin-American countries. More than half of the sample had at least one MS component, suggesting that preventive measures and treatments aimed at achieving low-risk health status are essential in this population.

ESTUDIO COMPARATIVO DE LA DECLARACIÓN DE ALÉRGENOS Y FRASES DE ADVERTENCIA EN RÓTULOS DE ALIMENTOS ENTRE LOS AÑOS 2019 Y 2022 / DECLARATIOM OF ALLERGENS AND WARNING PHRASES ON FOOD LABELS. COMPARATIVE STUDY BETWEEN 2019 AND 2022 YEARS

El etiquetado de alérgenos alimentarios en los productos es hoy uno de los temas que genera grandes preocupaciones en la población. Objetivo: evaluar cómo las distintas empresas se adecuaron a la legislación vigente sobre alérgenos en Argentina. Materiales y Métodos: en 2019 se relevaron 16 productos alimenticios dulces y salados que se codificaron como: ME, MN, TO, PA, GD, F, MLV, QM, BB, BT, TR, TM, PFK, BQK, CHB y CM. Para realizar la comparación de las declaraciones de alérgenos, a mediados de 2022 se volvieron a relevar los 16 productos, encontrándose tres de ellos discontinuados. El análisis del rótulo comprendió la verificación del cumplimiento de la declaración de alérgenos, uso de frases de advertencia (FA) y presentación de la información. Resultados y Discusión: en el 2019 en la declaración de alérgenos se incluyen expresiones como: "contiene gluten", en un 50% de los productos analizados. Por otro lado, en 5 de los 15 productos con FA, hay expresiones del tipo "puede contener trazas…". Asimismo, se incluye en 5 productos, al sésamo, alérgeno contemplado por legislaciones diferentes a la Argentina. Con respecto a la presencia de dióxido de azufre y sulfitos, hay dos productos que los declaran a continuación de la lista de ingredientes y otros dos productos que declaran a los sulfitos en sus frases de advertencia. Al analizar los rótulos en el 2022, el 80% de los productos analizados no presentan inconsistencias en lo que respecta a la presentación de la información. Conclusiones: en el estudio comparativo se observa una mejora en la correcta declaración de alérgenos y frases de advertencia. Sin embargo, después de más de cinco años de haber finalizado el plazo otorgado a las industrias para la adecuación de los rótulos, para una adecuada declaración de alérgenos, persisten algunos productos no conformes

The labeling of food allergens in products is today one of the issues that generates great concern in the population. Objective: was to evaluate how different companies adapted to current legislation on allergens in Argentina. Materials and methods: in 2019, sixteen sweet and salty food products were surveyed, coded as: ME, MN, TO, PA, GD, F, MLV, QM, BB, BT, TR, TM, PFK, BQK, CHB and CM. To compare the allergen declarations, in mid-2022 the sixteen products were surveyed again, finding three discontinued products. The analysis of the label included verification of compliance with the allergen declaration, use of warning phrases (FA), and presentation of information. Results and Discution: in 2019, the declaration of allergens includes expressions such as: "contains gluten", in 50% of the products analyzed. On the other hand, in five of the fifteen products with FA, there are expressions such as "may contain traces...". Likewise, it is included in five products, sesame, an allergen contemplated by legislations other than Argentina. Regarding the presence of sulfur dioxide and sulphites, there are two products that declare them below the list of ingredients and two other products that declare sulphites in their warning phrases. When analyzing the labels in 2022, 80% of the analyzed products do not present inconsistencies with regard to the presentation of the information.Conclusions: in the comparative study, an improvement is observed in the correct declaration of allergens and warning phrases.However, more than five years after the end of the period granted to the industries for the adaptation of the labels for an adequate declaration of allergens, some errors persist in them

Valoración del impacto de la legislación argentina sobre alérgenos alimentarios: cinco años de una travesía con aciertos y desafíos / Assessment of the impact of the argentine legislation on food allergens: five years of a journey with successes and challenges / Avaliação do impacto da legislação argentina sobre alérgenos alimentares: cinco anos de uma caminho de desafios e sucessos

Resumen Las alergias alimentarias representan un problema de salud pública. La declaración de alérgenos en el rótulo implicó un avance fundamental para la gestión del riesgo, ya que evitar el alimento desencadenante mediante el rotulado adecuado constituye actualmente una medida insustituible de cuidado para la población susceptible. Se realizó una valoración del impacto de la legislación nacional en referencia a la declaración de alérgenos alimentarios entre 2017 y 2022. Se utilizaron los motores de búsqueda interna de la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) para los retiros de productos alimenticios del mercado y se contrastó como herramienta de medición indirecta para la valoración del impacto de la implementación del Artículo 235 séptimo del Código Alimentario Nacional (CAA). Se analizaron 43 productos (galletitas, fideos, chocolates, alimentos a base de vegetales). El 53,5% (23 sobre un total de 43) presentaba declaración de alérgenos. El 70% de los mismos (16 sobre un total de 23) fueron categorizados "con inconsistencias" y el 14% (6 productos de 43) utilizaba etiquetado precautorio. El paradigma reactivo del control de alimentos sobresalió por sobre el de las auditorías, los programas de monitoreo y, en suma, sobre los programas de prevención, ya que el sistema se activó fundamentalmente por la vía reactiva de las denuncias. Esto representó un 72% de los productos categorizados.

Abstract Food allergies represent a public health problem. The declaration of allergens on the label implied a fundamental advance for risk management, since avoiding the triggering food through proper labelling is currently an irreplaceable measure of care for the susceptible population. An assessment of the impact of the national legislation was carried out in reference to the declaration of food allergens between 2017 and 2022. The ANMAT internal search engines were used for the withdrawals of food products from the market and contrastlised as an indirect measurement tool for the impact assessment of the implementation of Section 235 seventh of the Argentine Food Code (CAA, for its acronym in Spanish). Forty-three products (biscuits, noodles, chocolates, vegetable-based foods) were analysed. The allergen declaration was present in 53.5% (23 out of a total of 43). Some inconsistencies were present in 70% of them (16 out of a total of 23) and 14% (6 products out of 43) used precautionary labelling. The reactive paradigm of food control stood out above that of audits, monitoring programmes and, in short, prevention programmes, since the system was activated fundamentally through the reactive route of complaints. This represented 72% of the categorised products.

Resumo As alergias alimentares representam um problema de saúde pública. A declaração de alérgenos no rótulo envolveu um avanço fundamental para a gestão do risco, visto que evitar os alimentos que desencadeiam as alergias, por meio de uma rotulagem adequada, é atualmente uma medida insubstituível de cuidado para a população suscetível. Foi realizada uma avaliação do impacto da legislação nacional referida à declaração de alérgenos alimentares entre 2017 e 2022. Os motores de busca interna da ANMAT (Administração Nacional de Medicamentos, Alimentos e Tecnologia Médica) foram utilizados para as retiradas de produtos alimentares do mercado e contrastados como uma ferramenta indireta de medição para a avaliação do impacto da aplicação do artigo 235 sétimo, do CAA (Código Alimentar Nacional). Foram analisados 43 produtos (biscoitos, macarrão, chocolates, alimentos à base de vegetais). 53,5% (23 de um total de 43) apresentavam declaração de alérgenos, 70% deles (16 de um total de 23) foram categorizados "com inconsistências" e 14% (6 produtos de 43) utilizavam rotulagem de precaução. Destacou-se o paradigma "reativo" do controle de alimentos por sobre o controle das auditorias, dos programas de monitoramento e, em resumo, dos programas de prevenção, visto que o sistema foi ativado fundamentalmente pela via reativa das reclamações. Isso representou 72% dos produtos categorizados.

Evaluación del contenido, dializabilidad y aporte potencial de hierro, zinc y calcio en panificados libres de gluten elaborados a partir de premezclas comerciales / Evaluation of the content, dialyzability and potential contribution of iron, zinc and calcium in gluten-free bakery products made from commercial premixes

Resumen La población que debe consumir una dieta libre de gluten de por vida se encuentra en constante aumento. Es importante que la misma no sea deficiente en nutrientes, entre ellos, los minerales. En el presente trabajo se evaluó el contenido, dializabilidad, aporte potencial y porcentaje de cobertura del requerimiento diario de hierro, zinc y calcio en bizcochuelos, panes, galletitas y pizzas libres de gluten elaborados a partir de premezclas comerciales. Estos contenidos se compararon con un homólogo elaborado con harina de trigo enriquecida con sulfato ferroso. Se empleó un método in vitro con posterior cuantificación por espectroscopía de absorción atómica. Si bien se observó una amplia variación en los contenidos de los tres minerales para los cuatro grupos de alimentos elaborados a partir de premezclas, las dializabilidades porcentuales fueron bajas. Los porcentajes de cobertura de los requerimientos diarios de hierro, zinc y calcio resultaron muy bajos, a excepción del hierro de las pizzas cuyas coberturas por porción fueron considerables. Los resultados obtenidos para hierro en los homólogos reflejan el impacto del enriquecimiento de la harina de trigo con sulfato ferroso. Sería conveniente contemplar la utilización de harinas de pseudocereales para mejorar su calidad mineral, así como evaluar la implementación de políticas públicas para que la población que debe consumir alimentos libres de gluten tenga acceso a alimentos enriquecidos, como ocurre con la harina de trigo.

Abstract The number of people that must consume a gluten-free diet is constantly increasing. It is, however, important that this diet is not deficient in nutrients, in particular some key minerals. The present work focuses on the contents of iron, zinc and calcium in gluten-free sponge cakes, breads, cookies and pizzas made from commercial premixes. Other properties analysed were the dialyzability, the potential contribution and the percentage of coverage of the daily requirement of the mentioned minerals in each of the products. These properties were contrasted and compared with those of equivalent products elaborated with wheat flour enriched with ferrous sulfate. An in vitro methodology of mineral bioavailability was utilised, with subsequent quantification by atomic absorption spectroscopy. Even though a wide variation in the three minerals' content in each of the four products was observed, the percentage of dialysability was low. In terms of meeting the daily requirements, only the iron in the pizzas covered a considerable proportion. In all the other cases only very small parts of the daily requirements were covered. The results obtained for iron in the equivalent products reflect the impact of the enrichment of wheat flour with ferrous sulfate. It would be convenient to contemplate the use of pseudocereal flours to improve their mineral quality. In addition, it would be advisable to evaluate the implementation of public policies so that the population that should consume gluten-free foods has access to enriched foods, as is the case with wheat flour.

Resumo A população que deve consumir uma dieta sem glúten por toda a vida está aumentando constantemente. É importante que ela não seja deficiente em nutrientes, incluindo minerais. No presente trabalho foram avaliados o conteúdo, dialisabilidade, contribuição potencial e porcentagem de cobertura da necessidade diária de ferro, zinco e cálcio em bolos, pães, biscoitos e pizzas sem glúten elaborados com pré-misturas comerciais. Esses conteúdos foram comparados com uma contraparte feita com farinha de trigo enriquecida com sulfato ferroso. Foi utilizado um método in vitro com posterior quantificação por espectroscopia de absorção atômica. Embora se tenha observado uma grande variação no conteúdo dos três minerais para os quatro grupos de alimentos elaborados a partir de pré-misturas, as dialisabilidades porcentuais foram baixas. Os percentuais de cobertura das necessidades diárias de ferro, zinco e cálcio foram muito baixos, com exceção do ferro das pizzas cuja cobertura por porção foi considerável. Os resultados obtidos para o ferro nos homólogos refletem o impacto do enriquecimento da farinha de trigo com sulfato ferroso. Seria conveniente contemplar o uso de farinhas de pseudocereais para melhorar sua qualidade mineral, bem como avaliar a implementação de políticas públicas para que a população que deve consumir alimentos sem glúten tenha acesso a alimentos enriquecidos, como acontece com a farinha de trigo.

Situación nutricional en los primeros 1000 días del ciclo vital: una puesta al día de los datos disponibles en Argentina / Nutritional situation in the first 1000 days of life: an UpDate of the available data in Argentina

Introducción: Los primeros 1000 días de vida representan un período crítico del ciclo vital que impacta en el estado de salud de la mujer y de la progenie. Objetivo: Realizar una revisión sobre la información disponible con relación al estado nutricional materno-infantil, la lactancia materna y los hábitos alimentarios en esta etapa de la vida en el territorio de la Argentina. Métodos: Búsqueda de información de investigaciones realizadas en el país en niños y niñas de 0 a 2 años, embarazadas y mujeres en período de lactancia, publicadas en el período 2013-2020. Resultados: Los datos disponibles muestran que la alimentación tanto en las mujeres como en los niños y las niñas puede ser deficiente en nutrientes críticos, asociada a un perfil epidemiológico con prevalencia de sobrepeso. La baja talla, un indicador de malnutrición intergeneracional, se describe en una proporción de aproximadamente el 8% al 9% tanto en los menores de 2 años como en las gestantes, en tanto que la proporción de bajo peso se encuentra en el orden del 2 % al 10%, respectivamente. Los datos sobre lactancia materna revelan que aún no se alcanza a garantizar una cobertura satisfactoria; solo del 36,5% al 63,4% de los niños reciben lactancia materna exclusiva al sexto mes. La deficiencia de hierro y la anemia siguen siendo problemáticas frecuentes y en los pocos estudios regionales disponibles se encuentran resultados variables según la región y la población estudiada. Conclusión: Tanto los resultados de las encuestas nacionales como los procedentes de pequeños estudios poblacionales regionales muestran que las condiciones de vulnerabilidad social comprometen el estado nutricional durante estos primeros 1000 días de vida. Si bien se han implementado en el país en los últimos años una serie de programas e intervenciones de ayuda alimentaria, no existe información respecto del impacto que dichas políticas públicas han tenido en la población

Introduction: The first 1000 days of life represent a critical period of the life cycle that impacts the health status of women and their offspring. Objective: To carry out a review of the information available in relation to the maternal and infant nutritional status, breastfeeding and eating habits at this stage of life in the territory of Argentina. Methods: Search for information on research performed in Argentina on infants from 0 to 2 years of age, pregnant women and lactating women, published in the period 2013-2020. Results: The available data show that the diet of both women and children can be deficient in critical nutrients, associated with an epidemiological profile with prevalence of overweight. Short stature, an indicator of intergenerational malnutrition, is described in a proportion of approximately 8% to 9% in both those under 2 years of age and in pregnant women, while the proportion of underweight is in the order of 2% at 10% respectively. Data on breastfeeding reveal that satisfactory coverage has not yet been guaranteed; only 3,5% to 63,4% of children are exclusively breastfed at the sixth month. Iron deficiency and anemia continue to be frequent problems and the few available regional studies find variable results depending on the region and population studied. Conclusion: Both the results of national surveys and those from small regional population studies show that conditions of social vulnerability compromise nutritional status during these first 1,000 days of life. Although a series of food aid programs and interventions have been implemented in the country in recent years, there is no information regarding the impact that these public policies have had on the populatio

[Identification of extrinsic proteins in boneless cooked ham by SDS-PAGE: detection level in model systems]. / Identificación de proteínas extrínsecas en jamones cocidos por SDS-pAge: Nivel de detección en sistemas modelo.

Protein extraction and separation in polyacrylamide slab gel electrophoresis with Laemmli system (SDS-PAGE) were used to establish the detection level of protein raw materials in mixtures with porcine meat in boneless cooked ham. Model systems of boneless cooked ham with soy protein isolates, caseinate, skim powdered milk, bovine plasma, porcine plasma and whey proteins were studied. The quantification level of this method was 0.5% for soy protein isolates, caseinate and bovine plasma and 1.0% for porcine plasma, milk powder and whey proteins in boneless cooked ham. The electrophoretic method proved to be useful to identify some proteinic raw materials in porcine meat products and verify compliance with Argentine legislation. It may be used as a control methodology.

Infusiones a base de plantas medicinales durante el embarazo: una actualización en la temática / Herbal teas during pregnancy: an UpDate on the subject

Introducción: en las últimas décadas es creciente el empleo de plantas medicinales en todo el ciclo vital debido, por un lado, a una tendencia a revalorizar los saberes que forman parte de las culturas regionales de algunas comunidades y, por el otro, al uso cada vez más frecuente en los países desarrollados de medicinas alternativas complementarias. Objetivos: el presente trabajo tiene el propósito de realizar una actualización en relación al consumo de infusiones de plantas medicinales durante la gestación, con énfasis en las posturas sobre el tema emitidas por organismos de referencia. Desarrollo: las plantas medicinales presentadas en este documento son las que cuentan con un mayor aval científico respecto de la seguridad de su consumo en forma de infusiones durante el embarazo e incluyen al jengibre, la manzanilla, la menta piperita y el tilo. Se presentan las características de cada planta, la zona de producción en Argentina, los compuestos bioactivos presentes, los potenciales riesgos, y la postura de organismos nacionales e internacionales sobre su inocuidad durante la gestación. Conclusiones: en todos los casos, durante el embarazo el consumo seguro es en forma de infusión, no más de dos a tres tazas por día de cada planta, e idealmente se recomienda alternar su consumo o combinarlo. Además, se destaca que la comunidad debe reconocer la necesidad de consultar al profesional médico antes de usar una planta medicinal

Introduction: in the last decades, the use of medicinal plants throughout the life cycle is increasing due, on the one hand, to a tendency to revalue knowledges that are part of the regional cultures of some communities and, on the other hand, to the use increasingly frequent in developed countries of complementary alternative medicines. Objectives: the purpose of this work is to carry out an update in relation to the consumption of medicinal herbal teas during pregnancy with emphasis on the positions on the subject issued by reference organisms. Development: the medicinal plants presented in this document are the ones that have the greatest scientific endorsement regarding the safety of their consumption in the form of infusions during pregnancy and include ginger, chamomile, peppermint, and linden. The characteristics of each plant, the production area in Argentina, the bioactive compounds present, the potential risks and the position of national and international organizations regarding their safety during pregnancy are presented. Conclusions: In all cases during pregnancy, safe consumption is in the form of an infusion, not more than two to three cups per day of each plant, and ideally it is recommended to alternate its consumption or combine it. In addition, it is highlighted that the community must recognize the need to consult a medical professional before using a medicinal plant

Detección de trazas de soja y de leche en productos libres de gluten: desarrollo de dos enzimoinmunoensayos competitivos / Detection of traces of soy and milk in gluten-free products: development of two competitive enzyme immunoassays / Detecção de vestígios de soja e leite em produtos livres de glúten: desenvolvimento de dois enzimoimunoensaios competitivos

Resumen El objetivo del presente trabajo fue el desarrollo de dos enzimoinmunoensayos competitivos (EIC) para la detección de trazas de soja y de leche en productos libres de gluten. Como anticuerpos primarios se utilizaron antisueros policlonales de conejo específicos contra proteínas de soja o de leche. Se determinaron las concentraciones óptimas de antígenos a inmovilizar en la placa y las concentraciones de anticuerpos primarios a utilizar en la competencia. Las curvas de calibración se ajustaron utilizando concentraciones crecientes de un extracto de producto de soja y de un extracto de leche descremada en polvo. El producto de soja y la leche descremada se extrajeron con buffer Tris-HCl 0,0625 M con dodecilsulfato de sodio al 3% y sulfito de sodio 0,1 M al 2%. Se evaluaron los parámetros de validación: linealidad, límites de detección y de cuantificación, recuperación y precisión en el día y entre días, los cuales resultaron adecuados. Se analizaron 9 productos libres de gluten con los EIC desarrollados y con kits de ELISA comerciales. Ambos EIC se comportaron de manera similar con respecto a los kits comerciales. Los EIC permitieron confirmar la presencia de leche en las muestras que la declaraban. En algunas muestras que no declaraban ni leche ni soja, ambos EIC detectaron su presencia (resultados confirmados con los kits comerciales). Los EIC desarrollados poseen menor costo que los kits y, por lo tanto, éstos podrían utilizarse como métodos de screening. Cuando esta metodología resulte negativa, debe confirmarse con un método más sensible (comercial) para garantizar la ausencia de proteínas de soja o de leche.

Abstract The aim of this study was to develop two competitive enzyme immunoassays (CEI) to detect the presence of traces of soy and milk in gluten-free products. Specific rabbit polyclonal antiserums against soy protein and other against elemilk protein were used as primary antibodies. Optimal antigen concentrations to be immobilized on the plate and primary antibody concentrations to be used in competition were determined. The calibration curves were fitted using increasing concentrations of an extract of soy product and of defatted milk powder. The soy product and the defatted milk were extracted with Tris-HCl buffer 0,0625 M with 3% sodium dodecyl sulfate and 2% sodium sulfite 0.1 M. The validation parameters were evaluated: linearity, limit of detection and quantification, recovery and precision on the day and in between days. They were appropriate. Nine commercial samples of gluten-free products were analyzed with these developed CEI and commercial ELISA kits. It was observed that both CEI behaved similarly with respect to the commercial kits. The enzyme immunoassays confirmed the presence of milk in samples that declared it. In some samples that did not declare the presence of milk or soy, both enzyme immunoassays detected their presence -these results were confirmed using commercial kits. The developed CEI have a lower cost than the commercial kits, so these could be used as screening methods. When this methodology is negative, it should be confirmed with a more sensitive (commercial) method to ensure the absence of soy or milk protein.

Resumo O objetivo do presente trabalho foi o desenvolvimento de dois enzimoimunoensaios competitivos (EIC), para a detecção de vestígios de soja e leite em produtos livres de glúten. Antissoros policlonais de coelho específicos contra proteínas de soja ou de leite foram utilizados como anticorpos primários. Foram determinadas as concentrações ótimas de antígenos a serem imobilizados na placa e as concentrações de anticorpos primários a serem utilizadas na competição. As curvas de calibração foram ajustadas usando concentrações crescentes de um extrato de produto de soja e de um extrato de leite em pó desnatado. O produto de soja e o leite desnatado foram extraídos com tampão Tris-HCl 0,0625 M com dodecil sulfato de sódio a 3% e sulfito de sódio 0,1 M a 2%. Os parâmetros de validação foram avaliados: linearidade, limite de detecção e quantificação, recuperação e precisão no dia e entre os dias, os quais resultaram adequados. Nove produtos livres de glúten foram analisados com os EIC desenvolvidos e com kits de ELISA comerciais. Os dois EICs se comportaram de maneira semelhante em relação aos kits comerciais. Os EIC permitiram confirmar a presença de leite nas amostras que o declararam. Em algumas amostras que declaravam nem leite nem soja, ambos os EIC detectaram sua presença (resultados confirmados usando kits comerciais). Os EIC desenvolvidos têm um custo menor que os kits, portanto, eles poderiam ser utilizados como métodos de triagem. Quando esta metodologia é negativa, deve ser confirmada com um método mais sensível (comercial) para garantir a ausência de proteínasda soja ou do leite.

Aporte de energía, macronutrientes y fibra de alimentos farináceos libres de gluten elaborados a partir de premezclas comerciales / Energy, macronutrients and fiber contribution of gluten free farinaceous products produced from commercial premix

Resumen La dieta libre de gluten (DLG) es el único tratamiento frente a la enfermedad celíaca, la alergia al trigo y la sensibilidad al gluten no celíaca. Se reporta a la DLG como una dieta desbalanceada, escasa en fibra y alta en grasas y carbohidratos. El objetivo del estudio fue evaluar el aporte de energía, de macronutrientes y de fibra de alimentos libres de gluten (bizcochuelos, panes estilo inglés, galletitas dulces y pizzas) elaborados a partir de diferentes premezclas comerciales, disponibles en el mercado local. Además, los resultados fueron comparados con un homólogo comercial elaborado con harina de trigo. Para la determinación de la composición centesimal se aplicó la metodología oficial AOAC 2016. El valor energético se calculó utilizando los factores de Atwater. Los resultados obtenidos para los bizcochuelos fueron: 6,0-8,3 g% de proteína; 9,2-11,3 g% de grasas; 1,5-2,3 g% de fibra dietaria; 40,0-53,1 g% de carbohidratos y 285-339 Kcal% de valor energético. Para los panes: 3,0-6,6 g% de proteína; 3,1-12,7 g% de grasas; 2,7-4,0 g% de fibra dietaria; 36,8-50,1 g% de carbohidratos y 217-290 Kcal% de valor energético. Para las galletitas: 3,5-8,5 g% de proteína; 25,9-31,0 g% de grasas; 0,9-5,9 g% de fibra dietaria; 53,9-60,1 g% de carbohidratos y 483-527 Kcal% de valor energético. Para las pizzas: 7,4-9,3 g% de proteína; 7,3-11,2 g% de grasas; 2,8-8,0 g% de fibra dietaria; 19,1-29,6 g% de carbohidratos y 172-240 Kcal% de valor energético. Los alimentos elaborados con premezclas formuladas únicamente con harina de arroz y féculas contribuyen poco a cubrir el valor diario recomendado de fibra. Los que contienen otras fuentes farináceas (harina de sorgo, trigo sarraceno y teff) reflejan un mayor contenido de fibra. La presencia de harina de arveja, soja y teff refleja un aumento del contenido proteico. Los alimentos estudiados frente a su homólogo comercial con harina de trigo presentan, en general, igual o menor aporte proteico, similar aporte energético y de carbohidratos y un mayor aporte de grasas y fibra dietaria.

Abstract The gluten free diet (GFD) is the only treatment for celiac disease, wheat allergy and non-celiac gluten/wheat sensitivity. GFD is reported as an unbalanced diet, low in fibre and high in fat and carbohydrates. The aim of this study was to evaluate energy, macronutrients and fiber contribution of gluten-free cereal products (pound cake, tin loaf, cookies and pizza) coming from different commercial premixes, available at the local market. Also, the results were compared with a commercial equivalent made with wheat flour. For centesimal composition determination, AOAC Official Method 2016 was applied. The energy was calculated using Atwater factors. The results obtained for pound cake were: 6.0-8.3g% protein; 9.2-11.3g% fat; 1.5-2.3g% dietary fibre; 40.0-53.1g% carbohydrate and 285-339Kcal% energy. For tin loaf: 3.0-6.6g% protein; 3.1-12.7% fat; 2.7-4.0g% dietary fibre; 36.8-50.1g% carbohydrate and 217-290Kcal% energy. For cookies: 3.5-8.5g% protein; 25.9-31.0g% fat; 0.9-5.9g% dietary fibre; 53.9-60.1g% carbohydrate and 483-527Kcal% energy. For pizza: 7.4-9.3g% protein; 7.3-11.2g% fat; 2.8-8.0g% dietary fibre; 19.1-29.6g% carbohydrate and 172-240Kcal% of energy. Products made with premix that only contains rice flour and starches contribute little to meeting recommended daily intake. The ones that contain other farinaceous sources (sorghum flour, buckwheat and teff) show higher dietary fibre content. The presence of pea flour, soybean and teff show an increase of protein content. The analysed products present same or lower protein intake, similar energy and carbohydrate intake and higher fat and dietary fibre intake, compared to their commercial equivalent made with wheat flour.

Calidad de la dieta según el Índice de Alimentación Saludable: Análisis en la población adulta de la ciudad de Rosario, Argentina / Diet quality according to the Healthy Eating Index: Analysis in the adult population of Rosario City, Argentina

Introducción: el Índice de Alimentación Saludable (IAS) fue desarrollado en base a las recomendaciones de las guías alimentarias para la población americana y es de utilidad para identificar los grupos de alimentos que presentan menor consumo en relación a las recomendaciones y los grupos poblacionales con alimentación de baja calidad. Objetivo: estimar la calidad de la dieta en la población adulta de la ciudad de Rosario, e identificar su relación con variables sociodemográficas, indicadores antropométricos y del estilo de vida. Materiales y Método: investigación observacional, descriptiva y transversal de una muestra por cuotas estratificada de 1200 adultos entre 18 a 70 años. Se empleó la metodología actualizada en el 2010 para el cálculo de IAS, a partir de la información obtenida del recordatorio de 24 horas. Se utilizó un cuestionario para relevar las variables sociodemográficas y el consumo de tabaco, se realizaron mediciones antropométricas, la actividad física se midió con el cuestionario IPAQ y el consumo de alcohol por frecuencia de consumo. Las asociaciones se evaluaron mediante test Chi cuadrado y la diferencia de medias por Anova, considerando p<0,05. Resultados: los adultos evaluados tenían en promedio 39±15 años, el 69% fueron mujeres, el 32% con estudios terciarios completos o más, 56% tenía un IMC≥25 kg/m², 34% presentaba riesgo según circunferencia de cintura, 54% realizaba <150 min/sem de actividad física, 67% consumía alcohol y 26% era fumador actual. El IAS alcanzó un promedio de 48,5±15,1 puntos, los valores más alejados del ideal se encontraron en los pescados, mariscos y proteínas vegetales (0,7/5); granos enteros (1,5/10); granos y cereales refinados (2/10); frutas (1,7/5); vegetales verdes y legumbres (1,7/5); ácidos grasos (3,7/10) y lácteos (4,3/10). El 58,6% tuvo una dieta de pobre calidad (IAS <50). Se observó una alimentación menos saludable en los hombres (p<0,05), adultos jóvenes (p<0,01), aquellos con menor nivel educativo (p<0,01), los individuos que realizan <150 minutos semanales de actividad física moderada o intensa (p<0,01) y los que fuman en la actualidad (p<0,01). Conclusión: La alimentación de la población estudiada demuestra características poco saludables. La identificación de grupos de mayor riesgo permitirá orientar mejor las acciones educativas y sanitarias tendientes a modificar estilos de vida y hábitos alimentarios.

Introduction: The Healthy Eating Index (HEI) was developed based on the recommendations of the dietary guidelines for the American population and is useful to identify food groups that have lower consumption in relation to recommendations and population groups with low diet quality. Objective: To estimate the quality of the diet in the adult population of the city of Rosario, and to identify its relationship with sociodemographic, anthropometric indicators and lifestyle variables. Materials and Methods: Observational, descriptive and cross-sectional research of a stratified sample of 1200 adults aged 18 to 70 years. The updated methodology of HEI 2010 was used, based on the information obtained from the 24-hour recall. A questionnaire was used to collect sociodemographic variables and tobacco consumption, alcohol consumption was assessed by frequency of consumption, anthropometric measurements were measured and physical activity was assessed with the IPAQ questionnaire. The associations were evaluated by Chi square test and the difference of means by Anova (p<0,05). Results: The average age of adults evaluated was 39±15 years, 69% were women, 32% had completed tertiary studies or more, 56% with BMI≥25 kg/m², 34% had risk according to waist circumference, 54% realized <150 min/week of physical activity, 67% consumed alcohol and 26% were current smokers. The HEI reached an average of 48.5±15.1 points, the values farthest from the ideal were found in fish, shellfish and vegetable proteins (0.7/5); whole grains (1.5/10); refined grains and cereals (2/10); fruit (1.7/5); green vegetables and legumes (1.7/5); fatty acids (3.7/10) and dairy (4.3/10). The 58.6% had a poor quality diet (HEI <50). In men (p<0,05), young adults (p<0,01), those with a lower educational level (p<0,01), individuals who perform <150 minutes per week of moderate or intense physical activity (p<0,01) and those who smoke have observed a less healthy diet (p<0,01). Conclusion: The diet of the studied population shows unhealthy characteristics. The identification of groups of greater risk will allow to orient better the educative and sanitary actions tending to modify styles of life and alimentary habits.

[Pica during pregnancy: a frequently underestimated problem]. / La pica durante el embarazo: un trastorno frecuentemente subestimado.

Pica is the compulsive intake of non-nutritive substances such as earth, clay, chalk, soap and ice. The most common forms of pica are geophagia or the intake of earth and pagophagia or the intake of ice. The description of this peculiar phenomenon dates back to the Greco-Roman civilization. Its prevalence during pregnancy is generally underestimated. Published data reveal a prevalence of between 8% and 65%. Investigations from Latin America indicate a prevalence of 23% to 44%. It is not clear yet which are the causes that predispose to pica, but they are frequently associated with anemia or iron deficiency during pregnancy. Its diagnosis, which only consists in questioning pregnant women, is generally omitted during prenatal care, probably because health professionals have no knowledge about this disorder. The identification of pica in pregnant women could contribute to the detection of a risk group where it is necessary to implement strategies as regards both the evaluation and the nutritional education.

Biodisponibilidad potencial de hierro, calcio y zinc en galletitas, pastas y snacks comerciales libres de gluten / Potential bioavailability of iron, calcium and zinc in gluten-free commercial cookies, pasta and snacks

La prevalencia de enfermedad celíaca se encontraría entre 0,5 y 1%, pero su incidencia está en franco aumento. Esta patología no solo afecta a los niños, actualmente, el 60% de los recién diagnosticados con celiaquía son adultos. La población celíaca debe seguir como único tratamiento una dieta libre de gluten. Los productos utilizados comúnmente contienen pocos ingredientes y no están enriquecidos con micronutrientes como sus homólogos que contienen trigo. El objetivo del presente estudio fue evaluar la biodisponibilidad potencial de hierro, calcio y zinc en diez muestras comerciales libres de gluten, sin TACC (trigo, avena, cebada y centeno). Se analizaron pastas secas, budines, snacks, galletitas dulces y tostadas saladas. La dializabilidad de los minerales (D) fue determinada por método in vitro que simula el proceso de digestión fisiológico. El contenido total de minerales fue determinado por espectroscopía de absorción atómica previa mineralización con una mezcla HNO3-HClO4 (50:50). Se estableció el aporte potencial (AP) de cada mineral en los distintos productos teniendo en cuenta su concentración y dializabilidad. Los resultados obtenidos para las 10 muestras fueron: [Fe] 0,35 a 1,35 mg/%; [Ca] 5 a 315 mg/%; [Zn] 0,15 a 1,11 mg/%. Los valores de D% fueron: Fe 4,5-24,7; Ca 15,7-36,7; Zn 8,4-29,5. El contenido de minerales disponibles fue relativamente bajo. La bioaccesibilidad de minerales de las muestras depende del elemento y de la composición del producto analizado. Los alimentos libres de gluten prácticamente no aportan cantidades significativas de hierro. Los aportes de zinc y calcio son realmente bajos para los diferentes grupos etarios con cualquiera de los diez alimentos estudiados. Se concluye que sería conveniente sugerir a los responsables de establecer políticas públicas en el plano nutricional, que arbitren los medios para que la población que debe consumir alimentos libres de gluten tenga acceso a alimentos enriquecidos, fundamentalmente con hierro(AU).

The prevalence of celiac disease may be between 0.5 and 1%, but its incidence is in clear increase. This disease not only affects children; currently, 60% of newly diagnosed patients are adults. The only possible treatment for the celiac population is to follow a gluten-free diet. Gluten-free products commonly contain few ingredients and they are not enriched with micronutrients like their wheat-containing counterparts. The objective of the present work was to evaluate the potential bioavailability of iron, calcium and zinc in ten gluten free commercial samples, without TACC (wheat, oats, barley and rye). Dry pasta, puddings, snacks, sweet cookies and salty toasts were analyzed. Mineral dialyzability (D) was determined by an in vitro method that simulates the physiological digestion process. The total mineral content was determined by atomic absorption spectroscopy after mineralization with an HNO3-HClO4 mixture (50:50). The potential contribution (PC) of each mineral was established in the different products considering its concentration and dialyzability. The results obtained for the 10 samples were: [Fe] 0.35 to 1.35 mg /%; [Ca] 5 to 315 mg /%; [Zn] 0.15 to 1.11 mg /%. The values of D% were: Fe 4.5-24.7; Ca 15.7-36.7; Zn 8.4-29.5. The available mineral content of the gluten-free foods analyzed was relatively low. The bioavailability of minerals in the samples depends on the element and the composition of the product analyzed. Gluten-free foods do not provide significant amounts of iron. The contributions of zinc and calcium are very low for the different age groups with any of the ten samples studied. It is concluded that it would be advisable to suggest those responsible for establishing public policies in the nutritional field, to arbitrate the means in order to enable the population that must consume gluten-free foods to have access to enriched foods, fundamentally with iron(AU).