Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023.

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Evaluation of consent forms for clinical practice in Spanish Public Hospitals.

OBJECTIVE: To evaluate the access, development, and quality of consents forms for clinical practice within the Spanish Public Hospitals. METHOD: A cross-sectional study was conducted in a two-stage process (January 2018-September 2021). In stage 1, A nationwide survey was undertaken across all public general hospitals (n=223) in the Spanish Healthcare System. In stage 2, Data was taken from the regional health services websites and Spanish regulations. Health Regional Departments were contacted to verify the accuracy of the findings. Data was analyzed using a descriptive and inferential statistics (frequencies, percentages, Chi-square & Fisher's exact tests). RESULTS: The response rate was 123 (55.16%) of Spanish Public Hospitals. The results revealed a range of hospital departments involved in the development of consent documents and the absence of a standardized approach to consent forms nationally. Consent audits are undertaken in 43.09% hospitals and translation of written consents into other languages is limited to a minority of hospitals (35.77%). The validation process of consent documentation is not in evidence in 13% of Spanish Hospitals. Regional Informed Consent Committees are not place in the majority (70.7%) of hospitals. Citizens can freely access to consent documents through the regional websites of Andalusia and Valencia only. CONCLUSION: Variability is found on access, development and quality of written consent across the Spanish Public Hospitals. This points to the need for a national informed consent strategy to establish policy, standards and an effective quality control system. National audits at regular intervals are necessary to improve the consistency and compliance of consent practice.

Effect of Arabinogalactans on Induction of White-Opaque Somatic Embryos of Avocado (Persea americana Mill.) cv. Duke-7.

The development of somatic embryogenesis in avocado (Persea americana Mill.) has been hampered by different chronic problems. One such problem is the low level of induction of white-opaque somatic embryos (WOSEs) during the process of obtaining full avocado plants. We detected the induction of multiple WOSEs promoted after the placement of three or four small WOSEs over the embryogenic callus of Duke-7. Among the other possible chemical inductors of the Arabinogalactans (AGPs), we identified a family of extracellular plant proteoglycans implicated in many aspects of the in vitro induction of somatic embryos (SE). We extracted AGPs directly from embryogenic cultures of avocado. When the induction/proliferation medium of embryogenic avocado calli (MS-0.1 mg L-1 Picloram) was supplemented with 1-2 mg L-1 AGP, the induction rate of good-quality WOSEs from the embryogenic callus increased significantly (more than ten times that of the control without AGP) and this effect persisted for at least five subcultures after the initial treatment with AGP. AGP also modified the texture and quality of the callus. The effect of AGP extends to other cultivars and proliferation media. Our objectives were to improve the induction of WOSEs and study the effect of AGP in the somatic embryogenesis of avocado.

Comunicación y coordinación en el rol interdependiente de enfermería en un hospital de Bogotá, Colombia / Communication and Coordination in the Nurse's Interdependent Role in a Hospital in Bogota, Colombia / Comunicação e coordenação no papel interdependente de enfermagem em uma instituição hospitalar de Bogotá, Colômbia

Objetivo: describir las características de los procesos de comunicación y coordinación en el rol interdependiente de enfermería y determinar si hay diferencias significativas entre estos procesos en los distintos servicios de un hospital en Bogotá. Metodología: estudio descriptivo de corte transversal, en el que se utilizaron las escalas de Comunicación y Coordinación del Cuestionario de Práctica Colaborativa ICU Médico-Enfermera en su versión validada al español colombiano. El instrumento se aplicó a 124 profesionales (87 % mujeres con edad promedio de 34,1 años). Se usaron puntajes (de 0 a 100) con el fin de presentar los resultados de las dimensiones y realizar las pruebas de Tukey (diferencia mínima significativa) y Kruskal Wallis para establecer relaciones de diferencia y correlación por medio de SPSS 14.0. Resultados: las dimensiones más problemáticas fueron: Exactitud de lacomunicación entre los grupos (promedio de 47,8 puntos) en cuanto a comunicación, y Mecanismos de coordinación personales e informales entre la unidad (promedio de 51,8 puntos) en cuanto a coordinación, con diferencias significativas en la dimensión de Comunicación (p = 0,031), principalmente de Urgencias y Hospitalización con relación a los otros servicios. Conclusión: se evidenciaron problemas en la comunicacióny la coordinación, lo cual implica ruptura en la cohesión, fragmentación de la atención y riesgo para la seguridad de los pacientes. Se recomienda promover estrategias de comunicación efectiva y coordinación interprofesional, así como fortalecer el liderazgo y el trabajo en equipo.

Objective: To describe the characteristics of the communication and coordination processes of the nurse's interdependent role and to determine if there are significant differences within these processes in the different hospital services offered by a hospital in Bogotá. Methodology: Descriptive, cross sectional study that used the scales of Communication and Coordination of the "ICU Nurse­Physician Questionnaire" in its Colombian-Spanish validated version. The instrument was applied to 124 healthcare professionals (87 %, mean age 34.1 years). Scores from 0 to 100 were used to present the results of the dimensions and to apply the Tukey (minimum significant difference) and Kruskal Wallis tests to establish difference and correlation results using SPSS v.14 statistical software. Results: "Accuracy of the intergroup communication" in reference to communication and "Personal and informal coordination mechanisms inside the department" in reference to coordination were the more troublesome dimensions, with 48.7 points and 51.8 points respectively, with significant differences in the dimension of communication (p = 0.0031), principally in the emergency and inpatient unit in relation to other departments. Conclusion: The study evidenced communication and coordination problems, which implies a rupture in cohesion, a fragmentation of attention, and causes risk for the patient's safety. We encourage the promotion of effective communication and inter-professional coordination, as well as strengthening of leadership and teamwork.

Objetivo: Descrever as características dos processos de comunicação e coordenação do papel interdependente de enfermagem, em uma instituição de saúde na cidade de Bogotá, e determinar se há diferenças significativas entre estes processos nos diferentes serviços do hospital. Materiais e métodos: estudo descritivo de corte transversal, no qual foram utilizadas as escalas de Comunicação e Coordenação do Questionário de Prática colaborativa ICU Médico-Enfermeira (Shortell et al.), na versão validada para o espanhol colombiano. O instrumento foi aplicado a 124 profissionais (87 % mulheres, idade média de 34,1 anos). Usaram-se pontuações (0 a 100) para apresentar os resultados das dimensões e realizar os testes de Tukey (diferença mínima significativa) e Kruskal Wallis para estabelecer relações de diferença e correlação, por meio do SPSS 14.0. Resultados: as dimensões que resultaram mais problemáticas para os participantes foram a "exatidão da comunicação entre os grupos" na Comunicação (média de 47,8 pts.) e os "mecanismos de coordenação pessoais e informais dentro da unidade" na Coordenação (média de 51,8 pts.), com diferenças significativas na dimensão de Comunicação (p = 0,031), principalmente no Pronto Socorro e Internação, em relação aos outros serviços. Conclusão: evidenciaram-se problemas na comunicação e coordenação, o que envolve ruptura da coesão, fragmentação da atenção e coloca em risco a segurança dos pacientes. Recomenda-se promover o melhoramento contínuo da comunicação efetiva e a coordenação interprofissional, assim como o fortalecimento da liderança e do trabalho em equipe.

Factores condicionantes de la lactancia en recién nacidos sanos del Hospital Universitario Clínica San Rafael (HUCSR) / Factors conditioning the healthy newborns breasteeding in Hospital Universitario Clínica San Rafael (HUCSR) / Fatores condicionantes da amamentação em recém-nascidos saudáveis do Hospital Universitário Clínica San Rafael (HUCSR)

Tradicionalmente se han descrito factores asociados a la Lactancia que varían en las diferentes culturas. En Colombia, los indicadores de prevalencia de la Lactancia materna exclusiva y duración de la Lactancia están lejos de las recomendaciones establecidas por la Organización Mundial de la Salud (OMS). El Departamento de Pediatría del Hospital Universitario Clínica San Rafael, teniendo en cuenta los beneficios que la leche materna tiene, ha venido trabajando en los últimos años en pro de rescatar la lactancia como una práctica cultural adecuada. En respuesta a esta necesidad creó en Agosto de 2004 el programa institucional de Lactancia "Primero los niños, niñas y adolescentes", a partir del cual surgieron varios interrogantes acerca del comportamiento de la lactancia en nuestro medio, que dieron origen al presente trabajo de investigación. Se diseñó un estudio de cohorte prospectivo realizado mediante la aplicación de una encuesta a 372 madres de recién nacidos sanos en postparto. La cohorte se reclutó entre julio de 2007 y junio de 2008 y se siguió hasta los 24 meses de edad del bebé con el fin de determinar la duración de la lactancia, sus factores condicionantes y las causas más frecuentes de su abandono. Se estableció la salida de los pacientes del estudio al cumplir 24 meses (recomendación de la OMS de la duración de lactancia) o al documentar su abandono antes de los 24 meses. Se encontró una lactancia materna exclusiva a los 6 meses de 14.7% y una duración acumulada de 14 meses para la población analizada...

Traditionally, factors associated with breastfeeding which vary according to the different cultures have been described. In Colombia, the indicators of exclusive breastfeeding prevalence and breastfeeding duration are very far from the recommendations settled by the World Health Organization (WHO). The Pediatrics Department of the Hospital Universitario Clínica San Rafael, taking into account the benefits provided by the breast milk, have been working for the last years in favor of rescuing the breastfeeding as a suitable cultural practice. In response to this need, in August 2004, it created the Breastfeeding institutional program "First boys, girls and adolescents", form which various questions emerged regarding the breastfeeding behavior in our environment, which gave rise to the present research work. A cohort, prospective study was designed, conducted by administering a survey to 372 mothers of healthy newborns in post partum. The cohort was recruited between July 2007 and June 2008 and was followed-up until the infants were 24 months of age with the aim of determining the breastfeeding duration, its conditioning factors and the most frequent causes for its drop-out. The infants were to be withdrawed from the study when they completed 24 months of age (Breastfeeding duration recommended by the WHO) or upon documenting their drop-out before 24 months of age. 14.7% of exclusive breastfeeding at 6 months and a cumulative duration of 14 months were found for the examined population...

Tradicionalmente foram descrito fatores associados à amamentação que variam nas diferentes culturas. Na Colômbia, os indicadores de prevalência da amamentação materna exclusiva e duração da amamentação estão longe das recomendações estabelecidas pela Organização Mundial da Saúde (OMS). O Departamento de Pediatria do Hospital Universitário Clínica San Rafael, tendo em conta os benefícios que o leite materno tem, vem trabalhando nos últimos anos em prol de resgatar a amamentação como uma prática cultural adequada. Em resposta a esta necessidade criou-se em agosto de 2004 o programa institucional de Amamentação "Primeiro as crianças e adolescentes", a partir do qual surgiram várias dúvidas sobre o comportamento da amamentação em nosso meio que deram origem a este trabalho de pesquisa. Foi desenhado um estudo de cooorte prospectivo realizado mediante a aplicação de um questionário a 372 mães de recém nascido sãos em pós-parto. A população foi recrutada entre julho de 2007 e junho de 2008 e foi seguida até os 24 meses de idade do bebê com o objetivo de determinar a duração da amamentação, seus fatores condicionantes e as causas mais frequentes de seu abandono. Foi estabelecida a saída dos pacientes do estudo ao completar 24 meses (recomendação da OMS da duração da lactação) ou ao documentar seu abandono antes dos 24 meses. Encontrou-se uma lactação materna exclusiva aos 6 meses de 14.7% e uma duração acumulada de 14 meses para a população analisada...

Determinación del cambio generado por la interventoría en la calidad higiénico-sanitaria de los almuerzos suministrados en el proyecto "comedores comunitarios" de la Secretaría Distrital de Integración Social (SDIS) durante el año 2006 / Changes generated by auditor intervention on hygienic and sanitary quality of lunches on the project “community dining rooms” from Secretaria de Integración Social (DSIS), in Bogotá - Colombia, during 2006

Antecedentes. El proyecto 212 “comedores comunitarios” tiene como objetivo suministrar diariamente un complemento alimenticio balanceado a la población más vulnerable de Bogotá, con el fin de mejorar su estado nutricional. Objetivo. Determinar el cumplimiento de las buenas prácticas de manufactura BPM a través del análisis de las evaluaciones realizadas por la interventoría durante su primer año de ejecución, con el fin de demostrar el mejoramiento en los niveles de calidad microbiológica del complemento suministrado. Material y métodos. El universo estuvo representado por 167 comedores comunitarios de 19 localidades de Bogotá; 3.871 análisis microbiológicos de muestras de alimentos (tomados como indicadores de inocuidad), superficies, ambientes y manipuladores (indicadores de BPM) y aguas (indicador de calidad de agua), entre junio y octubre de 2006; y 489 registros de evaluaciones higiénico-sanitarias obtenidas en abril, julio, septiembre y noviembre de 2006. Resultados. Los comedores alcanzaron mejores niveles de cumplimiento para las categorías de evaluación higiénico-sanitaria luego de las intervenciones técnicas. Los indicadores microbiológicos mostraron una mejoría representada por un aumento en los porcentajes de aceptabilidad en un 7, 20 y 28%, para inocuidad, aguas y BPM, respectivamente. La media de aceptabilidad para indicadores de microbiología en el mes de junio fue 0,78 (con una dispersión entre 0,72 y 0,91); para octubre alcanzó una media de 0,88 (con una menor dispersión de 0,87 a 0,93). Conclusiones. A medida que se implementaban las acciones preventivas y correctivas establecidas por la interventoría en los comedores, aumentaban los porcentajes de aceptabilidad de indicadores microbiológicos y condiciones higiénico-sanitarias.

Characterization of asparagus lignin by HPLC.

Lignin is the cell wall component most frequently associated with hardening. Its characterization and quantification are very important to understand the biochemical modifications related to the changes in texture of vegetables such as asparagus (Asparagus officinalis), in which this organoleptic attribute is a very important quality factor. In this study, asparagus lignin from the basal sections of fresh and stored spears was analyzed using 2 methods, the traditional (Klason lignin) and the recently developed derivatization, followed by reductive cleavage (DFRC) method. The latter is a simple and reproducible technique for lignin characterization based on a degradation procedure that produces analyzable monomers and dimers by cleaving alpha- and beta-aryl ethers in lignins. The primary monomers derived from DFRC degradation of lignins are essentially p-coumaryl peracetate, coniferyl peracetate, and sinapyl peracetate. To evaluate the efficiency of the DFRC method, our investigations have been carried on distinct sample types, including wood (data not shown), straw, and asparagus samples. The results have confirmed that lignin composition is affected by plant nature. It has been found that whereas wood samples mostly contain coniferyl units, plant foods, such as straw and asparagus, contain both coniferyl and guaiacyl units.

Flavonoid profile of green asparagus genotypes.

The determination of flavonoid profiles from different genotypes of triguero asparagus and their comparison to those from green asparagus commercial hybrids was the main goal of this study. The samples consisted of 32 commercial hybrids and 65 genotypes from the Huetor-Tajar population variety (triguero). The analysis of individual flavonoids by HPLC-DAD-MS has allowed the determination of eight naturally occurring flavonol derivatives in several genotypes of triguero asparagus. Those compounds included mono-, di-, and triglycosides of three flavonols, that is, quercetin, isorhamnetin, and kaempferol. The detailed analysis of the flavonoid profiles revealed significant differences among the distinct genotypes. These have been classified in three distinct groups as the result of a k-means clustering analysis, two of them containing both commercial hybrids and triguero asparagus and another cluster constituted by 21 genotypes of triguero asparagus, which contain several key flavonol derivatives able to differentiate them. Hence, the triglycosides tentatively identified as quercetin-3-rhamnosyl-rutinoside, isorhamnetin-3-rhamnosyl-rutinoside, and isorhamnetin-3-O-glucoside have been detected only in the genotypes grouped in the above-mentioned cluster. On the other hand, the compound tentatively identified as isorhamnetin-3-glucosyl-rutinoside was present in most genotypes of triguero asparagus, whereas it has not been detected in any of the commercial hybrids.

Sexual dimorphism in lipid metabolic phenotype associated with old age in Sprague-Dawley rats.

PURPOSE: Aged male rats show a decrease in liver PPARalpha. We aimed to determine if the sexual dimorphism in lipid metabolism observed in the PPARalpha-/- mouse is also present in senescent rats. RESULTS: Eighteen-month old rats were obese and presented high plasma NEFA concentrations. Old male rats were more hypercholesterolemic and hyperleptinemic than females, presenting a higher content in hepatic triglycerides and cholesteryl esters, while 18-month old females were more hypertriglyceridemic than males. Although PPARalpha expression and binding activity was reduced in liver from old male and female rats, the mRNA for a PPARalpha target gene, such as CPT-I, was reduced in old males (-56%), while increased by 286% in old females. LXRalpha protein was increased, and its binding activity was decreased in livers of old males, while livers of old females showed an increase in DGAT1 (2.6-fold) and DGAT2 (4.9-fold) mRNA, with respect to 3-month old animals. The increases in DGAT1 and DGAT2 mRNAs matched in old females those of plasma (3.1-fold) and liver triglycerides (5.0-fold). CONCLUSIONS: These features disclose a marked sexual dimorphism in lipid metabolism associated to old age in rats that can be partially attributed not only to an age-related decrease in liver PPARalpha expression, but also to changes in other hepatic transcription factors and enzymes, such as liver X receptor alpha (LXRalpha) and diacylglycerol acyltransferases (DGAT).

Acercamientos conceptuales a la eutanasia: una perspectiva diferente desde la medicina paliativa

Los conceptos de eutanasia, muerte asistida, suicidio asistido, morir con dignidad, etc han sido usados de maneras muy diversas según la perspectiva de quien los utiliza y según la orilla desde la cual esté hablando en lo que al debate siempre suscitado por estos temas respecta. Este excelente articulo resume una perspectiva diferente, integral y sin orillas: la de la medicina paliativa

[The atrial contribution to ventricular filling in mitral stenosis. An evaluation by Doppler echocardiography]. / Contribución auricular al llenado ventricular en la estenosis mitral. Evaluación mediante ecocardiografía Doppler.

Using Doppler echocardiography, we have quantified the atrial contribution to ventricular filling in 22 patients with mitral stenosis in sinus rhythm without or with minimal mitral and/or aortic regurgitation. With continuous wave Doppler from apex we obtained the ventricular filling flow from which the valvular area was calculated. The product of the integrated ventricular filling waves multiplying by the valvular area was called total volume (TV). Assuming that the deceleration of the ventricular filling flow is linear and remain constant, we integrated the transmitral flow, this time without considering the atrial filling wave as if the patient was entering into atrial fibrillation. Multiplying this integration by the valvular area we obtained a second volume, atrial fibrillation volume (AFV). The atrial contribution was calculated by: 1) absolute value: TV-AFV and in 2) percent value or fraction: (TV-AFV/TV) x 100. When we correlate absolute and percent values with mitral valve area, the results were statistically significant in both cases (p less than 0.001), with an excellent regression factor both with absolute value r = 0.90 and the percent one r = 0.72. In mitral stenosis the atrial contribution to ventricular filling has an inverse relation with the grade of severity, being very low in the more severe lesions. This is why it would be doubtful that its lost (atrial contribution) is the only cause of hemodynamic deterioration that has been observed in patients who suddenly present atrial fibrillation.

[Study of diastolic regurgitation of the atrioventricular valves using Doppler echocardiography]. / Estudio mediante ecocardiografía Doppler de las regurgitaciones diastólicas de las válvulas auriculoventriculares.

In order to evaluate diastolic regurgitant flows in atrioventricular valves, we studied by Doppler echocardiography four patients in whom electric abnormalities like third degree atrioventricular block, pacemaker dysfunction and ventricular arrhythmias with atrioventricular dissociation were detected. In all of them, mitral and tricuspid high velocity regurgitant flows were found in systole. A second regurgitant atrioventricular flow was also registered, this flow being diastolic, intermittent, and with a lower velocity profile than the systolic regurgitation. The hemodynamic importance of this diastolic regurgitant flow over the cardiac output has not been well defined; in our cases the ventricular filling was not substantially modified by diastolic regurgitant flow.

Implantacion de cateteres epidurales por largos periodos de tiempo / Epidural catheters implantation for long periods of time

Se implantaron 12 cateteres en 11 pacientes y se administraron solamente opiodes extradurales en la mayoria de casos. La duracion del tratamiento vario de 1 a 180 dias, y 2 pacientes permanecieron con su cateter funcionando mas de 100 dias. Solo un cateter se reimplanto, y 3 fueron retirados. Como complicacion se observo la formacion de 2 fistulas epidural-piel, y un absceso a nivel de la salida del cateter de la piel. No se presento infeccion extradural. Concluimos que la implantacion de cateteres epidurales con la tecnica de Grunwald es segura y simple de realizar

Mecanismos de dolor: revision / Pain mechanisms: revision

Las estructuras y mecanismos de funcionamiento de los sistemas de transmision de los estimulos dolorosos son un area muy compleja dentro de los conocimientos fisiologicos, pero dia a dia se hace mas necesario su conocimiento clinico relacionado con el manejo del dolor ya que solamente a traves de el podremos realizar una terapeutica mas racional, basada en los posibles mecanismos de dolor utilizando combinaciones de drogas que actuen a diferentes sitios de los sistemas de transmision o modulacion siendo aditivas o sinergicas. Igualmente nuevos metodos de manejo del dolor solo pueden ser derivados del conocimiento basico. Alli radica la etica en nuestro trabajo cientifico para solucionar el dolor: es la diferencia entre el empirismo y lo cientifico

[Gamma-glutamyltransferase and alkaline phosphatase in the serum and saliva of patients with hepatic tumors and hepatic cirrhosis]. / Gamma-glutamil transferasa y fosfatasa alcalina en suero y saliva de enfermos con tumores hepáticos y cirrosis hepática.

The authors have previously described the presence of gammaglutamyl transferase and alkaline phosphatase in the saliva of healthy individuals and of patients with hepatobiliary and pancreatic diseases. The authors show in this work the values of said enzymes in the blood serum and saliva of 23 cases of liver cirrhosis and 17 patients with liver tumors. Both enzymes increase significantly in the serum of liver tumor patients with respect to the amounts found in liver cirrhosis patients (p less than 0.005). Alkaline phosphatase increased significantly in the saliva of patients with liver cirrhosis (p less than 0.005), where as no differences were found between the two groups of patients with liver cirrhosis (p less than 0.005), where as no differences were found between the two groups of patients for the salivary gamma-glutamyl transferase. The determination of seric alkaline phosphatase and gamma-glutamyl transferase, and of salivary alkaline phosphatase may be useful for the differential diagnosis between liver cirrhosis and liver tumor.