Presentación de un caso y revisión de literatura: anestesia total intravenosa en cirugía de estesioneuroblastoma / Presentation of a case and literature review: total intravenous anesthesia in estesioneuroblastoma surgery

Resumen: El estesioneuroblastoma es una neoplasia de las células del neuroepitelio olfatorio. Tiene una baja incidencia de 0.4 por cada millón de habitantes. Se caracteriza por síntomas como sinusitis, epistaxis, cefalea, discapacidad visual, obstrucción nasal, hiposmia y rinorrea. En este reporte se presenta el caso de un paciente masculino de 29 años con estesioneuroblastoma estadio Kadish C, quien fue programado para resección quirúrgica bajo anestesia total intravenosa con resultados satisfactorios durante el procedimiento quirúrgico.

Abstract: Esthesioneuroblastoma is a neoplasm of the olfactory neuroepithelium cells, it has a low incidence of 0.4 per million inhabitants. It is characterized by symptoms such as sinusitis, epistaxis, headache, visual impairment, nasal obstruction, hyposmia, and rhinorrhea. We present the case of a 29-year-old male patient with Kadish C stage esthesioneuroblastoma, who was scheduled for surgical resection under total intravenous anesthesia with satisfactory results during the surgical procedure.

A comprehensive review of the benefits of drinking craft beer: Role of phenolic content in health and possible potential of the alcoholic fraction.

Currently, there is greater production and consumption of craft beer due to its appreciated sensory characteristics. Unlike conventional beer, craft beers provide better health benefits due to their varied and high content of phenolic compounds (PCs) and also due to their alcohol content, but the latter is controversial. The purpose of this paper was to report on the alcoholic fraction and PCs present in craft beers and their influence on health. Despite the craft beer boom, there are few studies on the topic; there is a lot of field to explore. The countries with the most research are the United States > Italy > Brazil > United Kingdom > Spain. The type and amount of PCs in craft beers depends on the ingredients and strains used, as well as the brewing process. It was determined that it is healthier to be a moderate consumer of alcohol than to be a teetotaler or heavy drinker. Thus, studies in vitro, with animal models and clinical trials on cardiovascular and neurodegenerative diseases, cancer, diabetes and obesity, osteoporosis and even the immune system suggest the consumption of craft beer. However, more studies with more robust designs are required to obtain more generalizable and conclusive results. Finally, some challenges in the production of craft beer were detailed and some alternative solutions were mentioned.

[Herpes Zoster Ophthalmicus presenting as acute headache]. / Debut de herpes zóster oftálmico como cefalea intensa.

Herpes Zoster (HZ) is rare in childhood and is defined as the reactivation of the latent varicella-zoster virus in patients who have previously been infected with varicella. When the virus affects the ophthal mic nerve it is called herpes zoster ophthalmicus (HZO) and it can produce, among other symptoms, acute headache, so it must be considered as a differential diagnosis. OBJECTIVE: To describe a clinical case of HZO in a pediatric patient and to recognize its clinical manifestations and their importance in the differential diagnosis of acute headache in children. CLINICAL CASE: Immunocompetent 11-year- old girl, vaccinated according to the recommended immunization schedule, excluding chickenpox vaccine due to past infection, presented to the emergency department (ED) with a 5-day long uni lateral headache. After 36 hours of hospitalization, she presented vesicular cutaneous lesions in her forehead, left upper eyelid, and nose. Positive fluorescein stain dendritic corneal lesions were iden tified in the ophthalmic exam. Antiviral systemic and topic therapy were set, obtaining an initial good response, but later she presented complications such as postherpetic neuralgia one month after hospital discharge and several postherpetic neuralgia episodes despite treatment with gabapentin in addition to two herpes zoster ophthalmicus relapses with acute keratouveitis one year after the initial episode. CONCLUSION: It is essential to include HZO in the differential diagnosis of acute headache, especially when presented unilaterally and/or with ocular symptoms, regardless of the presence of cutaneous lesions, and even more so in patients with history of chickenpox infection. Those patients who were vaccinated against this disease in their childhood will benefit from at least partial protection against HZO.

Problemas diagnósticos de la intoxicación por cianuro derivada de la ingesta de almendras amargas / Difficulties in the diagnosis of cyanide poisoning following consumption of bitter almonds

Los casos de intoxicación por ingesta de cianuro en niños son raros. La almendra amarga contiene amigdalina y se descompone tras su ingesta, produciendo ácido cianhídrico que bloquea el uso celular del oxígeno, lo que ocasiona afectación de órganos diana. Presentamos un caso de sospecha de intoxicación por cianuro en un niño de 3 años tras ingesta de almendras amargas. El diagnóstico de sospecha se estableció con base en la clínica gastrointestinal y neurológica y en el hallazgo gasométrico de acidosis metabólica con hiperlactacidemia y anión GAP aumentado, lo cual es muy específico de esta entidad. No se pudieron determinar los niveles de cianuro en ningún laboratorio habitual de España, tampoco en el Instituto Toxicológico Nacional y Ciencias Forenses sin disponer de orden judicial. Ante la clínica inespecífica y las dificultades para determinar la concentración de cianuro en sangre, debe ofrecerse tratamiento precoz y antídoto específico ante la sospecha de intoxicación por cianuro (AU)

Cyanide poisoning in children is rare. Bitter almonds contain amygdalin, and hydrolysis of this compound following ingestion yields hydrocyanic acid, which inhibits cellular oxygen use and therefore causes target organ damage. We present a case of suspected cyanide poisoning in a child aged 3 years after the ingestion of bitter almonds. The diagnosis was based on the gastrointestinal and neurological symptoms and the detection of metabolic acidosis with hyperlacticaemia and a high anion gap, which are highly specific for this type of poisoning. Blood cyanide levels could not be measured in any clinical laboratory in Spain, and it was also not possible to do it in the National Institute of Toxicology and Forensic Sciences without a court order. Given the non-specific symptoms and the difficulty of measuring the concentration of cyanide in blood, treatment should be initiated early with administration of specific antidote if cyanide poisoning is suspected. (AU)

Size Effects in Single- and Few-Layer MoS2 Nanoflakes: Impact on Raman Phonons and Photoluminescence.

The high optical absorption and emission of bidimensional MoS2 are fundamental properties for optoelectronic and biodetection applications and the opportunity to retain these properties in high quality nano-sized flakes would bring further possibilities. Here, a large set of single-layer and few-layer (2-3 layers) MoS2 flakes with size in the range from 10 nm to 20 µm are obtained on sapphire by vapor deposition techniques and evaluated combining the information from the Raman phonons with photoluminescence (PL) and absorption bands. The flakes have triangular shape and are found to be progressively relaxed from the tensile strain imposed by the sapphire substrate as their size is reduced. An increasing hole doping as size decreases is deduced from the blue shift of the A1g phonon, related to charge transfer from adsorbed oxygen. No clear correlation is observed between defects density and size, therefore, doping would be favored by the preferential adsorption of oxygen at the edges of the flakes, being progressively more important as the edge/surface ratio is incremented. This hole doping also produces a shift of the PL band to higher energies, up to 60 meV. The PL intensity is not found to be correlated to the size but to the presence of defects. The trends with size for single-layer and for 2-3 layer samples are found to be similar and the synthesis method does not influence PL efficiency which remains high down to 40 nm being thus promising for nanoscale photonics.

Colour Preferences in Relation to Diet in Chimpanzees(Pan troglodytes), Gorillas (Gorilla gorilla) and Mandrills (Mandrillus sphinx).

Although trichromatic colour vision has been extensively studied as it grants significant advantages for Old World primates, it is unknown which selective pressures were behind the trait's evolution. The leading hypothesis would be that colour vision arose as a foraging adaptation because it allowed individuals to spot food more efficiently. To test this, we exposed 3 chimpanzees (Pan troglodytes), 5 gorillas (Gorilla gorilla) and 3 mandrills (Mandrillus sphinx) to colour cardboard plates to assess whether colours related to diet were the most preferred. The experimental setting was divided into two phases. During the first, animals were provided with colour cardboard plates of only 1 colour per data collection session. The order of colour presentation was randomly determined: white, black, yellow, green and red. In phase 2, primates were simultaneously provided with cardboard plates of all colours. Behavioural interactions with plates were measured using a one-zero group focal sampling (10-s sampling intervals and 20-min observation periods). Results showed that when animals were exposed to only 1 colour at a time, they exhibited different colour preferences depending on the species considered. Chimpanzees preferred red and yellow, the colours linked to fruits, while gorillas selected red and white. Mandrills exhibited fewer differences between colour preferences, with red being the most selected. Furthermore, when all colours were simultaneously provided, individuals chose colours related to diet over black and white. Although there were clear individual differences, our results support that trichromatic colour vision is an advantage in detecting and selecting red items. In the wild, it could be important in the detection of reddish fruits and leaves.

Raman and Fluorescence Enhancement Approaches in Graphene-Based Platforms for Optical Sensing and Imaging.

The search for novel platforms and metamaterials for the enhancement of optical and particularly Raman signals is still an objective since optical techniques offer affordable, noninvasive methods with high spatial resolution and penetration depth adequate to detect and image a large variety of systems, from 2D materials to molecules in complex media and tissues. Definitely, plasmonic materials produce the most efficient enhancement through the surface-enhanced Raman scattering (SERS) process, allowing single-molecule detection, and are the most studied ones. Here we focus on less explored aspects of SERS such as the role of the inter-nanoparticle (NP) distance and the ultra-small NP size limit (down to a few nm) and on novel approaches involving graphene and graphene-related materials. The issues on reproducibility and homogeneity for the quantification of the probe molecules will also be discussed. Other light enhancement mechanisms, in particular resonant and interference Raman scatterings, as well as the platforms that allow combining several of them, are presented in this review with a special focus on the possibilities that graphene offers for the design and fabrication of novel architectures. Recent fluorescence enhancement platforms and strategies, so important for bio-detection and imaging, are reviewed as well as the relevance of graphene oxide and graphene/carbon nanodots in the field.

Raman amplification in the ultra-small limit of Ag nanoparticles on SiO2 and graphene: Size and inter-particle distance effects.

Size, shape and hot spots are crucial to optimize Raman amplification from metallic nanoparticle (NPs). The amplification from radius = 1.8 ± 0.4 nm ultra-small silver NPs was explored. Increasing NP density redshifts and widens their plasmon that, according to simulations for NPs arrays, is originated by the reduction of the interparticle distance, d, becoming remarkable for d ≤ R. Inter-particle interaction red-shifts (N130 nm) and widens (N90 nm) the standard plasmon of non-interacting spherical particles. Graphene partly delocalizes the carriers enhancing the NIR spectral weight. Raman amplification of graphene phonons is moderate and depends smoothly on d while that of Rhodamine 6G (R6G) varies almost exponentially due to their location at hotspots that depend strongly on d. The experimental correlation between amplification and plasmon position is well reproduced by simulations. The amplification originated by the ultra-small NPs is compared to that of larger particles, granular silver films with 7 < R < 15 nm grains, with similar extinction values. The amplification is found to be larger for the 1.8nm NPs due to the higher surface/volume ration that allows higher density of hot spots. It is demonstrated that Raman amplification can be efficiently increased by depositing low density layers of ultra-small NPs on top of granular films.

Breast cancer biomarker detection through the photoluminescence of epitaxial monolayer MoS2 flakes.

In this work we report on the characterization and biological functionalization of 2D MoS2 flakes, epitaxially grown on sapphire, to develop an optical biosensor for the breast cancer biomarker miRNA21. The MoS2 flakes were modified with a thiolated DNA probe complementary to the target biomarker. Based on the photoluminescence of MoS2, the hybridization events were analyzed for the target (miRNA21c) and the control non-complementary sequence (miRNA21nc). A specific redshift was observed for the hybridization with miRNA21c, but not for the control, demonstrating the biomarker recognition via PL. The homogeneity of these MoS2 platforms was verified with microscopic maps. The detailed spectroscopic analysis of the spectra reveals changes in the trion to excitation ratio, being the redshift after the hybridization ascribed to both peaks. The results demonstrate the benefits of optical biosensors based on MoS2 monolayer for future commercial devices.

Supported Ultra-Thin Alumina Membranes with Graphene as Efficient Interference Enhanced Raman Scattering Platforms for Sensing.

The detection of Raman signals from diluted molecules or biomaterials in complex media is still a challenge. Besides the widely studied Raman enhancement by nanoparticle plasmons, interference mechanisms provide an interesting option. A novel approach for amplification platforms based on supported thin alumina membranes was designed and fabricated to optimize the interference processes. The dielectric layer is the extremely thin alumina membrane itself and, its metallic aluminum support, the reflecting medium. A CVD (chemical vapor deposition) single-layer graphene is transferred on the membrane to serve as substrate to deposit the analyte. Experimental results and simulations of the interference processes were employed to determine the relevant parameters of the structure to optimize the Raman enhancement factor (E.F.). Highly homogeneous E.F. over the platform surface are obtained, typically 370 ± (5%), for membranes with ~100 nm pore depth, ~18 nm pore diameter and the complete elimination of the Al2O3 bottom barrier layer. The combined surface enhanced Raman scattering (SERS) and interference amplification is also demonstrated by depositing ultra-small silver nanoparticles. This new approach to amplify the Raman signal of analytes is easily obtained, low-cost and robust with useful enhancement factors (~400) and allows only interference or combined enhancement mechanisms, depending on the analyte requirements.

Metabolic syndrome and urolithiasis: a case-control study. / Síndrome metabólico y litiasis urinaria en adultos: estudio de casos y controles.

BACKGROUND: The estimate for metabolic syndrome (MS) worldwide is above 20%; MS it has been linked to urolithiasis. OBJECTIVE: To determine the association between the components of MS as risk factors for urolithiasis in the adult population of Yucatán, Mexico. METHOD: Case-control study with a sample size of 85 subjects per group, paired by age and sex; patients with urolithiasis (stones > 5 mm) and controls without urolithiasis. Diagnosis was verified by ultrasound. Blood pressure, weight, height, waist circumference, serum triglycerides, HDL cholesterol, glycemia, and urinalysis were determined. International Diabetes Federation criteria were used for the MS diagnosis. Subjects with kidney damage, endocrinopathies and consumption of steroid drugs were excluded. Descriptive statistics, association analysis and risk calculation were performed. RESULTS: One hundred and seventy subjects were included, 83.5% were women and 52.4% presented MS. Was observed an association between urolithiasis and MS (odds ratio [OR]: 2.7; 95% confidence interval [95% CI]: 1.4-5.1; p = 0.001), hypertriglyceridemia (OR: 1.9; 95% CI: 1.06-3.66; p = 0.021) and high blood pressure (OR: 2.5; 95% CI: 1.2-4.8; p = 0.004). The analysis showed that a higher quantity of MS components increases the risk of urolithiasis (p = 0.004). CONCLUSIONS: MS increased in 2.7-fold the risk of urolithiasis. Hypertriglyceridemia and high blood pressure are MS components that increased the risk of urolithiasis.

INTRODUCCIÓN: El síndrome metabólico (SM) tiene una prevalencia mayor del 20% en todo el mundo, y se le ha relacionado con la urolitiasis. OBJETIVO: Determinar la asociación entre los componentes del SM como factores de riesgo para urolitiasis en población adulta de Yucatán, México. MÉTODO: Estudio de casos y controles con un tamaño muestral de 85 sujetos por grupo, pareados por edad y sexo. Los casos con urolitiasis (litos > 5 mm) y los controles sin urolitiasis fueron comprobados mediante ecografía. Se determinaron la presión arterial, el peso, la talla, la circunferencia de la cintura, la trigliceridemia, el colesterol-HDL y la glucemia; se realizó uroanálisis. Para el diagnóstico de SM se siguieron los criterios de la Federación Internacional de Diabetes. Se excluyeron los sujetos con daño renal, endocrinopatías y consumo de medicamentos esteroideos. Se realizaron estadística descriptiva, análisis de asociación y cálculo del riesgo. RESULTADOS: De las 170 personas incluidas, el 83.5% fueron mujeres y el 52.4% presentaban SM. Se observó asociación entre la urolitiasis y el SM (razón de momios [RM]: 2.7; intervalo de confianza del 95% [IC95%]: 1.4-5.1; p = 0.001), la hipertrigliceridemia (RM: 1.9; IC95%: 1.06-3.66; p = 0.021) y la hipertensión arterial (RM: 2.5; IC95%: 1.2-4.8; p = 0.004). El análisis mostró que, a más cantidad de componentes del SM, mayor es el riesgo de urolitiasis (p = 0.004). CONCLUSIONES: El SM incrementa 2.7 veces el riesgo de urolitiasis; de los componentes del SM, la hipertrigliceridemia y la hipertensión incrementan el riesgo de urolitiasis.

Granuloma de Majocchi / Majocchi granuloma

No disponible

The Cyclooxigenase-2 Inhibitor Parecoxib Prevents Epidermal Dysplasia in HPV16-Transgenic Mice: Efficacy and Safety Observations.

Carcinogenesis induced by high-risk human papillomavirus (HPV) involves inflammatory phenomena, partially mediated by cyclooxigenase-2. In pre-clinical models of HPV-induced cancer, cyclooxygenase-2 inhibitors have shown significant efficacy, but also considerable toxicity. This study addresses the chemopreventive effect and hepatic toxicity of a specific cyclooxigensase-2 inhibitor, parecoxib, in HPV16-transgenic mice. Forty-three 20 weeks-old female mice were divided into four groups: I (HPV16-/-, n = 10, parecoxib-treated); II (HPV16-/- n = 11, untreated); III (HPV16+/-, n = 11, parecoxib-treated) and IV (HPV16+/-, n = 11, untreated). Parecoxib (5.0 mg/kg once daily) or vehicle was administered intraperitoneally for 22 consecutive days. Skin lesions were classified histologically. Toxicological endpoints included genotoxic parameters, hepatic oxidative stress, transaminases and histology. Parecoxib completely prevented the onset of epidermal dysplasia in HPV16+/- treated animals (0% versus 64% in HPV16+/- untreated, p = 0.027). Parecoxib decreases lipid peroxidation (LPO) and superoxide dismutase (SOD) activity and increases the GSH:GSSG ratio in HPV16+/- treated animals meaning that oxidative stress is lower. Parecoxib increased genotoxic stress parameters in wild-type and HPV16-transgenic mice, but didn't modify histological or biochemical hepatic parameters. These results indicate that parecoxib has chemopreventive effects against HPV16-induced lesions while maintaining an acceptable toxicological profile in this model.

Determinantes sociales de diabetes mellitus tipo 2 en usuarios de 35 a 55 años que consultan en la Unidad Comunitaria de Salud Familiar de Zaragoza Febrero a Septiembre de 2019 / Social determinants of type 2 diabetes mellitus in users aged 35 to 55 who consult at the Community Family Health Unit of Zaragoza February to September 2019

Se identifican y analizan desde una perspectiva social como los estilos de vida, factores de riesgo y las condiciones de vida influyen en el aparecimiento de Diabetes Mellitus Tipo 2 (DMT2). Estudio cuantitativo descriptivo transversal utilizando la técnica de encuesta, a través de un cuestionario se obtuvo la información sobre los estilos de vida, factores de riesgo y las condiciones de vida, sistematizándose en frecuencias de respuesta para analizar el proceso salud- enfermedad, desde la perspectiva de la determinación social. En cuanto a las condiciones de vida población urbana, predominio femenino, nivel de escolaridad de primaria, disponibilidad de servicios básicos, mínima identificación de la existencia de un club de diabéticos en el establecimiento de salud, solo la mitad de la población estaría interesada en un club educativo, si identifican material educativo. Los factores de riesgo identificados: antecedentes de familiares de DMT2, desconocimiento de las complicaciones de la DMT2, presión arterial alta en un 5%, el control del peso no es una prioridad. Los estilos de vida predominio sedentario, ocupación laboral de servicios, la práctica de actividad física no es prioridad, la principal barrera es la no importancia del mismo, los hábitos alimenticios incluyen consumo frecuente de pan dulce-frituras, alto consumo de bebidas azucaradas. Limitado impacto de las intervenciones educativas del establecimiento de salud, la DMT2 tiene un fuerte componente en los determinantes sociales.

Variabilidad técnica de curación y cuidado del catéter de vena central en pacientes ingresados en el servicio de medicina interna del Hospital Nacional San Rafael, Febrero a Mayo 2017 / Technical variability of healing and care of the central vein catheter in patients admitted to the internal medicine service of the San Rafael National Hospital, February to May 2017

Propósito: Realizar una propuesta de mejora que permita estandarizar el procedimiento en el servicio de Medicina Interna del Hospital Nacional San Rafael. Material y métodos: El estudio fue de tipo descriptivo con enfoque cuantitativo y se utilizaron: el cuestionario, guía de entrevista y lista de chequeo para identificar conocimiento y verificar la aplicación de la técnica de curación y cuidado del Catéter Venoso Central. La información obtenida se tabuló en matrices de frecuencia y se procedió al análisis y discusión de resultados. Resultado: deficiente regulación no se encontraron lineamientos escritos, variación en: frecuencia de curación del Catéter Venoso Central, aplicación de la técnica de curación, manejo de material estéril, y uso de la vestimenta requerida. En cuanto a insumos el personal cuenta con lo necesario para el procedimiento. Conclusiones: Los factores que influyeron en la Variabilidad de la técnica de curación y cuidado del Catéter Venoso Central fueron: aplicación de la técnica; no existe un protocolo escrito que defina como se realizar el procedimiento. Recomendaciones: Creación de documentos regulatorios a nivel institucional y Ministerio de Salud para la técnica de curación y cuidado de Catéter Venoso Central, planes de capacitación para el personal operativo, instrumentos de monitoreo unificado, para disminuir riesgos en la seguridad del paciente y mejorar la calidad en los procesos de atención

Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients.

OBJECTIVE: The aim of this study was to describe relationships between oral status, dysphagia and malnutrition in a hospitalised older people. BACKGROUND: Undernutrition in older people is a major concern in geriatric hospital wards. Different factors can modify nutritional status like dysphagia or oral status. MATERIALS AND METHODS: About 159 consecutive inpatients (108 women, 51 men) were examined. Comprehensive gerontological data at baseline and nutritional status according to BMI, MNA and serum albumin concentration, dependency according to ADL scores, dietary intake, swallowing capacities and oral status were collected. Swallowing capacities and dietary intake were reassessed 1 week after. RESULTS: Mean age was 85.28 (SD 5.68). Seventy-seven patients were malnourished (MNA) and 34 had dysphagia. Oral treatment was necessary in 142 patients (89.30% of all population). Candidiasis was present in 17 patients and salivary flow reduction in 50. Patients with dysphagia had the lowest dietary intake. After 1 week, patients with dysphagia were retested and dysphagia had abated in three of them. Dysphagia and undernutrition were associated (p < 0.001), and both were related to candidiasis (p < 0.001 and p < 0.01). Dysphagia was also related to salivary hypofunction (p < 0.001), loss of posterior occluding pairs (POPs; p = 0.014), oral self-care dependency (p < 0.001) and self-feeding dependency (p < 0.001). Salivary hypofunction was related to candidiasis (p < 0.001) and loss of POPs (p < 0.05), and candidiasis to loss of POPs (p < 0.01). CONCLUSION: Although no causality can be demonstrated, poor oral health was strongly associated with malnutrition, emphasising the importance to develop oral care strategies and to incorporate a dental examination into comprehensive gerontological assessment.

[Relationship between body fat and creatinine clearence in adults with and without diabetes mellitus]. / Relación entre grasa corporal y depuración de creatinina en adultos con y sin diabetes mellitus.

BACKGROUND: Obesity is a risk factor for renal damage. This study aimed to determine the relationship between body fat percent and creatinine clearance in adult patients with and without type 2 diabetes mellitus (T2DM). METHODS: An observational prospective cross-correlation study was carried out among adults with and without T2DM between 18 and 60 years of age. It was determined the time of evolution with T2DM, as well as fat percentage (FP), body mass index (BMI), creatinine clearance (Cockroft-Gault [CrCCG]), glycemia and micro/macroalbuminuria. The correlation between CrCCG and FP was determined by Spearman's test. RESULTS: 174 subjects were included in this study. Obesity by BMI and FP in subjects with and without T2DM was similar. Of the studied subjects, 12.6 % didn't have kidney damage and 50.7 % had increased risk of renal disease; the frequencies for stages 1-4 of kidney damage were 12.0, 20.1, 4.0 and 0.6 %, respectively. Spearman's test showed a direct relationship between FP and CrCCG, higher in diabetics (r = 0.418, p < 0.0001) than in non-diabetics (p = 0.327, p < 0.0001). CONCLUSIONS: The FP was correlated directly with the CrCCG in subjects with and without T2DM; therefore, we can conclude that the greater the kidney damage, the smaller the fat porcentage in the study sample.

Introducción: la obesidad es un factor de riesgo para daño renal. El objetivo del estudio fue conocer la relación entre el porcentaje de grasa corporal (PG) y la depuración de creatinina en pacientes adultos con y sin diabetes mellitus 2 (DM2). Métodos: estudio observacional, prospectivo, transversal de correlación. Se evaluaron adultos entre 18 y 60 años, con y sin DM2. Se determinó el tiempo de evolución con DM2, el PG, el índice de masa corporal (IMC), la depuración de creatinina (Cockroft-Gault [DCrCG]), la glicemia y la micro/macroalbuminuria. Mediante la prueba de Spearman se determinó la correlación entre DCrCG y PG. Resultados: se incluyeron 174 sujetos. La frecuencia de obesidad por IMC y PG en sujetos con y sin DM2 fue similar. El 12.6 % no tuvo daño renal y el 50.7 % tuvo riesgo aumentado de enfermedad renal. Las frecuencias para los estadios 1 a 4 fueron 12.0, 20.1, 4.0 y 0.6 %, de forma respectiva. La prueba de Spearman mostró relación directa entre PG y DCrCG, mayor en diabéticos (r = 0.418 frente a r = 0.327, p < 0.0001). Conclusiones: el PG corporal se correlacionó en forma directa con la DCrCG en sujetos con y sin DM2; se infiere que a mayor daño renal, menor grasa tiene la población evaluada.

Efficiency at the resident's level of the NABUCCOD nutrition and oral health care training program in nursing homes.

OBJECTIVES: To assess the impact of a nutrition and oral care training program on nursing home (NH) policies and residents. DESIGN: Cross-sectional surveys before/after intervention. PARTICIPANTS: One hundred thirty-eight NHs participated in the initial training. INTERVENTION: Training sessions for staff, director, and medical practitioners for nutritional and oral care in NH. MEASUREMENTS: Two waves of self-assessments over a 6- to 8-month interval described NH policies (Institution questionnaire), quality of care in newly admitted residents (Admission questionnaire), and in those present for more than 6 months (Stay questionnaire). RESULTS: Questionnaires were completed at both waves in 24 NHs (17.8%) for Institution, in 42 NHs including 646 residents for Admission, and in 34 NHs including 287 residents for Stay. There was no significant difference in bed capacity and resident dependency between NHs, which performed both assessments, and nonresponders. No change was observed for Institution. Malnutrition screening was carried out in almost all residents. Two risk factors were better screened after training: pressure ulcers (39.4% to 49.1%, P = .014) and dysphagia (33.5% to 41.0%, P = .049). Oral examination improved quantitatively (38.5% of residents to 48.5%) and qualitatively: risk factors for malnutrition and dysphagia were better sought (loss of posterior teeth (P < .0001), asialia (P < .0001), and candidosis (P = .002)). Similar improvements were seen in Stay assessments. Actions to counteract weight loss or low dietary intake records were not found in one third of resident records. CONCLUSIONS: Training program improved staff knowledge with positive results at the level of residents but no significant changes were seen within NH policies.

[Changes in body composition according to kidney damage in patients with type 2 diabetes mellitus]. / Modificaciones en la composición corporal según el daño renal en pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To know the relationship between total body composition and the stage of kidney damage, according to the K/DOQI classification, in patients with type 2 diabetes mellitus (T2DM). METHODS: Under a correlation design, adults with T2DM were studied. Age, evolution time, fat and lean mass, fat percentage, total water, body index mass (BMI), creatinine clearance by Cockroft-Gault (CrCCG), glucose, HbA1c, proteinuria and microalbuminuria were determined. T test to compare independent means and Spearman correlation were used. RESULTS: The study included 60 men (23.4%) and 196 women (76.6%). There were no differences by gender when comparing age, BMI, duration of T2DM, blood glucose and HbA1c. The analysis showed a direct relationship between BMI (r = 0.281), the amount of fat mass (r = 0.360), lean tissue (r = 0.158), and water (r = 0.176) with the CrCCG (p < 0.0001). The biggest change in body composition, due to fat mass, was observed in chronic kidney disease stages 1-3, in which BMI had a good correlation with fat mass (r = 0.80, p < 0.001). CONCLUSIONS: Fat mass is inversely related to the stage of kidney damage in patients with T2DM.