Circulating maternal and umbilical cord steroid hormone and insulin-like growth factor concentrations in twin and singleton pregnancies.

In addition to being associated with a higher risk of complications during pregnancy, twinning may also be a proxy for altered hormonal exposure for mothers and twin offspring, with implications for their health later in life. We compared maternal and fetal steroid hormone and insulin-like growth factor concentrations between singleton (n=62) and twin (n=41) pregnancies. Maternal concentrations of androgens, estrogens, insulin-like growth factor (IGF)-1, IGF-binding protein (BP)-3 and prolactin were quantified during the third trimester and at delivery, as well as in the fetal circulation at birth. Geometric means accounting for gestational age were calculated for hormone concentrations and compared between matched twin and singleton pregnancies. Most maternal hormone concentrations were modestly higher in twin than in singleton pregnancies in the third trimester (ranging from 8.3% for IGF-1 to 17.1% for estradiol) and at delivery (ranging from 11.1% for IGFBP-3 to 15.2% for estriol). Cord serum hormones were generally similar in twin and singleton pregnancies, except for IGFBP-3, which was 200% lower in twins. The modest differences in maternal hormones in late gestation seem unlikely to explain alterations in hormonally related disease risk in mothers of twins compared with singletons. The large deficit of IGFBP-3 in the fetal circulation of twins at birth may allow for sufficient concentrations of IGF-2 for growth and development in an environment of shared nutritional resources.

Pulmonary hypoplasia: pathogenesis, diagnosis, and antenatal prediction.

OBJECTIVE: To review published data pertaining to the pathogenesis, antenatal prediction, and neonatal diagnosis of pulmonary hypoplasia. DATA SOURCES: A computerized search of articles published through February 1995 was performed on the MEDLINE data base. Additional sources were identified through cross-referencing. METHODS OF STUDY SELECTION: All available references were reviewed initially by the authors, and their impact on the clinical significance of this condition was summarized. DATA EXTRACTION AND SYNTHESIS: Pulmonary hypoplasia can be understood best by first defining the embryology of lung development. Although pulmonary hypoplasia can occur as a primary event, most cases are secondary to congenital anomalies or pregnancy complications. Several methods have been proposed to predict the subsequent occurrence of pulmonary hypoplasia, but no single criterion has adequately confirmed sensitivity and specificity for clinical decision making. CONCLUSION: For patients with premature rupture of membranes, the gestational age at time of rupture carries the highest risk correlation with subsequent pulmonary hypoplasia.

Amniotic fluid lamellar body count: cost-effective screening for fetal lung maturity.

OBJECTIVE: To create a highly specific cascade testing scheme for fetal lung maturity using the lamellar body count, lecithin/sphingomyelin ratio (L/S), and phosphatidylglycerol. METHODS: A nondedicated hematology analyzer (Sysmex NE 1500, Toa Medical Electronics, Los Angeles, CA) was used to determine the lamellar body counts of 209 unspun amniotic fluid specimens. Maximally specific lamellar body count cutoffs for biochemical maturity and immaturity were determined using receiver operating characteristic curves. Biochemical lung maturity was defined as either a mature L/S ratio or phosphatidylglycerol. Biochemical lung immaturity was defined as both an immature L/S ratio and an immature phosphatidylglycerol. RESULTS: A lamellar body count of less than 8000 (n = 17) was 100% specific for biochemical lung immaturity (positive predictive value = 100%, negative predictive value = 86%). A lamellar body count of greater than 32,000 was 98% specific for biochemical lung maturity (positive predictive value = 99%, negative predictive value = 63%). CONCLUSION: Testing only specimens where the lamellar body count was greater than 8000 and less than or equal to 32,000 for the L/S ratio and phosphatidylglycerol would preclude the need for 76% of all L/S and phosphatidylglycerol assays. Because the lamellar body count is quick, simple, and universally available, it could serve as an extremely cost-effective screening test for fetal lung maturity.

Adrenomedullin levels in normal and preeclamptic pregnancy at term.

OBJECTIVE: To describe maternal plasma levels of adrenomedullin (AM), a hypotensive and natriuretic peptide, in normal and preeclamptic women at term. STUDY DESIGN: Maternal plasma AM levels were determined in 13 preeclamptic and 15 normotensive primigravidas by radioimmunoassay. Plasma samples were obtained with the patients in the lateral recumbent position before the administration of any medications. RESULTS: Women with preeclampsia had significantly elevated AM levels when compared with normotensive controls (42.3 +/- 10.5 pg/mL versus 16.9 +/- 3.1 pg/mL, P < .011). CONCLUSION: In this pilot study, AM levels were significantly increased at term in preeclamptic women.

Lung maturity tests. Relation to source, clarity, gestational age and neonatal outcome.

OBJECTIVE: To determine whether gestational age is a significant determinant of neonatal outcome, irrespective of biochemical lung maturity. The effects of specimen source and clarity on the reliability of biochemical tests for predicting respiratory distress syndrome are also evaluated. STUDY DESIGN: Perinatal outcome was analyzed for 904 neonates undergoing amniotic fluid maturity studies within three days of delivery from 1991 to 1993. The relationships of gestational age and biochemical maturity to neonatal outcome were examined using multivariate analysis of covariance. Test reliability was evaluated using log-linear analysis of multiway frequency tables. RESULTS: Gestational age was a better predictor of neonatal outcome than biochemical lung maturity. Gestational age significantly correlated with every measure of outcome except intraventricular hemorrhage and jaundice. Test reliability was not significantly influenced by specimen source or clarity. CONCLUSION: Results obtained using contaminated amniotic fluid are reliable when the proper technique is used. Irrespective of biochemical maturity, neonatal outcome is significantly related to gestational age. Gestational age, and not just biochemical maturity, should be considered when timing delivery.

Chia seed (Salvia hispanica L.) as an omega-3 fatty acid source for broilers: influence on fatty acid composition, cholesterol and fat content of white and dark meats, growth performance, and sensory characteristics.

Five thousand four hundred, 1-d-old, male, Ross 308, broiler chicks were fed for 49 d to compare diets containing 10 and 20% chia (Salvia hispanica L.) seed to a control diet. Cholesterol content, total fat content, and fatty acid composition of white and dark meats were determined at the end of the trial. A taste panel assessed meat flavor and preference. Cholesterol content was not significantly different among treatments; however, the 10% chia diet produced a lower fat content in the dark meat than did the control diet. Palmitic fatty acid content was less in both meat types when chia was fed, with differences being significant (P < 0.05), except for the white meat and the 20% chia diet. alpha-Linolenic fatty acid was significantly higher (P < 0.05) in the white and dark meats with the chia diets. Chia significantly lowered the saturated fatty acid content as well as the saturated:polyunsaturated fatty acid and omega-6:omega-3 ratios of the white and dark meats compared to the control diet. No significant differences in flavor or preference ratings were detected among diets. Body weight and feed conversion were significantly lower with the chia diets than with the control, with weight reductions up to 6.2% recorded with the 20% chia diet.

[Technic of overlapping sphincter anal repair in the treatment of traumatic anal incontinence]. / Tecnica di "overlapping sphincter anal repair" nel trattamento dell'incontinenza anale traumatica (IAT).

Faecal incontinence is an important disabling symptom in the affected patients. Classically, we divide faecal incontinence in two main types: neurogenic faecal incontinence and traumatic anal incontinence. Traumatic anal incontinence is due to causes damaging sphincteric mechanism directly. The aim of the present study was to evaluate the outcome of overlapping sphincter anal repair procedure in the management of traumatic anal incontinence. To this end we studied 27 patients with traumatic anal incontinence who underwent an overlapping sphincter anal repair procedure according to the method described by Parks and McPartlin in 1971. Mean follow up was up three years and was based mainly both on clinical evaluation with anorectal exploration and manometric values carried out on a 6 monthly basis. When the outcome was evaluated in terms of faecal continence our date were similar to those reported by Parks and Fang. In the subjects studied we haven't reported any major complications apart from one case of abscess, one case of wound's infection and one case of stenosis which were efficaciously treated. Our findings supported the view that overlapping sphincter anal repair procedure is the surgical approach of choice in the patients with traumatic anal incontinence.

[Postanal repair in the treatment of idiopathic neurogenic fecal incontinence]. / Il postanal repair nel trattamento dell'incontinenza fecale neurogenica idiopatica.

Faecal incontinence is an important disabling symptom in the affected patients. Classically, we divide faecal incontinence in two main types: traumatic faecal incontinence and neurogenic faecal incontinence. Neurogenic faecal incontinence is characterized by a diffuse weakness of anal sphincter and of the elevator muscles. The aim of the present study was to evaluate the outcome of postanal repair procedure in the management of neurogenic faecal incontinence. To this end we studied 20 patients with neurogenic faecal incontinence who underwent a postanal repair procedure according to the method described by Parks. Mean follow up was up two years and was based mainly both on clinical evaluation and manometric values carried out on a 6 monthly basis. When the outcome was evaluated in terms of faecal incontinence our date were similar to those reported by Parks and Keighley. In the subjects studied we haven't reported any major complications apart from two cases of wound's infection which were efficaciously treated. Our findings supported the view that postanal repair procedure is the surgical approach of choice in the patients with idiopathic neurogenic faecal incontinence.

[Phyllodes tumor of the breast: diagnostic and therapeutic problems]. / Tumore fillode della mammella: problematiche diagnostiche e terapeutiche.

Phyllodes tumour (PT) is a rare breast tumor with mixed connective and epithelial components, which usually relapses topically after excision. Five patients with PT took part in the study (4 were positive for benign PT and one was positive for malignant PT at extemporary histological examination). The patients (3) with 3 cm or minus benign lesion had mass excision with a large resection of the surrounding mammary tissue. In the remaining patient with benign neoplasm (8 cm lesion) simple mastectomy was carried out. Finally the patient with malignant PT (5 cm lesion) underwent a simple mastectomy without following chemotherapy or radiotherapy. Follow-up (at 6 and 12 months) consisted of mammography and clinical examination. One out of the 3 patients treated with large resection had a local relapse which was then treated surgically. There was no evidence of relapse at 12 months in the remaining patients with benign tumor. The patient with malignant PT returned to our attention with multiple bone metastases in the thoracic lumbar tract two years later. She received multiple courses of combined radiotherapy and chemotherapy. Local relapses do not appear to affect survival: as a consequence, wide excision should be the primary treatment of benign phyllodes tumors. Total mastectomy has been indicated for malignant phyllodes tumors and for very large tumors.

[Early gastric cancer: our experience]. / Early gastric cancer: nostra esperienza.

The early gastric cancer (EGC) is a very interesting pathology as it represents the first phase of gastric cancer, curable in most cases. The aim of the present study is to evaluate the outcome of surgical treatment of EGC in 19 consecutive patients. The studied patients were followed up for 5 years, during which they underwent a gastroscopy, a hepatic echography and a TC at one year intervals in case of echographic suspicion. Ten patients with limited involvement of the antrum underwent a gastric resection with Billroth II's reconstruction; five patients with circumscribed involvement of the gastric body underwent a subtotal resection; four patients (one with a multifocal involvement of the gastric body and three with multifocal involvement of the fundus) underwent a total gastrectomy with Roux's reconstruction. All patients underwent a limited lymphadenectomy of the perigastric lymph nodes. By evaluating and comparing the results of the present study with previous data on EGC, we propose gastric resection, subtotal gastrectomy and total gastrectomy, according to the location of neoplasm, with limited lymphadenectomy of perigastric lymph nodes.

[Treatment of primary gastric lymphoma in IE/IIE stages]. / Il trattamento del linfoma gastrico primitivo negli stadi IE/IIE.

The primitive gastric lymphoma constitutes 2-5% of malignant gastric neoplasms. The present treatment of such a pathology is not defined, since it seems that this disease deserves a multidisciplinary approach: surgical, chemotherapical, radiotherapical. The authors by means of this study, intend to estimate the results of the therapeutic treatment employed in 18 patients suffering from primitive gastric lymphoma in the stage IE and IIE. From the results obtained by our study, it emerges that in the lymphomata located in the cavity at the stage IE, there takes place the almost total superimposition of the results, in terms of survival to 5 years, in the patients treated surgically and in those treated by chemotherapy. Therefore, in such cases the chemotherapic treatment can be proposed because it is bloodless, the patient appreciates it more and it seems to be accompanied by a very small number of complications. In the patients with lymphomat located in the antrum at the stage IIE, we have obtained good results in terms of survival joining radiotherapy and chemotherapy to surgery, as reported by Moore. Even taking into account the very small number of cases we have considered, we think the primitive gastric lymphoma at the stage IE must be treated by means of chemotherapy, while that one at the stage IIE requires and integrated treatment.

1º Congreso AADYND: Categoría Premio Congreso / Gasto energético y hemodiálisis crónica / Valoración nutricional cualitativa de los menús y diseño de la carta de restaurantes / Ferias Municipales: Viabilidad como canal de comercialización / Prueba piloto para conocer aceptabilidad, preferencia y saciedad de colaciones dulces con baja densidad energética y alto aporte proteico en mujeres perimenopáusicas / Rol de la infección por Helicobacter pylori en la regulación hormonal del apetito y el índice de masa corporal / Incursionando nuevas áreas de trabajo: "El licenciado en nutrición en una unidad de cuidados intensivos neonatales" / Diseño y proyección de audiovisuales animados como estrategia comunicativa / Proceso de mejora de las bases y condiciones para la concesión del servicio de confitería de la Facultad de Ciencias de la Salud (FCS). Universidad Nacional de Salta (UNSa) / Consumo de frutas en estudiantes universitarios

Introducción: Existen controversias sobre el comportamiento del gasto energético en reposo (GER) en pacientes en hemodiálisis (HD), algunos autores señalan que la HD aumenta el GER, mientras que otros no hallaron diferencias significativas. Objetivos: Determinar si el GER en pacientes en HD es superior al de individuos que no dializan. Determinar si el GER en pacientes en HD es mayor durante el momento de diálisis en comparación al momento que no dializan. Materiales y método: Para el objetivo 1, diseño comparativo a muestras independientes, observacional, prospectivo, transversal; para el objetivo 2, comparativo a muestras relacionadas, observacional, prospectivo, longitudinal. La muestra quedó conformada por 30 individuos en HD crónica y 30 controles apareados por edad, sexo, actividad física y estado nutricional. Se midió el GER utilizando un calorímetro indirecto móvil. Para el análisis estadístico se aplicaron test de diferencias (p < 0,05). Resultados: El GER de los individuos en HD no fue significativamente mayor al del grupo control (test de medias 56,8kcal, IC -76,6/190,2, p=0,1955; test de medianas 49,9kcal, IC -84,9/189,9, p=0,2142; test de signos 56,6%, IC 37,4/74,5, p=0,292). En los individuos en HD, el GER aumentó significativamente durante la sesión (test de medias 173kcal, IC -83,6/262,4, p=0,00022; test de medianas 170kcal, IC 85/255, p=0,00024; test de signos 83,33%, IC 65,3/94,3, p=0,00016). Al subdividir este grupo según presencia o ausencia de diabetes, se mantuvo el incremento del GER durante la diálisis. (test de medias 210kcal, IC 75,1/344,9, p 0,0044; test de medianas 212,5kcal, IC 65/340, p 0,0028; test de signos 85,71%, IC 42,1/99,6, p 0,06). Conclusiones: El GER de pacientes en HD no está incrementado con respecto a individuos sanos. En el paciente en HD crónica el GER aumenta durante el procedimiento dialítico en comparación al día que no asiste a diálisis.

Introducción: La carta de menú del restaurante, aparece como el elemento de comunicación más fuerte y a veces el único que se establece entre el restaurante y el consumidor. La tendencia creciente de comer fuera de casa convierte a los restaurantes en establecimientos cruciales para la promoción de un patrón alimentario saludable para toda la población. Una oferta alimentaria variada y equilibrada desde el punto de vista nutricional es el camino adecuado para mejorar la calidad de los menús, y con ello llevar mensajes nutricionales para mejorar la salud poblacional. Objetivos: Analizar el valor nutricional cualitativo de los menús y el diseño de la carta en los restaurantes de la ciudad de Mar del Plata en el año 2014. Materiales y método: La selección de restaurantes se llevó a cabo al azar por estratificación en zonas geográficas. Se realizó un análisis de valoración nutricional cualitativa de los menús con los datos recolectados. Simultáneamente, se analizó el diseño de las cartas de menús a través de una grilla de observación planteada específicamente para tal fin. Es un estudio descriptivo; no experimental y de tipo transversal. Resultados: Del menú se analizó un total de 258 entradas, 1186 platos principales, 137 guarniciones y 198 postres. La mayoría de las entradas y los platos principales ofrecidos están compuestos por proteínas animales, representado el 84% y el 70%, respectivamente. El promedio por restaurante es de 28 platos principales con papas fritas de guarnición. El diseño de la carta en su mayoría es sencillo y claro, sin elementos de comunicación visual llamativos. Conclusiones: Los menús analizados presentan un desequilibrio en su valor nutricional, con un exceso en proteína animal y poca oferta de platos con carbohidratos bajos.

Introducción: La perimenopausia se asocia con mayor probabilidad de padecer trastornos de la alimentación, destacándose la compulsión glucídica, que lleva a consumir fundamentalmente alimentos con alto contenido de carbohidratos entre comidas. Objetivos: evaluar aceptabilidad, preferencia y saciedad de colaciones dulces de baja densidad energética (DE) y alto aporte proteico en muestra de mujeres adultas perimenopáusicas. Materiales y método: A partir de receta estándar de merengues, se desarrollaron tres variantes con disminución de DE y sacarosa (Muestra A y C se reemplazó sacarosa por azúcar light y sucralosa en diferentes proporciones; Muestra B se disminuyó sacarosa y se agregó sucralosa). Se realizó ensayo de aceptabilidad y preferencia en 75 evaluadoras no entrenadas y prueba de saciedad a 27 evaluadoras no entrenadas, utilizando encuesta autoadministrada y escala hedónica de Likert de 9 puntos. Análisis estadístico: medidas de tendencia central, ANOVA, prueba de Friedman y Software "Statgraphics Centurion XVII" para pruebas de aceptabilidad. Resultados: Se desarrollaron merengues para las tres muestras de 1 g. cada uno, con disminución del 31% en la DE y 1,03 mg. de triptófano por unidad. La muestra B (se disminuyó la sacarosa al 88,7% y se agregó sucralosa en 11,3%), fue la de mayor preferencia y aceptabilidad por sus características sensoriales. Sobre esta muestra se aplicó el test de saciedad (libre demanda), obteniendo una media de ingesta de 10 unidades (Rango: 3-15). El 22,2% de las mujeres consumió 3 a 8 merengues; 51,8% 9 a 12 merengues y 25,9% más de 12 merengues. Se pudo observar que las mujeres estaban plenamente saciadas a los primeros 30 minutos, manifestando que a los 120 minutos tuvieron apetito. Conclusiones: La colación más aceptada y preferida fue la que mantuvo sacarosa y una proporción fue sustituida por edulcorante no calórico. El test de saciedad demostró que la colación seleccionada logró saciedad a corto plazo.

Introducción: Helicobacter pylori coloniza la mucosa gástrica y se asocia con el desarrollo de patologías gastrointestinales, pudiendo afectar la secreción de hormonas moduladoras del apetito. Objetivo: Evaluar la asociación entre la colonización gástrica por H. pylori, las concentraciones séricas de grelina y leptina y el índice de masa corporal (IMC) en pacientes con sintomatología digestiva. Materiales y método: Se llevó a cabo un estudio transversal que incluyó 163 pacientes dispépticos (18 - 70 años) derivados al Hospital de Gastroenterología "Dr. Carlos Bonorino Udaondo". Se realizó una encuesta sociodemográfica, recordatorio de 24 horas y se midió circunferencia de cintura (CC), peso y talla para el cálculo del IMC. La presencia de H. pylori se diagnosticó mediante 13C-Test del Aire Espirado (13C-UBT). Las concentraciones séricas de grelina y leptina se determinaron mediante enzimoinmunoensayo. Para el análisis estadístico se utilizaron los Tests de χ2, Mann-Whitney, correlación de Spearman y regresión lineal (SPSS19.0). Resultados: La prevalencia de la infección por H. pylori fue de 53,4% (IC95%;45,7-65,8%). La ingesta promedio de energía, carbohidratos, proteínas y lípidos no se asoció a la infección. Las prevalencias de sobrepeso/ obesidad y adiposidad central no difirieron significativamente entre H. pylori positivos y negativos (p=0.09 y p=0.87, respectivamente). La mediana de la concentración de grelina fue 306.5 pg/mL (RIC;230.0- 385.5) en H. pylori positivos y 358.3 pg/mL (RIC;253.8-547.8) en negativos. La infección se asoció con menores concentraciones séricas de grelina (p=0.016) aún ajustando por IMC y género (p=0.019), no habiéndose encontrado asociación entre los valores de leptina y la infección (p=0,76). Los niveles de grelina sérica se correlacionaron negativamente con el IMC (r=-0,25; p=0,0013), mientras que la correlación leptina-IMC fue positiva (r=0,56; p<0,00001) en la población total. Conclusiones: La colonización por H. pylori en pacientes con sintomatología digestiva se asoció con menores concentraciones séricas de grelina, enfatizando su rol en la regulación hormonal del apetito.

Introducción: La alimentación del recién nacido de pretérmino (RNPT) es un gran desafío. La administración óptima de nutrientes requiere de una infraestructura organizada y profesionales de distintas áreas que trabajen en forma conjunta. A partir de la necesidad de cumplir con estándares de calidad respecto del estado nutricional de pacientes neonatales, la Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital Universitario Austral (HUA) sugirió la incorporación de un licenciado en nutrición para colaborar en diferentes aspectos del cuidado nutricional de los mismos. Objetivos: Promover la inserción del licenciado en nutrición como parte del equipo colaborador del cuidado nutricional del neonato. Evaluar posibles herramientas que el licenciado en nutrición pudiera aportar dentro de una UCIN. Materiales y método: Se trabajó con monitoreo continuo de pacientes ingresados en la UCIN del HUA de Pilar durante el periodo de diciembre 2012 hasta la actualidad. Se diseñó una planilla para cargar datos de los pacientes que ingresan a la Unidad obtenidos de la historia clínica informatizada de la institución (Pectra Digital Gate®). Resultados: A partir de los datos recolectados se obtuvo información sobre: días de recuperación del peso de nacimiento; número de días para cubrir requerimientos propuestos; número de días que recibe NPT; aumento de peso de los últimos 7 días; monitoreo de soporte nutricional indicado y recibido; porcentaje de leche materna vs fórmula recibida. Se colaboró en el diseño de planillas de fraccionamiento de leches, protocolos de inicio de alimentación del recién nacido de bajo peso al nacer y uso de fortificadores de la leche materna; se optimizó el registro de la alimentación enteral y parenteral recibida en la historia clínica; se realizó asesoramiento de productos y búsqueda bibliográfica para la incorporación de nuevas fórmulas dentro del Vademécum de la institución. Conclusión: La existencia de protocolos básicos actualizados, cálculo de los requerimientos energéticos en función de la situación clínica y el estado nutricional, monitoreo de la alimentación enteral y parenteral, cumplimento del objetivo calórico, son algunos indicadores que pueden utilizarse como herramienta para medir la calidad de la actividad asistencial. El asesoramiento y monitoreo del cuidado nutricional del neonato son parte de las funciones que los nutricionistas pueden cumplir dentro de dichas unidades. La inclusión en la enseñanza de grado y postgrado del cuidado nutricional de este grupo es de vital importancia dentro del aprendizaje continuo del licenciado en nutrición.

Introducción: El proyecto se enmarca en el Programa de Ciudadanía Porteña, programa de asistencia alimentaria implementado por el Ministerio de Desarrollo Social de la Ciudad de Buenos Aires, basado en transferencia directa de ingresos a familias en situación de vulnerabilidad Objetivos: Realizar educación alimentaria nutricional en 3 mensajes: lactancia materna, alimentación complementaria e hidratación a usuarios del programa en salas de espera de las sedes en que realizan trámites. Materiales y método: Se diseñaron y proyectaron 3 animaciones audiovisuales de corta duración, cada una con contenidos de cada mensaje principal de los objetivos. Se entregaron 3 folletos para complementar la información del video. Se realizaron 148 encuestas directas a los beneficiarios que asistieron a las sedes del programa para evaluar la incorporación de los mensajes. Resultados: Se analizaron las encuestas por mensaje. Lactancia materna: 98% vio el video; 81,6 % recordó el tema principal; el beneficio de defensas fue el mayor con el 33%; 28% leyó el folleto; 42% opinó es bueno amamantar hasta los 2 años y más. Alimentación complementaria: 87% vio el video; 47,5% respondió como tema principal: Primeras comidas del bebé; 24% y el 17% según sede leyeron el folleto; 60% respondió como tema del folleto: Qué alimentos dar a los bebés por edades; 31% opinó en comenzar la alimentación complementaria antes de los 6 meses. Hidratación y consumo: 76% vio el video; 86% respondió correctamente el tema principal del video; 44% respondió como principal beneficio del agua saca la sed; 6% tomó el folleto. Conclusiones: Los mensajes fueron comprendidos satisfactoriamente. La implementación de la animación es un recurso práctico y moderno que facilita la incorporación de los mensajes. Su proyección repetitiva permite llegar a mayor cantidad de beneficiarios, el material gráfico tuvo menor recepción.

Introducción: El pliego de condiciones para la concesión de un servicio de confitería establece la calidad requerida. Por tal motivo es esencial especificar adecuadamente las condiciones del servicio que se espera recibir para brindar satisfacción a los usuarios y partes interesadas.Objetivos: Analizar el proceso y el pliego de bases y condiciones para la concesión del servicio de confitería de la FCS de la UNSa. Proponer mejoras para orientar las actividades futuras en relación a la compra, selección, preparación distribución y control del servicio. Materiales y Método: Se realizó una encuesta de satisfacción para conocer la calidad percibida por los usuarios de la confitería de la FCS. Se analizaron el proceso y los subprocesos de concesión del servicio, el pliego de condiciones mediante el cual se rige la actual concesión. Se aplicó el diagrama de Espina de Pescado para determinar la causa raíz el problema. Resultados: Los clientes manifestaron insatisfacción en relación a la variedad de preparaciones y la omisión de alimentos saludables como vegetales, pescados, lácteos descremados, jugos de frutas, cereales integrales. Problema raíz: pliego de condiciones incompleto y poco detallado. Conclusiones: El plan de mejoras en relación al pliego de bases y condiciones requiere tener en cuenta aspectos tales como: calidad de la materia prima, plan de menú, tipo y cantidad de comidas, ingredientes, formas de preparación, características físico químicas de las preparaciones saludables, porción estándar, presentación y tipos de vajilla.

Introducción: La importancia del consumo de frutas es vital debido a sus propiedades nutritivas, por su aporte de vitaminas, minerales, fibra y agua. Las Guías Alimentarias para la Población Argentina (GAPA) recomiendan el consumo diario de 2 a 3 frutas. Objetivos: Estimar la prevalencia de consumo inadecuado de frutas y determinar la prevalencia de dicho consumo por exceso o déficit, en estudiantes. Estimar la prevalencia de los motivos por los cuales no se consumen frutas en estudiantes. Materiales y método: Diseño descriptivo, observacional y transversal. La muestra quedó conformada por 486 estudiantes universitarios y terciarios. Se midió el consumo de frutas a través de una encuesta diseñada para tal fin. El análisis estadístico se realizó mediante el paquete VCCstat V.Beta 2.0. Resultados: El 23,5% de la muestra pertenecía a alguna carrera de ciencias de la salud. El 74% (IC95% 69,9-77,9) de los estudiantes no cumplió con la recomendación diaria de las GAPA. De este porcentaje, un 96,4% (IC95% 93,8-98) no llegó a consumir al menos dos frutas diarias, mientras que solo un 3,6% (IC95% 1,9-6,1) de los encuestados superó dicha recomendación. Se encontró un 34,6% (IC95%30,3-38,9) de estudiantes con consumo nulo. Entre los motivos de este hallazgo, un 72% (IC95% 64,5-78,6) lo adjudicó a la "falta de hábito". Entre los motivos restantes se destacan "no me gusta" con el 10,7% (IC95%6,4-16,4) y "falta de practicidad" con el 9,5% (IC95%,5-15). Conclusión: La mayoría de los estudiantes consume menos cantidad de frutas que la recomendada. Debido a la falta de hábito, un gran porcentaje de estudiantes no incorpora frutas en su alimentación diaria.

Microsatellite and AFLP markers in the Prunus persica [L. (Batsch)]xP. ferganensis BC(1)linkage map: saturation and coverage improvement.

A set of 146 single sequence repeats (SSRs) and 14 amplified fragment length polymorphism (AFLP) primer combinations were used to enrich a previously developed linkage map obtained from a (Prunus persicaxP. ferganensis)xP. persica BC(1) progeny. Forty-one SSR primer pairs gave polymorphic patterns detecting 42 loci. The restriction/selective primer AFLP combinations produced a total of 79 segregating fragments. The resulting map is composed of 216 loci covering 665 cM with an average distance of 3.1 cM. Novel regions were covered by the newly mapped loci for a total of 159 cM. Eight linkage groups were assembled instead of the earlier 10 as two small groups (G1a and G8b), previously independent, were joined to their respective major groups (G1b and G8a). Several gaps were also reduced resulting in an improved saturation of the map. Twelve gaps >or=10 cm are still present. A comparative analysis against the Prunus reference map (71 anchor loci) pointed out an almost complete synteny and colinearity. Six loci were not syntenic and only two were not colinear. Genetic distances were significantly longer in our map than in the reference one.

Continuity of cancer care.

The importance of providing continuity in the care of all patients with major medical problems, such as cancer, has widespread acceptance in our current health care system. From the perspective of an oncology social work clinician, this article offers a definition of the concept of continuity of care, examines factors influencing its provision in oncology, and reviews key components in continuity of cancer care planning and implementation. It also examines some innovative efforts in practice to improve continuity.

Centile-based ultrasound morphometric tables.

Current ultrasound morphometric tables estimate centiles assuming normal distribution and similar variation throughout gestation. Our goal was to develop normative tables for biparietal diameter, femur length and average abdominal diameter using actual centiles. We studied the last complete ultrasound examination from 9510 singleton, live pregnancies without major malformations delivered at our hospital. Actual 5th, 10th, 50th, 90th and 95th centiles were calculated for each week and compared to estimates based on means and standard deviations. With advancing gestational age, variation in average abdominal diameter increased and variation in biparietal diameter and femur length remained stable. The largest difference between an actual and an estimated centile limit was 2 mm for biparietal diameter or femur length and 3 mm for average abdominal diameter. Differences between true and estimated centile limits were less than the intraobserver variation of the ultrasound measurements and therefore clinically unimportant.

Meconium does not guarantee fetal lung maturity.

OBJECTIVE: In utero passage of meconium may represent a response to hypoxic stress or a normal maturational event. When found during the third trimester, one may be tempted to use its presence as prima facie evidence of fetal lung maturity. The purpose of our study was to determine the frequency of meconium-stained fluid in the third trimester and the incidence of biochemical and physiologic lung immaturity in these fetuses. METHODS: Amniotic fluid specimens obtained at our institution from 1991 through 1993 (n = 2,377) were analyzed for maturity and visually inspected for meconium. Perinatal outcome was obtained for intramural deliveries occurring within 3 days of amniotic fluid collection (n = 905). Gestational age was defined as the best obstetric estimate based on menstrual dates, clinical examination, and ultrasound results. RESULTS: Meconium staining was present in 2.7% (n = 64) of specimens. Although meconium-stained specimens were more likely to have mature lecithin-sphingomyelin (L:S) ratios (OR 2.1, 95% confidence interval [CI] = 1.2-3.6) and phosphatidylglycerol (PG) concentrations (OR 3.8, CI 2.2-6.7), 17.2% were immature for both L:S and PG (n = 11, CI = 9.9-28.2%). When analysis was limited to fetuses delivering intramurally within 3 days of amniotic fluid collection, respiratory distress syndrome occurred in 3.0% (CI = 0.5-15%) with meconium-stained fluid. CONCLUSIONS: The presence of meconium in amniotic fluid does not guarantee lung maturity. The same consideration of the risks of prematurity must be given to the fetus with meconium-stained fluid as given to the fetus with clear fluid.

Variety identification in maize lines via capillary electrophoresis of zeins in isoelectric acidic buffers.

Zeins (the prolamins or seed storage proteins in maize) have been used to characterize and identify different genotypes. Zeins were fractionated by capillary zone electrophoresis in acidic, amphoteric buffers, which represent a medium of moderate conductivity and are thus compatible with higher voltage gradients. The running buffer consisted of 40 mM isoelectric aspartic acid, in presence of 6 M urea and 0.5% hydroxyethyl cellulose (apparent pH: 3.8; pI in the absence of urea: 2.77). Thirty-one different zein peaks were mapped out of a total of 21 different maize genotypes. Each of them typically exhibited seven to twelve peaks, with some genotypes showing up to 20 zein bands. Due to slightly changing elution times, caused by a lack of reproducibility of the electroendoosmotic flow in uncoated silica surfaces, correct peak assignment and alignment among different runs was obtained by multivariate statistical analysis. The present method compares well, both in resolution and total number of peaks, with current protocols adopted for screening of maize inbreds, which consist of isoelectric focusing in agarose gels.

Pediatric liaison psychiatry: a forum for separation and loss.

Separation and loss issues arise frequently in pediatric hospital settings. Three forms of psychiatry/psychology liaison are presented which demonstrate: 1. case-centered collaboration to address child and family concerns about death; 2. team-centered activities which link family and staff roles in the course of terminal illness; and 3. the development of a program mechanism to meet the needs of staff "survivors" of recurrent childhood deaths. These examples illustrate the enrichment which pediatric psychiatry/psychology liaison program offer when the conceptual model of liaison service and teaching operates flexibly on case, team, and program levels.

Effects of tumor necrosis factor-alpha on human trophoblast cell adhesion and motility.

PROBLEM: Adhesive interaction between trophoblast cells and uterine endometrial basement membrane is one of the critical processes in embryo implantation. This interaction is directly or indirectly regulated by hormones, growth factors, and cytokines. Since tumor necrosis factor-alpha (TNF-alpha) is synthesized by both decidual and trophoblast cells, we hypothesized that TNF-alpha may play a regulatory role in trophoblast cell invasion. To test this hypothesis, we have used in vitro models to determine the effect of TNF-alpha on human trophoblast cell adhesion and motility, two major steps in trophoblast invasion. METHODS: The effect of TNF-alpha on the motility of extended-lifespan first trimester trophoblasts (HTR) and JEG-3 choriocarcinoma cells was tested using the phagokinetic track motility assay. An in vitro adhesion assay was used to determine the effect of TNF-alpha on the adhesion of HTR and JEG-3 cells to laminin, a major basement membrane component. In addition, the effect of TNF-alpha on the surface expression of the laminin receptor beta 1 integrin subunit was examined using flow cytometry. RESULTS: HTR or JEG-3 cells strongly adherent to laminin which was not significantly altered by TNF-alpha treatment. We also measured the effect of TNF-alpha on the surface expression of beta 1 integrin on HTR and JEG-3 cells; no difference was observed between control and treatment groups. Interestingly, the motility of both HTR and choriocarcinoma JEG-3 cells was significantly inhibited by TNF-alpha. CONCLUSIONS: The role of TNF-alpha in human embryo implantation is currently unknown. Our data demonstrate that TNF-alpha does alter trophoblast cell adhesion to laminin, but significantly inhibits trophoblast cell motility in vitro, suggesting that TNF-alpha may play a regulatory role in trophoblast cell invasion.

The maize WD-repeat gene ZmRbAp1 encodes a member of the MSI/RbAp sub-family and is differentially expressed during endosperm development.

Members of the MSI/RbAp sub-family of WD-repeat proteins are widespread in eukaryotic organisms and form part of multiprotein complexes that are involved in various biological pathways, including chromatin assembly, regulation of gene transcription, and cell division. In this study we report the isolation and characterization of a cDNA sequence from Zea mays, which encodes an RbAp-like protein (ZmRbAp1) that binds acetylated histones H3 and H4 and suppresses mutations that have a negative effect on the Ras/cAMP pathway in yeast. The ZmRbAp genes form a gene family and are expressed in different tissues of Z. mays L. plants. Determination of its expression pattern during maize seed development revealed that ZmRbAp transcripts are abundant during the initial stages of endosperm formation. In addition, the transcripts are specifically localized in shoot apical meristem and leaf primordia of the embryo. A possible role for the ZmRbAp genes in early endosperm differentiation and plant development is discussed.