Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease.

Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/µL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.

Cortical blindness as severe neuro-ophthalmological manifestation of tuberous sclerosis complex.

Patients with retinal lesions related to tuberous sclerous complex (TSC) commonly have no impairment of visual acuity. We present a case of a 1-year-old Hispanic girl with TSC in which bilateral cortical blindness is documented.

Mental health, migration stressors and suicidal ideation among Latino immigrants in Spain and the United States.

BACKGROUND: Immigration stress appears to augment the risk for suicide behaviors for Latinos. Yet, specific risk factors that contribute to suicidal ideation (SI) among diverse Latino immigrant populations are not well established. METHODS: Data were collected in Boston, Madrid and Barcelona using a screening battery assessing mental health, substance abuse risk, trauma exposure, demographics, and sociocultural factors. Prevalence rates of lifetime and 30-day SI were compared across sites. Logistic regression modeling was used to identify sociodemographic, clinical, and sociocultural-contextual factors associated with 30-day SI. RESULTS: Five hundred and sixty-seven Latino patients from primary care, behavioral health and HIV clinics and community agencies participated. Rates of lifetime SI ranged from 29-35%; rates for 30-day SI were 21-23%. Rates of SI were not statistically different between sites. Factors associated with SI included exposure to discrimination, lower ethnic identity, elevated family conflict, and low sense of belonging (P<0.01). In the adjusted model, higher scores on depression, posttraumatic stress disorder, and trauma exposure were significantly associated with 30-day SI (OR=1.14, 1.04, and 7.76, respectively). Greater number of years living in the host country was significantly associated with increased odds of having SI (OR=2.22) while having citizenship status was associated with lower odds (OR=0.45). CONCLUSION: Latinos suffering depression, trauma exposure, and immigration stressors are more likely to experience SI. Despite differences in country of origin, education, and other demographic factors between countries, rates of SI did not differ. Recommendations for prevention and clinical practice for addressing suicidal ideation risk among Latino immigrants are discussed.

Impacto que genera el diagnóstico de VIH en mujeres trabajadoras de la Región de Antofagasta y Metropolitana / Impact of hiv diagnosis in working women in the Region of Antofagasta and the Metropolitan Region

El propósito del presente artículo expone como el diagnóstico de VIH ha afectado a mujeres chilenas en su rol de trabajadoras, conociéndolo desde su propia perspectiva. Es una investigación cualitativa, donde se entrevistan a 3 mujeres sero positivo de edad entre los 20 y 65 años, que cuentan con experiencia laboral previo al diagnóstico de VIH. Los resultados identifican un antes y después del diagnóstico de VIH, donde para mantener su rol de trabajadoras ocultan su diagnóstico al empleador y a sus compañeros de trabajo por miedo a ser discriminada; dan a conocer abiertamente su diagnóstico al contexto social que se desenvuelven para evitar prejuicios; o cambian su rubro laboral. De esta manera, se reconoce que la ley del SIDA de Chile no logra cubrir una protección real que permita el respeto, fiscalización y responsabilidad de estas normas, siendo vulnerados los derechos de las mujeres que viven con VIH. Las mujeres diagnosticadas sufren apartheid ocupacional e injusticia ocupacional, ya que no logran realizar su rol como trabajadoras debido a la desinformación que existe en la sociedad frente al VIH y a los estigmas que se encuentran en torno a ella, desencadenando prejuicios sociales históricos que han favorecido que mujeres vivan ocultando su realidad...

The purpose of this article is to present how an HIV diagnosis has affected Chilean women in their role as workers, from the perspective of the women themselves. It is qualitative research involving three interviews which HIV positive women between the ages of 20 and 65 who have work experience prior to receiving their HIV diagnosis. The results identify that there is a difference in the women’s experience pre- and post-diagnosis, whereby to maintain their role as workers they hide their diagnosis from their employer and colleagues for fear of discrimination; that the women openly disclose their diagnosis in the social context in which they operate to avoid bias; or that they change their job. Thus, it is clear that the AIDS Chile legislation fails to offer real protection to ensure respect, execution of, and accountability regarding these rules being violated for women living with HIV. The diagnosed women suffer an occupational apartheid and occupational injustice, as they are unable to perform their role as workers due to the misunderstandings that exist in society regarding HIV and to the stigmas that surround it and, moreover, are victims of historical social biases that have favored women live hiding their HIV reality...

Community cluster of meningococcal disease by Neisseria meningitidis serogroup C in Andalusia, Spain, March to May 2011.

Between March and May of 2011, a cluster of three fatal cases of meningococcal sepsis occurred in Andalusia, Spain, in a municipality with a population of around 20,000 inhabitants. The cases were in their mid-teens to early thirties and were notified to the epidemiological surveillance system of Andalusia (Sistema de Vigilancia Epidemiológica de Andalucía, SVEA) during a 68-day period from March through May 2011. All three were infected with the same strain of Neisseria meningitidis serogroup C genosubtype VR1:5-1;VR2:10-8. None of the cases had been previously vaccinated against N. meningitidis serogroup C. Antibiotic post-exposure chemoprophylaxis was administered to close contacts of every diagnosed case. Once the cluster was confirmed, the local population was informed through the media about the control measures taken by the health authorities. The vaccination history against N. meningitidis serogroup C of the population under 25 years-old in the municipality was checked. Vaccination was offered to unimmunised individuals younger than 25 years of age and an additional dose of vaccine was offered to those who had been vaccinated between 2000 and 2006 with a vaccination schedule of three doses before the first year of age. No further cases occurred since the beginning of these actions.

The Latin American Consortium of Studies in Obesity (LASO).

Current, high-quality data are needed to evaluate the health impact of the epidemic of obesity in Latin America. The Latin American Consortium of Studies of Obesity (LASO) has been established, with the objectives of (i) Accurately estimating the prevalence of obesity and its distribution by sociodemographic characteristics; (ii) Identifying ethnic, socioeconomic and behavioural determinants of obesity; (iii) Estimating the association between various anthropometric indicators or obesity and major cardiovascular risk factors and (iv) Quantifying the validity of standard definitions of the various indexes of obesity in Latin American population. To achieve these objectives, LASO makes use of individual data from existing studies. To date, the LASO consortium includes data from 11 studies from eight countries (Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Peru, Puerto Rico and Venezuela), including a total of 32,462 subjects. This article describes the overall organization of LASO, the individual studies involved and the overall strategy for data analysis. LASO will foster the development of collaborative obesity research among Latin American investigators. More important, results from LASO will be instrumental to inform health policies aiming to curtail the epidemic of obesity in the region.

Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease.

BACKGROUND: Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. OBJECTIVE: To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. METHODS: We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. RESULTS: WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. CONCLUSION: WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

Rio de La Plata study: a multicenter, cross-sectional study on cardiovascular risk factors and heart failure prevalence in peritoneal dialysis patients in Argentina and Uruguay.

A multicenter cross-sectional study was performed to evaluate the prevalence of heart failure (HF) and the associated cardiovascular (CV) risk factors in 298 peritoneal dialysis (PD) patients from Argentina and Uruguay, representing almost 30% of the total number of PD patients in the two countries. Bidimensional echocardiography, electrocardiography, and biochemical analysis were performed. Systolic HF was defined as an ejection fraction <50%. According to echocardiography, 84.6% showed left ventricular hypertrophy (LVH), 38.3% valvular heart disease, and 35.4% valvular calcification, whereas 20% showed intraventricular conduction disturbances on the electrocardiogram. The prevalence of CV risk factors was of 73% hypertension, 51% sedentarism, 18% diabetes, 16.8% obesity, 12% smokers, 42.3% phosphorus >5.5 mg per 100 ml, 42.3% parathyroid hormone>300 pg ml(-1), and 29.6% calcium phosphate product >55. The prevalence of systolic HF was 9.9%, being significantly associated with diabetes: odds ratio (OR)=4.11 (P<0.006) and hypoalbuminemia: OR=3.45 (P<0.011). Forty percent of patients with a diagnosis of left ventricular dysfunction at the time of the study were asymptomatic. Variables associated with LVH in the multivariate analysis were anemia (OR=4.06; P<0.001) and previous hemodialysis (OR=1.99; P<0.031). The identification of reversible risk factors associated to HF and the diagnosis of asymptomatic ventricular dysfunction in this PD population will lead our efforts to establish guidelines for prevention and early treatment of congestive HF in patients on PD.

WITHDRAWN: Calcium supplementation on bone loss in postmenopausal women.

BACKGROUND: Although calcium is one the simplest and least expensive strategies for preventing osteoporotic fractures calcium supplementation is nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and Drug Administration in the US has permitted a bone health claim for calcium-rich foods, and the NIH in its Consensus Development Process approved a statement that high calcium intake reduces the risk of osteoporosis. OBJECTIVES: To assess the effects of calcium on bone density and fractures in postmenopausal women. SEARCH STRATEGY: We searched Cochrane Controlled Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant articles and proceedings of international meetings. SELECTION CRITERIA: Trials that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm or recorded the number of fractures, and followed patients for at least one year were considered for inclusion. DATA COLLECTION AND ANALYSIS: Three independent reviewers assessed the methodologic quality and extracted data for each trial. For each bone density site (lumbar spine, total body, combined hip and combined forearm), we calculated the weighted mean difference in bone density between treatment and control groups using the percentage change from baseline. We constructed regression models in which the independent variables were year and dose, and the dependent variable was the effect size. This regression was used to determine the years across which pooling was appropriate. Heterogeneity was assessed. For each fracture analysis we calculated a risk ratio. MAIN RESULTS: Fifteen trials, representing 1806 participants, were included. Calcium was more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86) for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to 3.50) for the distal radius. The relative risk of fractures of the vertebrae was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures was 0.86 (95% CI 0.43 to 1.72). AUTHORS' CONCLUSIONS: Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but it is unclear if calcium reduces the incidence of non vertebral fractures.

Trastorno fonológico y conciencia fonológica en preescolares con trastorno específico del lenguaje / Phonological disorder and phonological awareness in pre-school with specific language impairments

Uno de los síntomas lingüísticos más frecuentes en los niños con trastorno específico del lenguaje (TEL) es el trastorno fonológico. Además, se acepta que los niños que evidencian este cuadro pueden manifestar un desempeño descendido en la conciencia fonológica. No obstante, no hay acuerdo sobre la importancia que tiene el trastorno fonológico en esta habilidad metalingüística. Por ello, el propósito del estudio es aportar más información sobre la posible relevancia del trastorno fonológico en el desempeño de las habilidades metalingüísticas de tipo fonológico en preescolares con TEL. El grupo en estudio estuvo constituido por 24 preescolares con TEL. Su promedio de edad era de 4 años y 2 meses. Por su parte, el grupo control se formó con 26 preescolares sin TEL con un promedio de edad de 4 años y 4 meses. La evaluación fue individual y consistió en aplicar el test para evaluar los procesos fonológicos de simplificación (TEPROSIF) y la prueba destinada para evaluar habilidades metalingüísticas de tipo fonológico (PDEHMF). Los resultados señalan que no existe relación entre el desempeño de la conciencia fonológica y del trastorno fonológico en ambos grupos de niños. También, se estableció que la cantidad de procesos de simplificación no influía en el desempeño de la conciencia fonológica en ambos grupos de niños. Finalmente, se observó que todos los niños con TEL que presentaban descendida las habilidades metafonológicas evidenciaban un trastorno fonológico severo

One of the most frequent linguistic symptoms in children with specific language impairment (SLI) is the phonological deficit. Children with SLI also displayed low performances on phonological awareness tasks. However, the effect of SLI in phonological awareness development is not clear. The aim of this study is to search for the weight of phonological deficits in preschool students with SLI on meta-linguistic abilities such as phonological awa-reness. The sample included 24 preschoolers with SLI (x = 4.2 years old) and 26 preschoolers without SLI (x = 4.4 years old). Students were individually measured with a test for evaluating phonological simplification processes (TEPROSIF) and a test for assessing phonological meta-linguistic abilities (PDEHMF). Results indicated a lack of relationship between phonological awareness abilities and phonological deficits in both control and experimental groups. Finally, all students with SLI who showed poor meta-linguistic abilities also displayed a severe phonological deficit

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

BACKGROUND: Acute bronchiolitis is the leading cause of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is thought to assist infants in the clearance of secretions and to decrease ventilatory effort. OBJECTIVES: To determine the efficacy and safety of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. SEARCH STRATEGY: In June 2006 we updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006); MEDLINE (2004 to May Week 4 2006); EMBASE (July 2004 to December 2005) and CINAHL (1982 to May Week 4 2006). SELECTION CRITERIA: Randomised controlled trials (RCTs) in which chest physiotherapy was compared against no intervention or against another type of physiotherapy in paediatric patients younger than 24 months old. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data. The primary outcome was a severity clinical score. Secondary outcomes were length of hospital stay, duration of oxygen supplementation, and the use of bronchodilators and steroids. MAIN RESULTS: Three clinical trials met the inclusion criteria. All evaluated vibration and percussion techniques with children in postural drainage positions compared to no intervention. The study populations were hospitalised infants with a clinical diagnosis of acute bronchiolitis, although one study included only infants who required nasogastric tube feeding or intravenous fluids. None of the other included trails observed any differences in the severity of the clinical score at day five, during each of the five days of the trial, or until discharge; length of hospital stay; or oxygen requirements between paediatric patients receiving chest physiotherapy and control. AUTHORS' CONCLUSIONS: Based on the results of three RCTs, chest physiotherapy using vibration and percussion techniques does not reduce length of hospital stay, oxygen requirements, or improve the severity clinical score in infants with acute bronchiolitis. These were infants who were not on mechanical ventilation and who did not have any other co-morbidity. Chest physiotherapy using forced expiratory techniques needs to be further evaluated by clinical research.

Radiotherapy for malignant pleural mesothelioma.

BACKGROUND: Malignant pleural mesothelioma is a relatively uncommon disease, but the incidence is increasing and is expected to peak in many developed countries in the next two decades. The management of patients with malignant mesothelioma is controversial. Very few patients are suitable for any potentially curative treatment and the effectiveness of radical therapy with surgery, radiotherapy and/or chemotherapy in curing patients or prolonging survival is uncertain. The role of radiotherapy is controversial although it has been used as part of multimodal therapy. The present review will try to clarify these uncertainties. OBJECTIVES: To assess the effectiveness and safety of radiotherapy on patients with malignant pleural mesothelioma in any stage of the disease. SEARCH STRATEGY: Both electronic and handsearches were conducted. All randomised controlled clinical trials were searched in electronic databases such as: Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Handsearching was aimed at the identification of evidence by reviewing journals not indexed in databases, proceedings of conferences and/or scientific meetings. SELECTION CRITERIA: All randomised controlled clinical trials using radiotherapy for malignant pleural mesothelioma in any stage, alone or combined with other therapies in patients of either sex and any age, were included. Studies without a control group were excluded. DATA COLLECTION AND ANALYSIS: There were no studies that fulfilled the inclusion criteria. MAIN RESULTS: To date we have not found any reports of randomised comparisons of radiotherapy alone or combined for patients with malignant pleural mesothelioma. AUTHORS' CONCLUSIONS: As radiotherapy has never been compared to chemotherapy or surgery or to best supportive care (as part of combination therapy) in a prospective, randomised trial, no data exist supporting one or the other treatment as a better option for patients with malignant pleural mesothelioma. There is a need for multicentre controlled randomised trials assessing the role of radiotherapy in the radical treatment of malignant pleural mesothelioma. The studies should be limited to patients with malignant pleural mesothelioma, classified by stage, cytology and type of radiotherapy. The type of radiotherapy should be defined in advance and variables of radiotherapy dose definition and delivery should be carefully controlled.

Comprensión de la salud sexual y reproductiva de los adolescentes en el marco del desarrollo a escala humana / Comprhension of the reproductive and sexual health of adolescents in the context of human development scale

El presente documento plantea una propuesta para la comprensión e intervención de la salud sexual reproductiva de los adolescentes en el marco del desarrollo a escala humana, específicamente para aquellos que pertenecen a la comunidad académica de los grados 10 y 11 de las instituciones educativas. En este capítulo se propone la creación de un centro itinerante de consejería para los adolescentes y sus padres y un programa de capacitación para los docentes, con el fin de impactar los efectos negativos que se pueden generar como producto de la falta de comprensión de la salud sexual y reproductiva y de la ausencia de satisfactores sinérgicos de la misma.

Implementación de un programa de mejoramiento de la seguridad de los pacientes: resultados preliminares / Implementation of a program of improvement of the security of the patients: preliminary results

Tradicionalmente, el error ha servido para aprender lo que no había que hacer y lo que no era verdad. Luego se sumó la reacción de castigar al responsable del error suponiendo que éste era producto de la incapacidad o irresponsabilidad individual. La búsqueda, explícita o no, del "culpable" ha promovido mayor temor en los profesionales de la salud y generado una creciente tendencia a ocultar los errores. Desde 2001, la Academia Nacional de Medicina, a través de su Centro de Investigaciones Epidemiológicas, desarrolló e implementó un programa para el mejoramiento de la seguridad en la atención de los pacientes, en cuatro instituciones sanitarias de nuestro país de diferentes características. El propósito del programa es: "diseñar, validar y evaluar metodologías que permitieran identificar errores, casi errores y eventos adversos; analizar el mecanismo de su producción y contribuir a señalar los procesos correctivos". El mismo está organizado en cuatro componentes: a) cultura organizacional para la seguridad del paciente; b) sistemas de información para la vigilancia del error durante el proceso de atención, c) mejoramiento continuo de la seguridad del paciente y d) gestión de conocimiento.

La mejoría electrocardiográfica con el tratamiento de la enfermedad de Chagas crónica, es independiente de la persistencia de Trypanosoma cruzi / No association between persistence of the parasite and electrocardiographic evolution in treated patients with Chagas disease

Background: International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.

[Prepatency, parasitemia and histological lesions in mice infected with two Trypanosoma cruzi populations isolated in Chile]. / Concordancia de lesiones histológicas en ratones infectados por dos poblaciones de Trypanosoma cruzi de Chile.

BACKGROUND: The great variability in the clinical presentation of Chagas disease may depend in part in the genetic variability of Trypanosoma cruzi populations. AIM: To compare prepatent period, parasitemia, mortality and histological lesions in mice infected with two populations of Trypanosoma cruzi isolated in Chile. MATERIAL AND METHODS: Two Trypanosoma cruzi populations, isolated from Chilean Triatomides and genetically characterized by kinetoplast restriction fragment DNA profiles, were compared. Two groups of 40 Balb/c mice were studied. Each mouse was inoculated with 10(4) trypomastigotes, of the V-121 and sp COMB 2 Trypanosoma cruzi populations. The prepatent period, parasitemia, mortality and histopathological lesions, at different evolutionary stages of infection were registered during 32 days. RESULTS: Prepatency and mortality were similar in both groups of mice. However, parasitemia was significantly greater in mice inoculated with V-121 than those inoculated with sp COMB 2. Amastigote pseudocysts and inflammation were present only in skeletal muscle and myocardium in both groups of mice. The intensity of tissue involvement was associated to the level of parasitemia, therefore it was greater in mice inoculated with V-121 population. CONCLUSIONS: V-121 population of Trypanosoma cruzi caused a greater parasitemia than COMB 2, in inoculated mice.

Alternativas de futuro de la salud pública en el municipio de Bello (Antioquia) / Future alternatives of public health in Bello, Antioquia

Objetivo: explorar las alternativas de futuro de la salud pública del municipio de Bello en las dimensiones política, social, ambiental y económica. Metodología: estudio prospectivo realizado entre noviembre de 2003 y agosto de 2004 mediante enfoque cualitativo, utilizando la estrategia de grupo focal a partir de los anhelos, proyectos y temores de los actores sociales involucrados y su relación con las políticas de salud pública del orden internacional, nacional y local. Inicialmente se describió un escenario probable que presenta condiciones poco favorables para alcanzar la salud para todos y el desarrollo a escala humana, si no se modifican sustancialmente las dimensiones de la salud pública con participación social, compromiso y responsabilidad del nivel político y de otros sectores. Posteriormente se diseñaron cuatro escenarios alternos y las condiciones necesarias para lograrlos y se proyectó uno de ellos como escenario deseable. En el estudio se destacaron más temores y anhelos, y gran parte de estos últimos y de los proyectos se relacionaron con los lineamientos de las conferencias internacionales sobre salud para todos y con directrices nacionales de salud pública. Resultados: se encontraron menos coincidencias con los programas propuestos en el actual plan de gobierno municipal, lo que genera mayor incertidumbre para los actores sociales.

Megestrol acetate for the treatment of anorexia-cachexia syndrome.

BACKGROUND: Megestrol acetate (MA) is currently used to improve appetite and to increase weight in cancer-associated anorexia. In 1993 MA was approved by the USA's Federal Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with AIDS. The mechanism by which MA increases appetite is unknown, and its effectiveness for anorexia and cachexia in neoplastic and AIDS patients is under investigation. OBJECTIVES: To evaluate the efficacy, effectiveness and safety of MA in palliating anorexia-cachexia syndrome in patients with cancer, AIDS and other underlying pathologies. SEARCH STRATEGY: Studies were sought thorough an extensive search of the electronic databases, journals, reference lists, contact with investigators and other search strategies outlined in the methods. The most recent search was carried out on October 2002. SELECTION CRITERIA: Studies were included in the review if they assessed megestrol acetate compared to placebo or other drug treatments in randomized controlled trials of patients with a clinical diagnosis of anorexia-cachexia related to cancer, AIDS or another underlying pathology. DATA COLLECTION AND ANALYSIS: Data extraction was conducted by two independent authors, and methodological quality evaluated. Quantitative analyses were performed using appetite and quality of life as a dichotomous variable, and weight gain was analysed as continuous and dichotomous variables. Studies with more than 50% of patients lost to follow-up were excluded from the analysis. MAIN RESULTS: Thirty trials met the inclusion criteria (4123 patients). Twenty-one trials compared MA at different doses with placebo; four compared different doses of MA versus other drugs; two compared MA with other drugs and placebo; and three compared different doses of MA. For all patient conditions, meta-analysis showed a benefit of MA compared with placebo, particularly with regard to appetite improvement and weight gain in cancer patients. Analysing quality of life, clinical and statistical heterogeneity was found and discussed. There was insufficient information to define the optimal dose of MA. AUTHORS' CONCLUSIONS: This review demonstrates that MA improves appetite and weight gain in patients with cancer. No overall conclusion about quality of life (QOL) could be drawn due to heterogeneity. The small number of patients, methodological shortcomings and poor reporting have not allowed us to recommend megestrol acetate in AIDS patients or with other underlying pathologies.

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

BACKGROUND: Acute bronchiolitis is the leading causes of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is thought to assist infants in the clearance of secretions and decrease ventilatory effort. OBJECTIVES: To determine the efficacy and safety of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004) which contains the Acute Respiratory Infection Group's specialised register; MEDLINE (January 1966 to June 2004); EMBASE (1990 to June 2004); PASCAL; SCISEARCH; LILACS; and Cumulative Index to the Nursing & Allied Health Literature (CINAHL) (1982 to May 2004). SELECTION CRITERIA: Randomised controlled trails (RCTs) in paediatric patients younger than twenty four months old in which chest physiotherapy was compared against no intervention or against another type of physiotherapy. DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted the data. Primary outcome was a severity clinical score. Secondary outcomes were length of hospital stay, duration of oxygen supplementation, and the use of bronchodilators and steroids. MAIN RESULTS: Three clinical trials met the inclusion criteria. All evaluated vibration and percussion techniques in postural drainage positions compared to no intervention. The study population were hospitalised infants with a clinical diagnosis of acute bronchiolitis, although one study included only infants who required nasogastric tube feeding or intravenous fluids. None of the other included trails observed any differences in the severity of the clinical score at day five or during each of the five days of the trial or until discharge, length of hospital stay, or oxygen requirements between chest physiotherapy group and control. AUTHORS' CONCLUSIONS: Based on the results of three RCTs, chest physiotherapy using vibration and percussion techniques does not reduce length of hospital stay, oxygen requirements, or improve the severity clinical score in infants with acute bronchiolitis that are not under mechanical ventilation, and who do not have any other co-morbidity. Chest physiotherapy using forced expiratory technique needs to be evaluated by clinical research.