Baby led weaning, ¿seguro y eficaz? Una revisión narrativa / Baby led weaning, safe and effective? A narrative review

Introducción: el baby led weaning (BLW) o destete dirigido por el bebé es una técnica de alimentación complementaria que se ha puesto de moda en los últimos años gracias principalmente a su difusión por internet. Objetivo: determinar si dos de las principales críticas recibidas por este método (riesgo de atragantamiento y déficits nutricionales) son reales en comparación con otras técnicas de alimentación complementaria. Metodología: revisión narrativa de estudios de cohorte y diseños aleatorizados publicados en los últimos años en las bases de datos PubMed y Google Scholar. Resultados: once trabajos (siete relacionados con el atragantamiento y cuatro vinculados con los déficits nutricionales) fueron incluidos y analizados en esta revisión. Conclusiones: el BLW se presenta como una técnica de alimentación complementaria segura ya que no presenta más riesgo de atragantamiento que otras. En relación a su eficacia nutricional, no existe una evidencia sólida en relación a la exposición de alimentos ricos en hierro en niños que siguen el BLW con respecto a niños que siguen otra técnica (AU)

Introduction: the baby led weaning (BLW), or weaning directed by the baby, is a complementary feeding technique that has become fashionable in recent years thanks mainly to its diffusion on the internet. Objective: to determine if two of the main criticisms received by this method (risk of choking and nutritional deficits) are real compared to other complementary feeding techniques. Methodology: narrative review of cohort studies and randomized designs published in recent years in the PubMed and Google Scholar databases. Results: eleven works (seven related to choking and four related to nutritional deficits) were included and analyzed in this review. Conclusions: the BLW is presented as a safe complementary feeding technique since it presents no more choking risk than others. Regarding their nutritional efficacy, there is no solid evidence regarding the exposure of iron-rich foods in children who follow the BLW with respect to children who follow another technique (AU)

Referentes teóricos para la preparación pedagógica de los tutores de la carrera de Medicina / Theoretical Referents for the Pedagogical Training of Tutors in the Medical Major

Introducción: La necesidad de elevar la calidad en la Educación Superior en los planos científico y práctico ha dado lugar al surgimiento de la figura del tutor, al que se le ha establecido formalmente la tarea de guiar y acompañar a los estudiantes que se le asignan a lo largo de la carrera. Objetivo: Realizar un análisis sistemático sobre los referentes teóricos de la preparación pedagógica que permita el mejoramiento del desempeño profesional pedagógico de los tutores de la carrera de Medicina en la Atención Primaria de Salud. Métodos: Se revisó la literatura referente a la labor profesional y pedagógica del tutor como figura clave en el proceso de formación del estudiantado en las ciencias médicas durante los últimos 30 años. Fueron seleccionados un total de 50 artículos de literatura nacional e internacional en idiomas español e inglés. Resultados: Con la revisión de la literatura se pudo hacer el estudio de la figura del tutor en la educación médica, así como conceptualizar algunos términos necesarios para la comprensión de la enseñanza pedagógica. Conclusiones: Las regularidades encontradas en el proceso de tutoría enriquecen las ciencias de la educación médica en lo relacionado con la figura del tutor. La preparación pedagógica le permite a este profesional el mejoramiento del desempeño pedagógico y el desarrollo de su competencia para la formación integral de los estudiantes de la carrera de Medicina, lo que se manifiesta en la educación en el trabajo en los diferentes escenarios de la Atención Primaria de Salud(AU)

Introduction: The need to raise the quality of higher education in the scientific and practical levels has given rise to the figure of the tutor, who has been formally established the task of guiding and accompanying the students assigned throughout the major. Objective: To carry out a systematic analysis about the theoretical references of the pedagogical training that allows the improvement of the pedagogical professional performance of the tutors of the medical major in primary health care. Methods: The literature referring to the professional and pedagogical work of the tutor was reviewed as a key figure in the process of training students in medical sciences during the last 30 years. A total of 50 articles of national and international literature in Spanish and English languages were selected. Results: With the literature review, it was possible to study the figure of the tutor in medical education, as well as conceptualize some necessary terms to understand pedagogical teaching. Conclusions: The regularities found in the tutoring process enrich the sciences of medical education in relation to the figure of the tutor. The pedagogical training allows this professional to improve pedagogical performance and the development of his competence for the comprehensive formation of the students of the Medicine major, which is manifested in the education at work in the different settings of primary health care(AU)

Reduction of Preneoplastic Lesions Induced by 1,2-Dimethylhydrazine in Rat Colon by Maslinic Acid, a Pentacyclic Triterpene from Olea europaea L.

Maslinic acid triggers compelling antiproliferative and pro-apoptotic effects in different human cancer cell lines. Hence, the chemopreventive activity was investigated on early stages of carcinogenesis induced by 1,2-dimethylhydrazine (DMH) which is a model that mimics human sporadic colorectal cancer. Male Sprague-Dawley rats were orally administered either maslinic acid at 5, 10 or 25 mg/kg dissolved in (2-hydroxypropyl)-ß-cyclodextrin 20% (w/v) or the solvent for 49 days. After one week of treatment, animals received three weekly intraperitoneal injections of DMH at the dose of 20 mg/kg. Maslinic acid reduced the preneoplastic biomarkers, aberrant crypt foci (ACF) and mucin-depleted foci (MDF), already at 5 mg/kg in a 15% and 27%, respectively. The decline was significant at 25 mg/kg with decreases of 33% and 51%, respectively. Correlation analysis showed a significant association between the concentrations of maslinic acid found in the colon and the reduction of ACF (r = 0.999, P = 0.019) and MDF (r = 0.997, P = 0.049). The present findings demonstrate that maslinic acid induced an inhibition of the initiation stages of carcinogenesis. The assessment of this pentacyclic triterpene at the colon sheds light for designing diets with foods rich in maslinic acid to exert a chemopreventive activity in colorectal cancer.

Envejecimiento poblacional: su pertinencia en el currículo de las ciencias médicas / Population aging: its relevance in the medical sciences curriculum

Se analizan presupuestos teóricos sobre la relación entre la sociedad y la universidad y la pertinencia de la inserción de temas que demandan su presencia en los planes de estudio y proyectos de investigación de estas instituciones. Se contextualiza el envejecimiento poblacional como una de las responsabilidades sociales de obligada introducción en los programas de estudio de la carrera de Medicina, lo cual posibilita ratificar el carácter científico, tecnológico y humanístico de la educación superior cubana al asumir en sus procesos sustantivos la formación de un profesional integral, competente, con preparación científica para aceptar los retos de la modernidad, y con amplio desarrollo humanístico para vivir en una sociedad con una población envejecida. Los autores se propusieron como objetivo reflexionar acerca de la pertinencia del tema en el currículo de la carrera, como expresión del vínculo universidad-sociedad.

Theoretical foundations about the relationship between university and society and the pertinence of the insertion of topics that demand their presence in the study plans and research projects of these institutions are analyzed. Population aging is contextualized as one of the social responsibilities of necessary introduction in the study programs of the Medicine career, which makes it possible to ratify the scientific, technological and humanistic character of Cuban higher education by assuming in its core processes the formation of a comprehensive professional, competent, with scientific preparation to accept the challenges of modernity, and with ample humanistic development to live in a society with an aging population. The authors set out to reflect on the relevance of the topic in the career curriculum as an expression of the university-society link.

Predictive capacity of a multimarker strategy to determine short-term mortality in patients attending a hospital emergency Department for acute heart failure. BIO-EAHFE study.

OBJECTIVE: A multimarker strategy may help determine the prognosis of patients with acute heart failure (AHF). The aim of this study was to evaluate the capacity of mid-regional pro-adrenomedullin (MRproADM), copeptin and interleukin-6 (IL-6) combined with conventional clinical and biochemical markers to predict the 30-day mortality of patients with AHF. METHODS: We performed an observational, multicenter, prospective study of patients attended in the emergency department (ED) for AHF. We collected clinical and biochemical data as well as comorbidities and biomarker values. The endpoint variable was mortality at 7, 14, 30, 90 and 180days. The clinical model included: gender, age, blood pressure values, hemoglobin, sodium <135mmol/L and estimated glomerular filtration <60mL/min/1.73m2. We made receiver operating curves (ROC) curves, and areas under the curve (AUC) and survival analysis for each model and calculated the hazard ratio (HR) and its 95% confidence interval. RESULTS: A total of 547 individuals were included: 55.6% were women with a mean age of 79.9 (9.5) years. Copeptin alone showed greater discriminatory power for 30-mortality [AUC 0.70 (0.62-0.78)]. The AUC for 30-day mortality of the clinical model plus copeptin and NTproBNP was 0.75 (0.67-0.83), being better than the clinical model alone with 0.67 (0.58-0.76; p=0.19). The discriminatory power of the different biomarkers alone, in combination or together with the clinical model decreased over time. CONCLUSIONS: The combination of a clinical model with copeptin and NTproBNP, which are available in the ED, is able to prognose early mortality in patients with an episode of AHF.

Identification of gut-derived metabolites of maslinic acid, a bioactive compound from Olea europaea L.

SCOPE: Maslinic acid has been described to exert a chemopreventive activity in colon cancer. Hereby, we determined maslinic acid and its metabolites in the rat intestine previous oral administration as a first step in elucidating whether this triterpene might be used as a nutraceutical. METHODS AND RESULTS: Maslinic acid was orally administered at 1, 2, and 5 mg/kg to male Sprague-Dawley for 2 days. At 24 h after the last administration, the content of the duodenum and jejunum, ileum, cecum, and colon was collected and extracted with methanol 80% prior to LC-APCI-MS analysis. The developed method was validated providing suitable sensitivity (LOQ of 5 nM), good recovery (97.8 ± 3.6%), linear correlation, and appropriate precision (< 9%). Maslinic acid was detected in all the segments with higher concentrations in the distal part of the intestine. LC-APCI-LTQ-ORBITRAP-MS allowed the identification of 11 gut-derived metabolites that were formed by mono-, dihydroxylation, and dehydrogenation reactions. CONCLUSION: Maslinic acid undergoes phase I reactions resulting in a majority of monohydroxylated metabolites without the presence of phase II derivatives. The high concentration of maslinic acid achieved in the intestine suggests that it could exert a beneficial effect in the prevention of colon cancer.

Identification in Rat Plasma and Urine by Linear Trap Quadrupole-Orbitrap Mass Spectrometry of the Metabolites of Maslinic Acid, a Triterpene from Olives.

Maslinic acid is a natural pentacyclic triterpenoid widely distributed in edible and medicinal plants with health-promoting activities. The identification and quantification of its metabolites is a requirement for a better understanding of the biological effects of this triterpene. Therefore, maslinic acid was orally administered to Sprague-Dawley rats at a dose of 50 mg/kg of body weight. Blood and urine were withdrawn at 45 min. Samples were extracted with ethyl acetate prior to liquid chromatography-atmospheric pressure chemical ionization-linear trap quadrupole-Orbitrap (LC-APCI-LTQ-Orbitrap) analysis. Screening of plasma yielded four monohydroxylated derivatives (M1-M4), one monohydroxylated and dehydrogenated metabolite (M5), and two dihydroxylated and dehydrogenated compounds (M6 and M7). In urine, M1, M4, M5, and M6 were detected. Quantification by LC-APCI-mass spectrometry (MS) revealed maslinic acid as the prevalent compound in both plasma (81.8%) and urine (73.9%), which indicates that metabolism is low and mainly attributable to phase I reactions.

Maslinic acid, a natural phytoalexin-type triterpene from olives--a promising nutraceutical?

Maslinic acid is a pentacyclic triterpene found in a variety of natural sources, ranging from herbal remedies used in traditional Asian medicine to edible vegetables and fruits present in the Mediterranean diet. In recent years, several studies have proved that maslinic acid exerts a wide range of biological activities, i.e. antitumor, antidiabetic, antioxidant, cardioprotective, neuroprotective, antiparasitic and growth-stimulating. Experimental models used for the assessment of maslinic acid effects include established cell lines, which have been often used to elucidate the underlying mechanisms of action, and also animal models of different disorders, which have confirmed the effects of the triterpene in vivo. Overall, and supported by the lack of adverse effects in mice, the results provide evidence of the potential of maslinic acid as a nutraceutical, not only for health promotion, but also as a therapeutic adjuvant in the treatment of several disorders.

Population pharmacokinetics of maslinic acid, a triterpene from olives, after intravenous and oral administration in rats.

SCOPE: Maslinic acid is a bioactive minor component of Olea europaea L. with health-enhancing activities and no harmful effects. A pharmacokinetic (PK) study was conducted to determine its bioavailability for future studies of maslinic acid in humans. METHODS AND RESULTS: Intravenous (1 mg/kg) and oral (50 mg/kg) administrations to Sprague-Dawley rats were performed. Blood was obtained several times over 24 h and PKs were analyzed with NONMEM 7.2, applying a population approach. Body weight was included a priori in the model with fixed allometric exponents, based on allometric principles. Plasma concentrations versus time were best characterized by a two-open compartment model with first-order absorption and linear elimination. Maslinic acid had a relative rapid oral absorption with a peak concentration after administration at 0.51 h and a bioavailability of 5.13%. Once in bloodstream, it distributed extensively into tissues, since the central and peripheral distribution volumes were 8.41 L/70 kg and 63.6 L/70 kg, respectively. The clearance (8 L/h/70 kg) was related to unaltered renal excretion. The prediction-corrected visual predictive check confirmed its stability and predictive ability. CONCLUSION: An allometric population PK model was performed for maslinic acid, which adequately described and predicted plasma concentrations.

Liquid chromatography-mass spectrometry determination in plasma of maslinic acid, a bioactive compound from Olea europaea L.

Maslinic acid, a pentacyclic triterpene from Olea europaea L., exerts hypoglycemic, antioxidant, cardioprotective and antitumoral activities. Here, an LC-APCI-MS method to determine this compound in plasma is presented as a first step in pharmacokinetic studies. Maslinic acid was extracted from plasma with ethyl acetate and separated on a C18 column using a gradient elution of water and acetonitrile. The target ions were m/z 471.3 for maslinic acid and m/z 455.3 for I.S. The method was validated by the analysis of spiked plasma samples obtaining a linear correlation, a recovery of 99.0±0.9% and a quantification limit of 5 nM. The precision and accuracy were ≤8.38% and ≤4.82%, respectively. Finally, the method was verified by measuring the rat plasmatic concentrations 24h after the single oral administration of 10, 25 and 50 mg/kg of maslinic acid, thereby ensuring that the procedure is appropriate for its use in bioavailability studies.

Assessment of the safety of maslinic acid, a bioactive compound from Olea europaea L.

SCOPE: Maslinic acid, the main pentacyclic triterpene of the cuticle of Olea europaea L. fruit, has multiple beneficial effects on health, most notably antitumor and hypoglycemic properties. Notwithstanding the biological activities, there is a lack of knowledge about its safety. Therefore, the purpose of this study was to evaluate whether high doses of maslinic acid have harmful effects on Swiss CD-1 male mice. METHODS AND RESULTS: The single oral administration of the pentacyclic triterpene at 1000 mg/kg to mice did not produce any signs of morbidity or mortality. The repeated daily oral administration of 50 mg/kg of maslinic acid for 28 days did not induce any sign of toxicity during the experimental period. Body weight did not differ between mice that received the triterpene and the control group. Similarly, hematological and biochemical variables were not affected by the treatment. Histopathologic examination of the organs revealed that there were no differences between the control and the treated mice. CONCLUSION: Taken together the results obtained from the acute and the repeated intake of maslinic acid indicate that the compound does not exert any adverse effects on the variables tested in mice, thus suggesting a sufficient margin of safety for its putative use as a nutraceutical.

Fundamentos conceptuales y metodológicos para una enseñanza-aprendizaje desarrolladora de la disciplina Morfofisiología Humana / Conceptual and methodological fundamentals for a developing teaching-learning process in the human morphophysiology

Con la instauración del modelo del Policlínico Universitario, el estudiante debe asumir con independencia la adquisición de los conocimientos. En el estudio inicial que se hizo de esta problemática, como resultado de los controles a clases y talleres didácticos para facilitadores y tutores, se encontró que durante el proceso enseñanza-aprendizaje de la Fisiología y la Morfofisiología Humana en los diferentes modelos pedagógicos de la carrera de Medicina, existen aún rasgos de la llamada enseñanza "tradicional". Por todo lo anteriormente expuesto, existen insuficiencias en la concepción del proceso enseñanza-aprendizaje de la disciplina, por cuanto no están determinados aquellos fundamentos conceptuales y metodológicos a tomar en consideración durante su diseño y ejecución. Los objetivos de este estudio fueron sistematizar los fundamentos conceptuales y metodológicos para una enseñanza-aprendizaje desarrolladora de la disciplina Morfofisiología Humana, identificar los requerimientos metodológicos y los principios didácticos para la concepción del proceso enseñanza-aprendizaje en la disciplina Morfofisiología Humana. Se propusieron los requerimientos metodológicos y principios didácticos para una nueva concepción del proceso enseñanza-aprendizaje. Se concluyó que el carácter desarrollador del proceso estará determinado por la organización y dirección el proceso hacia un papel protagónico del estudiante en su actividad de aprendizaje. La estructuración de la enseñanza-aprendizaje hacia la búsqueda activa del conocimiento por el estudiante y el desarrollo de sus procesos lógicos del pensamiento constituye el punto de partida para la transformación y regulación de la actividad del profesor y de los estudiantes(AU)

The setting of the university polyclinics model implies that the student should independently acquire his/her own knowledge. In the initial study of this situation, as a result of the class supervision and the didactic workshops for facilitators and tutors, it was found that in the teaching-learning process of the Human Physiology and Morphology subject at several teaching models in the medical studies, there are still some traits of the so-called "traditional" teaching. For all the above-mentioned, the conception of the teaching-learning process of this discipline is still poor since those conceptual and methodological fundamentals for its design and implementation are not determined yet. The objectives of this study were to systematize the conceptual and methodological fundamentals for a developing teaching-learning in Human Morphology and to identify the methodological requirements and the didactic principles for this process. It was concluded that the developing character of this process will be determined by its organization and orientation towards a leading role of the student in the learning activity. The structuring of the teaching and learning process aimed at the active search of knowledge on the part of the students and the development of their logical processes of thinking is the starting point for changing and regulating the activity of both the student and the professor(AU)

Fundamentos conceptuales y metodológicos para una enseñanza-aprendizaje desarrolladora de la disciplina Morfofisiología Humana / Conceptual and methodological fundamentals for a developing teaching-learning process in the human morphophysiology

Con la instauración del modelo del Policlínico Universitario, el estudiante debe asumir con independencia la adquisición de los conocimientos. En el estudio inicial que se hizo de esta problemática, como resultado de los controles a clases y talleres didácticos para facilitadores y tutores, se encontró que durante el proceso enseñanza-aprendizaje de la Fisiología y la Morfofisiología Humana en los diferentes modelos pedagógicos de la carrera de Medicina, existen aún rasgos de la llamada enseñanza "tradicional". Por todo lo anteriormente expuesto, existen insuficiencias en la concepción del proceso enseñanza-aprendizaje de la disciplina, por cuanto no están determinados aquellos fundamentos conceptuales y metodológicos a tomar en consideración durante su diseño y ejecución. Los objetivos de este estudio fueron sistematizar los fundamentos conceptuales y metodológicos para una enseñanza-aprendizaje desarrolladora de la disciplina Morfofisiología Humana, identificar los requerimientos metodológicos y los principios didácticos para la concepción del proceso enseñanza-aprendizaje en la disciplina Morfofisiología Humana. Se propusieron los requerimientos metodológicos y principios didácticos para una nueva concepción del proceso enseñanza-aprendizaje. Se concluyó que el carácter desarrollador del proceso estará determinado por la organización y dirección el proceso hacia un papel protagónico del estudiante en su actividad de aprendizaje. La estructuración de la enseñanza-aprendizaje hacia la búsqueda activa del conocimiento por el estudiante y el desarrollo de sus procesos lógicos del pensamiento constituye el punto de partida para la transformación y regulación de la actividad del profesor y de los estudiantes.

The setting of the university polyclinics model implies that the student should independently acquire his/her own knowledge. In the initial study of this situation, as a result of the class supervision and the didactic workshops for facilitators and tutors, it was found that in the teaching-learning process of the Human Physiology and Morphology subject at several teaching models in the medical studies, there are still some traits of the so-called "traditional" teaching. For all the above-mentioned, the conception of the teaching-learning process of this discipline is still poor since those conceptual and methodological fundamentals for its design and implementation are not determined yet. The objectives of this study were to systematize the conceptual and methodological fundamentals for a developing teaching-learning in Human Morphology and to identify the methodological requirements and the didactic principles for this process. It was concluded that the developing character of this process will be determined by its organization and orientation towards a leading role of the student in the learning activity. The structuring of the teaching and learning process aimed at the active search of knowledge on the part of the students and the development of their logical processes of thinking is the starting point for changing and regulating the activity of both the student and the professor.