Supervivencia global y libre de enfermedad en mujeres con sobrepeso/obesidad al diagnóstico de cáncer de mama: Un estudio observa-cional de centro único / Overall and disease-free survival in women being over-weight/obesityat the diagnosis of breast cancer. A single-center observationalstudy

Introducción:El objetivo del presente estudio fue evaluar las características clínicas, patológi-cas e histológicas tumorales y su asociación con la recurrencia, metástasis y pronóstico en términos de supervivencia global y libre de enfermedad, de las pacientes que padecen sobre-peso u obesidad al momento del diagnóstico de cáncer de mama.Materiales y métodos:Se condujo un estudio descriptivo,longitudinal,retrospectivo, en un centro oncológico de referencia de Medellín. Se recolectó información de pacientes mayores de 18 años, con cáncer de mama infiltrante temprano y avanzado, entre los años 2012 ­2017, quienes presentaran IMC ≥ 25 kg/m2 al momento del diagnóstico. Las medianas de supervi-vencia se calcularon a través de curvas de Kaplan Meier y las diferencias mediante Log Rank Test.Resultados:Se analizó información de 1.349 pacientes. La mortalidad por todas las causas fue de 13.6% y aumentó proporcionalmente con el IMC (HR = 1.03, IC 1.0-1.05). Se identifica-ron 12.6% de recurrencias y el riesgo con el aumento de IMC no fue estadísticamente signifi-cativo (HR =1.02, IC 0.99 -1.05). Características como mala diferenciación tumoral, invasión linfovascular y estadio tumoral se asociaron de forma univariada con mayor mortalidad.Conclusión:Se demostró una asociación positiva e independiente entre el IMC elevado, la mortalidad y el riesgo de recurrencia en pacientes con cáncer de mama. Así como una aso-ciación con fenotipos tumorales agresivos y características de peor pronóstico. Se sugiere considerar modificaciones en el estilo de vida y un manejo multidisciplinario, como estrate-gias que posiblemente impacten en estos desenlaces

Introduction:The objective of the present study was to evaluate the clinical, pathological, and histological characteristics of tumors and their associations with recurrence, metastasis,and prognosis in terms of overall and disease-free survival inoverweight or obese patients at the time of diagnosis.Materials and methods: A descriptive, longitudinal, retrospective study was conducted at a reference cancer center in Medellin. Information was collected from patients older than 18 years of age with early or advanced infiltrating breast cancer between 2012 and 2017 who had a BMI ≥ 25 kg/m2 at the time of diagnosis. Median survival rates were calculated using Kaplan­Meier curves, and differences were determined using the log-rank test.Results: Information from 1,349 patients was analyzed. All-cause mortality was 13.6% and increased proportionally with BMI (HR = 1.03, CI 1.0-1.05). A total of 12.6% of the recurrences were identified,and the risk with increasing BMI was not significantly different(HR =1.02, CI 0.99 -1.05). Patient characteristicssuch as poor tumor differentiation, lymphovascular inva-sion, and tumor stage were univariately associated with increasedmortality.Conclusion: Positiveand independent associations weredemonstrated between high BMI and mortality and between high BMI and the risk of recurrence in patients with breast cancer. In addition, there wasan association betweenaggressive tumor phenotypes and worse prog-nostic characteristics. Lifestylemodifications and multidisciplinary management should be considered strategies for impactingthese outcomes

Psicologia e diabetes no Brasil: um mapeamento de profissionais e de suas ações / Psychology and diabetes in Brazil: the mapping of professionals and their practices / Psicología y diabetes en Brasil: un mapeo de los profesionales y sus acciones

Pouco se sabe sobre a atuação do psicólogo no Brasil junto a pessoas com Diabetes Mellitus. O objetivo desta pesquisa foi identificar os psicólogos brasileiros que trabalham com essa população e suas ações. Foram convidados a responder a um questionário online psicólogos que atuam ou atuaram junto a pessoas com diabetes. Participaram 79 psicólogos, principalmente da região Sudeste (59,5%). Todos declararam que haviam cursado pósgraduação. Na amostra, predominou o gênero feminino (89,9%), com idade entre 26 e 40 anos (46,8%). A maioria dos que atuam com diabetes declarou-se autônoma ou voluntária, e quase metade trabalhava menos do que 10 horas semanais. Entre aqueles que deixaram de trabalhar com diabetes, apenas uma minoria tinha vínculo empregatício. Além do trabalho com pessoas com diabetes, a maior parte declarou exercer outras atividades profissionais, como atendimentos clínicos em consultórios particulares, sugerindo que esta não é a atividade principal. Majoritariamente, os respondentes declararam não ter conhecimentos suficientes para o atendimento específico às pessoas com diabetes. Discute-se a qualidade da formação profissional dos psicólogos no Brasil, a necessidade de aprimoramento em relação à atuação com pessoas com diabetes e as condições de trabalho.(AU)

Little is known about the practice of psychologists in Brazil caring for people with Diabetes Mellitus. The aim of this research was to identify the Brazilian psychologists who work with this population and describe their actions. Psychologists who work or have worked with people diagnosed with diabetes were invited to answer an online questionnaire. The 79 participants lived mainly in the Southeast Region (59.5%). All of them declared to have a graduate degree, most were female (89.9%), aged 26 to 40 years (46.8%). Most of those working with diabetes declared to be autonomous or voluntary, and almost half had a workload of less than 10 hours a week. Among those who stopped working with diabetes, only a minority had a formal employment contract. In addition, most of them stated that they had other professional activities related to clinical care in private offices, suggesting that working with diabetes is not their main activity. Mostly, respondents stated that they did not have enough knowledge to care for people with diabetes. The quality of professional education of psychologists in Brazil, the need for specific improvement in labor relations and conditions were discussed.(AU)

Son escasas las informaciones del trabajo de los psicólogos en Brasil con las personas con Diabetes Mellitus. El objetivo de este estudio fue identificar los psicólogos brasileños que trabajan con esta población y describir sus acciones. Se invitó a psicólogos que trabajan o hayan trabajado con personas con diabetes a responder un cuestionario en línea. Participaron 79 psicólogos, principalmente de la región Sureste de Brasil (59,5%). Todos declararon tener posgrado. En la muestra hubo una mayor prevalencia del género femenino (89,9%), de edades de entre 26 y 40 años (46,8%). La mayoría de los que trabajan con personas con diabetes se declararon autónomos o voluntarios, y casi la mitad trabajaba menos de 10 horas a la semana. Entre los que dejaron de trabajar con las personas con diabetes, solo una minoría tenía una relación laboral. Además de trabajar con personas con diabetes, la mayoría afirmó tener otras actividades profesionales, como la atención clínica en consultorios privados, lo que sugiere que esta no es su actividad principal. La mayoría de los encuestados afirmaron que no tenían los conocimientos suficientes para atender específicamente a las personas con diabetes. Se discuten la calidad de la formación profesional de los psicólogos en Brasil, la necesidad de mejora en relación con el trabajo con personas con diabetes y las condiciones laborales.(AU)

Mapa de evidências sobre a efetividade clínica das plantas medicinais brasileiras: informe executivo / Evidence Map on the clinical effectiveness of Brazilian medicinal plants: executive report

O mapa apresenta uma visão geral das evidências sobre os efeitos das Plantas Medicinais Brasileiras para desfechos em saúde. A partir de uma ampla busca bibliográfica foram incluídos no mapa 214 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores de Laboratório de Tecnologia de Produtos Naturais (LTPN) da Faculdade de Farmácia da Universidade Federal Fluminense. Principais Achados: ● As revisões avaliaram o efeito de intervenções com 69 tipos de plantas organizadas em 4 categorias: cultivadas, nativas, exóticas e introduzidas no Brasil. ● As intervenções foram associadas a 130 desfechos de saúde organizados em 17 grupos: Bem-Estar, Vitalidade e Qualidade de Vida, Câncer, Condições Patológicas, Dermatopatias, Doenças Cardiovasculares, Doenças Nutricionais e Metabólicas, Doenças Respiratórias, Doenças Reumáticas, Doenças Urogenitais, Dor, Fatores Biológicos, Gastroenteropatias e Hepatopatias, Indicadores Psicológicos e Comportamentais, Indicadores Metabólicos e Fisiológicos, Saúde Mental, Saúde Bucal e Saúde Reprodutiva. ● No total foram 465 associações entre intervenções (as plantas) e desfechos de saúde, com destaque para as plantas cultivadas (251 associações, 54%). ● O grupo dos desfechos "Saúde Mental" foi o que recebeu mais associações (66 associações, 14%), seguido do grupo "Saúde Bucal" (42 associações, 9%). ● Quanto aos desfechos, destaque para: Transtornos de Ansiedade (20 associações), Demência (16 associações), Diabetes Mellitus (17 associações) e Distúrbios Menstruais (15 associações). ● Dentre as plantas, destaque para: Ginkgo biloba (76 associações), Aloe Vera (50), Zingiber officinale (39), Panax ginseng (28) e Curcuma longa (23). Implicações para a prática e pesquisa: ● Considerando o efeito das intervenções para os desfechos, os estudos reportaram efeito positivo ou potencialmente positivo para a maioria (68%) das associações (181 associações com efeito positivo e 137 com efeito potencialmente positivo). ● Destaque para os efeitos positivos ou potencialmente positivos reportados nas intervenções com Ginkgo biloba para os desfechos: Demência, Doença de Alzheimer e Desempenho Cognitivo (8, 7 e 7 associações respectivamente). ● Em 87 associações foi reportado "sem efeito" da intervenção para o desfecho (19,7%). ● Foi reportado efeito inconclusivo para uma pequena parte das associações (9%), que merece mais pesquisas. Nenhum efeito negativo ou potencialmente negativo foi reportado. O efeito não foi informado para 19 associações. ● Note-se que essa lista é dinâmica, podendo mudar com a publicações de novos estudos.

The map provides an overview of the evidence on the effects of Brazilian Medicinal Plants on health outcomes. Based on an extensive literature search, the map includes 214 systematic review studies. All studies were assessed, characterized, and categorized by a group of researchers from the Laboratory of Natural Product Technology (LTPN) at the Faculty of Pharmacy of the Federal Fluminense University. Key Findings: - The reviews evaluated the effects of interventions using 69 types of plants organized into 4 categories: cultivated, native, exotic, and introduced to Brazil. - The interventions were associated with 130 health outcomes organized into 17 groups: Well-being, Vitality and Quality of Life, Cancer, Pathological Conditions, Dermatopathies, Cardiovascular Diseases, Nutritional and Metabolic Diseases, Respiratory Diseases, Rheumatic Diseases, Urogenital Diseases, Pain, Biological Factors, Gastroenteropathies and Hepatopathies, Psychological and Behavioral Indicators, Metabolic and Physiological Indicators, Mental Health, Oral Health, and Reproductive Health. - In total, there were 465 associations between interventions (plants) and health outcomes, with a significant emphasis on cultivated plants (251 associations, 54%). - The "Mental Health" group received the most associations (66 associations, 14%), followed by the "Oral Health" group (42 associations, 9%). - Notable health outcomes included Anxiety Disorders (20 associations), Dementia (16 associations), Diabetes Mellitus (17 associations), and Menstrual Disorders (15 associations). - Among the plants, notable ones included Ginkgo biloba (76 associations), Aloe Vera (50), Zingiber officinale (39), Panax ginseng (28), and Curcuma longa (23). Implications for Practice and Research: - Considering the effects of interventions on health outcomes, the studies reported a positive or potentially positive effect for the majority (68%) of the associations (181 associations with a positive effect and 137 with a potentially positive effect); - Noteworthy are the positive or potentially positive effects reported for interventions with Ginkgo biloba on the outcomes of Dementia, Alzheimer's Disease, and Cognitive Performance (8, 7, and 7 associations, respectively); - In 87 associations, the intervention was reported to have "no effect" on the outcome (19.7%); - An inconclusive effect was reported for a small portion of the associations (9%), indicating a need for further research. No negative or potentially negative effects were reported. The effect was not reported for 19 associations; - It should be noted that this list is dynamic and may change with the publication of new studies.

Riesgo nutricional asociado a mortalidad de pacientes oncológicos ingresados a una unidad de cuidados intensivos: Un estudio descriptivo de centro único / Nutritional risk associated with mortality in cancer patients admitted to an intensive care unit: A descriptive study of a single center

Introducción: Los pacientes críticos con enfermedades oncológicas desarrollan una respuesta metabólica severa frente a la agresión con un alto grado de hipermetabolismo, lo que constituye un riesgo asociado e incide en la mortalidad de estos pacientes. El objetivo del presente estudio fue medir el estado nutricional de un grupo de pacientes oncológicos ingresados en terapia intensiva y establecer una asociación con la mortalidad. Metodología: El presente estudio observacional retrospectivo se realizó en la unidad de cuidados intensivos del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" - Guayaquil en el período septiembre - 2017 /agosto -2018. La muestra fue no probabilística, de pacientes con diagnóstico oncológico. Las variables fueron edad, sexo, mortalidad, NUTRIC score, condición de ingreso, tipo de tumores, escalas fisiológicas APACHE y SOFA, días de hospitalización y número de comorbilidades. Se utilizó análisis de curvas ROC, Rho de Spearman y Chi2 para establecer la asociación. Resultados: Se incluyeron 176 casos, con edad de 57 años (RI 43-67). 113/176 mujeres (64.2%). La media de puntuación de APACHE fue de 18 ±7.3 y la mediana de SOFA fue de 4.0 (RI 1.0 ­ 6.0). El tipo de cáncer más frecuente fue el ginecológico con un 25% (44/176) de los casos. La mortalidad fue del 19.9% (35/176). Los puntajes de NUTRIC fueron mayores en los pacientes fallecidos (Me 6.00 (RI 5-9) vs Me 3.00 (RI 1-4); P <0.0001). La presencia de puntaje NUTRIC >4 tiene una sensibilidad del 74.3% (IC 95% 56.7 ­ 87.5), especificidad del 80.9% (IC 95% 73.4 ­ 87.0), valor predictivo positivo del 49.1% (IC 95% 39.4 ­ 58.7) y un valor predictivo negativo 92.7% (IC 95% 87.8 ­ 95.7) para el desenlace de mortalidad. Conclusión: En este estudio las puntuaciones altas de NUTRIC score modificado se encuentran fuertemente asociadas a mortalidad en pacientes oncológicos críticos. Las puntuaciones altas del test NUTRIC score modificado se correlaciona con peor condición clínica al momento de la admisión y mayor estancia en la unidad de cuidados intensivos.

Introduction: Critically ill patients with oncological diseases develop a severe metabolic response to aggression with a high degree of hypermetabolism, which constitutes an associated risk and affects the mortality of these patients. The objective of the present study was to measure the nutrition-al status of a group of cancer patients admitted to intensive care and establish an association with mortality. Methodology: This retrospective observational study was conducted in the intensive care unit of the National Oncology Institute "Dr. Juan Tanca Marengo" - Guayaquil in September - 2017 / August -2018. The sample was nonprobabilistic of patients with a cancer diagnosis. The variables were age, sex, mortality, NUTRIC score, admission condition, type of tumor, APACHE and SOFA physiological scales, days of hospitalization, and some comorbidities. ROC curve, Spearman's Rho, and Chi2 analyses were used to establish the association. Results: A total of 176 cases were included, aged 57 years (IR 43-67). 113/176 women (64.2%). The mean APACHE score was 18 ±7.3, and the median SOFA score was 4.0 (IR 1.0 ­ 6.0). The most fre-quent type of cancer was gynecological, with 25% (44/176) of cases. Mortality was 19.9% (35/176). NUTRIC scores were higher in deceased patients (Me 6.00 (IR 5-9) vs Me 3.00 (IR 1-4); P<0.0001). The presence of a NUTRIC score >4 has a sensitivity of 74.3% (95% CI 56.7 ­ 87.5), a specificity of 80.9% (95% CI 73.4 ­ 87.0), a positive predictive value of 49.1% (95% CI 39.4 ­ 58.7) and a negative predic-tive value of 92.7% (95% CI 87.8 ­ 95.7) for the outcome of mortality. Conclusion: In this study, high modified NUTRIC score scores were strongly associated with mor-tality in critical cancer patients. High scores on the modified NUTRIC score test correlate with worse clinical condition at admission and more extended stay in the intensive care unit.

Associação entre insatisfação com a imagem corporal e indicadores antropométricos de obesidade em escolares do sul do brasil / Association between body image dissatisfaction and anthropometric indicators of obesity in students from southern brazil

O objetivo do presente estudo foi investigar a associação entre a insatisfação com a imagem corporal, por excesso de peso e pela magreza, e diferentes indicadores antropométricos de obesidade em adolescentes do sul do Brasil. Caracterizou-se com um estudo transversal, realizado na cidade de Criciúma ­ SC, com 575 adolescentes de 11 a 17 anos, de ambos os sexos. A imagem corporal foi avaliada por meio de escala de silhuetas. Os indicadores antropométricos de obesidade Índice de Massa Corporal, Relação Cintura-Estatura, Perímetro da Cintura e Índice de Conicidade foram avaliados conforme protocolo da Sociedade internacional para o Avanço da Cineantropometria. Adolescentes do sexo masculino, de 11 a 13 anos insatisfeitos pela magreza, apresentaram menores chances de ter Relação Cintura-Estatura elevada (RC: 0,1; IC95%: 0,04 - 0,51) e maiores chances de ter Índice de Conicidade elevado (RC: 4,4; IC95%:1,28-15,20) quando comparados com adolescentes satisfeitos com a imagem corporal. Adolescentes do sexo feminino, de 11 a 13 anos insatisfeitas pela magreza, apresentaram menores chances de ter Índice de Massa Corporal (RC: 0,1; IC95%: 0,02 - 0,58) e Índice de Conicidade (RC: 0,2; IC95%: 0,05 - 0,94) elevados e maiores chances de ter Relação Cintura-Estatura elevada (RC: 23,6; IC95%: 3,35-166,85) quando comparadas às adolescentes satisfeitas com a imagem corporal. Concluiu-se que existe associação entre a imagem corporal e indicadores antropométricos de obesidade para adolescentes de 11 a 13 anos, principalmente nos insatisfeitos pela magreza. No sexo masculino, distintos indicadores antropométricos de obesidade abdominal trazem interpretações distintas na associação com a imagem corporal. No sexo feminino, indica distorção da própria imagem corporal, que pode levar as adolescentes a adotarem comportamentos alimentares inadequados, levando à riscos à sua saúde. (AU)

The aim of the present study was to investigate the association between body image dissatisfaction due to overweight and thinness and different anthropometric indicators of obesity in adolescents from southern Brazil. Characterized as a Cross - sectional study conducted in the city of Criciúma - SC, with 575 adolescents aged 11-17 years of both sexes. Body image was assessed by a silhouette scale. Anthropometric indicators of obesity body mass index, waist-to-height ratio, waist circumference and conicity index were evaluated according to the International Society for the Advancement of Kinantropometry protocol. Male adolescents aged 11-13 years dissatisfied due to thinness, were less likely of having high waist-to-height ratio (OR: 0.1; 95% CI: 0.04 - 0.51) and more likely of having elevated conicity index (OR: 4.4; 95% CI: 1.28-15.20) when compared to adolescents satisfied with their body image. Female adolescents aged 11-13 years dissatisfied due to thinness were less likely of having high body mass index (OR: 0.1; 95% CI: 0.02 - 0.58) and conicity index (OR: 0.2; 95% CI: 0.05 - 0.94) and more likely of having high waist-to-height ratio (OR: 23.6; 95% CI: 3.35-166.85) when compared to adolescents satisfied with their body image. Concluded that there is an association between body image and anthropometric indicators of obesity for adolescents aged 11-13 years, especially those dissatisfied due to thinness. In males, different anthropometric indicators of abdominal obesity bring different interpretations in association with body image. In females, it indicates distortion of their own body image, which can lead adolescents to adopt inappropriate eating behaviors, leading to health risks. (AU)

Evaluación integral del paciente con obesidad candidato a cirugía bariátrica­endócrino metabólica / Comprehensive evaluation of the patient with obesity who is a candidate for metabolic bariatric-endocrine surgery

En la actualidad, la obesidad es conside-rada una pandemia, cuya incidencia se ha triplicado en los últimos 30 años, y ha ge-nerado problemas de salud pública cada vez mayores. Tomando como base las guías de la Asociación Americana de Endocrinólogos (AACE), la Sociedad para la Obesidad, la Sociedad Americana de Cirugía Bariátrica y Metabólica (ASMBS), la Asociación para Medicina de la Obe-sidad y la Asociación Americana de Anes-tesiólogos, se realiza el presente docu-mento, con el fin de que se constituya en la hoja de ruta que guíe el procedimiento a seguir en los pacientes que padecen de esta enfermedad crónica y que acuden al Hospital General San Francisco (HGSF)1. La obesidad se caracteriza por el uso de varios medicamentos debido a las co-morbilidades relacionadas: enfermedad cardiovascular, diabetes mellitus tipo 2, enfermedad renal crónica, hígado graso no alcohólico, síndrome metabólico y varios tipos de cánceres2. Este protocolo contiene el más alto nivel de evidencia disponible hasta la fecha, en relación al manejo quirúrgico y no quirúrgico del paciente con diagnóstico de obesidad, incluyendo temas como la identificación de los pacientes candidatos para los pro-cedimientos bariátricos, tipo de proce-dimientos que deberían ser ofertados, el manejo preoperatorio, transoperatorio y el cuidado post operatorio de seguimiento2-4.Desde la publicación por parte de la Ame-rican Society for Metabolic and Bariatric Surgery (ASMBS) en el año 2013 de las guías de manejo del paciente con obe-sidad, se ha evidenciado un incremento significativo en las publicaciones que avalan excelentes resultados para el tra-tamiento de los pacientes con obesidad y con diabetes mellitus tipo 2 mediante la cirugía bariátrica y metabólica 2,5,6. En el año 2016 la publicación del Diabetes Sur-gery Summit (DSS2)7 marca diferencia en el manejo de los pacientes con diabetes mellitus tipo 2, es así que las mismas han crecido sustancialmente y la evidencia demuestra que el manejo metabólico ba-riátrico de estos pacientes es superior al manejo médico y cambios de estilo de vida cuando se evalúa el control glucémico y remisión de las comorbilidades. Con la evaluación previa del equipo mul-tidisciplinario, tendremos información científica del más alto nivel que nos per-mita tener un paciente con recuperación óptima aplicando los criterios de En-hanced Recovery after Bariatric Surgery (ERASB)8. En el Ecuador, la obesidad se ha conver-tido en un problema de salud pública, es así que en la población pediátrica ha au-mentado desde el año 1986 pasando del 8,0% al 26,0% para el año 2012 en el grupo de 11 a 19 años. La prevalencia de sobrepeso y obesidad en población adulta en el Ecuador es del 62,8%, según el sexo es 5,5% mayor en las mujeres (65,5%) que en los hombres (60,0%), y el mayor índice de obesidad y sobrepeso se pre-senta entre la cuarta y quinta décadas de vida, con prevalencias superiores a 73,0%9,10.

Currently, obesity is considered a pan-demic, the incidence of which has tripled in the last 30 years, and has generated in-creasing public health problems. Based on the guidelines of the American As-sociation of Endocrinologists (AACE), the Obesity Society, the American So-ciety for Metabolic and Bariatric Surgery (ASMBS), the Association for Obesity Medicine and the American Association of Anesthesiologists, this document is intended to serve as a roadmap to guide the procedure to be followed in patients suffering from this chronic disease who come to San Francisco General Hospital (HGSF)1.Obesity is characterized by the use of se-veral medications due to related comor-bidities: cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease, meta-bolic syndrome and several types of can-cers2. This protocol contains the highest level of evidence available to date, in relation to the surgical and non-surgical management of the patient with a diag-nosis of obesity, including issues such as the identification of candidate patients for bariatric procedures, type of proce-dures that should be offered, preopera-tive, trans-operative management and fo-llow-up post-operative care2-4.Since the publication by the American So-ciety for Metabolic and Bariatric Surgery (ASMBS) in 2013 of the guidelines for the management of patients with obesity, there has been a significant increase in publications that support excellent results for the treatment of patients with obesity and type 2 diabetes mellitus through bariatric and metabolic surgery2,5,6. In 2016 the pu-blication of the Diabetes Surgery Summit (DSS2)7 makes a difference in the mana-gement of patients with type 2 diabetes mellitus, it is so that the same have grown substantially and the evidence shows that bariatric metabolic management of these patients is superior to medical manage-ment and lifestyle changes when glycemic control and remission of comor-bidities are evaluated. With the previous evaluation of the multidisciplinary team, we will have scientific information of the highest level that will allow us to have a patient with optimal recovery applying the criteria of Enhanced Recovery after Bariatric Surgery (ERASB)8.In Ecuador, obesity has become a public health problem; thus, in the pediatric population it has increased since 1986 from 8,0% to 26,0% in 2012 in the 11 to 19 years age group. The prevalence of overweight and obesity in the adult po-pulation in Ecuador is 62,8%, according to sex is 5,5% higher in women (65,5%) than in men (60,0%), and the highest rate of obesity and overweight occurs between the fourth and fifth decades of life, with prevalences higher than 73,0%9,10.

Programación fetal / Fetal programming

El término Origen Temprano de las Enfermedades del Adulto explica la aparición temprana de las condiciones anormales cardiovasculares y metabólicas en la vida adulta, mayor riesgo de morbilidad y muerte asociados a factores ambientales, especialmente nutricionales, que actúan en las primeras etapas de la vida. Estas respuestas programadas dependen de la naturaleza del estímulo o noxa, del tiempo de exposición y del momento de ocurrencia de la noxa, pudiendo un solo genotipo original varios fenotipos y estarían condicionadas por criterios críticos en los cuales se desarrollarían cambios a largo plazo pudiendo ser reversibles o no. La Programación Fetal explica que respuestas adaptativas embrionarias y fetales en un ambiente subóptimo genera consecuencias adversas permanentes. La desnutrición, así como la sobrenutrición fetal aumenta el riesgo de desarrollar alteraciones en el peso y composición corporal fetal, y posteriormente obesidad, síndrome metabólico, incremento en la adiposidad, alteración en el metabolismo de la glucosa y / o insulina, alteración del metabolismo lipídico, alteraciones hepáticas y de las cifras tensionales. La impronta genómica es esencial para el desarrollo y defectos en la misma puede originar alteraciones de la identidad parental transmisibles a las siguientes generaciones. Esta programación fetal puede ser explicada por la epigenética, definida como la serie de alteraciones hereditarias de la expresión genética a través de modificaciones del ADN y las histonas centrales sin cambios en la secuencia de ADN. Estas modificaciones epigenéticas alteran la estructura y condensación de la cromatina, afectando la expresión del genotipo y fenotipo. Este artículo desarrolla los aspectos involucrados en la Programación Fetal y los posibles mecanismos sobre la misma(AU)

The term Early Origin of Adult Diseases explains the early onset of abnormal cardiovascular and metabolic conditions in adult life, increased risk of morbidity and death associated with environmental factors, especially nutritional factors, that act in the early stages of life. These programmed responses depend on the nature of the stimulus or noxa, the time of exposure and the moment of occurrence of the noxa, with a single original genotype being able to have several phenotypes and would be conditioned by critical criteria in which long-term changes could develop, reversibles or not. Fetal Programming explains that embryonic and fetal adaptive responses in a suboptimal environment generate permanent adverse consequences. Fetal malnutrition as overnutrition increases the risk of developing alterations in fetal body weight and composition, and subsequently obesity, metabolic syndrome, increased adiposity, impaired glucose and / or insulin metabolism, impaired lipid metabolism, liver disorders and altered blood pressure. The genomic imprint is essential for development and defects in it can cause alterations of the parental identity and are transmitted to the following generations. This fetal programming can be explained by epigenetics, defined as the series of inherited alterations of genetic expression through modifications of DNA and central histones without changes in the DNA sequence. These epigenetic modifications alter the structure and condensation of chromatin, affecting the expression of the genotype and phenotype. This article develops the aspects involved in Fetal Programming and the possible mechanisms on it(AU)

Efetividade Clínica das Plantas Medicinais e Fitoterapia para Distúrbios Metabólicos e Fisiológicos. Efetividad Clínica de las Plantas Medicinales y Fitoterapia para Trastornos Metabólicos y Fisiológicos Clinical. Effectiveness of Medicinal Plants and Phytotherapy for Metabolism and Physiological Disorders

O mapa apresenta uma visão geral das evidências sobre os efeitos das Plantas Medicinais e Fitoterapia para Distúrbios Metabólicos e Fisiológicos. A partir de uma ampla busca bibliográfica foram incluídos no mapa 48 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores do Laboratório de Pesquisa & Desenvolvimento de Práticas Integrativas e Complementares (LabPICs) da Faculdade de Farmácia da Universidade Federal do Rio de Janeiro. El mapa presenta una visión general de la evidencia sobre los efectos de las plantas medicinales y la fitoterapia para el trastornos metabólicos y fisiológicos. A partir de una amplia búsqueda bibliográfica, se incluyeron 48 estudios de revisión sistemática en el mapa. Todos los estudios fueron evaluados, caracterizados y categorizados por un grupo de investigadores del Laboratorio de Investigación y Desarrollo para Prácticas Integrativas y Complementarias (LabPIC) en la Facultad de Farmacia de la Universidad Federal de Rio de Janeiro. The map presents an overview of the evidence on the effects of Medicinal Plants and Phytotherapy for Metabolic and Physiological Disorders. From a wide bibliographic search, 48 systematic review studies were included in the map. All studies were evaluated, characterized and categorized by a group of researchers from the Research & Development Laboratory for Integrative and Complementary Practices (LabPICs) at the Faculty of Pharmacy, Federal University of Rio de Janeiro.

Eficacia de la cirugía bariátrica-metabólica en pacientes con obesidad y diabetes mellitus tipo 2 / Efficacy of bariatric-metabolic surgery in patients with obesity and type 2 diabetes mellitus

La prevalencia de la diabetes mellitus tipo 2 está incrementando rápidamente a nivel mundial de manera paralela a la epidemia de obesidad. El número de personas con diabetes, alrededor del mundo, se ha duplicado en los últimos 20 años; una de las características más preocupantes de este rápido crecimiento es el aparecimiento de diabetes tipo 2 en niños, adolescentes y adultos jóvenes. Debido a la reducción de la esperanza de vida causada por las morbilidades producidas por la diabetes, los pacientes que sufren de esta patología requieren un manejo integral. La cirugía bariátrica / metabólica ha demostrado que: • Mejora significativamente el control glucémico. • Reduce los factores de riesgo cardiovasculares. • Incluso ha demostrado la posibilidad de producir remisión de la diabetes tipo 2, hipertensión arterial y otras comorbilidades asociadas con la obesidad. Los resultados de múltiples estudios demuestran claramente la eficacia de la cirugía metabólica en el control glucémico y de otras comorbilidades asociadas con la diabetes tipo 2 y la obesidad; se observa, con mucha frecuencia, casos de remisión de la diabetes, incluso hasta 5 años después de la intervención quirúrgica. Por esta razón, la Asociación Americana para la Diabetes (ADA) considera a la cirugía bariátrica como una opción terapéutica viable en pacientes obesos con diabetes mellitus tipo 2.Las cirugías gastrointestinales diseñadas para controlar la obesidad pueden mejorar la homeostasis de la glucosa más efectivamente que el tratamiento farmacológico-clínico y producir cambios importantes en el estilo de vida; incluso, en un considerable número de pacientes, se logra la remisión de la diabetes tipo 2. (AU)

The prevalence of type 2 diabetes mellitus is rapidly increasing to global level parallel to the epidemic that obesity. The number of people with diabetes, around the world, have doubled in the last 20 years; one of the most worrisome features of this rapid growth It is the appearance of type 2 diabetes in children, adolescents and young adults. Due to the reduction in life expectancy caused by morbidities produced by diabetes, patients suffering from this pathology require comprehensive management bariatric / metabolic surgery has shown that: • Significantly improves glycemic control. • Reduces cardiovascular risk factors. • It has even demonstrated the possibility of producing diabetes remission type 2, arterial hypertension and other comorbidities associated with obesity. The results of multiple studies clearly demonstrate the effectiveness of the metabolic surgery in glycemic control and other associated comorbidities with type 2 diabetes and obesity; cases are very often observed of remission of diabetes, even up to 5 years after the intervention surgical For this reason, the American Diabetes Association (ADA) considers bariatric surgery as a viable therapeutic option in obese patients with type 2 diabetes mellitus. Gastrointestinal surgeries designed to control obesity can improve glucose homeostasis more effectively than treatment clinical pharmacological and produce important changes in lifestyle; even, in a considerable number of patients, remission of the type 2 diabetes. (AU)

Obtención de hidrolizados proteicos bajos en fenilalanina a partir de suero dulce de leche y chachafruto (Erythrina edulis Triana) / Obtaining protein products low in phenylalanine from milk whey and chachafruto (Erythrina edulis Triana)

La fenilcetonuria (PKU) es causada por una actividad deficiente de la enzima fenilalanina hidroxilasa. En los pacientes con esta deficiencia la fenilalanina (Phe) no puede ser convertida en tirosina, aumentando sus niveles en sangre y de otros metabolitos neurotóxicos, provocando un retraso mental irreversible. El tratamiento fundamentalmente se basa en una dieta controlada de Phe. Sin embargo, los alimentos libres o bajos en Phe son escasos. El objetivo de esta investigación es obtener hidrolizados proteicos con bajo contenido de Phe a partir del suero dulce de leche en polvo y harina de E. edulis Triana. El aislado proteico (96,01% proteína cruda) se obtuvo por solubilización y precipitación de las proteínas de la harina, mientras que las proteínas del suero (15,69% proteína cruda) fueron tratadas en su matriz original. Las proteínas del suero y el asilado fueron hidrolizadas enzimáticamente con pepsina y proteasa de Streptomyces griseus. La concentración de Phe se determinó por fluorometría y por HPLC, de lo cual la Phe de las proteínas del suero es liberada una hora antes que las del chachafruto, debido a que las proteínas del suero en parte fueron hidrolizadas en la elaboración del queso. Además, los resultados de la utilización del carbón activados como captor de Phe indican la reducción total del contenido de este aminoácido en los hidrolizados y la reducción de la concentración de otros aminoácidos(AU)

henylketonuria (PKU) is caused by a low activity of the enzyme phenylalanine hydroxylase. In patients with this deficiency, phenylalanine (Phe) cannot be converted to tyrosine, increasing blood levels and other neurotoxic metabolites, causing irreversible mental retardation. The treatment is fundamentally based on a controlled diet of Phe. However, free or low-Phe foods are scarce. The objective of this research is to obtain protein hydrolysates with low Phe content from sweet milk powder and E. edulis Triana flour. The protein isolate (96.01% crude protein) was obtained by solubilization and precipitation of the flour proteins, while the whey proteins (15.69% crude protein) were treated in their original matrix. Serum and asylated proteins were enzymatically hydrolyzed with pepsin and Streptomyces griseus protease. The concentration of Phe was determined by fluorometry and by HPLC, from which the Phe of whey proteins is released one hour earlier than those of chachafruto, due to the fact that the whey proteins were partially hydrolyzed in the elaboration of the cheese. In addition, the results of the use of charcoal activated as Phe captor indicate the total reduction of the content of this amino acid in the hydrolysates and the reduction of the concentration of other amino acids(AU)

Qualidade nutricional do café da manhã na população de São Paulo e sua associação com fatores de risco cardiometabólico / Nutritional quality of breakfast in the São Paulo population and its association with cardiometabolic risk factors

Introdução: O consumo do café da manhã é conhecido por proporcionar benefícios à saúde, contribuindo para uma dieta saudável e auxiliando no controle dos fatores de risco para doenças crônicas não transmissíveis. O café da manhã pode ser composto por diferentes alimentos e, consequentemente, apresentar qualidades nutricionais variadas. Nesse contexto, índices de qualidade do café da manhã têm sido utilizados como métodos de mensuração da qualidade nutricional dessa refeição. No entanto, poucos estudos têm sido conduzidos para avaliar sua associação com desfechos de saúde. Objetivos: Avaliar a qualidade nutricional do café da manhã por meio do Índice Brasileiro de Qualidade do Café da Manhã (IQCM), e sua associação com fatores de risco cardiometabólico. Metodologia: Foram utilizados dados de 606 adultos e 537 idosos de ambos os sexos, participantes do Inquérito de Saúde no Município de São Paulo, ISA-Capital 2015. Trata-se de um estudo transversal de base populacional, com amostra probabilística de residentes em área urbana do município de São Paulo. Dados socioeconômicos, de estilo de vida, antropométricos e amostra de sangue foram coletados em visitas domiciliares. Informações dietéticas foram coletadas em domicílio e por telefone. A qualidade nutricional do café da manhã foi avaliada considerando recordatórios de 24 horas, e classificada de 0 a 10 de acordo com sua pontuação. Para verificar fatores associados, os indivíduos foram estratificados segundo sua categoria de qualidade do café da manhã em: baixa (0 - 3 pontos), média (4 - 6 pontos) ou alta (7 - 10 pontos). Os fatores de risco cardiometabólico avaliados foram: excesso de peso, síndrome metabólica, circunferência da cintura aumentada, pressão arterial elevada, glicose de jejum elevada, resistência insulínica, e dislipidemia. A associação do IQCM com os fatores de risco cardiometabólico foi observada através de modelos de regressão múltipla considerando o desenho amostral do estudo. Resultados: Indivíduos com maior renda familiar per capita, educação do chefe da família, idosos, com cor de pele autorreferida branca ou amarela, que nunca fumaram, e praticantes de atividade física de lazer, apresentaram uma melhor qualidade do café da manhã. A pontuação média do IQCM para a população total foi de 4,9. Idosos apresentaram a maior pontuação média (5,4), e tabagistas a menor (4,4). A maioria da população foi classificada com qualidade média de café da manhã (67%). Indivíduos com alta qualidade do café da manhã (16%) apresentaram aumento na ingestão de energia total, gramas totais de alimentos e bebidas, proteínas, ácidos graxos saturados, fibra total e cálcio, e uma diminuição no açúcar de adição, carboidratos e sódio dessa refeição. Em relação à dieta total, apresentaram aumento de ácidos graxos saturados totais, fibras totais e cálcio, IQD-R, e uma diminuição na adição de açúcar, carboidratos e sódio. Os maiores valores de IQCM se associaram negativamente com 7 dos 10 fatores de risco cardiometabólico investigados: pressão arterial (OR: 0.81; IC95%: 0.70, 0.94), glicose de jejum (OR: 0.85; IC95%: 0.73, 0.98), HOMA-IR (OR: 0.86; IC95%: 0.74, 0.98), colesterol total (OR: 0.86; IC95%: 0.76, 0.99), LDL (OR: 0.85; IC95%: 0.74, 0.97), excesso de peso (OR: 87; IC95%:0.76, 0.99), e presença de síndrome metabólica (OR: 0.82, IC95%: 0.72, 0.93). Conclusão: O Índice de Qualidade do Café da Manhã para a população brasileira se associou negativamente com os fatores de risco cardiometabólico investigados, enfatizando o papel dessa refeição na diminuição do risco de doenças cardiovasculares.

Introduction: Breakfast consumption is known to provide health benefits, contributing to a healthy diet, and assisting in controlling risk factors for non-communicable diseases. Its structure can acquire various compositions, with different foods, and consequently, different nutritional qualities. In this context, breakfast quality indexes come as quantitative tools to evaluate nutritional quality of breakfast. However, few studies have been conducted to evaluate their associations with health outcomes. Objective: To evaluate the nutritional quality of breakfast using the Brazilian Breakfast Quality Index (BQI) and its association with cardiometabolic risk factors in residents of São Paulo city, Brazil. Methods: Data were drawn from the 2015 São Paulo Health Survey (ISA-Capital 2015), a cross-sectional population-based study, with probabilistic sample of individuals living in permanent homes located in the urban area of São Paulo, Brazil. 606 adults and 537 older adults of both sexes were included. Socioeconomic, lifestyle and diet information was collected in personal and phone interviews. Blood sample, blood pressure and anthropometric measurements were collected at home by a nurse assistant. The breakfast quality was evaluated considering 24-h recalls and classified in scores ranging from 0 to 10 according to BQI. To verify associated factors, individuals were stratified according to their category of breakfast quality into: Low (0 - 3 scores), Medium (4 - 6 scores) or High quality (7 - 10 scores). The cardiometabolic risk factors evaluated were: overweight, metabolic syndrome, increased waist circumference, high blood pressure, high fasting glucose, insulin resistance, and dyslipidemia. BQI associations with cardiometabolic risk, demographic, socioeconomic and lifestyle variables were determined using multiple logistic regression models adjusted for the complex sampling design. Results: Individuals in higher categories of household income, educational level, age, with racial self-identification as white or yellow, who never smoke, and meet the recommendation of leisure-time physical activity had higher breakfast quality. The majority of the population had a medium breakfast quality (67%), and the mean BQI score was 4.9. Older adults had the highest mean BQI score (5.4), and smokers the lowest mean score (4.4). For individuals in the high breakfast quality (16%) there was an increase in the breakfast intake of total energy, total grams of foods and beverages, protein, total saturated fatty acids, total fiber and calcium, and a decrease in added sugar, carbohydrate and sodium. At total dietary intake there was an increase of total saturated fatty acids, total fiber, and calcium, BHEI-R, and a decrease in added sugar, carbohydrate and sodium. Higher scores of BQI was negatively associated with 7 of the 10 cardiometabolic risks factors investigated: elevated blood pressure (OR: 0.81; IC95%: 0.70, 0.94), fasting glucose (OR: 0.85; IC95%: 0.73, 0.98), HOMA-IR (OR: 0.86; IC95%: 0.74, 0.98), total cholesterol (OR: 0.86; IC95%: 0.76, 0.99), LDL (OR: 0.85; IC95%: 0.74, 0.97), excess body weight (OR: 87; IC95%:0.76, 0.99), and metabolic syndrome (OR: 0.82, IC95%: 0.72, 0.93). Conclusion: The Brazilian Breakfast Quality Index was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasizing the role of breakfast in reducing risk of cardiovascular disease.

Infecciones y anemia en estudiantes de la parroquia Guapán, Azogues, Ecuador / Infections and anemia in students of theGuapán parish, Azogues, Ecuador

Introducción: Las unidades educativas constituyen un entorno ideal para el diagnóstico de enfermedades y la promoción de salud. Objetivo:Identificar la presencia de enfermedades infecciosas y anemia en los estudiantes de la Unidad Educativa Ezequiel Cárdenas Espinoza de la parroquia Guapán del cantón Azogues en Ecuador y tomar medidas correctivas al respecto.Métodos:Se realizó un estudio observacional, descriptivo, transversal y prospectivo.El universo fueron los316 estudiantes matriculados enla Unidad Educativa Ezequiel Cárdenas Espinoza de la parroquia Guapán del cantón Azogues en Ecuador durante el periodo académico 2013-2014. La muestra fue coincidente pues setrabajó con todos los estudiantes de la institución en edades comprendidas entre 11 y 17 años de edad. Las variables evaluadas fueron edad, sexo y enfermedades más frecuentes para lo cual se utilizó como técnicas el coproparasitario, examen de sangre (hemoglobina), y examen elemental y microscópico de orina.Resultados:El 21.6% de los estudiantes evaluados presentaron parasitosis intestinal. La parasitosis más frecuente fue causada por Ameba histolytica con un 60% y 25% de Ascaris lumbricoides. El sexo predominantemente afectado fue el masculino con el 71%. Solo una estudiante del 8vo curso, correspondiente al 1.3% y un 5% de los estudiantes de 9no curso presentaron anemia. En todos los cursos se diagnosticaron estudiantes con infección de vías urinarias, representando el 15.2%. El 77.1% de los afectados fue del sexo femenino.Conclusiones:La presencia de enfermedades infecciosas y anemia determina el diseño de estrategias educativas a estudiantes, padres de familia y profesores de la institución

Introduction:The educational units constitute an ideal environment for diagnosing diseases and promoting health.Objective:To identify the presence of infectious diseases and anemia in the students of the Ezequiel Cárdenas Espinoza Educational Unit of the Guapan parish of the Azogues canton in Ecuador and to take corrective measures in this regard.Methods:An observational, descriptive, cross-sectional and prospective study was carried out. The universe was the 316 students enrolled in the Ezequiel Cárdenas Espinoza Educational Unit of the Guapan parish of the Azogues canton in Ecuador during the 2013-2014 academic period. The sample was coincident because it worked with all the students of the institution in ages between 11 and 17 years of age. The variables evaluated were age, sex and most frequent diseases for which coproparasitic, blood test (hemoglobin), and elementary and microscopic urine tests were used as techniques.Results:21.6% of the students evaluated presented intestinal parasitosis. The most frequent parasitosis was caused by Ameba histolytica with 60% and 25% of Ascaris lumbricoides. The predominantly affectedsex was male with 71%. Only one student in the 8th grade, corresponding to 1.3% and 5% of the 9th grade students, presented anemia. In all the courses, students with urinary tract infection were diagnosed, representing 15.2%. 77.1% of those affected were female.Conclusions:The presence of infectious diseases and anemia determines the design of educational strategies for students, parents and teachers of the institution.

Conocimientos, percepciones y prácticas relacionados con enfermedades no transmisibles en las personas colaboradoras del Centro Cultural Batahola Norte, durante el período de marzo a septiembre del año 2016 / Knowledge, Perceptions and Practices related to Noncommunicable Diseases in the collaborators of the Batahola Norte Cultural Center, during the period from March to September of 2016

OBJETIVO: describir los Conocimientos, Percepciones y Prácticas de las personas colaboradoras relacionados con Enfermedades No Transmisibles (ENT) de marzo a septiembre del año 2016. DISEÑO: se trató de un estudio de tipo descriptivo, de corte transversal, en el que participaron 43 personas directivas y colaboradoras de las diferentes áreas que conforman el Centro Cultural Batahola Norte, quienes cumplieron con el criterio de inclusión, a quienes se solicitó la participación de forma voluntaria, realizando el llenado del formulario de forma anónima. Para el análisis de la información se utilizo el programa SPSS versión 20.0 RESULTADOS: entre los principales hallazgos se encontraron que el 74% son mujeres, el 72% obtuvo información de las ENT por conferencias. El conocimiento en ENT, se ubicó en la categoría malo. En las percepciones la mayoría tienen una imagen global de las ENT, consideran que se pueden hacer cosas para mejorarlas, identifican la afectación del estado emocional. Sobre las prácticas la mayoría de las personas no fumaban, en una semana típica comen frutas y verduras. Más de la mitad caminaban al menos 10 minutos cada día, la mayoría pasa de cuatro a ocho horas sentada o recostada al día, eran obesos o tenían sobrepeso, la mayor parte con valores de presión sistólica y diastólica normales, la mitad tenían sus valores de glucemia en ayunas alterado. CONCLUSIONES: conocimiento malo, cuatro factores riesgo presentes sedentarismo, alto porcentaje de obesidad y sobrepeso, nivel glucemia alto. Se recomendó al equipo de dirección fomentar acciones de promoción y prevención de las ENT incorporando un plan de mejoras de entorno laboral saludable

Antioxidative and antiproliferative activities of ethanol extracts from pigmented giant embryo rice (Oryza sativa L. cv. Keunnunjami) before and after germination

BACKGROUND/OBJECTIVES: Oxidative stress is a major cause of cancer. This study investigated the effects of the ethanol extracts from germinated and non-germinated Keunnunjami rice, a blackish-purple pigmented cultivar with giant embryo, on selected human cancer cell lines and on the antioxidant defense system of mice fed with a high-fat diet. MATERIALS/METHODS: High fat-fed mice were orally administered with either distilled water (HF) or extracts (0.25%, w/w) from brown (B), germinated brown (GB), Keunnunjami (K), and germinated Keunnunjami (GK) rice. RESULTS: In comparison with the brown rice extract, Keunnunjami extract showed higher anticancer effect against cervical and gastric cell lines but lower anticancer activity on liver and colon cancer cells. Mice from the HF group showed significantly higher lipid peroxidation and lower antioxidant enzyme activities than the control group. However, the oxidative stress induced by high-fat diet markedly decreased in B, GB, K, and GK groups as compared with the HF group. CONCLUSIONS: Germination may be an effective method for improving the anticancer and antioxidative properties of Keunnunjami rice and extracts from germinated Keunnunjami rice may serve as a therapeutic agent against cervical and gastric cancers and oxidative damage.

Intervención multi-componente en la prevención de la obesidad infantil como medida de salud pública / Multi-component intervention in the prevention of childhood obesity as a public health measure

Objetivos: se propone identificar y revisar aquellas estrategias potenciales que incluyan un enfoque multifacético a la hora de hacer frente a la obesidad en niños escolarizados. De acuerdo a la evidencia más reciente, las intervenciones más efectivas para combatir la obesidad infantil son aquellas que involucran actividad física, educación nutricional y entornos de apoyo. Así, en esta revisión nos centramos en buscar dichas intervenciones, que además incluyan seguimientos a medio y largo plazo, monitoreo y evaluación, que son críticos para mantener una acción efectiva. Material y métodos: se incluyó una revisión de artículos científicos publicados en bases de datos especializadas como Pubmed (Medline), the Cochrane Library, The Cochrane Controlled Trials Register (CCTR), ScienceDirect, Scielo, La Biblioteca Cochrane Plus y la página web de la Organización Mundial de la Salud (http://www.who.int). Resultados: de 199 artículos potenciales, sólo 8 fueron incluidos en esta revisión. Los resultados mostraron que aquellas intervenciones multi-componente y de largo plazo tienen beneficios sobre IMC, actividad física y elecciones alimentarias. Sin embargo, pocos estudios mostraron cambios significativos sobre los hábitos alimentarios generales y sobre la prevalencia de la obesidad. También, se observó que las intervenciones multicomponente que se llevaron a cabo tanto en países en desarrollo de Latinoamérica, como en países desarrollados tuvieron resultados similares. Conclusión: esta revisión demuestra que pueden ocurrir cambios sobre las medidas antropométricas, la actividad física y las elecciones alimentarias cuando se llevan a cabo intervenciones multicomponente en ambientes a nivel de la educación académica primaria, sin importar la localización geográfica, pero manteniendo similar metodología y materiales (AU)

Objective: it is proposed to identify and review potential strategies that include a multifaceted approach when dealing with obesity in school children. According to the most recent evidence, the most effective interventions to combat childhood obesity are those that involve physical activity, Nutrition education, and supportive environments. Thus, in this review we focus on looking for such interventions, which also include Monitoring in the medium and long term, monitoring and evaluation, which are critical to maintain effective action. Material and methods: a review of scientific articles published in specialized databases such as Pubmed (Medline), the Cochrane Library, The Cochrane Controlled Trials Register (CCTR), ScienceDirect, Scielo, The Cochrane Library Plus and the website of the World Health Organization (http://www.who.int). Results: of 199 potential articles, only 8 were included in this review. The results showed that multi-component and long-term interventions have benefits on BMI, physical activity and food choices. However, few studies showed significant changes in generaldietary habits and the prevalence of obesity. Also, it was observe that the multicomponent interventions that were carried out both in developing countries in Latin America, and in developed countries had similar results. Conclusion: this review demonstrates that changes can occur on anthropometric measures, physical activity and food choices when multicomponent interventions are carried out in environments at the level of primary academic education, regardless of geographical location, but maintaining similar methodology and materials.(AU)

Hipertrigliceridemia asociada a sobrepeso y obesidad en médicos del hospital San Francisco del IESS, en la ciudad de Quito: una alerta para los profesionales médicos / Hypertriglyceridemia associated with overweight and obesity in doctors at the San Francisco del IESS hospital, in the city of Quito: an alert for medical professionals

Contexto: la OMS menciona que la alteración del estado nutricional será notorio en países en vías de desarrollo, en los cuales se experimentará cambios acelerados en los regímenes alimentarios y el modo de vida de su población, y será una respuesta a "la industrialización, la urbanización, el desarrollo económico y la globalización de los mercados"; en Ecuador la población aumentó el consumo de productos alimenticios de rápida disponibilidad, saturados en grasas y con un gran contenido calórico; y según estadísticas actuales en la última década en Ecuador se ha demostrado un notable cambio nutricional. Y es por eso que, al existir estos nuevos accesos se debe tomar en cuenta a la Hipertrigliceridemia como factor de riesgo a futuro de Enfermedades Crónicas No Transmisibles especialmente cardiovasculares. Objetivo: describir la tasa de prevalencia de Hipertrigliceridemia en relación con el sobrepeso y obesidad en médicos del Hospital San Francisco del IESS en la ciudad de Quito del período 2015 ­ 2016. Sujetos y métodos: Se realizó un estudio Epidemiológico Descriptivo de conjunto para describir la tasa de prevalencia de Hipertrigliceridemia y su relación con el estado nutricional del personal médico, para lo cual se utilizó el I.M.C. y nivel de triglicéridos en sangre. Mediciones principales: estado nutricional, triglicéridos. Resultados: se estudiaron 90 profesionales médicos, de los cuales el 60% IC95% 49,67 ­ 69,51% fueron mujeres con una media de edad de 37,96 ± 5,95 años y el 40% IC95% 30,49 ­ 50,33% fueron hombres de 40,94 ± 7,53 años de edad. Se observó que la prevalencia de Hipertrigliceridemia fue de 34,44% IC95% 25,45 ­ 44,72%, según el sexo fue de 22,22% IC95% 13,20 ­ 34,94% en mujeres y de 52,78% IC95% 37,01 ­ 68,01% en hombres. La prevalencia de sobrepeso y obesidad fue de 52,2% IC95% 37,76 ­ 57,98 %, por sexo fue de 42,59% IC95% 30,33 ­ 55,84% en mujeres y de 66,67% IC95% 50,33 ­ 79,79% en hombres. El 23,26% IC95% 13,15 ­ 37,74% de los 43 sujetos con sobrepeso u obesidad fueron hipertrigliceridémicos, es decir, representa una tasa de Hipertrigliceridemia de 232,6 x cada 1000 habitantes con sobrepeso. Conclusiones: 5 de cada 10 médicos tuvieron obesidad. 3 de cada 10 médicos presentaron hipertrigliceridemia. Aproximadamente la cuarta parte de los sujetos con sobrepeso y obesidad tienen hipertrigliceridemia. La hipertrigliceridemia se relaciona con el sobrepeso y la obesidad. Los profesionales de la salud tienen una alta prevalencia de hipertrigliceridemia con sobrepesou obesidad, lo que los expone a desarrollar enfermedades de riesgo cardiovascular. (AU)

Context: the World Health Organisation has mentioned that accelerated changes in the food regime and lifestyles of the population will cause noticeable alterations in the nutritional conditions of people in developing countries occurring as a response to the "industrialization, urbanisation, economic development and globalization of markets". In Ecuador, people have increased their consumption of readily available food products which are high in saturated fats and are distinctly calorific; and thus, according to current statistics, in the past ten years a noticeable nutritional shift has taken place. It is therefore imperative to consider Hypertriglyceridemia as a future risk factor for chronic non-communicable diseases, especially cardiovascular ones. Objective: to describe the rate of prevalence of Hypertriglyceridemia in relation to excess weight and obesity in doctors working for IESS (National Health Service) San Francisco Hospital in Quito during the 2015 ­ 2016 period. Subjects and methods: this is an epidemiological descriptive set of studies using BMI and triglyceride counts, aimed at describing the prevalence of Hypertriglyceridemia and its relation to the nutritional conditions of medical personnel. Main measurements: nutritional conditions, triglycerides Results: a total of 90 medical staff took part: 60% IC95% 49.67 ­ 69.51% were female with an average age of 37.96 ± 5.95 years, and 40% IC95% 30.49 ­ 50.33% were male ranging 40.94 ± 7.53 years of age. The prevalence of Hypertriglyceridemia was 34.44% IC95% 25.45 ­ 44.72%, and according to gender: 22.22% IC95% 13.20 ­ 34.94% in women and 52.78% IC95% 37.01 ­ 68.01% in men. The prevalence of excess weight and obesity was 52.2% IC95% 37.76 ­ 57.98 %: in terms of gender 42.59% IC95% 30.33 ­ 55.84% in women and 66.67% IC95% 50.33 ­ 79.79% in men. The results indicated that 23.26% IC95% 13.15 ­ 37.74% of the 43 subjects suffering excess weight or obesity are hypertriglyceridemic: this is equal to a hypertriglyceridemic rate of 232.6 x per every 1000 overweight persons. Conclusion: five of every 10 doctors are obese, and 3 out of every 10 present Hypertriglyceridemia. Approximately a quarter of the persons suffering excess weight and obesity have Hypertriglyceridemia which is a disease that is directly related to excess weight and obesity. Medical professionals have a high prevalence of Hypertriglyceridemia due to being overweight and obese, and are therefore at increased risk of developing cardiovascular disease.(AU)

Estudio para determinar los niveles de calcio y paratohormona en pacientes con y sin vaciamiento central profiláctico, con diagnóstico de cáncer papilar de tiroides / Study to determine calcium and parathyroid hormone levels in patients with and without prophylactic central emptying, with diagnosis of papillary thyroid cancer

Contexto: El cáncer papilar de tiroides representa una patología que va en aumento, y el manejo quirúrgico es complejo. Una disección profiláctica cervical central para los pacientes con cáncer papilar de tiroides es controvertida. Dado que los riesgos de complicaciones transitorias probablemente son altas, y los beneficios parecen ser pequeños, de tal forma, que para realizarlo se utiliza un enfoque selectivo, en función de factores de riesgo del paciente y el nivel de experiencia del cirujano. Objetivo: determinar en el postquirúrgico los niveles de calcio y paratohormona en pacientes adultos, de ambos sexos con sospecha alta de cáncer papilar de tiroides, a los cuales se les realizó o no, vaciamiento central en los hospital Eugenio Espejo de la ciudad de Quito, durante un año. Sujetos y métodos: observacional, analítico, epidemiológico transversal, de cohortes. Se estudiaron todos los pacientes con sospecha citológica de cáncer papilar de tiroides, sometidos a tiroidectomía total, con o sin vaciamiento central profiláctico; se midió a las 24 horas los niveles de calcio y paratohormona. Las variables cuantitativas se reportaron como promedios y las cualitativas con sus valores absolutos y relativos. Las comparaciones de variables cuantitativas se realizaron con la prueba t-Student, mientras que para las cualitativas se usaron pruebas de independencia para proporciones x2 y prueba exacta de Fisher. Se hizo un análisis multivariados con regresión logística reportada como Odds Ratios ajustados (ORadj). Resultados: con respecto al calcio el grupo con vaciamiento central presentó valores significativamente menores que el grupo sin vaciamiento, esta diferencia fue de -0.07 mmol/L (IC 95 %: -0.036, -0.097 mmol/L;p < 0.0001). Los pacientes sometidos a vaciamiento central tuvieron tasas significativamente menores de paratohormona (para valores inferiores a los 10pg/ml) hasta el 53.9%, mientras que en el grupo sin vaciamiento solo el 11.1%(IC 95%: 29.5, 56.2%; p < 0.0001). Conclusión: se observó que en el grupo de tiroidectomía con vaciamiento central profiláctico, hubo una tasa importante de hipocalcemia e hipoparatiroidismo, todos estos pacientes presentaron signos de hipocalcemia durante su periodo postquirúrgico, lo que prolongo su estadía hospitalaria, (AU)

Introduction: Papillary thyroid cancer is on the rise and surgical treatment is complex. Prophylactic central neck dissection for papillary thyroid cancer patients is controversial because of the possibility of higher risk of transient complications and the benefits of the surgery are low. As a result, the surgery is performed based of the risk factors of the patient and the experience of the surgeon. Objective: to determine the levels of calcium and parathyroid hormone post-surgery in adult male and female patients with suspected risk of papillary thyroid cancer, to who prophylactic central drainage, was and was not performed. Subjects and methods: this is an epidemiological, observational, analytic, cross-sectional, of cohorts. The research will be done on all patients suspected of cytological papillary thyroid cancer in Hospital Eugenio Espejo, and who underwent total thyroidectomy with and without prophylactic central drainage. Calcium and parathyroid hormone levels will be checked 24 hours post-surgery. The quantitative variables will be reported as averages and the qualitative variables as absolute and relative data. t-Student test was used to compare qualitative data. Qualitative data was compared using independent test with scales of x2 and the Fisher exact test. A logistic regression analysis was done and reported as Adjusted Odds ratios (AOR). Results: calcium level on the group with central drainage had significant lower levels compare to the group without central drainage, the difference was of -0.07 mmol/L (IC 95 %: -0.036, -0.097 mmol/L; p<0.0001). The patients with central drainage had significantly lower levels of parathyroid hormone (levels lower than 10pg/ml) up to 53.9%; while the group without central drainage only had 11.1% %(IC 95%: 29.5, 56.2%; p < 0.0001). Conclusion: though the study the thyroidectomy with prophylactic central drainage group had a significant rate of hypocalcemia and hypoparathyroidism. These patients had symptoms of hypocalcemia post-surgery, which prolong their hospital stay. (AU)

Hipocalcemia clínica post-cirugía de tiroides / Clinical hypocalcemia post-thyroid surgery

La hipocalcemia posterior a la cirugía de tiroides es una de las complicaciones más frecuentes, situación que prolonga la estancia hospitalaria y incrementando los costos derivados del procedimiento. Debe indagarse factores predictivos para administrar calcio a pacientes en riesgo a fin de disminuir la severidad de los síntomas y acortar la hospitalización. En el Hospital Carlos Andrade Marín, la cirugía electiva de tiroides es el tercer procedimiento quirúrgico en frecuencia, de las colecistecomías y hernioplastias. Reviste particular importancia la detección precoz de las complicaciones derivadas de esta cirugía. (AU)

Hypocalcemia following thyroid surgery is one of the most frequent complications, a situation that prolongs hospital stay and increases the costs of the procedure. Predictive factors should be investigated to administer calcium to at-risk patients in order to decrease the severity of symptoms and shorten hospitalization. In the Carlos Andrade Marín Hospital, elective thyroid surgery is the third surgical procedure in frequency, of cholecystechias and hernioplasties. Of particular importance is the early detection of complications arising from this surgery. (AU)

Xantoastrocitoma pleomórfico / Pleomorphic Xanthoastrocytoma

El xantoastrocitoma pleomórfico, por su extrema rareza, conlleva alta complejidad en el diagnóstico histopatológico. Se presenta el caso clínico en un sujeto de sexo masculino, de 40 años, con antecedentes de crisis convulsivas de presentación tardía, secundarias a meningioma atípico grado II localizado en región occipital izquierda, resecado por dos ocasiones en el transcurso de 6 años. Recibió radioterapia a dosis completa luego de la segunda resección. El diagnóstico histopatológico inicial fue meningioma atípico gra-do II. El paciente acude al HCAM por cefalea holocraneal intensa y hemiparesia braquiocrural derecha; en los estudios de resonancia magnética nuclear con gadolinio se observó el crecimiento de una lesión occipi-tal izquierda con edema perilesional que ameritó resección total de la lesión a través de la craniectomía previa. Como hallazgo macroscópico, se describe una masa violácea que infiltra duramadre carente de un plano de clivaje; el estudio histopatológico detalla una neoplasia glial hipercelular con infiltración difusa con reacción inmunohistoquímica intensa para PGAF (proteína glial acida fibrilar), S100 y CD56 en células tumorales, CD34 positivo. KI67 positivo en 3% y P53 débilmente positivo, compatible con xantoastroci-toma pleomórfico WHO II.(AU)

The pleomorphic xantoastrocytoma, due to its extreme rarity, carries high complexity in the histo-pathological diagnosis. The clinical case is presented in a male subject, 40 years old, with a history of sei-zures with late presentation, secondary to atypical meningioma grade II located in the left occipital region, resected twice in the course of 6 years. He received full-dose radiation therapy after the second resection. The initial histopathological diagnosis was atypical meningioma grade II. The patient comes to HCAM due to intense holocranial headache and right brachiocrural hemiparesis; In the gadolinium nuclear magnetic resonance studies the growth of a left occipital lesion with perilesional edema that warranted total resec-tion of the lesion through previous craniectomy was observed. As a macroscopic finding, a violaceous mass is described which infiltrates dura mater lacking a plane of cleavage; The histopathological study details a hypercellular glial neoplasia with diffuse infiltration with intense immunohistochemical reaction for PGAF (glial acidic glial protein), S100 and CD56 in tumor cells, CD34 positive. It was KI67 positive in 3% and P53 weakly positive, compatible with pleomorphic xantoastrocytoma WHO II. (AU)