Growth Performance and Immunity of Broilers Fed Sorghum-Soybean Meal Diets Supplemented with Phytases and Β-Mannanases.

Most grains and vegetable feedstuffs used in commercial poultry feed contain phytates and polysaccharides-non-starchy chemical structures that are not degraded by digestive tract enzymes. Exogenous enzymes optimize the use of dietary ingredients. This study aimed to determine whether combining ß-mannanases (400 g/ton) and phytases in broiler sorghum-soybean diets could improve performance and immunity in broilers. Four diets were randomized in a 2 × 2 factorial design, with two phytase levels (500 or 1500 FTU/kg) and ß-mannanase supplementation (0-400 g/ton; 158 million units/kg minimum enzyme activity). Six replicate battery cages of 10 chicks were fed each diet ad libitum. To assess cellular and humoral immune responses, 10 birds per treatment were euthanized on day 21. Supplementation with ß-mannanase enzymes led to increased body weight and a higher feed conversion index (FCI) (p < 0.05). The phytase factor improved the FCI at 1500 FTU/kg (p < 0.05). Supplementation with ß-mannanases improved the immune response by increasing the IgA concentration in the duodenum (95%) and total serum immunoglobulins (p < 0.05). The morphometric index increased in all organs (p < 0.05), and the heterophile/lymphocyte ratio (HLR) decreased by 50% (p < 0.05). Supplementing broilers with ß-mannanases in sorghum-soybean meal diets with phytases improved their performance and immunity.

Perceived Stress Is Directly Associated with Major Consumption of Sugar-Sweetened Beverages among Public University Students.

Stress is a condition that has been related to the development of risk behaviors for health such as sugar-sweetened beverages (SSBs) consumption. The aim of this study was to examine the link between SSBs consumption and perceived stress level in university students. This was an observational, cross-sectional and single-time-point study where the subjects were recruited as a non-probabilistic sample of first-year university students. The students reported their SSBs consumption through a validated questionnaire, as well as their perceived stress level, evaluated through the Cohen scale. Comparisons were made between the means of all variables. Factorial analysis of variance was conducted to explore the effect of the variables' interaction on the stress level. One-way analysis of variance was performed to assess differences between the sexes. Men consumed more SSBs (6101.17 ± 3772.50 mL/week) compared to women (4294.06 ± 3093.8 mL/week). However, women had higher scores of perceived stress and showed a strong association of stress with the SSBs consumption pattern (r and p-value). This study shows for the first time the association that exists between stress and SSBs consumption and indicates that it is related to sex in the young population.

Isothiocyanate-Rich Extracts from Cauliflower (Brassica oleracea Var. Botrytis) and Radish (Raphanus sativus) Inhibited Metabolic Activity and Induced ROS in Selected Human HCT116 and HT-29 Colorectal Cancer Cells.

Cruciferous vegetables such as cauliflower and radish contain isothiocyanates exhibiting chemoprotective effects in vitro and in vivo. This research aimed to assess the impact of cauliflower (CIE) and radish (RIE) isothiocyanate extracts on the metabolic activity, intracellular reactive oxygen species (ROS), and LDH production of selected human colorectal adenocarcinoma cells (HCT116 and HT-29 for early and late colon cancer development, respectively). Non-cancerous colon cells (CCD-33Co) were used as a cytotoxicity control. The CIE samples displayed the highest allyl isothiocyanate (AITC: 12.55 µg/g) contents, whereas RIE was the most abundant in benzyl isothiocyanate (BITC: 15.35 µg/g). Both extracts effectively inhibited HCT116 and HT-29 metabolic activity, but the CIE impact was higher than that of RIE on HCT116 (IC50: 0.56 mg/mL). Assays using the half-inhibitory concentrations (IC50) of all treatments, including AITC and BITC, displayed increased (p < 0.05) LDH (absorbance: 0.25-0.40 nm) and ROS release (1190-1697 relative fluorescence units) in both cell lines. BITC showed the highest in silico binding affinity with all the tested colorectal cancer molecular markers (NF-kB, ß-catenin, and NRF2-NFE2). The theoretical evaluation of AITC and BITC bioavailability showed high values for both compounds. The results indicate that CIE and RIE extracts display chemopreventive effects in vitro, but additional experiments are needed to validate their effects.

Hospitalized population diagnosed with Covid-19 in public health centers in the southeastern region of Greater Buenos Aires / [Población hospitalizada con diagnóstico de Covid-19 en los centros de salud públicos de la región sudeste del Gran Buenos Aires]

Introduction: The present work describes the clinical characteristics and interventions to minimize morbidity and mortality in hospitalized patients diagnosed with COVID-19. Methods: It is a prospective cohort investigation of patients who received a response from the Health Centers in the southeast region (RS) of the metropolitan area (AMBA) from April 8 to September 30, 2020. A Situation Room was used epidemiological with two monitoring and follow-up boards, one for bed management and the other for patient management. Results: During the analyzed period, 2,588 patients with confirmed COVID-19 diagnosis were admitted, 1,943 with suspected COVID-19 pathology, and 1,464 subjects with other pathologies. 55% of the patients were men and the mean age was 51 years. There were 82.8% patients with pre-existing diseases, hypertension and diabetes were the most frequent. 14% were hospitalized in the Intensive Care Unit. The mortality of the cohort was 15.05%, mortality was higher for men, with a mean age of 60 years, 92.65% had some pre-existing disease. Conclusion: Our cohort is younger than other published works. Older people, men, and people with comorbidities are at increased risk for COVID-19-related mortality. The public health system was able to respond to the demand without collapsing the hospital institutions.

Introducción: En el presente trabajo se describen las características clínicas y las intervenciones para minimizar la morbimortalidad en pacientes hospitalizados con diagnóstico de COVID-19. Métodos: Es una investigación de cohorte prospectiva de pacientes que recibieron respuesta de los Centros de Salud en la región sudeste (RS) del área metropolitana (AMBA) desde el 8 de abril hasta el 30 de septiembre de 2020. Se utilizó una Sala de Situación epidemiológica con dos tableros de monitoreo y seguimiento, uno de gestión de camas y otro de gestión de pacientes. Resultados: Durante el periodo analizado se internaron2.588pacientes con diagnóstico COVID-19 confirmados, 1.943 con sospecha de patología COVID-19, y 1.464sujetos con otras patologías. El 55% de los pacientes eran hombres y la edad media fue de 51 años. Hubo 82,8% pacientes con enfermedades preexistentes, hipertensión y diabetes fueron las más frecuentes. El 14% fue hospitalizado en la Unidad de Terapia Intensiva. La mortalidad de la cohorte fue del 15,05%, la mortalidad fue mayor para los hombres, con una edad media de 60 años, el 92,65% tenía alguna enfermedad preexistente. Conclusión: Nuestra cohorte es más joven que otros trabajos publicados. Las personas mayores, los hombres y las personas con comorbilidades tienen mayor riesgo de mortalidad relacionada con COVID-19. El sistema de salud público pudo responder a la demanda sin llegar a colapsar las instituciones hospitalarias.

Cardiac abnormalities in Trypanosoma cruzi seropositive patients in the State of Querétaro, México / Alteraciones cardiacas en una población seropositiva a Trypanosoma cruzi en Querétaro, México

Abstract: Background: Chagas disease is an endemic illness in the Americas and therefore constitutes a public health problem. An estimated 8 million people are infected and over 20 million live in areas at risk. In Mexico, the problem is under reported and no epidemiological data by the different States indicating true prevalence for this infection is available. During the chronic phase, 30% of infected patients may develop chagasic cardiomyopathy (CCM), characterized by different types of alterations of cardiac function. Objective: To describe cardiac abnormalities in Trypanosoma cruzi seropositive subjects in the endemic areas. Material and methods: This is a descriptive cross-sectional study with non-random sampling. In our project the endemic area was considered for Trypanosoma cruzi using the Epi Info statistical program (Stat Calc) to calculate the number of subjects to study by means of a sample of 1 033 subjects aged 2-90 years. Prior informed consent or parental consent, implementation of a survey, a 5 mL of blood sample free from anticoagulant was taken from the cubital vein to detect anti-Trypanosoma cruzi by ELISA, recombinant ELISA, hemagglutination indirect (HAI), indirect immunofluorescence (IFI) and Western blot (using the enzyme superoxide dismutase iron as antigen). Those subjects who were positive in two or more tests were chosen for electrocardiogram (EKG) and an echocardiogram (ECO) with portable devices. Results: Of the 1 033 participants, 84 between 6 and 88 years tested positive for Trypanosoma cruzi. In the analysis of data with echocardiograms and electrocardiograms, 47 subjects over 26 years (56%), presented right bundle branch block or left bundle block (RBBB/LBBB), changes in the diameters of the right ventricle or left ejection fraction accounting of 70%. In subjects under 26 years there were electrocardiographic changes (RBBB/LBBB). Conclusion: 8.13% were seropositive for Trypanosoma cruzi with ventricular conduction system and morphological alterations.

Resumen: Antecedentes: La enfermedad de Chagas es una patología endémica en las Américas, donde representa un problema de salud pública. Se estima que aproximadamente 8 millones de personas están infectadas y 20 millones viven en áreas de riesgo de infectarse. En México el problema está subestimado y se carece de datos epidemiológicos por estado del país que indiquen una prevalencia real de este padecimiento. Durante la fase crónica, el 30% de los pacientes infectados pueden desarrollar miocardiopatía chagásica (MCC), que se caracteriza por presentar diferentes alteraciones de la función cardiaca. Objetivo: Describir las alteraciones cardiacas en sujetos seropositivos para Trypanosoma cruzi de áreas endémicas. Material y métodos: Es un estudio con diseño transversal descriptivo, con muestra no probabilística. En nuestro proyecto, se consideró una zona endémica a Trypanosoma cruzi, mediante el programa estadístico Epi Info (Stat Calc), para estimar el número de sujetos a estudiar, obteniéndose una muestra de 1 033 sujetos de edades entre 2 a 90 años. Previo consentimiento informado, y aplicación de una encuesta, se puncionó la vena cubital, obteniéndose una muestra sanguínea de 5 mL, sin anticoagulante, para buscar anticuerpos anti-Trypanosoma cruzi mediante, ELISA, ELISA recombinante, hemaglutinación indirecta (HAI), inmunofluorescencia indirecta (IFI) y Western-Blot (usando la enzima superóxido dismutasa de hierro como antígeno). Los sujetos reactivos a dos o más pruebas fueron seleccionados para la realización de un electrocardiograma (EKG) y un ecocardiograma (ECO) con equipos portátiles Resultados: De los 1 033 participantes, 84 entre 6 a 88 años resultaron positivos para Trypanosoma cruzi. En el análisis de los hallazgos ecocardiográficos y electrocardiográficos en los 47 sujetos mayores de 26 años (56%) presentaron bloqueo de rama derecha o izquierda del haz de His (BRDHH/BRIHH). Conclusión: El 8.13% fueron seropositivos para Trypanosoma cruzi con cambios morfológicos ventriculares y del sistema de conducción del haz de His.

Anestesia subaracnoidea con ropivacaína hiperbárica versus bupivacaína hiperbárica asociadas a fentanilo para operación cesárea de urgencia. Ensayo clínico controlado con asignación aleatoria / Hyperbaric subarachnoid anesthesia with hyperbaric bupivacaine versus ropivacaine associated with fentanyl for emergency cesarean section. Randomized controlled clinical trial

Introducción: se comparó la anestesia subaracnoidea con ropivacaína hiperbárica y bupivacaína hiperbárica ambas asociadas a fentanilo en pacientes sometidas a operación cesárea de urgencia. Se utilizaron dosis menores a las estudiadas hasta el momento, pero más adecuadas a las recomendadas en la actualidad. Objetivos: se buscó comparar los dos tipos de anestésico local analizando su incidencia en el bloqueo motor, como en el comportamiento hemodinámico intraoperatorio posterior a la administración subaracnoidea de las soluciones en estudio, y describir la frecuencia de efectos adversos asociados al procedimiento. Método: el estudio realizado es un ensayo clínico controlado con asignación aleatoria, multicéntrico, en pacientes embarazadas de término (37 a 41 semanas de embarazo), ASA I o II, entre 18 y 40 años que recibieron bupivacaína hiperbárica 10 mg más fentanilo 20 mg (grupo 1) o ropivacaína hiperbárica 15 mg más fentanilo 20 mg (grupo 2), por vía intratecal. Todas las drogas utilizadas en el presente protocolo se encuentran aprobadas por la ANMAT. Evaluando bloqueo motor, hemodinamia y efectos adversos. Resultados: no hubo diferencias significativas en cuanto a edad, talla, peso, edad gestacional y tiempo quirúrgico. La ropivacaína –suministrada en dosis equipotentes en relación con la bupivacaínamostró un menor potencial en la prolongación del bloqueo motor. El grupo bupivacaína enseñó una mayor incidencia de hipotensión –con una significación de p= 0,02en relación con la ropivacaína. Estos hallazgos se confirman a través de las diferencias en cuanto a la administración de efedrina requerida para cada uno de los grupos: más de 25% mayor para el grupo bupivacaína. Otros efectos adversos no presentaron significancia estadística. Conclusión: tanto la ropivacaína como la bupivacaína proporcionan seguridad y calidad en pacientes sometidas a operación cesárea de urgencia...

Anestesia subaracnoidea con ropivacaína hiperbárica versus bupivacaína hiperbárica asociadas a fentanilo para operación cesárea de urgencia.: Ensayo clínico controlado con asignación aleatoria

RESUMEN Introducción: se comparó la anestesia subaracnoidea con ropivacaína hiperbárica y bupivacaína hiperbárica ambas asociadas a fentanilo en pacientes sometidas a operación cesárea de urgencia. Se utilizaron dosis menores a las estudiadas hasta el momento, pero más adecuadas a las recomendadas en la actualidad. Objetivos: se buscó comparar los dos tipos de anestésico local analizando su incidencia en el bloqueo motor, como en el comportamiento hemodinámico intraoperatorio posterior a la administración subaracnoidea de las soluciones en estudio, y describir la frecuencia de efectos adversos asociados al procedimiento. Método: el estudio realizado es un ensayo clínico controlado con asignación aleatoria, multicéntrico, en pacientes embarazadas de término (37 a 41 semanas de embarazo), ASA I o II, entre 18 y 40 años que recibieron bupivacaína hiperbárica 10 mg más fentanilo 20 mg (grupo 1) o ropivacaína hiperbárica 15 mg más fentanilo 20 mg (grupo 2), por vía intratecal. Todas las drogas utilizadas en el presente protocolo se encuentran aprobadas por la ANMAT. Evaluando bloqueo motor, hemodinamia y efectos adversos. Resultados: no hubo diferencias significativas en cuanto a edad, talla, peso, edad gestacional y tiempo quirúrgico. La ropivacaína -suministrada en dosis equipotentes en relación con la bupivacaína- mostró un menor potencial en la prolongación del bloqueo motor. El grupo bupivacaína enseñó una mayor incidencia de hipotensión -con una significación de p= 0,02- en relación con la ropivacaína. Estos hallazgos se confirman a través de las diferencias en cuanto a la administración de efedrina requerida para cada uno de los grupos: más de 25% mayor para el grupo bupivacaína. Otros efectos adversos no presentaron significancia estadística. Conclusión: tanto la ropivacaína como la bupivacaína proporcionan seguridad y calidad en pacientes sometidas a operación cesárea de urgencia. Sin embargo, la ropivacaína presenta mayor eficiencia debido a la menor incidencia de complicaciones hemodinámicas y a una recuperación más rápida del bloqueo motor.

SUMMARY Introduction: we compared hyperbaric ropivacaine with hyperbaric bupivacaine in subarachnoid anesthesia, both associated to fentanyl, in patients subject to urgent cesarean section. The doses used were lower than those studied so far but more adequate than those currently recommended. Objectives: we compared the two types of local anesthesia and analyzed their effect on motor block and on hemodynamic performance during the surgery after the subarachnoid administration of the solutions under study; at the same time we described the frequency of adverse effects associated to this procedure. Method: the study performed consisted of a multicenter randomized controlled clinical trial, in term pregnant patients (37 to 41 weeks pregnant), ASA I or II, between 18 and 40 years of age, who received intrathecal hyperbaric bupivacaine 10 mg plus 20 mcg fentanyl (Group 1) or intrathecal hyperbaric ropivacaine 15 mg plus 20 mcg fentanyl (Group 2). All drugs used in this protocol are approved by the A.N.M.A.T (National Administration of Drugs, Foods and Technology). Motor block, hemodynamics and adverse effects were evaluated. Results: there were no significant differences in terms of age, size, weight gestational age and surgical time. Ropivacaine -administered in equipotent doses in relation with bupivacaine- showed a lower potential in the prolongation of motor block. The bupivacaine group evidenced a higher incidence of hypotension - with a significant p= 0,02- compared to ropivacaine. These findings are confirmed by the differences in the administration of ephedrine required for each group: more than 25% higher for the bupivacaine group. Other adverse effects were not statistically significant. Conclusion: both ropivacaine and bupivacaine provide safety and quality in patients undergoing urgent cesarean section. However, ropivacaine proves to be more efficient due to lower incidence of hemodynamic complications and a rapid recovery from motor block.

RESUMO Introdução: comparou-se a anestesia subaracnóidea com ropivacaína hiperbárica e bupivacaína hiperbárica ambas associadas à fentanil em pacientes que foram à cesariana de urgência. Utilizaram-se doses menores as estudadas até o momento, porêm mais adequadas às recomendadas na atualidade. Objetivos: procurou-se comparar os dois tipos de anestésicos locais analisando o bloqueio motor, comportamento hemodinâmico intra-operatório posterior a administração subaracnóidea das soluções em estudo e descrever a frequência de efeitos adversos associados ao procedimento. Método: O estudo realizado é um ensaio clinico controlado e aleatório, multicêntrico, em pacientes grávidas a termo (37 a 41 semanas de gravidez), ASA I ou II, dentre 18 e 40 anos que receberam bupivacaina hiperbarica 10 mg + fentanil 20 µg (Grupo 1) ou ropivacaina hiperbarica 15 mg + fentanil 20 µg (Grupo 2), por via intratecal. Todas as drogas usadas no presente protocolo se encontram aprovadas pela A.N.M.A.T. avaliando o bloqueio motor, hemodinâmica e efeitos adversos. Resultados: não houve diferenças significativas quanto à idade, estatura, peso, idade gestacional e tempo cirúrgico. A ropivacaina (administrada em dose equipotente em relação a bupivacaina), mostrou um menor potencial no tempo de bloqueio motor. O grupo bupivacaina apresentou maior hipotensão (p =0.02) em relação a ropivacaina. Estes resultados se confirmam através da diferença de administração de efedrina requerida para cada um dos grupos: mais de 25 % a mais para o grupo bupivacaina. Outros efeitos adversos não aprestaram significância estatística. Conclusão: as duas soluções, ropivacaina e bupivacaina, proporcionaram segurança e qualidade em pacientes em que se realizou cesarianas de urgência. Entretanto, a ropivacaina apresentou maior eficiência devido à menor incidência de complicações hemodinâmicas e uma recuperação mais rápida do bloqueio motor.

Caracterización de células serotoninérgicas en el tejido cardiaco fetal / Characterization of serotonergic cells in fetal heart tissue

Objetivo: Caracterizar morfológica y bioquímicamente células productoras de serotonina durante el desarrollo del tejido cardiaco. Material y métodos: Se utilizaron ratas gestantes de la cepa Wistar. A los días 10, 12, 16 y 20 de gestación se obtuvieron los fetos por cesárea, a los cuales se les disecaron los corazones, que se fijaron para los ensayos de inmunohistoquímica para triptófano- 5-hidroxilasa (Tph), además se efectuó Western Blot para la enzima; se determinó la concentración de serotonina y la actividad de Tph por cromatografía de líquidos de alta resolución. Los resultados fueron analizados mediante U de Mann-Whitney, aceptando un nivel de significación de p < 0.05. Resultados: En los cortes de corazón fetal, desde el día 10 de gestación se observaron células inmunorreactivas para Tph, con metacromasia en su interior. Fibras nerviosas inmunorreactivas para la misma enzima que hacen contacto probablemente con las células serotoninérgicas. La actividad enzimática y la concentración de la serotonina aumentaron con la edad gestacional, además, se encontró la proteína enzimática por Western- Blot en el corazón fetal de 16 días de gestación. Conclusiones: Se demostró la presencia de células productoras de serotonina en el miocardio fetal, cuyo fenotipo corresponde a mastocitos cardiacos, lo cual sugiere que la serotonina puede ser importante en el desarrollo del tejido cardiaco y que también participa en los mecanismos fisiopatológicos de los defectos cardiacos estructurales o en la predisposición a enfermedades cardiovasculares en el adulto.

BACKGROUND: We undertook this study to present biochemical and morphological characterization of serotonergic cells during fetal heart development. METHODS: Wistar rats (10, 12, 16 and 20 days of gestation) were used. After obtaining the fetuses by Cesarean section, the hearts were removed and fixed for immunohistochemical assay of tryptophan-5-hydroxylase (Tph), in addition to Western blot for enzyme. Serotonin concentration and Tph were also evaluated with high-performance liquid chromatography. Results were analyzed using Mann-Whitney U test with a significance level of p <0.05. RESULTS: Metachromatic cells immunoreactive for Tph were observed from day 10 of gestation. Nerve fibers were also labeled, apparently making contact with serotonergic cells. Tph activity was measurable and serotonin levels increased with gestational age. The presence of Tph protein was confirmed by Western blot on day 16. CONCLUSIONS: The present results support the existence of cells located in the fetal myocardium, capable of producing serotonin whose phenotype belongs to cardiac mast cells. Their presence in this tissue strongly suggests that serotonin may play a key role in normal and abnormal development of cardiac tissue.

[Risk factors for cognitive and functional impairment in the elderly]. / Factores riesgo para deterioro cognitivo y funcional en el adulto mayor.

OBJECTIVE: To establish association between cognitive and functional impairment with economic, social and demographic factors, chronic disease and multidrug therapy in the aged patient. METHODS: A cross-sectional study was carried out in 2002 with 422 individuals 60 years old and older. A questionnaire for exploring social and economic conditions was applied. Folsteins' mini-mental exam and Katz, Lawton and Bronfman instruments were also applied. A bivariate analysis was performed to select variables for logistic regression (p = 0.20 in a chi(2)). Adjusted odds ratios were used to estimate association. RESULTS: There were 422 individuals interviewed, 178 were male and 244 female, with a mean age of 68 years. The factors associated with cognitive impairment were stroke, female gender, and social and economic level. For daily activities diabetes mellitus 2 and for daily instrumental activities the associations were female gender, visual impairment and multi-drug therapy, all with p < 0.05. CONCLUSIONS: Some factors can prevent the presence of cognitive and functional impairment in the elderly.

Characterization of serotonergic cells in fetal heart tissue.

BACKGROUND: We undertook this study to present biochemical and morphological characterization of serotonergic cells during fetal heart development. METHODS: Wistar rats (10, 12, 16 and 20 days of gestation) were used. After obtaining the fetuses by Cesarean section, the hearts were removed and fixed for immunohistochemical assay of tryptophan-5-hydroxylase (Tph), in addition to Western blot for enzyme. Serotonin concentration and Tph were also evaluated with high-performance liquid chromatography. Results were analyzed using Mann-Whitney U test with a significance level of p <0.05. RESULTS: Metachromatic cells immunoreactive for Tph were observed from day 10 of gestation. Nerve fibers were also labeled, apparently making contact with serotonergic cells. Tph activity was measurable and serotonin levels increased with gestational age. The presence of Tph protein was confirmed by Western blot on day 16. CONCLUSIONS: The present results support the existence of cells located in the fetal myocardium, capable of producing serotonin whose phenotype belongs to cardiac mast cells. Their presence in this tissue strongly suggests that serotonin may play a key role in normal and abnormal development of cardiac tissue.

Percepción del adulto mayor acerca del proceso de muerte / Perception by senior adults of dying process

Introducción: La muerte es un misterio inexplorado lleno de incógnitas, temores y angustias, es un proceso inherente a la vida, va de la mano en cada instante. Objetivo: Identificar la percepción del adulto mayor acerca del proceso de muerte. Metodología: Estudio transversal en adultos mayores de 60 años, en dos Unidades de Medicina Familiar. Se entrevistaron 121 adultos mayores seleccionados por cuota de los grupos de actividades recreativas. La percepción se midió a través de ocho Ítems (4 positivos y 4 negativos), posteriormente se reclasificó en positiva, indiferente y negativa. El plan de análisis incluyó frecuencias simples y regresión logística. Resultados: Predominó el sexo femenino 61 %, el promedio de edad fue de 67.97±5.61,32.2% correspondiente al grupo etéreo de 60 a 64 años, 50.4% casados y 57% con primaria completa. Los sentimientos que frecuentemente se presentaron de manera independiente fueron de paz y tristeza con 27.3%. El 43.8% de la población estudiada se concentró en la percepción negativa. El modelo que mejor se ajustó para explicar la percepción incluyó, vivir solo, no platicar con nadie en relación a la muerte, no estar preparado para el momento de morir y morir en el hospital (p<0.5). Conclusión: La percepción sobre la muerte puede modificarse en la medida que se tenga consciencia que su ocurrencia está totalmente garantizada, de manera paradójica, natural, única e individual. "Nadie más la puede vivir por nosotros".

Introduction: Death is an unexplored mystery full of incognita, fears, and anguish; it is an inherent process which goes along to life at every single moment. Objective: To identify the perception of the dying process by elderly. Methodology: Transversal study on elderly older than 60 years in two Family Medicine Facilities. 121 elderly selected proportionally from the groups of recreational activities were interviewed. The perception was measured through 8 items (4 positive and 4 negative). Afterward, they were reclassified as positive, indifferent, and negative. The analysis plan included simple frequencies and logistic regression. Results: Female gender was predominant 61 %; the average age was 67.97±5.61; 32.2% from the range 60 to 64 years old; 50.4% married and 57% with elementary school. Feelings showed frequently, on independently way were peace and sadness with 27.3%. The 43.8% of studied population was focused on the negative perception. The model that best fit to explain the perception included living by oneself, not talking with anybody regarding death, not being prepared for the decease moment, and dying in the hospital (p<0.5). Conclusions: The perception regarding death may be modified as long as everyone makes oneself conscious regarding the fact that the occurrence will be completely guaranteed, paradoxically, in a natural, unique, and individual way. "Nobody else might live our life instead ourselves".

[Effectiveness of a strategy in type 2 diabetic patient education in relation to metabolic control, nutrition and blood pressure]. / Control metabólico, estado nutricional y presión arterial de diabéticos tipo 2. Eficacia de una estrategia educativa.

BACKGROUND: diet is a main strategy treatment in the diabetic patient. It allows effective use of energy sources in the tissues, and to support apropiate glucose, protein and lipid serum levels. OBJECTIVE: to determine the effectiveness of a participative educational program on metabolic control of patients with newly diagnosed diabetes mellitus type 2 (less than 12 months). METHODS: cuasiexperimental design with newly diagnosed diabetic patients of both sexes and previously informed consent. Biochemical and anthropometric markers were analyzed at basal measure and then monthly for 6 months: lipids profile, glycemia, glycosilated hemoglobin, body mass index, and tricipital fold and hip circumference and blood pressure. Educational sessions were with a participative strategy. The diet was calculated according with their physical activitiy and patient's requirements. A subsequent adjustments were done to due according biochemical measures. RESULTS: of 16 patients, 81.2 % were female. The average age was 52 +/- 1 3 years. There were statistical significance values in glucose (28.7 %), glycosilated hemoglobin (35.4 %), cholesterol (12.6 %), high density lipoproteins (11.3 %), systolic (6.1 %) and diastolic (16.8 %) blood pressure, body mass index (6.7 %) and weight (6.9 %). CONCLUSIONS: it was demonstrated that a participative educational program is effective in the control of newly diagnosed type 2 diabetic patient when diet is individualized according to requirements.

[Self-esteem, family function, and school achievement of adolescents]. / Autoestima, funcionalidad familiar y rendimiento escolar en adolescentes.

OBJECTIVE: To determine the relationship between academic achievement, self-esteem and family function in adolescents. DESIGN: Descriptive, cross-sectional study. SETTING: State secondary school in Querétaro state, Mexico. PARTICIPANTS: Seventy-four adolescents of both sexes between the ages of 10 and 17, enrolled in a state secondary school. Two groups of 37 pupils were formed, chosen by simple randomized sampling according to high or low academic achievement. Participants were clinically healthy and prior informed consent for their participation was obtained. MAIN MEASUREMENTS: Self-esteem based on self-concept format A, family function based on FACES III and academic achievement based on the school evaluation scale. A descriptive statistical analysis and the chi2 test were used (P < .05). RESULTS: Pupils with high academic achievement had high self-esteem, 68% (P = .00007; OR, 7.55; 95% CI, 2.39-24.84); a functional family, 54% (P = .011); were mainly female, 73% (P = .018); age, 13 (60%) (P = .062); school in the morning, 95% (P = .000); and were in second grade, 46% (P = .026). Pupils with low academic achievement had low self-esteem, 78% (P = .00007; OR, 7.55; 95% CI, 2.39-24.84); came from borderline-function families, 43% (P = .47); were male, 54% (P = .018; OR, 3.18; 95% CI, 1.08-9.48); age 13, 38% (P = .062); in afternoon school, 76% (P = .00); and were in first grade, 43% (P = .144). Upon establishing a relationship between academic achievement and family dynamics, it was found that family dysfunction is a risk factor (OR, 6.67; 95% CI, 1.42-34). CONCLUSIONS: Low self-esteem and family dysfunction are risk factors for low academic achievement.

Enteropatía por sensibilidad al gluten: enfermedad celíaca / Gluten sensitive enteropathy: celiac disease

Se informan 14 pacientes con diagnóstico de enteropatía por sensibilidad al gluten (ESG) estudiados en el curso de 10 años. La mediana de la edad al momento del diagnóstico fue de 38 meses. Se realizó prueba de absorción de d-xilosa (cuantificación en suero a los 60 minutos) con valores por debajo de 15 mg/dL al momento del diagnóstico (normal 28.0 ñ 7.5 mg/dL), los que se normalizaron durante la recuperación (p < 0.01) y volvieron a ser subnormales posterior a la re-exposición al gluten en 8/8 casos (p < 0.01). La biopsia yeyunal peroral mostró atrofia grado IV en 11 y grado III en tres, con inversión de la relación villosidad-cripta. En la lámina propia se observó infiltrado inflamatório difuso de tipo linfoplasmocitario y en el epitelio fue de tipo cuboidal en la meyoria; hubo linfocitos intraepiteliales por arriba del promedio normal. Todos los pacientes tuvieron una evolución clínica satisfactoria con la dieta libre de gluten, ignorándose la evolución de uno de ellos por abandono de la consulta externa. Hubo correlación de los hallazgos clínicos histopatológicos y con la prueba de la d-xilosa en todos los casos; esta última alternativa de diagnóstico cuando no sea posible la obtención de la biopsia yeyunal en pacientes con sospecha de ESG