The role of metabolic and bariatric surgery on the obesity pandemic in Latin America: A review of current practices and future directions.

Latin America faces a significant public health challenge due to the high prevalence of obesity and its associated diseases. Metabolic and bariatric surgery is effective and safe to treat obesity when other treatments fail; however, its implementation in Latin America remains unsatisfactory. This review explores the current status, challenges, and innovations of metabolic and bariatric surgery in Latin America. We searched peer-reviewed journals in English and Spanish for relevant articles published between 1998 and 2023. We found that more than 20% of the Latin American population is affected by obesity. Unfortunately, only a limited number of patients have access to metabolic and bariatric surgery due to high cost, limited availability, and shortage of specialists. The review found that ongoing clinical trials are being conducted in Brazil, Mexico, Chile, and Venezuela, indicating some regional progress. However, published studies remain low in number compared with other regions. Furthermore, we summarized the clinical outcomes, risks, and perioperative assessments associated with metabolic and bariatric surgery. We discussed potential strategies to enhance the availability and affordability of this intervention. This review emphasizes the significance of metabolic and bariatric surgery in addressing the obesity pandemic, specifically for Latin America, and proposes directions for future research and innovation.

Dynamical classic limit: Dissipative vs conservative systems.

We analyze the nonlinear dynamics of a quartic semiclassical system able to describe the interaction of matter with a field. We do it in both dissipative and conservative scenarios. In particular, we study the classical limit of both frameworks and compare the associated features. In the two environments, we heavily use a system's invariant, related to the Uncertainty Principle, that helps to determine how the dynamics tends to the pertinent classical limit. We exhibit the convergence to the classical limit and also verify that the Uncertainty Principle is complied with during the entire process, even in the presence of dissipation.

Neutralizing Ability of a Single Domain VNAR Antibody: In Vitro Neutralization of SARS-CoV-2 Variants of Concern.

Severe Acute Respiratory Syndrome Coronavirus 2 is the causal pathogen of coronavirus disease 2019 (COVID-19). The emergence of new variants with different mutational patterns has limited the therapeutic options available and complicated the development of effective neutralizing antibodies targeting the spike (S) protein. Variable New Antigen Receptors (VNARs) constitute a neutralizing antibody technology that has been introduced into the list of possible therapeutic options against SARS-CoV-2. The unique qualities of VNARs, such as high affinities for target molecules, capacity for paratope reformatting, and relatively high stability, make them attractive molecules to counteract the emerging SARS-CoV-2 variants. In this study, we characterized a VNAR antibody (SP240) that was isolated from a synthetic phage library of VNAR domains. In the phage display, a plasma with high antibody titers against SARS-CoV-2 was used to selectively displace the VNAR antibodies bound to the antigen SARS-CoV-2 receptor binding domain (RBD). In silico data suggested that the SP240 binding epitopes are located within the ACE2 binding interface. The neutralizing ability of SP240 was tested against live Delta and Omicron SARS-CoV-2 variants and was found to clear the infection of both variants in the lung cell line A549-ACE2-TMPRSS2. This study highlights the potential of VNARs to act as neutralizing antibodies against emerging SARS-CoV-2 variants.

[Central nervous system infections associated with CSF shunt devices in children, at a national reference hospital]. / Infecciones del sistema nervioso central asociadas a dispositivos de derivación de LCR en niños, en un centro neuro-quirúrgico de referencia nacional.

BACKGROUND: Infections associated with CSF shunt devices are a frequent complication in their use. The most common is the presence of gram positive coccaceae, such as coagulase negative Staphylococcus (50% in some series) and Staphylococcus aureus. This complication adds morbidity and mortality to the neurosurgical patient, increasing hospital stay and treatment costs. AIM: To determine the incidence of infections associated with CSF shunt devices in a national referral center. METHODS: Retrospective, descriptive study. Information was collected on pediatric patients between 2018 and 2019. A descriptive and inferential statistical analysis was performed using the statistical language R 3.4.0 and RStudio 1.3.9. The cumulative incidence for each procedure was calculated, evaluating whether there were significant differences between them. This study was approved by the Pediatric Ethics Committee of the SSMO. RESULTS: In the period studied, 175 surgeries were performed. We found 19 cases of ventriculitis associated with ventriculoperitoneal derivative and 7 cases in ventricular-external derivative. The most frequent agents were grampositive coccaceae. It was not possible to identify significant risk factors.

Infecciones del sistema nervioso central asociadas a dispositivos de derivación de LCR en niños, en un centro neuro-quirúrgico de referencia nacional / Central nervous system infections associated with CSF shunt devices in children, at a national reference hospital

INTRODUCCIÓN: Las infecciones asociadas a dispositivos de derivación de LCR son una complicación frecuente en su utilización. Lo más habitual es la presencia de cocáceas grampositivas, como Staphylococcus coagulasa negativa (50% en algunas series) y Staphylococcus aureus. Esta complicación agrega morbimortalidad al paciente neuroquirúrgico, aumentando la estadía hospitalaria y los costos de tratamiento. OBJETIVO: Conocer la incidencia de infecciones asociadas a dispositivos de derivación de LCR en un centro de referencia nacional. METODOLOGÍA: Estudio descriptivo, retrospectivo. Se recolectó la información de los pacientes pediátricos (bajo 18 años) entre 2018 y 2019. Se realizó un análisis estadístico descriptivo e inferencial utilizando el lenguaje estadístico R 3.4.0 y RStudio 1.3.9. Se calculó la incidencia acumulada para cada procedimiento, evaluando si existe diferencias significativas entre ellas. Estudio aprobado por el Comité de Ética Pediátrico del SSMO. RESULTADOS: En el período estudiado se realizaron 175 cirugías. Encontramos 19 casos de ventriculitis asociada a derivativa ventriculo-peritoneal y 7 casos en derivativa ventricular-externa. Los agentes más frecuentes fueron las cocáceas grampositivas. No se logró identificar factores de riesgo significativos.

BACKGROUND: Infections associated with CSF shunt devices are a frequent complication in their use. The most common is the presence of gram positive coccaceae, such as coagulase negative Staphylococcus (50% in some series) and Staphylococcus aureus. This complication adds morbidity and mortality to the neurosurgical patient, increasing hospital stay and treatment costs. AIM: To determine the incidence of infections associated with CSF shunt devices in a national referral center. METHODS: Retrospective, descriptive study. Information was collected on pediatric patients between 2018 and 2019. A descriptive and inferential statistical analysis was performed using the statistical language R 3.4.0 and RStudio 1.3.9. The cumulative incidence for each procedure was calculated, evaluating whether there were significant differences between them. This study was approved by the Pediatric Ethics Committee of the SSMO. RESULTS: In the period studied, 175 surgeries were performed. We found 19 cases of ventriculitis associated with ventriculoperitoneal derivative and 7 cases in ventricular-external derivative. The most frequent agents were grampositive coccaceae. It was not possible to identify significant risk factors.

The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review.

BACKGROUND: Intra-arterial chemotherapy is a new retinoblastoma treatment associated with high rates of globe salvage that has been widely adopted for primary treatment of retinoblastoma but is less frequently used as secondary treatment for refractory retinoblastoma. This systematic review aims to summarize the reported outcomes of intra-arterial chemotherapy for refractory retinoblastoma. METHODS: We conducted a systematic review of studies published on PubMed, Medline, and Embase from 2011 to 2021 reporting globe salvage rates following intra-arterial chemotherapy for secondary treatment of refractory retinoblastoma. RESULTS: Our search yielded 316 studies, and 24 met inclusion criteria. The 24 included studies were comprised of 1366 patients and 1757 eyes. Among these, 1184 (67%) eyes received secondary indication treatment, and globe salvage was achieved for 776 of these 1184 eyes (64%). Sixteen studies reported cannulation success rates from 71.8 to 100%. Pooled analysis of subjects revealed 21 patients (2.6%) with metastatic disease and 26 deaths (3%) during study follow-up periods (7-74 months). The most common ocular complications were vitreous hemorrhage (13.2%), loss of eyelashes (12.7%), and periocular edema (10.5%). The most common systemic complications were nausea/vomiting (20.5%), neutropenia (14.1%), fever (8.2%), and bronchospasm (6.2%). CONCLUSIONS: Intra-arterial chemotherapy is associated with high rates of globe salvage and low rates of serious complications in patients with refractory retinoblastoma. Unfortunately, current literature is predominantly comprised of retrospective case studies, and further high-quality evidence is necessary to inform clinical practice.

Exactly solvable SIR models, their extensions and their application to sensitive pandemic forecasting.

The classic SIR model of epidemic dynamics is solved completely by quadratures, including a time integral transform expanded in a series of incomplete gamma functions. The model is also generalized to arbitrary time-dependent infection rates and solved explicitly when the control parameter depends on the accumulated infections at time t. Numerical results are presented by way of comparison. Autonomous and non-autonomous generalizations of SIR for interacting regions are also considered, including non-separability for two or more interacting regions. A reduction of simple SIR models to one variable leads us to a generalized logistic model, Richards model, which we use to fit Mexico's COVID-19 data up to day number 134. Forecasting scenarios resulting from various fittings are discussed. A critique to the applicability of these models to current pandemic outbreaks in terms of robustness is provided. Finally, we obtain the bifurcation diagram for a discretized version of Richards model, displaying period doubling bifurcation to chaos.

Turing instability conditions in confined systems with an effective position-dependent diffusion coefficient.

We study a reaction-diffusion system within a long channel in the regime in which the projected Fick-Jacobs-Zwanzig operator for confined diffusion can be used. We found that under this approximation, Turing instability conditions can be modified due to the channel geometry. The dispersion relation, range of unstable modes where pattern formation occurs, and spatial structure of the patterns itself change as functions of the geometric parameters of the channel. This occurs for the three channels analyzed, for which the values of the projected operators can be found analytically. For the reaction term, we use the well-known Schnakenberg kinetics.

Membrane stress and torque induced by Frank's nematic textures: A geometric perspective using surface-based constraints.

An elastic membrane with embedded nematic molecules is considered as a model of anisotropic fluid membrane with internal ordering. By considering the geometric coupling between director field and membrane curvature, the nematic texture is shown to induce anisotropic stresses additional to Canham-Helfrich elasticity. Building upon differential geometry, analytical expressions are found for the membrane stress and torque induced by splaying, twisting, and bending of the nematic director as described by the Frank energy of liquid crystals. The forces induced by prototypical nematic textures are visualized on the sphere and on cylindrical surfaces.

Evolution of incidence and geographical distribution of Chagas disease in Mexico during a decade (2007-2016).

Chagas disease, whose aetiological agent is the protozoan Trypanosoma cruzi, mainly occurs in Latin America. In order to know the epidemiology and the geographical distribution of this disease in Mexico, the present work analyses the national surveillance data (10 years) for Chagas disease issued by the General Directorate of Epidemiology (GDE). An ecological analysis of Chagas disease (2007-2016) was performed in the annual reports issued by the GDE in Mexico. The cases and incidence were classified by year, state, age group, gender and seasons. A national distribution map showing Chagas disease incidence was generated. An increase of new cases was identified throughout the country (rates from 0.37 to 0.81 per 100 000 inhabitants). Of the total cases accumulated (7388), the major cases were attributed to the states of Veracruz, Chiapas, Quintana Roo, Oaxaca, Morelos and Yucatán. The analysis per age groups and gender revealed that, in most age groups, the incidence was higher in the male population. The most number of cases was identified in spring and summer; a direct relationship between the environmental temperature increase and the number of new cases was identified. The analysis showed that the rate of Chagas disease increased presumably due to state programmes; the search for new cases has expanded and we speculate that the disease is associated with occupational activities. These results summarise and recall how important it is to implement the monitoring of Chagas disease mainly in south states of the Mexican Republic in order to implement strategies to control this disease.

Voluntary alcohol intake after noise exposure in adolescent rats: Hippocampal-related behavioral alterations.

Different physical or chemical agents, such as noise or alcohol, can induce diverse behavioral and biochemical alterations. Considering the high probability of young people to undergo consecutive or simultaneous exposures, the aim of the present work was to investigate in an animal model if noise exposure at early adolescence could induce hippocampal-related behavioral changes that might be modified after alcohol intake. Male Wistar rats (28-days-old) were exposed to noise (95-97 dB, 2 h). Afterwards, animals were allowed to voluntarily drink alcohol (10% ethanol in tap water) for three consecutive days, using the two-bottle free choice paradigm. After that, hippocampal-related memory and anxiety-like behavior tests were performed. Results show that whereas noise-exposed rats presented deficits in habituation memory, those who drank alcohol exhibited impairments in associative memory and anxiety-like behaviors. In contrast, exposure to noise followed by alcohol intake showed increases in exploratory and locomotor activities as well as in anxiety-like behaviors, unlike what was observed using each agent separately. Finally, lower levels of alcohol intake were measured in these animals when compared with those that drank alcohol and were not exposed to noise. Present findings demonstrate that exposure to physical and chemical challenges during early adolescence might induce behavioral alterations that could differ depending on the schedule used, suggesting a high vulnerability of rat developing brain to these socially relevant agents.

Agencia de autocuidado en pacientes hipertensos del Hospital Erasmo Meoz / Self care agency in patients with hypertension of the Erasmo Meoz Hospital / Administração de autocuidado em pacientes com hipertensão do Hospital Erasmo Meoz

El propósito del estudio fue determinar la capacidad de agencia de autocuidado de los hipertensos usuarios del servicio de \r\nconsulta externa del Hospital Universitario Erasmo Meoz en San José de Cúcuta (Colombia). Se realizó un estudio descriptivo, \r\ntransversal con abordaje cuantitativo durante el primer semestre del 2012. Mediante muestreo no probabilístico fueron seleccio\r\n-\r\nnados 200 hipertensos a quienes se les aplicó el cuestionario de evaluación de la capacidad de agencia de autocuidado en el \r\npaciente hipertenso.\r\nA nivel global se encontró que un porcentaje representativo de los encuestados (62,5%) presentó mediana capacidad de agencia \r\nde autocuidado; el 37,0% alta capacidad y baja un 0,5%. Estos resultados guardan correspondencia con el comportamiento de las \r\nrespuestas dadas por los participantes a la gran mayoría de los ítems que componen el instrumento. Además plantean un impor\r\n-\r\ntante desafío para la enfermería en la definición de estrategias de intervención asistencial y educativa que motiven y apoyen a las \r\npersonas hipertensas, para que sean autosuficientes frente a su propio cuidado, con capacidad de tomar sus propias decisiones y \r\nde solventar de manera autónoma sus necesidades en el manejo de su enfermedad.

The purpose of this study was to determine the capacity for \r\nself-care agency of hypertensive patients of the Hospital \r\nUniversitario Erasmo Meoz outpatient service in San José de \r\nCúcuta (Colombia). A descriptive, cross-sectional study with a \r\nqualitative approach was performed during the first semester \r\nof 2012. In a non-probabilistic sample a questionnaire was \r\nadministered to 200 hypertensive patients to evaluate the \r\nability of self-care agency in hypertensive patients.\r\nGlobally, it was found that a representative percent of the \r\nrespondents (62.5%) had a medium capacity for auto-care \r\nagency; 37% high capacity and 0.5% had low. These results are \r\nin line with the results of the answers given by the participants \r\nin the great majority of the items that make up the instru\r\n-\r\nment. In addition, the results represented a major challenge for \r\nnursing in defining of intervention strategies for assistance and \r\neducational intervention that encourage and supports people \r\nwith hypertension, to become auto sufficient in their own care, \r\nwith capacity to make their own decisions and to solve in an \r\nautonomous way their needs in the handling of their illness.

O propósito do estudo foi determinar a capacidade da admi\r\n-\r\nnistração de autocuidado dos pacientes hipertensos do \r\nserviço de consulta externa do Hospital Universitário Erasmo \r\nMeoz, em San José de Cúcuta (Colômbia). Foi realizado um \r\nestudo descritivo, transversal com abordagem quantitativa \r\ndurante o primeiro semestre de 2012. Por meio de amos\r\n-\r\ntragem não probabilística foram selecionados 200 hipertensos, \r\nque receberam o questionário de avaliação da capacidade de \r\nadministração de autocuidado no paciente hipertenso.\r\nA nível global descobriu-se que uma percentagem represen\r\n-\r\ntativa dos respondentes, 62,5%, apresentou capacidade média \r\nda agência de autocuidado, 37,0%, capacidade alta e 0,5%, \r\nbaixa. Estes resultados correspondem ao comportamento das \r\nrespostas dadas pelos participantes para a maioria dos itens \r\nque compõem o instrumento. Além disso, expõem um impor\r\n-\r\ntante desafio para a enfermagem na definição de estratégias \r\nde intervenção assistencial e educativa que motivem e apoiem \r\nas pessoas hipertensas, para que sejam autossuficientes \r\nquanto ao seu próprio cuidado, capazes de tomar suas próprias \r\ndecisões e resolver de forma autônoma suas necessidades na \r\ngestão de sua doença.

Sulforaphane reduces the alterations induced by quinolinic acid: modulation of glutathione levels.

Glutamate-induced excitotoxicity involves a state of acute oxidative stress, which is a crucial event during neuronal degeneration and is part of the physiopathology of neurodegenerative diseases. In this work, we evaluated the ability of sulforaphane (SULF), a natural dietary isothiocyanate, to induce the activation of transcription factor Nrf2 (a master regulator of redox state in the cell) in a model of striatal degeneration in rats infused with quinolinic acid (QUIN). Male Wistar rats received SULF (5mg/kg, i.p.) 24h and 5min before the intrastriatal infusion of QUIN. SULF increased the reduced glutathione (GSH) levels 4h after QUIN infusion, which was associated with its ability to increase the activity of glutathione reductase (GR), an antioxidant enzyme capable to regenerate GSH levels at 24h. Moreover, SULF treatment increased glutathione peroxidase (GPx) activity, while no changes were observed in γ-glutamyl cysteine ligase (GCL) activity. SULF treatment also prevented QUIN-induced oxidative stress (measured by oxidized proteins levels), the histological damage and the circling behavior. These results suggest that the protective effect of SULF could be related to its ability to preserve GSH levels and increase GPx and GR activities.

A novel phospholipase A2 (D49) from the venom of the Crotalus oreganus abyssus (North American Grand canyon rattlesnake).

Currently, Crotalus viridis was divided into two species: Crotalus viridis and Crotalus oreganus. The current classification divides "the old" Crotalus viridis into two new and independent species: Crotalus viridis (subspecies: viridis and nuntius) and Crotalus oreganus (subspecies: abyssus, lutosus, concolor, oreganus, helleri, cerberus, and caliginis). The analysis of a product from cDNA (E6d), derived from the gland of a specie Crotalus viridis viridis, was found to produce an acid phospholipase A2. In this study we isolated and characterized a PLA2 (D49) from Crotalus oreganus abyssus venom. Our studies show that the PLA2 produced from the cDNA of Crotalus viridis viridis (named E6d) is exactly the same PLA2 primary sequence of amino acids isolated from the venom of Crotalus oreganus abyssus. Thus, the PLA2 from E6d cDNA is actually the same PLA2 presented in the venom of Crotalus oreganus abyssus and does not correspond to the venom from Crotalus viridis viridis. These facts highlight the importance of performing more studies on subspecies of Crotalus oreganus and Crotalus viridis, since the old classification may have led to mixed results or mistaken data.

Processed meat consumption and risk of cancer: a multisite case-control study in Uruguay.

BACKGROUND: The role of processed meat in the aetiology of several cancers was explored in detail. METHODS: In the time period 1996-2004, a multisite case-control study was conducted in Montevideo, Uruguay. The study included 6 060 participants (3 528 cases and 2 532 controls) corresponding to cancers of the oral cavity, pharynx, oesophagus, stomach, colon, rectum, larynx, lung, female breast, prostate, urinary bladder, and kidney (renal cell carcinoma only). RESULTS: The highest odds ratios (ORs) were positively associated with cancers of the colon, rectum, stomach, oesophagus, and lung. With the exception of renal cell carcinoma, the remaining cancer sites were significantly associated with elevated risks for processed meat consumption. Furthermore, mortadella, salami, hot dog, ham, and salted meat were strongly associated with risk of several cancer sites. CONCLUSION: It could be concluded that processed meat intake could be a powerful multiorgan carcinogen.

Vascular effects and electrolyte homeostasis of the natriuretic peptide isolated from Crotalus oreganus abyssus (North American Grand Canyon rattlesnake) venom.

Crotalus oreganus abyssus is a rattlesnake that is usually found in the Grand Canyon, United States of America. Knowledge regarding the composition of C. o. abyssus venom is scarce. New natriuretic peptides (NPs) have been isolated and characterized from the venoms of members of the Crotalinae family. The NP family comprises three members, ANP (atrial natriuretic peptide), BNP (b-type natriuretic peptide) and CNP (c-type natriuretic peptide), and has an important role in blood pressure regulation and electrolyte homeostasis. The aim of the present study was to characterize a novel natriuretic-like peptide (Coa_NP2), isolated from C. o. abyssus venom. The Coa_NP2 presents an average molecular mass of 3419.88Da (theoretical average molecular mass 3418.94Da, monoisotopic molecular mass 3416.66Da and theoretical PI 7.78) and its amino acid sequence presents the loop region that is characteristic of natriuretic peptides. The peptide has 32 amino acids and its complete sequence is SYGISSGCFGLKLDRIGTMSGLGCWRLLQDSP. Coa_NP2 is a natriuretic peptide of the ANP/BNP-like family, since the carboxyterminal region of CNP has its own NP domain. We demonstrate, herein, that Coa_NP2 produces a dose-dependent decrease in mean arterial pressure in rats, followed by significant increases in concentrations of markers of nitric oxide formation measured in the plasma and vasorelaxation in a thoracic aortic ring bath. The structural and biological aspects confirm Coa_NP2 as a new natriuretic peptide, isolated from snake venom.

[Deficient lactose digestion and intolerance in a group of patients with chronic nonspecific ulcerative colitis: a controlled, double-blind, cross-over clinical trial]. / Digestión deficiente e intolerancia a lactosa en un grupo de enfermos con colitis ulcerativa crónica inespecífica: Ensayo clínico controlado, cruzado y doblemente a ciegas.

INTRODUCTION: Despite the fact that the frequency of hypolactasia and lactose intolerance is similar in both chronic idiopathic ulcerative colitis patients and the general population, the elimination of dairy products from the patient's diet is a habitual recommendation. Hypolactasia is common in Mexico, but its relation to chronic idiopathic ulcerative colitis has not been established. AIMS: To evaluate lactose digestion and lactose intolerance in persons with chronic idiopathic ulcerative colitis. MATERIAL AND METHODS: Thirty-nine patients with confirmed chronic idiopathic ulcerative colitis diagnosis were included in the study (mean: 31 years, range: 15 to 38). Twenty-two patients presented with rectosigmoid involvement and the remaining patients with pancolitis. No patient showed inflammatory activity according to the Truelove-Witts criteria and all consumed dairy products before diagnosis. A prospective, controlled, double-blind, cross-over study was designed. Patients randomly received 12.5 g of lactose or maltose in 250 cc water- each test 72 hours apart - and ydrogen was measured in exhaled air before disaccharide ingestion and then every 30 minutes for 3 hours. Digestion was considered deficient when there was an increase in hydrogen of at least 20 ppm. Symptom intensities were evaluated by Visual Analog Scales before, during, and after the hydrogen test. Differences between the groups were contrasted with the Mann-Whitney U and the Wilcoxon tests. RESULTS: Eighteen patients (46%) presented with deficient lactose digestion. No significant differences were found in the symptoms, extension, or progression of chronic idiopathic ulcerative colitis between patients that could digest and those that could not digest lactose. No patient had symptom exacerbation with the disaccharides used. CONCLUSIONS: Lactose digestion deficiency frequency is similar in subjects with chronic idiopathic ulcerative colitis and in healthy individuals in Mexico. We do not know whether higher doses could have some effect, but symptoms in patients with inactive chronic idiopathic ulcerative colitis were not modified using 12.5 g of lactose/day.

Dietary folate intake and the risk of 11 types of cancer: a case-control study in Uruguay.

BACKGROUND: There is limited, but inconclusive, epidemiological evidence that high folate intake decreases the risk of colorectal and esophageal cancers. For other cancer sites, the evidence is even less consistent or extensive. MATERIALS AND METHODS: We conducted a case-control study of dietary folate intake and risk of 11 cancer sites in Uruguay between 1996 and 2004, including 3539 cancer cases and 2032 hospital controls. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cancer associated with folate intake. RESULTS: In the multivariable model, there was a significant decrease in the risk of cancers of the oral cavity and pharynx (OR = 0.49, 95% CI 0.24-0.98), esophagus (OR = 0.29, 95% CI 0.14-0.60), upper aerodigestive tract (OR = 0.41, 95% CI 0.26-0.65), colorectum (OR = 0.42, 95% CI 0.23-0.76) and kidney (OR = 0.35, 95% CI 0.13-0.93) for the highest versus the lowest quartile of dietary folate intake. CONCLUSIONS: Our results not only confirm earlier findings of decreased risk of colorectal and esophageal cancers with a high dietary folate intake but also suggest decreased risk of several other cancers. However, we cannot exclude the possibility that residual confounding, multiple comparisons or other forms of bias could explain these results.

Enfrentamiento terapéutico del trastorno por déficit atencional en una población infantil escolar perteneciente a la Región Metropolitana de Chile / Attentional deficit disorder treatment at a school children population in Region Metropolitana of Chile

An evaluation was made of a retrospective evolution presented by the patients from to 14 years and 11 month old (average 9,2 years old), with a diagnostic of attentional hyperactive disorder (AHD), treated with metilfenidate in Huechuraba during the year 2007. A revision of every clinic history showed the principal results: a high positive response (higher than the 76 percent of the measured parameters). The evaluated parameters were, academic response, self report of subjective opinion from the patient, opinion from the tutor of the child in relationships with his/her conduct at home and teacher's evaluations of the child conduct at school. No differences were found between the evolution of the clinic parameters, in children with and without comorbilities. It was found a 52, 7 percent of comorbility. Specific learning disease, adaptative disorder, anxious disorder, and depression were more frequent diagnoses. This study concludes that the high percent of success in the treatment of the student group is similar to the one found in literature. The presence of comorbility won't cause to down of the treatment efficiency. This is conditioned by the presence of psychosocial factors like maternal psychopathology and familiar violence.

Se realizó una evaluación restrospectiva de la evolución presentada por los pacientes desde 6 a 14 años 11 meses de edad (edad media de 9,2 años) con diagnóstico de Trastorno por déficit atencional (TDA) bajo tratamiento con metilfenidato en la comuna de Huechuraba durante el año 2007. Se hizo la revisión y el análisis de cada ficha clínica, encontrándose como principales resultados el alto porcentaje de mejoría, igual o mayor al 76 por ciento de los parámetros medidos, consistentes en evolución del rendimiento académico; autoreporte de sensación subjetiva del niño; reporte del cuidador principal en relación a la conducta del niño (a) en el hogar y evaluación del profesor en cuanto su conducta en el colegio. No se encontraron diferencias entre la evolución de los parámetros clínicos entre los niños con comorbilidad y sin comorbilidad, se encontró un 52,7 por ciento de esta, siendo los diagnósticos más frecuentes Trastorno específico del aprendizaje, trastorno adaptativo, trastorno ansioso y del ánimo. Se concluye que el alto porcentaje de éxito del tratamiento en el grupo estudiado es similar al encontrado en la literatura; que la presencia de comorbilidad no condiciona la disminución de la eficiencia del tratamiento y que esta es condicionada por presencia de factores psicosociales como psicopatología materna y violencia intrafamiliar.