Comparación de la conducta alimentaria en niños de diferentes establecimientos educacionales y estado nutricional / Comparison of food behavior among school children by educational establishment and nutritional status

RESUMEN La conducta alimentaria en escolares está dada por grandes cambios, en este periodo adquieren mayor relevancia los hábitos alimentarios que determinarán su alimentación futura. Objetivo: Comparar la conducta alimentaria en escolares de diferentes establecimientos educacionales según estado nutricional. Métodos: Estudio observacional transversal, se aplicó cuestionario de comportamiento de alimentación infantil a 270 madres/tutores de niños entre 6 a 8 años de colegios públicos, subvencionados y privados de Viña del Mar, Chile. Resultados: El 49,6% de los niños presentó mal- nutrición por exceso. Los niños con obesidad presentaron respuestas positivas a la ingesta alimentaria en situaciones de molestia, preocupación y enojo, no fueron exigentes al momento de introducir nuevos sabores y fueron rápidos para comer (p<0,05). Al diferenciar por establecimiento, sólo el colegio particular presenta diferencias entre los niños con distinto estado nutricional, tanto en dimensiones de sobre ingesta como de antiingesta (p <0,05). Conclusiones: Los escolares de 6 a 8 años no presentaron diferencias significativas en su conducta alimentaria, niños con obesidad se asociaron positivamente a conducta de proingesta. Los niños del colegio público mantuvieron la misma conducta alimentaria, independiente de su estado nutricional, evidenciando mayor riesgo a presentar malnutrición por exceso a futuro, a diferencia del colegio particular.

ABSTRACT Eating behavior in schoolchildren is marked by great changes. In this period, eating habits acquire greater relevance as they will determine future behaviors. Objective: To compare feeding behaviors among schoolchildren by school type and nutritional status. Methods: A cross-sectional observational study in which a child eating behavior questionnaire was applied to 270 mothers / guardians of children between 6 and 8 years from public, subsidized and private schools in Viña del Mar, Chile was conducted. Results: Nearly half (49.6%) of children had malnutrition due to excess. Children with obesity had positive responses to food intake in situations of discomfort, worry and anger, were not demanding when introduced to new flavors and were quick to eat (p <0.05). When comparing by establishment, differences between children by nutritional status were observed only in those attending private schools, in terms of excess-intake and anti-eating (p <0.05). Conclusions: Children from 6 to 8 years old did not present significant differences in their eating behavior, children with obesity reported pro-eating behavior. Children attending public schools maintained the same eating behavior, independent of their nutritional status, showing a higher risk of malnutrition due to excess in the future, unlike those attending private school.

Description of an efficacious behavioral peer-driven intervention to reduce racial/ethnic disparities in AIDS clinical trials.

AIDS clinical trials (ACTs) are critical to the development of new treatments for HIV infection. However, people of color living with HIV/AIDS are involved in ACTs at disproportionally low rates, with African-Americans experiencing the greatest under-representation. In this article, we describe the core elements and key characteristics of a highly efficacious multi-component peer-driven intervention (PDI) designed to increase rates of screening for and enrollment into ACTs among African-American and Latino/Hispanic individuals, by addressing the main complex, multi-level barriers they experience to ACTs. We discuss the process of developing the intervention, the theoretical models guiding its delivery format and content, and provide an overview of the intervention's components. We then use brief case studies to illustrate a number of key issues that may arise during intervention implementation. Finally, we describe lessons learned and provide recommendations for the PDI's uptake in clinical and clinical trials settings.

Más allá del moeesto ronquido: síndrome de apne obstructiva del sueño y su pelligrosa asociación con el síndrome metbbólico / Behid bothersomee snoring: obstructie sleep apnea syndrome and its dangerous association with metabolic síndrome / Alé do hum irrittante: síndrome da pnéia obstrutiva do sono e assoociação perigosa com síndrome metabólcaa

El síndrome de apnea hipoapnea obstructiva del sueño (SAHOS) es una enfermedad frecuente que afecta alrededor del 5 % de la población general y a casi la mitad de los pacientes obesos. La asociación de SAHOS con obesidad ha sido bien establecida desde que fue descrito por primera vez; durante los últimos años ha sido creciente la producción literaria que asocia la hipoxemia con un incremento de la enfermedad cardiovascular y metabólica, las cuales finalmente originan un mayor riesgo cardiovascular en los pacientes afectados no necesariamente obesos. Debido a la presencia de hipoxemia secundaria a la obstrucción mecánica del flujo aéreo que se encuentra en los pacientes afectados por el síndrome de apnea hipoapnea obstructiva del sueño, se desencadenan eventos fisiopatogénicos tales como la liberación de radicales libres, la disminución de la expresión de algunas enzimas importantes para el clivaje del colesterol y la producción de óxido nítrico y el aumento en la producción de mediadores inflamatorios que generan disrupción de vías metabólicas y endocrinológicas, lo cual ocasiona un incremento en el riesgo de sufrir diabetes mellitus, resistencia a la insulina, hipertensión arterial, obesidad y dislipidemia aterogénica.

Obstructive sleep apnea syndrome (OSAS) is a frequent disease that affects around 5% of the general population and almost half the obese patients. The association between OSAS and obesity has been well established since it was described for the first time. in the last few years a lot of literature has been issued that associates hypoxemia with the increase in cardiovascular and metabolic diseases which finally originates a major cardiovascular risk in patients not necessarily obese. Due to hypoxemia secondary to airflow mechanical obstruction present in OSAS patients, there are physiopathogenic events such as the liberation of free oxygen radicals, the decrease of the expression of some enzymes useful for cholesterol cleavage and nitric oxide production, and the increase in the production of inflammatory mediators that generates a disruption in metabolic and endocrine ways, which also increases the risk of diabetes mellitus, insulin resistance, arterial hypertension, obesity and atherogenic dyslipidemia.

O síndrome da apnéia obstrutiva do sono (SAOS) é uma doença comum que afeta cerca de 5% da população geral e quase a metade dos pacientes obesos; a associação de SAOS com a obesidade tem sido bem estabelecida desde que foi descrita pela primeira vez; a produção literária que associa a hipoxemia com um aumento da doença cardiovascular e metabólica nos últimos anos tem sido crescente, o que acabou por dar origem a um maior risco cardiovascular em pacientes afetados, não necessariamente obesos. Devido à presença de hipoxemia secundária à obstrução mecânica do fluxo de ar encontrado em pacientes afetados pela síndrome da apnéia hipopnéia obstrutiva do sono, se desencadena eventos fisiopatológicos, tais como radicais livres, diminuição da expressão de várias enzimas para a clivagem de colesterol e produção de óxido nítrico e aumento da produção de mediadores inflamatórios que produzem interrupção de vias metabólicas e endócrinas que resultam en um aumento deo risco de diabetes mellitus, resistência à insulina, hipertensão, obesidade e dislipidemia aterogênica.

Secuelas de histoplasmosis pulmonar / Sequelae of pulmonary histoplasmosis / Seqüelas de histoplasmose pulmonar

Radiografía de Tórax en la que se ven múltiples lesiones calcificadas distribuidas en ambos campos pulmonares con la presentación clásica en "perdigones" que corresponden a granulomas en fase de calcificación, esta apariencia radiológica es considerada clásica y patognomónica de histoplasmosis pulmonar; el único diagnóstico diferencial radiológico es la neumonía por varicela la cual es invariablemente sintomática...

A chest X ray in where they are multiple calcified lesions distributed in both lungs which the classic "pellets" presentation that are calcified granulomas, this radiologic presentation is considered classic and pathognomonic of pulmonary histoplasmosis, the only radiologic differential diagnosis is chickenpox pneumonia which is always symptomatic...

Radiografia de tórax em que múltiplas lesões calcificadas são distribuídos em ambos pulmões com a apresentação clássica em "perdigones" que correspondem a granulomas no processo de calcificação, o aspecto radiológico é considerado clássica e patognomônico de histoplasmose pulmonar, o único diagnóstico diferencial radiológico é a pneumonia pela varicela, que é invariavelmente sintomático...

Osteoporosis asociada a glucocorticoides, una aproximación práctica: revisión / Osteoporosis associated with glucocorticoids, a practical approach: a review / Osteoporose associada com glicocorticóides, uma abordagem prática: revisão

La osteoporosis es una enfermedad de alta prevalencia en el mundo y una de las causas más importantes de su forma secundaria es el uso crónico de glucocorticoides; aproximadamente el 0,5% de la población mundial es consumidora crónica de estos medicamentos, dadas sus múltiples indicaciones en el tratamiento de enfermedades reumáticas, dermatológicas, pulmonares o renales entre otras. Los pacientes con osteoporosis inducida por glucocorticoides presentan complicaciones como la fractura de cadera, situación que genera altos costos a los sistemas de salud. Por lo tanto, es muy importante hacer un diagnóstico rápido para iniciar un tratamiento oportuno, debido a que la prevención y el tratamiento de la enfermedad son menos costosos que el manejo de sus complicaciones. Se consideran en riesgo de osteoporosis todos aquellos pacientes que toman 5 mg diarios de prednisolona o más, por un tiempo mínimo de tres meses; a estos pacientes se les debe realizar una densitometría ósea (DXA), que es el método diagnóstico de elección para todos los tipos de osteoporosis. Un T Score diagnóstico para osteoporosis u osteopenia indican el inicio de tratamiento específico principalmente con bifosfonatos, entre los cuales el risedronato y alendronato han demostrado mejor efectividad. Otra de las indicaciones para el tratamiento específico estaría basada en el riesgo de fractura definido por la OMS con el Score FRAX. Finalmente, la prevención se debe hacer en todo paciente usuario crónico de glucocorticoides con medidas generales que implican cambios en el estilo de vida y la ingesta diaria de 1000 a 1500 mg de calcio elemental y 600 u de vitamina D...

Osteoporosis is a highly prevalent disease in the world and one of the most important causes of its secondary form is the chronic use of glucocorticoids; approximately 0.5% of the world's population is chronic consumer of this medicine because of its many indications in the treatment of rheumatic, dermatologic, pulmonary or renal diseases among others. Patients with glucocorticoid induced osteoporosis generates high costs for health systems derived from its complications, such as hip fractures, being more cost-effective the prevention and treatment of the disease than the management of its complications, that constitutes an important reason for its early diagnose and treatment. Every patient who takes prednisolone 5 mg daily or more for a minimum of three months is considered at risk of glucocorticoid induced osteoporosis; these patients should be screened with DXA, which is the election diagnostic method for all types of osteoporosis. Diagnosis of osteoporosis or osteopenia by T score is indicative for specific treatment with biphosphonates, among which risedronate and alendronate have demonstrated to be more effective. Other indication for the treatment of these patients is based on the WHO's score FRAX. Finally, prevention must be done in every glucocorticoid chronic consumer, basically with changes in lifestyle and the daily intake of 1000-1500 mg of elemental calcium and 600 units of vitamin D...

A osteoporose é uma doença de alta prevalência no mundo e uma das causas mais importantes da forma secundária é o uso crônico de glicocorticóides; aproximadamente 0,5% da população mundial é usuária crônica destas drogas dadas as suas múltiplas indicações no tratamento de doenças reumáticas, pele, rim, pulmão e outros. Os doentes com osteoporose induzida por glucocorticóide apresentam complicações tais como fraturas de quadril que geram altos custos para os sistemas de saúde. Por isso é muito importante o diagnóstico precoce para dar tratamento imediato, devido a que são mais custo-efetiva que as suas complicações. São considerados de risco para osteoporose todos aqueles doentes que tomam 5 mg de prednisolona por dia ou mais, por um período mínimo de três meses, esses pacientes devem ser submetidos a densitometria óssea (DEXA), que é considerado o método diagnóstico de escolha para todos os tipos de osteoporose. Um escore T para diagnosticar a osteoporose ou osteopenia indicam o início de um tratamento específico, principalmente, com bifosfonatos, incluindo o risedronato e alendronato mostraram maior eficácia. Outra indicação para o tratamento específico seria baseado no risco de fratura definida pelo Índice OMS com FRAX. Finalmente, a prevenção deve ser feita em todos os pacientes usuários crônicos de glucocorticoides com medidas gerais que envolvem mudanças no estilo de vida e ingestão diária de 1000-1500 mg de cálcio elementar e 600 U de vitamina D...

Serum protein binding of itraconazole and fluconazole in patients with diabetes mellitus.

The protein binding of itraconazole and fluconazole in the serum of patients with insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus was investigated in vitro. The unbound percentage of itraconazole in patients with IDDM and NIDDM was significantly higher than that in healthy volunteers. In contrast, there were no significant differences in fluconazole protein binding. A negative correlation was established between itraconazole protein binding and albumin concentration, and a positive correlation with free fatty acid concentration. The existence of a larger percentage of unbound itraconazole in diabetes patients could imply a change in drug disposition and an alteration in the effect of the drug. This should be taken into consideration in long duration treatment, especially in view of the non-linear kinetics of itraconazole.

Etiología microbiana de la enfermedad inflamatoria pélvica leve y moderada (EIP) / Microbial ethiology of mild and moderate pelvic inflammatory disease

La Enfermedad Inflamatoria Pélvica (EIP) es una de las complicaciones más severas de las Enfermedades de Transmisión Sexual (ETS) se puede deber entre otros eventos al ascenso de la microflora genital femenina o a la infección de gérmenes implicados en ETS como la Chlamydia trachomatis o Neisseria gonorrhoeae. Esto trae como consecuencia serias repercusiones desde el punto de vista gineco-obstétrico. Una de las principales limitaciones a la que se enfrenta el médico es el conocer su etiología. De tal manera que con el presente trabajo, se pretende establecer el tipo de microorganismos involucrados en esta patología a fin de que al identificarlos, mediante el cultivo de endocérvix, endometrio y líquido peritoneal; se otorgue a la paciente el tratamiento adecuado, oportuno y certero, logrando así una mayor eficacia terapéutica

Protein binding of itraconazole and fluconazole in patients with cancer.

The serum protein binding of itraconazole and fluconazole, new azole antifungal agents, has been investigated in vitro, in serum from healthy volunteers and from patients with cancer. Protein binding was determined by ultrafiltration. Concentrations of both alpha 1-acid glycoprotein (AAG) and albumin (HSA) were measured in all serum samples. The serum protein binding of itraconazole was reduced in patients (96.02 +/- 1.41% vs 97.25 +/- 0.54%; p < 0.01) with respect to healthy volunteers. In contrast, fluconazole protein binding was increased in the same group of patients (22.96 +/- 3.60% vs 13.30 +/- 2.58%; p < 0.01). HSA levels in cancer patients were significantly decreased (p < 0.01) and AAG levels were found to be significantly elevated in patients with respect to control subjects (p < 0.05). A significant linear relationship between the bound/unbound concentration ratio of itraconazole and HSA (r2 = 0.3340; p < 0.01) was found. Similarly, a significant relation was established between the bound/unbound concentration ratio of fluconazole and AAG levels (r2 = 0.2235; p < 0.05). Thus, a weak association between the binding of these drugs and serum protein levels has been observed. It is concluded that both antifungal drugs show different protein binding behaviour in cancer patients.

Protein binding of itraconazole and fluconazole in patients with chronic renal failure.

The serum protein binding of itraconazole and fluconazole, new triazole antifungal agents, has been investigated in vitro in the serum of healthy volunteers and in patients with chronic renal failure (predialysis). Protein binding was determined by ultrafiltration. Concentrations of both alpha 1-acid glycoprotein (AAG) and albumin were measured in all serum samples. The protein binding of itraconazole showed no significant changes in patients with chronic renal failure when compared to healthy volunteers (96.64 +/- 0.99% vs. 96.85 +/- 0.33%). In contrast, fluconazole protein binding was significantly increased in the same patients (22.91 +/- 6.15% vs. 12.51 +/- 2.37%; p < 0.001). In addition, whereas albumin levels in the latter patients were significantly decreased (p < 0.001), their AAG levels were found to be significantly elevated with respect to control subjects (p < 0.001). While no correlation was established between itraconazole protein binding and albumin or AAG concentrations, a significant correlation was found between fluconazole protein binding and AAG levels (r = 0.72; p < 0.001). Fluconazole protein binding was found to be independent of albumin concentrations. In vitro carbamylation of serum protein with potassium cyanate caused no changes in the protein binding of fluconazole or itraconazole. We conclude that the binding of itraconazole by serum proteins is not altered in diseases involving changes of AAG or albumin concentrations. However, fluconazole protein binding may be altered in disease states associated with increased AAG concentrations.

Hepatitis C en el puerperio / Hepatitis C during puerperium

Recientemente se ha descrito al virus de la hepatitis C (VHC) como el agente causal más frecuente de la hepatitis post-transfusional No-A, No-B. La vía más importante de transmisión de le hepatitis C es la sangre. El 50 por ciento de los individuos que padecen una hepatitis viral aguda tipo C evolucionarán a una hepatitis crínica, y aproximadamente el 20 por ciento de estos a cirrosis hepática; por otra parte existen evidencias de que el VHC juega un papel en el desarrollo del carcinoma hepatocelular. Presentamos el caso de una paciente que por complicaciones obstétricas fues politransfundida, desarrollando en el puerperio un síndrome ictérico llegándose al diagnóstico de hepatitis C; describimos la metodología diagnóstica, las características clínicas, evolución y se hace énfasis en las medidas de prevención de este padecimiento.

[Characteristics of gastric cancer in the IX region of Chile]. / Caracteristicas del cancer gastrico en la IX region en Chile.

The results of a prospective protocol for the management of patients with gastric cancer applied from May 1988 to June 1991 are reported. 123 patients were operated on and a resection performed in 55%. Only 14 patients had incipient tumor and 44 had "curative" surgery. There was a preponderance of non differentiated tumors located high in the stomach. Endoscopy and biopsy were performed in cases with positive diagnosis in 91 and 93%, respectively. The overall actuarial survival rate was 37% at 38 months, rising to 50% for patients undergoing resection and to 82% in patients with "curative" resection.

Morphogenesis of the gubernaculum testis in Sprague-Dawley rat. Preliminary report.

The morphology of testicular descent in the Sprague-Dawley rat from day 14 of gestation to newborn was studied; the purpose was to analyse the anatomy and related observations made with light and scanning microscopy. Adult female rats were mated during estrus. The presence of spermatozoa in vaginal smears was taken to indicate day 0 of gestation. Animals were kept in a controlled 12-hour light-darkness cycle; food and water were provided ad libitum. At day 14 genital ducts are similar in both sexes. At day 15 and 16 the gubernaculum testis is seen as a mesenchymal cord that extends from mesonephros to the pelvic floor. At day 17 near the enlarged caudal end of gubernaculum, evagination of the abdominal cavity begins forming the peritoneo-vaginal process. The testis ligament as well as the gubernaculum testis attaching to the epididymis at different locations have no direct relation between themselves as such. During day 18, testis rotates on its own longitudinal axis in a ventral-lateral direction. This movement twists the testis ligament, the epididymis and deferent duct lengthen and these structures are lined up in the direction of the peritoneo-vaginal process. The testis is generally situated in the newborn, on or near the internal ring. The gubernaculum testis is attached to the epididymis but does not exercise traction on the testis. The epididymis is a factor in this descending process.

Association of differing dietary, metabolic, and clinical risk factors with macrovascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. I.

Macrovascular and microvascular complications of diabetes may be associated with different environmental factors. To investigate this further, a prevalence study of 503 Mexican type II diabetic subjects was carried out while their patterns of nutrition were constrained by government food subsidies. Average daily dietary intakes were 1866 kcal; 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. With respect to macrovascular disease, 49.3% of patients had evidence of peripheral vascular disease, and 21.6% myocardial ischemia, 6.0% angina, 10.8% EKG evidence of ischemia, 4.8% EKG evidence of myocardial infarction. Only 1.2% (six patients) had a clear history of completed stroke, and all were hypertensive. Six patients had also undergone amputations for diabetic gangrene. Tabulation of the means of clinical characteristics according to presence or absence of myocardial ischemia showed that higher cholesterol, calorie, and fat intake, higher mean blood pressure, higher serum cholesterol, and serum triglyceride levels were found in those with myocardial ischemia. Patients with peripheral vascular disease were more commonly smokers. Stepwise logistic regression revealed significant positive associations between myocardial ischemia and dietary cholesterol, serum cholesterol, and mean blood pressure. In contrast, the presence of peripheral vascular disease was significantly related only to smoking and retinopathy. There were no associations between macrovascular complications and duration of diabetes in the multivariate analysis, and they occurred with equal frequency in men and women. Prospective studies of atherosclerosis in maturity-onset diabetes should assess and seek to modify dietary cholesterol, serum cholesterol, and hypertension.

Association of differing dietary, metabolic, and clinical risk factors with microvascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. II.

The overall prevalences of microvascular complications and their association with dietary, clinical, and metabolic characteristics have been studied in 503 Mexican type II diabetic subjects. Average daily dietary intakes were 1866 kcal, 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. Prevalence rates of microvascular and metabolic complications were as follows: background retinopathy 12.3%, exudative retinopathy 24.2%, proliferative retinopathy 8.1% (1% blind, 4% able to read large print only), 9.1% of patients had cataract, 15.9% nephropathy, and 40.8% peripheral neuropathy. In addition, 3.6% had experienced transient lower motor neuron facial paralysis and 0.2% oculomotor paralysis. Patients with retinopathy had a longer mean duration of diabetes, were less obese at the time of examination, and had higher initial and mean blood pressures and higher mean fasting blood glucose levels when compared with those without retinopathy. Similar differences were observed between groups with and without nephropathy except that mean blood glucose levels were similar in the two groups. The presence of peripheral neuropathy was associated with longer duration of diabetes, less obesity, higher mean blood pressure and mean blood glucose levels, and lower hemoglobin concentration. Patients treated with diet alone had significantly lower prevalences of all three microvascular complications but they also had significantly shorter duration of diabetes and lower mean blood glucose levels. However, multivariate analyses on the subgroup of 360 patients who had repeated fasting blood glucose measurements for at least 5 yr demonstrated associations between retinopathy and duration of diabetes, mean blood pressure and mean blood glucose, and percent calories from carbohydrate.(ABSTRACT TRUNCATED AT 250 WORDS)