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.

Limited performance of MALDI-TOF for identification of fish Aeromonas isolates at species level.

The aim of this study was to evaluate the usefulness of the MALDI-TOF MS to identify 151 isolates of Aeromonas obtained mostly from diseased fish. MALDI-TOF MS correctly identified all isolates to the genus level but important differences in the percentage of isolates correctly identified depending on the species were observed. Considering exclusively the first identification option, Aeromonas bestiarum, Aeromonas hydrophila, Aeromonas salmonicida, Aeromonas veronii and Aeromonas sobria were the best identified with results >95%. However, considering the first and second identification options, the only species that showed values >90% was A. hydrophila. Overall, when the database was supplemented with 14 new spectra, the number of accurate identifications increased (41% vs. 55%) and the number of inconclusive identifications decreased (45% vs. 29%), but great differences in the success of species-level identifications were found. Species-distinctive mass peaks were identified only for A. hydrophila and A. bestiarum (5003 and 7360 m/z in 95.5% and 94.1% of their isolates, respectively). This work demonstrates the utility of MALDI-TOF MS for Aeromonas identification to the genus level, but there is no consistency for the accurate identification of some of the most prevalent species implicated in fish disease.

Importancia ginecológica del istmocele ¿cómo y cuándo tratar? / Gynecological importance of the isthmocele ¿When and how to treat?

Resumen OBJETIVO: determinar la incidencia de defectos en el cierre de la histerorrafia, sus síntomas y analizar las conductas terapéuticas. MATERIALES Y MÉTODOS: estudio observacional, prospectivo y comparativo de pacientes con defectos en el cierre de la histerorrafia, atendidas en la Clínica de Colposcopia del Centro Estatal de Oncología del Estado de Sonora entre el 1 de enero de 2013 y el 31 de diciembre de 2015. Criterios de inclusión: pacientes con citología anormal y antecedente de cesárea, a quienes se practicaron: colposcopia, endocervicocolposcopia e histeroscopia. Criterios de exclusión: problemas técnicos que impidieron la observación del canal endocervical o la histeroscopia, pacientes posmenopáusicas, y las que tuvieran diagnóstico colposcópico de cáncer invasor. RESULTADOS: se estudiaron 120 pacientes con antecedente de cesárea, que se practicó en diferentes centros hospitalarios, de éstas se excluyeron 25 y quedaron 95 casos: 62 (65%) del grupo A (con defectos en el cierre de la histerorrafia) y 33 (35%) del grupo B (sin defectos en el cierre de la histerorrafia). De los 62 casos con defectos en el cierre de la histerorrafia, 30 (50%) fueron en el cierre de la histerorrafia tipo cúpula, 20 (31%) tipo divertículo y 12 (19%) dehiscencia total. Hubo manchado menstrual en 73% de las pacientes, polimenorrea en 31% y dismenorrea en 33%. Solo 20% de las pacientes sintomáticas refirieron los síntomas como relevantes. El aumento de la vascularidad y el sangrado se encontraron en las pacientes con más síntomas.

Abstract OBJECTIVE: The Cesarean Scar Defect (CSD) has been underestimated in frequency and importance. Is necessary to know its incidence, the symptoms, and analyze new therapeutic procedures. MATERIAL AND METHODS: Observational, prospective and comparative study of patients with defects in the closure of hysterorrhaphy, attended at the Colposcopy Clinic of the State Oncology Center of the State of Sonora between January 1, 2013 and December 31, 2015. Inclusion criteria: Patients with abnormal cytology and previous cesarean section, who were: colposcopy, endocervicocolposcopy and hysteroscopy. Exclusion criteria: technical problems that prevented observation of the endocervical canal or hysteroscopy, postmenopausal patients, and those with a colposcopic diagnosis of invasive cancer. RESULTS: We found in 65.2%, spotting in a 73.3%, polymenorrhea at 31.3%, and to dysmenorrhea in 32.3%. Only 20% of the symptomatic patients referred the symptom as Relevant. We found "CSDs producers of bleeding" that are related to the patients more systematic. CONCLUSIONS: The cesarean scar defects are frequent cause of gynecological symptomatology that is irrelevant most of the time. A small number of patients needs treatment, we found CSD that produce bleeding, this cases present relevant symptomatology and require treatment. It is necessary to take this into account to choose the best therapeutic approach.

[Telephone attendance system in a dementia unit: analysis and description]. / Descripcion y analisis del sistema de actividad telefonica implantado en una unidad de demencias.

AIM: To describe the characteristics of a telephone attendance system (TAS) implemented in our dementia unit, its relevance in the global activity and the users-themselves utility and satisfaction. MATERIALS AND METHODS: We retrospectively analyzed the incoming telephone calls during a period of one year. Telephone call type, user's gender and relationship with the patient, reason for calling, who answer, class of answer and patients' Global Deterioration Scale (GDS) were systematically registered. Caregivers' satisfaction was evaluated by a semi structured telephone questionnaire checking the following variables: accessibility, difficulty in answer comprehension, utility and global satisfaction. Professionals' opinion about global impression, overcharge in daily activity, TAS satisfaction and utility were evaluated by a semi structured interview. RESULTS: On the period of study, 444 telephone incoming calls were registered, 58.3% of them from relatives of patients with GDS 5-6. To adjust the treatment (43.2%) or to bring forward the next appointment were the most frequent responses. Next aspects were considered as good or very good for interviewed users: accessibility (58.3%), response delay (83.3%), service utility (91.6%), global satisfaction (86.5%) and answer comprehension (93.8%). Professionals' opinion were good, but with some comments about the need for a specific appointment book, improvements aspects in initial accessibility (direct telephone line), and the establishment of a specific schedule for telephonic attendance. CONCLUSIONS: The TAS is a formal, structured and complementary attendance service for traditional visit, with the ability to resolve most problems. The delayed reply mode allows the clinicians to choose the best moment to reply. Furthermore, the availability of the complete chart of every patient attended improve the quality of the clinical answer.

Dual mycorrhizal colonization of forest-dominating tropical trees and the mycorrhizal status of non-dominant tree and liana species.

The contribution of mycorrhizal associations to maintaining tree diversity patterns in tropical rain forests is poorly known. Many tropical monodominant trees form ectomycorrhizal (EM) associations, and there is evidence that the EM mutualism contributes to the maintenance of monodominance. It is assumed that most other tropical tree species form arbuscular mycorrhizal (AM) associations, and while many mycorrhizal surveys have been done, the mycorrhizal status of numerous tropical tree taxa remains undocumented. In this study, we tested the assumption that most tropical trees form AM associations by sampling root vouchers from tree and liana species in monodominant Dicymbe corymbosa forest and an adjacent mixed rain forest in Guyana. Roots were assessed for the presence/ absence of AM and EM structures. Of the 142 species of trees and lianas surveyed, three tree species (the mono-dominant D. corymbosa, the grove-forming D. altsonii, and the non-dominant Aldina insignis) were EM, 137 were exclusively AM, and two were non-mycorrhizal. Both EM and AM structures wer e observed in D. corymbosa and D. altsonii. These results provide empirical data supporting the assumption that most tropical trees form AM associations for this region in the Guiana Shield and provide the first report of dual EM/AM colonization in Dicymbe species. Dual colonization of the Dicymbe species should be further explored to determine if this ability contributes to the establishment and maintenance of site dominance.

Hurricane disturbance and tropical tree species diversity.

The debate over the maintenance of high diversity of tree species in tropical forests centers on the role of tree-fall gaps as a primary source of disturbance. Using a 10-year data series accumulated since Hurricane Joan struck the Caribbean coast of Nicaragua in 1988, we examined the pattern of species accumulation over time and with increased sampling of individuals. Our analysis shows that the pattern after a hurricane differs from the pattern after a simple tree-fall disturbance, and we conclude that pioneers are limited in large disturbances and thus do not suppress other species the way they do in smaller disturbances.

Detection of steroid receptors in breast cancer: relationship between EIA and IHC methods.

The efficiency of EIA and IHC (frozen tissue) in the detection of ER and PR in 51 breast cancers were compared. ER were detected in 51% of cases by IHC and in 49% of tumours by EIA. PR were detected in 56.8% of cases by IHC and in 54.8% of tumours by EIA. Concordance of the results of IHC and EIA reached 78.4% in ER and 82.4% in PR detection. Discordance between IHC and EIA seems to be related to minor changes in sensibility of methods, but we cannot conclude that one of the two techniques is superior to the other in the detection of hormonal receptors. There is a common trend of association between low grade of histologic or nuclear malignancy and a high expression of hormonal receptors.