Profile of the Health and Nutritional Status of Older Adults in Mexico. 2012 National Health and Nutrition Survey.

BACKGROUND: The health and nutritional conditions of older adults in Mexico are heterogeneous. The prevalence of chronic noncommunicable diseases is elevated with disparities in functionality and socioeconomic inequities. OBJECTIVES: To obtain updated information of the health and nutritional profile of older adults in Mexico in a national representative sample. METHODS: Information was obtained from 6,687 60 years and older adults from the 2012 National Health and Nutrition Survey (ENSANUT 2012). An index defining the status of «healthy adult¼ was constructed taking into account the variables of independence in performing activities of daily living (ADL), based on the development by Katz, instrumental ADL, no chronic diseases, nonsmoker and no active use of alcohol. Tables of frequencies and proportions were constructed and expanded to describe the general characteristics and nutritional status of the adult Mexican population. A logistic regression model was used to study changes in the probability of being classified as a healthy adult with respect to different variables of interest. Probabilities using the delta method were estimated to establish 95% confidence intervals. RESULTS: In this study 12.2% of the older adults, were classified as healthy. The logistic regression model adjusted for the variables included in the study shows that the interaction of age and gender is significant (P = 0.068), where the probability of healthy adult status decreases in women with ageing and remains stable for men. Also, living in the southern region of the country significantly decreases the probability of healthy adult status (P = 0.001). Gender of the older adult was not significant. CONCLUSIONS: In Mexico, the health conditions of older adults are deficient. Public policies need to be generated that are directed at this population group and will translate into self-care actions in the early stages of life so as to guarantee a healthy future.

[Diabetic neuropathy. Current concepts on etiopathogenesis, diagnosis, and treatment]. / Neuropatía diabética. Conceptos actuales sobre etiopatogénesis, diagnóstico y tratamiento.

Diabetic neuropathy (DN) is chronic complication which occurs in 50% of long standing diabetes mellitus. DN is a consequence of hyperglycemia probably through the following mechanisms: a) activation of aldose-reductase, intracellular sorbitol accumulation and myoinositol depletion, reduced activity of Na+/K+ATPase, loss of Na+ channels and demyelination; b) proteins glycation; c) microangiopathy; the first mechanism being the best known and the most reliable. DN may be subclinical or clinical. The main clinical picture is a peripheral, bilateral, symmetric polyneuropathy with a "socks and gloves" sensory impairment, muscular weakness, hyporeflexia, plantar ulcers and arthropathy. Less frequent syndromes are proximal motor neuropathy and mononeuropathy of cranial nerves or thoraco-abdominal roots. Diagnosis is based on clinical data, and may be sustained on impaired nerve conduction velocity, abnormal evoked somatosensory potentials, or sural nerve biopsy. These methods are highly sensitive but unspecific. Etiopathogenic treatment is based on glycemic control and aldose reductase inhibitors. Improvement in clinical, electrophysiologic and histopathologic data have been obtained with the latter. Symptomatic treatment includes carbamazepin, phenytoin, tricyclic antidepressives and a phenotiazin. Mononeuropathies tend to complete recovery in less than 6 months. Polyneuropathy is thought to be irreversible and progressive; however, with excellent glycemic control or with aldose reductase inhibitors nerve damage may be stabilized or even reversed.

[Acute infections, growth velocity and nutritional status in children from developing countries: a meta-analytic review]. / Infecciones agudas, velocidad de crecimiento y estado nutricio en niños de países en desarrollo: una revisión metanalítica.

Aiming to explore the direction of the cause-effect relationship between the changes in the nutritional status, the physical growth and the selected acute infections, we performed a meta-analysis. It was based on 12 publications selected out of 993 eligible. In 6 papers (50%) a direct relationship between infections and growth velocity was found; in 5 a negative association was reported. A positive association between malnutrition (Gómez's criteria) and infection was found in 4 (33%). Two more reported no association between growth (Z score) and infection. The most remarkable confounding variables were: previous episodes of infection, duration, birth weight and feeding mode. Most of the studies did not met the criteria for causality. Better designed studies are in order to address this question.

[Plasma clearance of ethanol and its excretion in the milk of rural women who consume pulque]. / Depuración plasmática de etanol y su excreción en la leche de mujeres rurales que consumen pulque.

Women from rural areas of the central plateau of Mexico drink during pregnancy and lactation a mild alcoholic beverage called pulque as a galactogogue. Ethanol present in milk could have a harmful effect on growth and development of breast-fed children. The purpose of this study was to quantify the ethanol consumed as pulque by eleven lactating rural women as well as its clearance rate in blood and milk. Mothers were separated in two groups depending upon the ethanol ingested in a single dose of pulque 0.21 +/- 0.08 g/kg of body weight (group A) and 0.44 +/- 0.11 g/kg (group B). Maximal concentration of ethanol was reached in milk at 60 minutes and almost equaled that in plasma. Both groups showed a similar clearance pattern regardless of the volume of pulque ingested. Clearance rates between groups were different: ethanol concentration in milk at 60 min were 8.4 +/- 3.0 mg/dL for group A and 26.2 +/- 7.0 mg/dL for group B. Two hours later ethanol levels were 3.6 +/- 3.4 mg/dL and 23.3 +/- 9.4 mg/dL respectively. Clearance rates were slower in mothers showing the highest concentration of ethanol in milk. The present data demonstrate that there is no differential elimination of ethanol in maternal blood and milk following ingestion of a moderate amount of pulque during lactation. The amount of ethanol received by infants through milk is relatively low and therefore it is unlikely to have harmful effects on them. Pulque consumption adds about 350 kcal/day to the customary dietary intake of these lactating women.

PIP: This work assessed the quantity of ethanol consumed in pulque, a mildly alcoholic beverage from the maguey cactus, and its clearance rate in the blood and milk of 11 rural women in the state of Mexico. 27% of women in the rural and semirural areas of central Mexico drink pulque with their meals. Pulque is believed to stimulate milk production in lactating women. The 11 women lived in the community of San Mateo Capulhuac. All exclusively breast fed their infants, who ranged in age from 3-12 months. On the study day the women breakfasted on tortillas, beans, soup and tea, accompanied by their usual quantity of pulque. During the study, samples of milk and blood were taken from the women at 60, 90, and 120 minutes after 1st ingestion of pulque. The volume of pulque consumed was measured and a sample was saved to determine the ethanol content. Mature pulque showed little variation in ethanol concentration or in total carbohydrates, independently of temperature or duration of storage. The average concentration of ethanol in pulque produced in San Mateo Capulhuac was 3.08 + or - 1.09 g/dL, with a minimum of 1.35 and a maximum of 4.70. The 11 mothers were divided into 2 groups depending on whether the maximum concentration of ethanol quantified in their blood and milk was less than 20 mg/dL (group A) or greater than 20 (group B). The mothers in group A had younger infants, lower body weights, and smaller volumes of pulque ingested on average than the mothers in group B. The average dose of ethanol ingested with pulque was .21 + or - .08 g/kg body weight for group A and .44 + or - .22 g/kg of body weight for group B. concentrations of ethanol in the blood were similar to those in milk for both groups at 60, 90, and 120 minutes. The maximum ethanol concentration occurred 60 minutes after ingestion. Maximum concentrations of ethanol in milk were 8.4 + or - 3.0 mg/dL for group A and 26.2 + or - 7.0 mg/dL for group B, slightly lower than the maximal plasma concentrations in each group. Ethanol levels in blood and milk of group A declined rapidly, with 63% of the ethanol disappearing from the blood and 52% from the milk at 120 minutes. At 120 minutes the ethanol concentration had declined by only 5.5% in the blood and 11% in the milk of group B. Pulque contributes about 350 kcal per day to these women, who have daily caloric intakes averaging 2100 kcal. The relatively small amount of ethanol taken in by infants through milk is unlikely to have harmful effects.

[Bovine and rat albumin used as a biodegradable matrix for the slow release of insulin]. / Albúmina bovina y de rata usada como una matriz biodegradable para la liberación lenta de insulina.

The daily treatment of insulin-dependent diabetes includes one or several insulin injections per day. About 50 years ago non-hormonal molecules were added to insulin in order to enhance its half life. In this report albumin microspheres, serving as a matrix for crystalline insulin, were used for delivery of insulin. They were implanted in a group of rats with alloxan-induced diabetes. Body weight, plasma glucose and insulin were measured at periodic intervals. The stability, bacterial purity and pyrogenicity of the microspheres were tested. Five days after the microspheres were implanted the mean concentrations of glucose (32.9 vs 5.7 nMol/L) and insulin (2.9 vs 20.2 microU/mL) and the body weight (217 vs 250 g) returned to values comparable to those in the non-diabetic state. They remained stable for 15 days; afterwards, glucose increased and the latter two decreased: all became abnormal 20 days after implantation. When the microspheres were implanted on three occasions in the same animal at 15 days intervals, glucose and insulin concentrations and body weight remained within the limits observed in 100 non-diabetic rats, and no antibodies against albumin or insulin were detected.

Preoperative ultrasonographic diagnosis of a parathyroid adenoma in a child.

The case of a young boy with primary hyperparathyroidism due to an adenoma is reported. The tumor was localized by ultrasonography, and a close correlation between the image and the surgical findings was found. Since primary hyperparathyroidism in children under 15 years of age is frequently due to adenomata larger than 1.5 cm it is suggested that ultrasonography of the neck should be included in the work-up of every children suspected to have this pathology.

[Hormone profile of the essential hypertension patient with ischemic cardiopathy. I. Renin, angiotensin and aldosterone]. / El perfil hormonal del hipertenso esencial con cardiopatía isquémica. (I) Renina, angiotensina y aldosterona.

To evaluate the characteristics that the renin and aldosterone profile could present in essential hypertensive patients complicated with ischemic heart disease, and as a contribution to the knowledge of the roll that these hormones could have as possible "risk factors" of coronary heart disease, sixty male patients were studied. These were divided in three groups: group I, formed by 15 essential hypertensive patients with objectively demonstrated ischemic heart disease; group II integrated by 15 essential hypertensives with no ischemic heart disease and group III with 30 normal volunteers. Serum levels of plasma renin activity (PRA) and aldosterone determined by radioimmunoassay, and of urinary sodium excretion were measured in all the patients. The distribution of cases with high, normal and low renin and aldosterone were similar in group I and in group II. It was interesting to find that the four patients of group I who were non-smokers, presented the lower renin levels (from 0.36 to 2.8 ng/ml/h). The relation between PRA and the number of occluded coronary arteries revealed an increased number of patients and affected arteries in the subgroup with renin levels above 5 ng/ml/h in comparison with the subgroup with PRA from 0 to 5, although the difference was not statistically significant. By our study, we cannot conclude that the PRA and aldosterone behave in a different fashion in essential hypertensives from those complicated with ischemic heart disease.

Sindrome de sobreinsulinizacion cronica: metodo para prevenirlo. / Syndrome of chronic overdose of insulin: method to prevent it

El empleo de preparaciones de insulina de accion prolongada permitio mejorar el control de los diabeticos. Cuando la dosis se incrementa con el proposito de alcanzar un grado de control tal que la glucemia en ayunas no exceda los limites normales y la excrecion urinaria de glucosa se conserve y la excrecion urinaria de glucosa se conserve negativa, frecuentemente aparece un sindrome caracteristico. En este sindrome se encuentran mezclados con frecuencia signos y sintomas de hipoglucemia y de hiperglucemia, a causa de que el exceso de insulina produce hipoglucemias fugaces seguidas de hiperglucemias reactivas. Se ha denominado frecuentemente sindrome de sobreinsulinizacion. Puesto que las manifestaciones mas notables son los de hiperglucemia, frecuentemente es tratada con incrementos en la dosis de insulina. Se sugiere que para tratar a un diabetico con insulina se vigile que la dosis no exceda de 1 U/kg de peso, y que las decisiones clinico del paciente y no solamente en una determinacion de laboratorio. Nuestro grupo ha encontrado util tomar en consideracion las modificaciones del peso corporal y la excrecion urinaria de glucosa en 24 horas a fin de decidir los ajustes en la dosis de insulina