[Body profile and physical and cognitive function by age in ambulatory elderly women from the city of Córdoba]. / Perfil corporal y función física y cognitiva según edad en mujeres mayores ambulatorias de la ciudad de Córdoba.

UNLABELLED: Aging produces body changes such as redistribution of fat and loss of muscle mass and strength, predisposing to fragility, functional impairment and disability. OBJECTIVE: To analyze the relationship between body profile and physical and cognitive function by age in in ambulatory elderly women from the city of Córdoba. METHODS: 178 healthy older women (OW) ≥60 years free living were evaluated attending centers of retirees and day homes in the city of Córdoba. We evaluated body profile from: skeletal muscle mass index (SMMI), relative body adiposity (RBA) -dual X-ray absorptiometry- and muscle strength (MS) -dynamometry-. Categories: normal/(N) sarcopenia/(SP), obesity/(OB), sarcopenic obesity/(SO); Physical function: with/without physical limitation (PL); cognitive function: with/without cognitive impairment (CI). INSTRUMENTS: Lunar Prodigy Densitometer and Smedley dynamometer, Lawton and Brody and Minimental Examination of Folstein scales. RESULTS: SO prevailed and increased with age, contrary to OB. Most of the OW did not PL or CI. Only 2.25% had low SMMI and 48.3% dynapenia. 76.97% had elevated RBA. The SP - obese or not - had greater PL and CI. CI frequency doubled to PL (15.17% versus 6.74%). We found negative correlations and significant associations between age and MS (r= -0.279; p=0.0001), physical function (r=-0.164; p=0.0283) and cognitive function (r=-0.028; p=0.0002). CONCLUSIONS: In this group of healthy OW the dynapenia was responsible for the observed SP, not low SMMI. The OW with SP had more PL and CI, and increased with age.

El envejecimiento produce cambios corporales como redistribución de la grasa y pérdida de la masa y fuerza muscular, predisponiendo a fragilidad, deterioro funcional y discapacidad. Objetivo: Analizar la relación entre perfil corporal y función física y cognitiva según edad en mujeres mayores de la ciudad de Córdoba. Material y Métodos: Se valoraron 178 Mujeres Mayores (MM) sanas ambulatorias ≥60 años que asisten a Centros de Jubilados y Hogares de Día de Córdoba capital. Se evaluó Perfil Corporal a partir de: índice de masa muscular esquelética (IMME), adiposidad corporal relativa (ACR) -absorciometría dual de rayos X- y fuerza muscular (FM) ­dinamometría-. Categorías: Normal/(N) Sarcopenia/(SP), Obesidad/(OB), Obesidad Sarcopénica/(OB/SP); Función Física: con/sin limitación física (LF); y Función Cognitiva: con/sin deterioro cognitivo (DC). Instrumentos: Densitómetro Lunar Prodigy y dinamómetro Smedley, Escalas de Lawton y Brody y Minimental Examination de Folstein. Resultados: La OB/SP predominó y se incrementó con la edad; contrario a la OB. La mayoría de las MM no presentó LF ni DC. Sólo 2,25% tuvo IMME bajo y 48,3% dinapemia. El 76,97% tenía ACR elevada. Las SP ­obesas o no- presentaron mayor LF y DC. La frecuencia de DC duplicó a la de LF (15,17% versus 6,74%). Se hallaron correlaciones negativas y asociaciones significativas entre edad y FM (r= -0,279; p=0,0001), FF (r= -0,164; p=0,0283) y FC (r= -0,028; p=0,0002). Conclusiones: En este grupo de MM sanas la dinapenia fue responsable de la SP observada, no el IMME bajo. Las ancianas SP tuvieron mayor LF y DC, y aumentaron con la edad.

Cardiac condition in young chagasic women.

RATIONALE: Chagas disease is a complex disorder caused by Trypanosoma cruzi. Most patients remain asymptomatic for several years and 30% of them progress quietly to developing cardiomyopathy. The factors that lead to chronic myocardial lesions are not fully understood. OBJECTIVE: To investigate the association between clinical symptoms and single nucleotide polymorphisms in chagasic and non-chagasic women younger and older than 55 years of age. METHODS AND RESULTS: we analyzed Ala-9Val and Ile58Thr polymorphisms of the SOD-Mn gene, 138ex1ins/del A of the endothelin-1 gene (ET-1) and H323H (T/C) of the endothelin receptor A gene (ETA), by PCR-RFLP using genomic DNA from leukocyte of 85 women. We also evaluated serum lipid profile, renal and liver function, chest X-rays, electrocardiograms (ECGs) and echocardiography (EchoCG). Biochemical profiling did not show differences between chagasic and non-chagasic patients. The polymorphisms analyses showed a significant association in the distribution of frequencies of the Mn-SOD Ile58Thr gene between both groups. Young chagasic patients had a significantly higher prevalence of abnormalities in X-rays, in ECGs and they showed grade II and III of NYHA functional classes. The chance of having an abnormal EchoCG was 5.87 higher in young chagasic patients (OR=5.87, 95% CI 1.47-23.4). DISCUSSION: We concluded that the parasite affects young females by accelerating the deterioration of cardiac function, independent of other cardiovascular risk factors and the cardioprotective action of estrogens present in the premenopausal stage.

Alimentos cárnicos y huevos: perfil de consumo en adultos mayores ambulatorios / Food meat and eggs: consumption profile in elderly outpatients

En los Adultos Mayores (AM) el acceso a una alimentación adecuada es primordial para mantener la salud, disminuir el efecto de las enfermedades y contribuir a preservar la independencia. Nutrientes fundamentales como las proteínas de alto valor biológico, vitaminas y minerales son aportadas por el grupo de huevos, carnes y sus derivados.Objetivos: Describir el perfil de consumo de alimentos del grupo de huevos, carnes y derivados, de los AM; evaluar si existen asociaciones en el perfil de consumo según edad, sexo, nivel educacional y convivencia. Métodos: Universo: todos los AM≥60 años ambulatorios, beneficiarios del programa ProBienestar, de Córdoba capital. Muestreo estratificado de centros de jubilados; muestra aleatoria de cada centro (n 451 AM). Instrumento: Cuestionario de Frecuencia de Consumo de Alimentos. Categorías: consumo Habitual (1 a 7 días/semana), consumo Ocasional (1 a 3 días/mes) y Nulo (no consume). Resultados: el consumo habitual (CH) prevaleció para carnes de res 93% y de aves 85%; pescados sólo 19%. El 56% no consumía pescados nunca. Para los huevos, el CH fue de 76%. Entre las vísceras preponderó el consumo ocasional (CO) siendo el hígado la más consumida (30%); igual que para embutidos: morcilla, chorizo, salchicha, mortadela y salame; y fiambres: paleta. El CO de corazón y riñón prevaleció entre los varones, y el de fiambres/embutidos fue mayor en los AM que vivían acompañados. Conclusiones: las carnes bovina y de ave (pollo), y huevos fueron los alimentos proteicos más consumidos por los AM del programa ProBienestar, Córdoba capital. El sexo se asoció al consumo de vísceras y la convivencia al de fiambres/embutidos. A excepción dehuevos y conservas de pescado (en escasa cantidad), el resto no integran el módulo alimentario otorgado a los AM del programa, no obstante los alimentos cárneos son consumidos habitualmente por esta población de bajos ingresos.

Alimentos cárnicos y huevos: perfil de consumo en adultos mayores ambulatorios / Food meat and eggs: consumption profile in elderly outpatients

En los Adultos Mayores (AM) el acceso a una alimentación adecuada es primordial para mantener la salud, disminuir el efecto de las enfermedades y contribuir a preservar la independencia. Nutrientes fundamentales como las proteínas de alto valor biológico, vitaminas y minerales son aportadas por el grupo de huevos, carnes y sus derivados.Objetivos: Describir el perfil de consumo de alimentos del grupo de huevos, carnes y derivados, de los AM; evaluar si existen asociaciones en el perfil de consumo según edad, sexo, nivel educacional y convivencia. Métodos: Universo: todos los AM≥60 años ambulatorios, beneficiarios del programa ProBienestar, de Córdoba capital. Muestreo estratificado de centros de jubilados; muestra aleatoria de cada centro (n 451 AM). Instrumento: Cuestionario de Frecuencia de Consumo de Alimentos. Categorías: consumo Habitual (1 a 7 días/semana), consumo Ocasional (1 a 3 días/mes) y Nulo (no consume). Resultados: el consumo habitual (CH) prevaleció para carnes de res 93% y de aves 85%; pescados sólo 19%. El 56% no consumía pescados nunca. Para los huevos, el CH fue de 76%. Entre las vísceras preponderó el consumo ocasional (CO) siendo el hígado la más consumida (30%); igual que para embutidos: morcilla, chorizo, salchicha, mortadela y salame; y fiambres: paleta. El CO de corazón y riñón prevaleció entre los varones, y el de fiambres/embutidos fue mayor en los AM que vivían acompañados. Conclusiones: las carnes bovina y de ave (pollo), y huevos fueron los alimentos proteicos más consumidos por los AM del programa ProBienestar, Córdoba capital. El sexo se asoció al consumo de vísceras y la convivencia al de fiambres/embutidos. A excepción dehuevos y conservas de pescado (en escasa cantidad), el resto no integran el módulo alimentario otorgado a los AM del programa, no obstante los alimentos cárneos son consumidos habitualmente por esta población de bajos ingresos.(AU)

[Interventional study in the natural evolution of Chagas disease. Evaluation of specific antiparasitic treatment. Retrospective-prospective study of antiparasitic therapy]. / Estudio de intervención en la evolución natural de la enfermedad de Chagas. Evaluación del tratamiento antiparasitario específico. Estudio retrospectivo-prospectivo de terapéutica antiparasitaria.

In this study is presented the comparative therapeutical experience comparing the Allopurinol, Benznidazol y Nifurtimox, in a prospective following in a long term, considering the responses to the parasitemia, specific serology and evolution of the clinic manifestations and complementaries in the 535 chronic chagasic cases (44.5%), instead of 668 patients who did not get any treatment (1203 chagasic cases followed for more than 5 years average). This study was done between April 1984 and April 1994 in patients with and without cardiopathy, in the Córdoba Hospital and the Salud Estudiantil Direccion, Universidad Nacional de Córdoba (U.N.C.); from them, 309 patients were given Allopurinol, 130 were given Benznidazol, and 96 were given Nifurtimox, with usual doses of Benznidazol and Nifurtimox, but with Allopurinol it was made an study evaluating the answering-doses, with a following time of post-therapeutic average of 55.6 months (D.S. = + -57 m.) The comparative parameters were the starting clinic characteristics, the qualitative and quantitative for Chagas, the pre-treatment xerodiagnostic, the treatment fulfillment, the treatment duration, the adverse effects, the treatment abandon, the time of postreatment longitudinal following till the last clinic-complementary evaluation, the clinic characteristics at the end of the following period; quantitative and qualitative serology for Chagas after the treatment, and post-treatment xerodiagnostic. It was observe a prevalence of Electrocardiographic Changes in the ECG in rest, in the first complementary evaluation in 76 of the 535 "Treated" and in the 225 "No-treated" patients, being Electrocardiographic abnormality proportion much more in the "No-treated" patients (P = 0.000000). After the end of the following period it was thought to have been found Miocardic Damage Progression in 120 patients "No-treated" and in 31 "Treated" patients (17.9% and 5.8% respectively) (P = 0.0000000). The complications in the evolution course were proved in 113 of the "No-treated" and in 19 of the "Treated" patients (16.9% and 3.5%, being this a statistically significant difference (P = 0.0000000). The mortality along the evolution was proved in 37 of the "No-Treated:" patients and in 7 of the "Treated" patients (5.5% and 1.3%), being this a statistically significant difference (P = 0.00019). The most tolerated drug and the one with the least incidence of therapeutic abandons was the Allopurinol. The xerodiagnostic negativization percentages were 72.5% for Allopurinol, 76.4% for Benznidazol and 76.5% for Nifurtimox (non-significant differences). A year and two years after the end of the treatment was made a titled serology with the Inmunofluorescence and Indirect Hemoaglutination Tests, getting significant statistical differences between the three drugs, resulting lower the values obtain after the treatment with Benznidazol and Nifurtimox than with Allopurinol (P = 0.0042 and P = 0.00039), respectively). The biggest proportion of Progression in the Cardiopathies, Complications, General Mortality and Attributed Mortality in "No Treated" (specially in older than 30 years) significant both for infected patient and slight cardiopathy, stabilises the possibility of stopping or reducing the morbid course of the Chronic Chagasic Cardiopathy, specially relevant in the formers, where the pathogenic process seems to be accelerated related to the latters. The negativation of the parasitemia and the parasitemia and the title disminution of the specific serology like effectiveness treatment parameters, and the stopping in the progression or dissemination of the incidence in new cases of Chronic Chagasic Cardiopathies were considered to be the real benefit of the antiparasitaric therapeutic in the Chagas Disease. As a conclusion, it is thought that the further the instauration of the specific antiparasitaric treatment the more the possibilities of effectiveness, as well as the increase in the probabilities of preventing or reducing the incidence of cardiopathy in chronic infected, or to stop its evolution and reduce its morbimortality in patients with already installed cardiopathy.

Estudio de intervención en la evolución natural de la enfermedad de Chagas. Evaluación del tratamiento antiparasitario específico. Estudio retrospectivo-prospectivo de terapéutica antiparasitaria. / [Interventional study in the natural evolution of Chagas disease. Evaluation of specific antiparasitic treatment. Retrospective-prospective study of antiparasitic therapy]

In this study is presented the comparative therapeutical experience comparing the Allopurinol, Benznidazol y Nifurtimox, in a prospective following in a long term, considering the responses to the parasitemia, specific serology and evolution of the clinic manifestations and complementaries in the 535 chronic chagasic cases (44.5

), instead of 668 patients who did not get any treatment (1203 chagasic cases followed for more than 5 years average). This study was done between April 1984 and April 1994 in patients with and without cardiopathy, in the Córdoba Hospital and the Salud Estudiantil Direccion, Universidad Nacional de Córdoba (U.N.C.); from them, 309 patients were given Allopurinol, 130 were given Benznidazol, and 96 were given Nifurtimox, with usual doses of Benznidazol and Nifurtimox, but with Allopurinol it was made an study evaluating the answering-doses, with a following time of post-therapeutic average of 55.6 months (D.S. = + -57 m.) The comparative parameters were the starting clinic characteristics, the qualitative and quantitative for Chagas, the pre-treatment xerodiagnostic, the treatment fulfillment, the treatment duration, the adverse effects, the treatment abandon, the time of postreatment longitudinal following till the last clinic-complementary evaluation, the clinic characteristics at the end of the following period; quantitative and qualitative serology for Chagas after the treatment, and post-treatment xerodiagnostic. It was observe a prevalence of Electrocardiographic Changes in the ECG in rest, in the first complementary evaluation in 76 of the 535 [quot ]Treated[quot ] and in the 225 [quot ]No-treated[quot ] patients, being Electrocardiographic abnormality proportion much more in the [quot ]No-treated[quot ] patients (P = 0.000000). After the end of the following period it was thought to have been found Miocardic Damage Progression in 120 patients [quot ]No-treated[quot ] and in 31 [quot ]Treated[quot ] patients (17.9

and 5.8

respectively) (P = 0.0000000). The complications in the evolution course were proved in 113 of the [quot ]No-treated[quot ] and in 19 of the [quot ]Treated[quot ] patients (16.9

and 3.5

, being this a statistically significant difference (P = 0.0000000). The mortality along the evolution was proved in 37 of the [quot ]No-Treated:[quot ] patients and in 7 of the [quot ]Treated[quot ] patients (5.5

and 1.3

), being this a statistically significant difference (P = 0.00019). The most tolerated drug and the one with the least incidence of therapeutic abandons was the Allopurinol. The xerodiagnostic negativization percentages were 72.5

for Allopurinol, 76.4

for Benznidazol and 76.5

for Nifurtimox (non-significant differences). A year and two years after the end of the treatment was made a titled serology with the Inmunofluorescence and Indirect Hemoaglutination Tests, getting significant statistical differences between the three drugs, resulting lower the values obtain after the treatment with Benznidazol and Nifurtimox than with Allopurinol (P = 0.0042 and P = 0.00039), respectively). The biggest proportion of Progression in the Cardiopathies, Complications, General Mortality and Attributed Mortality in [quot ]No Treated[quot ] (specially in older than 30 years) significant both for infected patient and slight cardiopathy, stabilises the possibility of stopping or reducing the morbid course of the Chronic Chagasic Cardiopathy, specially relevant in the formers, where the pathogenic process seems to be accelerated related to the latters. The negativation of the parasitemia and the parasitemia and the title disminution of the specific serology like effectiveness treatment parameters, and the stopping in the progression or dissemination of the incidence in new cases of Chronic Chagasic Cardiopathies were considered to be the real benefit of the antiparasitaric therapeutic in the Chagas Disease. As a conclusion, it is thought that the further the instauration of the specific antiparasitaric treatment the more the possibilities of effectiveness, as well as the increase in the probabilities of preventing or reducing the incidence of cardiopathy in chronic infected, or to stop its evolution and reduce its morbimortality in patients with already installed cardiopathy.

Characterization of Trypanosoma cruzi populations by zymodemes: correlation with clinical picture.

Trypanosoma cruzi isolated from 55 chronic chagasic patients were grouped into isozymic strains on the basis of electrophoretic patterns for a set of six enzymes. The total sample showed a distribution of asymptomatic (63.6%) and clinically ill (36.4%) patients similar to that generally reported for Chagas' disease. Six of the 12 zymodemes known to exist in Argentina have been isolated from humans. Only two (Z1 and Z12) are frequent and widely distributed in the endemic area. These two zymodemes differ significantly in their pathogenicity. The proportion of asymptomatic patients was higher with the Z1 zymodeme (81.1%) than with the Z12 zymodeme (27.3%). The incidence of heart alterations was lower in Z1 than in Z12 zymodeme patients (18.9% versus 72.7%). Clinically evident acute disease was seen in 36.3% of cases with zymodeme Z12 and in 8.1% of cases with zymodeme Z1. The differences between the two prevalent zymodemes in Argentina are statistically significant. These observations indicate that the Z1 T. cruzi is a more benign strain than Z12. Patients infected with Z1 would be more likely to be asymptomatic for a longer time than those infected with Z12. The risk of cardiac lesion would be greater for patients harboring Z12 T. cruzi than for those with Z1. The results suggest that strain identification could be a useful prognostic tool.

Therapeutic efficacy of allopurinol in patients with chronic Chagas' disease.

Laboratory and animal studies have demonstrated that pyrazolopyrimidines have significant activity against Trypanosoma cruzi. This clinical investigation was to ascertain the efficacy of allopurinol in the treatment of chronic Chagas' disease. Of 307 patients studied, 91 were untreated; the remaining 216 were divided into 4 treatment groups. These corresponded to 600 or 900 mg/day of allopurinol for 60 days and benznidazole or nifurtimox at conventional dosage regimens. Patients were evaluated clinically, serologically, and parasitologically. Allopurinol was found to be as efficacious as the conventional therapeutic modalities in eliminating the parasitemia and rendering patients seronegative. Adverse reactions occurred in 11% of patients who received allopurinol and in 30% of those receiving nitrofurans. Reactions with the conventional therapy were more frequent and of a more serious nature. Oral allopurinol is as effective as the nitrofurans, but has none of the side effects.

Allopurinol Vs. testigo en la parasitemia de la enfermedad de chagas cronica asintomatica valorada por xenodiagnosticos seriados / Allopurinol and placebo in the evaluation by serial xenodiagnosis of the parasitemia of asimptomatic chronic Chagas disease

Se estudiaron 58 pacientes en total, siendo 26 mujeres y 32 varones. El promedio de edad fue semejante a los tres grupos (29+/-5,13 anos)La parasitemia fue evaluada mediante xenodiagnosticos seriados (Xd). Cada estudio se realizo con 4 cajas de 10 ninfas del 3er estadio del T. Infestans cada una de acuerdo a la tecnica de Cerisola y Col.> El personal que realizo la lectura en todos los casos ignoraba a que grupo pertenecia el paciente estudiado e igualmente si habia recibido tratamiento o no