Neuroleptic malignant syndrome in a postoperative patient: A case report.

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis. A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity. Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms. The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.

Síndrome neuroléptico maligno en paciente postoperada: a propósito de un caso / Neuroleptic malignant syndrome in a postoperative patient: a case report

El síndrome neuroléptico maligno es una emergencia médica poco frecuente asociada al uso de antipsicóticos y otros fármacos antidopaminérgicos. No se dispone de una prueba específica para su diagnóstico, basándose este en una alta sospecha clínica y la realización de un buen diagnóstico diferencial. Un cuadro clínico compatible, destacando la hipertermia, rigidez muscular, alteración del nivel de conciencia y signos de rabdomiolisis en los estudios analíticos, junto con el antecedente de la toma de fármacos neurolépticos, constituyen los elementos clave para la detección de esta entidad. Debido a su escasa incidencia y su potencial mortalidad, es primordial su conocimiento a través de series de casos descritos en la literatura para facilitar su sospecha diagnóstica ante un caso clínico compatible. A continuación, exponemos un caso de una paciente de 79 años con consumo crónico de alcohol como único antecedente de interés, que recibió una dosis única de haloperidol tras un cuadro de delirio en el contexto de un postoperatorio convencional de traumatología. Posteriormente, desarrolló un cuadro de deterioro progresivo del nivel de conciencia, diaforesis, rigidez muscular generalizada, hipertermia, junto a acidosis metabólica severa, hiperlactacidemia, rabdomiolisis, hipertransaminasemia e hipocalcemia. Tras excluir otras entidades compatibles con la clínica, el síndrome neuroléptico maligno se postuló como la principal hipótesis diagnóstica, reforzándose el diagnóstico tras la mejoría clínica y analítica evidente posterior al inicio del tratamiento con dantrolene. La paciente pudo, finalmente, ser dada de alta escasos días después del inicio del cuadro sin presentar secuelas.(AU)

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis.A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity.Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms.The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.(AU)

Neuroleptic malignant syndrome in a postoperative patient: a case report. / Síndrome neuroléptico maligno en paciente postoperada: a propósito de un caso.

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis. A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity. Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms. The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.

[Vitamin A and zinc levels in gastroenterological surgical patients: Relation with inflammation and postoperative complications]. / Niveles de vitamina A y zinc en pacientes de cirugía gastroenterológica: relación con la inflamación y la aparición de complicaciones postoperatorias.

INTRODUCTION: It is accepted that even mild nutrient depletion may affect the evolution of the surgical patient. OBJECTIVE: To evaluate the influence of preoperative levels of plasma retinol and zinc on postoperative evolution of surgical patients; to evaluate the influence of inflammation on both level markers. METHODS: Plasma retinol and zinc were determined in 50 patients before programmed gastroenterological surgeries. To detect global malnutrition BMI and weight loss percentage (WL%) were included. C-reactive protein (CRP) was included as inflammation marker. During follow up postoperative complications were recorded. The present analysis was carried out in 43 patients with complete information. RESULTS: Low retinol values (< 20 µg/dl) were founded in 3 cases and low Zn values (< 85 µg/dl) in 20 cases, being 9 of them indicative of severe deficiency (< 70 µg/dl). Postoperative complications were recorded in 17 patients; patients with complications presented lower values of plasma Zn (78.4 ± 25.8 vs. 87.8 ± 25.7 µg/dl) and retinol (36.9 ± 14.5 vs. 49.7 ± 20.6; P = 0.0318) than those with no complications; the number of patients with complications decreased when retinol and Zn ranges increased. No relation between BMI or WL% and appearance of complications was founded; patients with higher WL% were those with higher usual weight. Inflammation affected both markers: retinol dropped from 50.1 ± 17.2 to 44.0 ±20.8 and to 23.7 ± 4.0 µg/dl for CRP ranges of < 0.5, 0.5-3.9 and ≥ 4 mg/dl, respectively (p = 0.0193); levels of zinc fell from 90.1 ± 17.8 to 85.2 ± 29.9 and to 55.0 ± 25.9 µg/dl for the same CRP ranges (P = 0.0195). Zn level influenced retinol level, dropping to 33.1 ± 11.7 µg/dl of retinol in the Zn severe deficiency group (P = 0.0386). CONCLUSIONS: The obtained results confirm the influence of vitamin A and zinc on postoperative evolution of the surgical patient, while alert about the interrelationships among vitamin A, zinc and inflammation, which lead to difficulty to establish the real source of deficiencies. Beyond these difficulties, retinol and zinc plasma levels determine the nutrient availability for the body and appear as promissory markers of surgical risk.

[Preoperative nutritional status and surgical risk. Identification of promissory biochemical markers]. / Estado nutricional preoperatorio y riesgo quirúrgico. Identificación de marcadores bioquímicos promisorios.

BACKGROUND: The fact that deficient or even marginal nutritional levels may contribute to increase morbidity and mortality in the surgical patient is well accepted. The usefulness of vitamin and mineral markers has not been much explored. OBJECTIVE: To evaluate the usefulness of vitamin and mineral indicators as nutritional markers of surgical risk. METHODS: Biomarkers of vitamin A (plasma retinol), carotenes (plasma carotenes), vitamin C (plasma vitamin C), iron (hematocrit, hemoglobin, serum iron, transferrin saturation and erythrocyte protoporphyrin), calcium (calcium/creatinine in basal urine) and zinc (zinc/creatinine in basal urine), were performed 24 ours before surgery. Appearance of complications was evaluated in 100 adult patients from programmed surgical procedures of hernia (n = 41) or gallbladder lithiasis (n = 59), two of the most frequent interventions in general surgery services. RESULTS: Patients were grouped in those that presented postoperative complications (C; n = 26) and those who did not (NC; n=74). Two of the studied markers presented significant differences between both groups: plasma retinol and erythrocyte protoporphyrin. Plasma retinol of C was significantly lower than that obtained in NC: 33.2 +/- 13.5 microg/dl vs. 40.2 +/- 16.3 microg/dl; P = 0.0495 and an association between values below 30 microg/dl and postoperative complications was founded (53.8% in C vs. 30.1% in NC; P = 0.0360). Erythrocyte protoporphyrin of C was significantly higher to that obtained in NC: 52.0 +/- 34.0 microg/dl RBC vs. 36.8 +/- 17.5 microg/dl RBC; P = 0.0453 and the association between values higher than 70 microg/dl RBC and presence of complications were highly significant (25.0% vs. 4.2%; P = 0.0069). CONCLUSIONS: On the basis of the obtained results is concluded that plasma retinol and erythrocyte protoporphyrin would provide useful tools in evaluating surgical risk since they had been allowed to identify patients who were at risk of suffering postoperative complications.

APOE epsilon variation in multiple sclerosis susceptibility and disease severity: some answers.

BACKGROUND: Previous studies have examined the role of APOE variation in multiple sclerosis (MS), but have lacked the statistical power to detect modest genetic influences on risk and disease severity. The meta- and pooled analyses presented here utilize the largest collection, to date, of MS cases, controls, and families genotyped for the APOE epsilon polymorphism. METHODS: Studies of MS and APOE were identified by searches of PubMed, Biosis, Web of Science, Cochrane Review, and Embase. When possible, authors were contacted for individual genotype data. Meta-analyses of MS case-control data and family-based analyses were performed to assess the association of APOE epsilon genotype with disease risk. Pooled analyses of MS cases were also performed to assess the influence of APOE epsilon genotype on disease severity. RESULTS: A total of 22 studies (3,299 MS cases and 2,532 controls) were available for meta-analysis. No effect of epsilon2 or epsilon4 status on MS risk was observed (summary OR 1.14, 95% CI 0.96-1.34 and OR 0.89, 95% CI 0.78-1.01). Results obtained from analyses of APOE genotypes in 1,279 MS families were also negative (p = 0.61). Finally, results from pooled analyses of 4,048 MS cases also argue strongly that APOE epsilon status does not distinguish a relapsing-remitting from primary progressive disease course, or influence disease severity, as measured by the Expanded Disability Status Scale and disease duration. CONCLUSION: Overall, these findings do not support a role for APOE in multiple sclerosis, and underscore the importance of using large sample sizes to detect modest genetic effects, particularly in studies of genotype-phenotype relationships.

Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity.

BACKGROUND: There is no consensus method for determining progression of disability in patients with multiple sclerosis (MS) when each patient has had only a single assessment in the course of the disease. METHODS: Using data from two large longitudinal databases, the authors tested whether cross-sectional disability assessments are representative of disease severity as a whole. An algorithm, the Multiple Sclerosis Severity Score (MSSS), which relates scores on the Expanded Disability Status Scale (EDSS) to the distribution of disability in patients with comparable disease durations, was devised and then applied to a collection of 9,892 patients from 11 countries to create the Global MSSS. In order to compare different methods of detecting such effects the authors simulated the effects of a genetic factor on disability. RESULTS: Cross-sectional EDSS measurements made after the first year were representative of overall disease severity. The MSSS was more powerful than the other methods the authors tested for detecting different rates of disease progression. CONCLUSION: The Multiple Sclerosis Severity Score (MSSS) is a powerful method for comparing disease progression using single assessment data. The Global MSSS can be used as a reference table for future disability comparisons. While useful for comparing groups of patients, disease fluctuation precludes its use as a predictor of future disability in an individual.

A whole genome screen for association with multiple sclerosis in Portuguese patients.

Multiple sclerosis (MS) is common in Europe affecting up to 1:500 people. In an effort to identify genes influencing susceptibility to the disease, we have performed a population-based whole genome screen for association. In this study, 6000 microsatellite markers were typed in separately pooled DNA samples from MS patients (n=188) and matched controls (n=188). Interpretable data was obtained from 4661 of these markers. Refining analysis of the most promising markers identified 10 showing potential evidence for association.

Desensitization of bladder sensory fibers by intravesical resiniferatoxin, a capsaicin analog: long-term results for the treatment of detrusor hyperreflexia.

OBJECTIVES: To assess the pungency and the desensitizing effects of intravesical resiniferatoxin, an ultrapotent capsaicin analog, in patients with detrusor hyperreflexia. METHODS: Fourteen patients with detrusor hyperreflexia were instilled during 30 min, without any form of local anesthesia, with 100 ml (or the bladder capacity if lower than that volume) of 50 or 100 nM resiniferatoxin solutions in 10% alcohol in saline. Patients were evaluated by voiding chart and urodynamic tests (volume to first contraction, maximal cystometric capacity, maximal detrusor pressure, icewater test) at 14, 30, 60, and 90 days and every 3 months thereafter RESULTS: Resiniferatoxin instillation did not evoke pain or temporary worsening of urinary symptoms. Treatment improved or abolished incontinence in 9 out of 12 incontinent patients. Mean urinary frequency decreased from 14.2+/-6.4 to 10.3+/-3.2 at 3 months (p = 0.01). At this time point, mean maximal cystometric capacity increased from 182.3+/-119.8 to 330.0+/-201.6 ml (p = 0.01) and the ice water test, positive in 13 cases, became negative in 8 of them. Maximal detrusor pressure was not modified by the treatment. The effect was long-lasting, reaching 12 months in 7 cases. CONCLUSIONS: The absence of irritative symptoms during bladder instillation of resiniferatoxin and the rapid onset of desensitization make this vanilloid superior to capsaicin for the treatment of detrusor hyperreflexia.

[Assessment of normal growth patterns in rats by Z score]. / Evaluación del crecimiento normal en ratas a través del puntaje Z.

Malnutrition is one of the most important causes of normal growth disruption. Anthropometric methods are highly valuable in clinic pediatric diagnosis to determine the nutritional status of children and as recovery monitoring. In previous studies, we have demonstrated that the standards weight-age, height-age and weight-height of growing rats had similar distribution to those in normal children. However, to improve the diagnostic effectiveness of anthropometric information, statistical analysis to normally and non-normally distributed variables should be applied. One hundred Wistar rats (50 male and 50 female rats) from weaning (day = 25, weight = 35-40 g) to 70 days of age were fed with a commercial diet. Water and diet were offered "ad libitum". Body weight and height were recorded every two or four days, respectively. Percentiles of weight vs age, height vs age and weight vs height were plotted for male and female rats. The statistical criterion for classifying the anthropometric measurements into nutritional categories was based on percentiles cutoff and Z-score. The Z-score was calculated according to: Z = (standard mean value-subject value/standard deviation of standard). The statistical anthropometric categories of growing rats were similar to those obtained in children. This evidence suggest that the rat can be used as an experimental model to infer and predict the nutritional response in children.

[Nutritional status of surgical patients without apparent nutritional compromise]. / Estado nutricional de pacientes quirúrgicos sin aparente compromiso nutricional.

Nutritional status of 80 preoperative patients from programmed surgeries of hernias and lithiasis was studied by anthropometric and biochemical parameters. Nutritional deficiencies related to pathology were not expected in these patients. Results were as follows: 77% of the population showed overweight, being 15% obese. Prevalent protein intake, evaluated by the urea nitrogen/creatinine ratio, was adequate in 87.5% of the patients; however, patients presented 72% of albumin, 52% of prealbumin and 50% of RBP below reference values. Transferrin, ceruloplasmin, alpha 2-macroglobulin and haptoglobin were not decreased. Assessment of vitamin A, carotenes and vitamin C showed plasmatic levels below reference values in 16% of the patients for vitamin A, 5% for carotenes and 27% for vitamin C. Respect to calcium status, data of calcium/creatinine ratio show deficiency in 45% of the population. Respect to iron, the nutritional status was in general adequate, patients at risk being 5% by Htc, 11% by Hb, 5% by TS% and 12.5% by FEP, women showed over twice abnormal values than men. Although some isolated relations were observed, in this population sex, age and pathology were variable that did not affect in a relevant way the nutritional status. In spite of the individual analysis of each nutrient did not show important deficiencies, the analysis by patient showed that only a few of them (7%) presented an optimal biochemical profile with all the studied parameters within the reference values.

[Erythrocyte protoporphyrin during recovery from malnutrition in rats]. / Protoporfirina eritrocitaria durante la recuperación nutricional en ratas.

Interrelationships between Erythrocyte Protoporphyrin (EP), dietary Iron/Protein ratio (Fe/Prot) and Fe liver content (Feh) were studied during nutritional recovery in an experimental model: weanling female Wistar rats (To) were depleted with a protein-free diet (LP), losing 20% of their initial body weight. Then they were recovered until 45 days of age (T45) with diets containing: casein: 20 g/100 g; Fe (ammonium Fe citrate) (ppm.): 0, 75 or 100 (groups A1, A2 and A3, respectively). Hematocrit, Hemoglobin (Hb) (g/dL). Erythrocyte Protoporphyrin (EP) (microgram/dL Red Blood Cells) and Feh (microgram) were determined at To, LP and T45. Results were compared with control rats (C) fed with 20% of casein and Fe, 50 ppm. EP: a) decreased in C from To to T45 (99 +/- 24; 36 +/- 9; p < 0.01); b) increased in A1 and A2 at T45 (123 +/- 21; 93 +/- 29, respectively, p < 0.01) while A3 did not show significant difference (45 +/- 7) regarding to C: c) correlated inversely with Feh. According to the inverse correlation between EP and Fe/Prot (r = -0.99), we found that 92 ppm was an adequate Fe amount to prevent EP increase. These results confirm that during recovery from undernutrition EP depends on iron liver content, being an adequate indicator of iron nutritional status; therefore, EP would be useful as a predictor of the optimum Fe/Prot ratio for nutritional recovery.

Desensitization of bladder sensory fibers by intravesical capsaicin has long lasting clinical and urodynamic effects in patients with hyperactive or hypersensitive bladder dysfunction.

PURPOSE: Capsaicin was used to treat symptomatic patients with hyperactive or hypersensitive bladders. MATERIALS AND METHODS: Capsaicin solution (1 mM.) was instilled into the bladder of 16 patients with spinal hyperreflexia, bladder instability or hypersensibility. RESULTS: Frequency decreased in 14 patients and continence was achieved in 10 of 14 incontinent cases. Mean first desire to void and maximal cystometric capacity increased significantly. These effects lasted for 6 to 12 months and were renewed following repeat treatment. CONCLUSIONS: Bladder afferent desensitization with capsaicin is promising in patients with motor or sensory bladder dysfunction, although initial pungency might limit its use.

[Free erythrocyte protoporphyrin as a function of age in growing rats]. / Protoporfirina libre eritrocitaria en función de la edad en ratas en crecimiento.

The assessment of the iron (Fe) status is very important because its deficiency is one of the most common in both developing and industrialized countries, being particularly prevalent among infants and young children. Diagnosis is difficult in the presence of other conditions which interfere with the interpretation of laboratory tests, such as hemoglobin (Hb), hematocrit (Hct), serum iron, transferrin saturation percentage and serum ferritin. Free erythrocyte protoporphyrin (FEP) is a precursor of Heme and normally occurs in very low concentration in red blood cells (RBC); elevated values indicate early impaired iron nutritional status, providing information about gradual changes in the iron supply to the marrow. This laboratory test is a practical and convenient method because it needs a small blood sample easily preserved. Although the Second National Health and Nutritional Examination Survey (NHANES II) of USA has provided a good opportunity to define more precisely the cut-off points, it is doubtful whether the age-related differences in children represent normal development or the effects of iron deficiency. In order to provide information about these aspects the present experimental model was performed: weanling Wistar rats were fed until 95 days of age (t 95) with an isocaloric diet containing 20 or 30 g/100 g. of protein (casein) (N 20 and N 30, respectively), allowing the highest growth and erythropoiesis rates and covering the requirements of all the nutrients (Table 1). Body weight and food intake were recorded three times/week.(ABSTRACT TRUNCATED AT 250 WORDS)

Protoporfirina libre eritrocitaria en función de la edad en ratas en crecimiento. / [Free erythrocyte protoporphyrin as a function of age in growing rats]

The assessment of the iron (Fe) status is very important because its deficiency is one of the most common in both developing and industrialized countries, being particularly prevalent among infants and young children. Diagnosis is difficult in the presence of other conditions which interfere with the interpretation of laboratory tests, such as hemoglobin (Hb), hematocrit (Hct), serum iron, transferrin saturation percentage and serum ferritin. Free erythrocyte protoporphyrin (FEP) is a precursor of Heme and normally occurs in very low concentration in red blood cells (RBC); elevated values indicate early impaired iron nutritional status, providing information about gradual changes in the iron supply to the marrow. This laboratory test is a practical and convenient method because it needs a small blood sample easily preserved. Although the Second National Health and Nutritional Examination Survey (NHANES II) of USA has provided a good opportunity to define more precisely the cut-off points, it is doubtful whether the age-related differences in children represent normal development or the effects of iron deficiency. In order to provide information about these aspects the present experimental model was performed: weanling Wistar rats were fed until 95 days of age (t 95) with an isocaloric diet containing 20 or 30 g/100 g. of protein (casein) (N 20 and N 30, respectively), allowing the highest growth and erythropoiesis rates and covering the requirements of all the nutrients (Table 1). Body weight and food intake were recorded three times/week.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fat and oil consumption in a university student population in Buenos Aires]. / Ingesta de grasas y aceites en una población estudiantil universitaria de Buenos Aires.

The purpose of this study was to evaluate the fat and oil intake and their distribution according to the dietary origin in students of the University of Buenos Aires. A 7 day dietary record of students (49 males and 127 females) attendant to the 1989 Course of Nutrition, School of Pharmacy and Biochemistry, to obtain in Pharmacy and Biochemistry was collected. This information was processed in a PC Computer (VAN Program, Lujan University, Argentina) to obtain the energy and fat daily intake, according to the Dietary Composition Tables compiled by INCAP; missing data were completed t with the German, Italian or Argentine Tables. The results obtained were (average daily intake +/- SD) for females and males, respectively: Energy (Kcal): 1805 +/- 5431 and 2551 +/- 712; total fat (g): 65.6 +/- 21.8 and 87.8 +/- 28.7; percentage of energy provided by fat: 33.0 and 31.1. The distribution of fat intake according to its dietary source was (g/100 g): meat: 33.3; oils: 15.5; diary products: 19.3; cakes and pasta: 11.6; cereals (bread, crackers, etc.): 8.3; separate animal fat: 5.1; legumes and oil seeds: 1.4; eggs: 2.9; poultry: 1.5; margarines: 0.6; fish: 0.3; viscera: 0.3. These data show that the fat intake is not excessive, about 30% of the energy intake; but the high percentage of animal fat might be one of the risk factors responsible for the high incidence of cardiovascular diseases in the population of Buenos Aires.

Análisis de los valores de protoporfirina eritrocitaria libre, en escolares de una zona urbana de Buenos Aires / Free erythrocyte protoporphyrins study in school-children of Buenos Aires city

El aumento de la Protoporfirina Eritrocitaria Libre (FEP), detecta deficiencias marginales de hierro (Fe), constituyendo un indicador precoz que, a las características de simplicidad y rapidez, une las de su determinación en una muestra mínima de sangre de fácil conservación. Pese a esta ventajas, ha sido poco utilizada en estudios poblacionales, salvo en USA, donde su aplicación en la II Nutritional and National Health Examination Survey (NANHES II), ha permitido establecer valores normativos para las diferentes edades. En este trabajo, se aporta información sobre los valores hallados en una población escolar (n = 102), perteneciente al nivel socio-económico bajo y medio-bajo de la ciudad de Buenos Aires, en la que se determinó Hematocrito (Hto) y FEP (según Piomelli). Los resultados, expresados como FEP/dL de glóbulos rojos (FEP/dLg.r.), se agruparon de acuerdo con intervalos de edad y se compararon: a)entre sí, mediante análisis de varianza; b)con los valores normativos derivados de NHANES II, para los mismos rangos de edad. El 99%de la población mostró valores normales de Hto, y de FEP/dL g.r. Los promedios de FEP/dLg.r., para los datos agrupados por años de edad cumplida, no presentaron diferencias estadísticamente significativas: 40ñ22; 23ñ17; 25ñ14; 29ñ13; 31ñ15; 29ñ15; 28ñ20; 32ñ12; 30ñ30 (4 a 12 años, respectivamente). Estos valores fueron sensiblemente inferiores a los considerados normales en NHANES II y en el 90%de los casos inferiores a los de su mediana. Se observó correspondencia entre el valor de la mediana y el percentilo 5 de la población norteamericana. Los valores obtenidos para la mediana y percentilo 95 fueron, respectivamente: < 5 años: 25 & 55; 6-8 años: 25 & 57; 9-11 años: 29 & 55; 12-13 años; 29 & 51

Análisis de los valores de protoporfirina eritrocitaria libre, en escolares de una zona urbana de Buenos Aires / Free erythrocyte protoporphyrins study in school-children of Buenos Aires city

El aumento de la Protoporfirina Eritrocitaria Libre (FEP), detecta deficiencias marginales de hierro (Fe), constituyendo un indicador precoz que, a las características de simplicidad y rapidez, une las de su determinación en una muestra mínima de sangre de fácil conservación. Pese a esta ventajas, ha sido poco utilizada en estudios poblacionales, salvo en USA, donde su aplicación en la II Nutritional and National Health Examination Survey (NANHES II), ha permitido establecer valores normativos para las diferentes edades. En este trabajo, se aporta información sobre los valores hallados en una población escolar (n = 102), perteneciente al nivel socio-económico bajo y medio-bajo de la ciudad de Buenos Aires, en la que se determinó Hematocrito (Hto) y FEP (según Piomelli). Los resultados, expresados como FEP/dL de glóbulos rojos (FEP/dLg.r.), se agruparon de acuerdo con intervalos de edad y se compararon: a)entre sí, mediante análisis de varianza; b)con los valores normativos derivados de NHANES II, para los mismos rangos de edad. El 99%de la población mostró valores normales de Hto, y de FEP/dL g.r. Los promedios de FEP/dLg.r., para los datos agrupados por años de edad cumplida, no presentaron diferencias estadísticamente significativas: 40ñ22; 23ñ17; 25ñ14; 29ñ13; 31ñ15; 29ñ15; 28ñ20; 32ñ12; 30ñ30 (4 a 12 años, respectivamente). Estos valores fueron sensiblemente inferiores a los considerados normales en NHANES II y en el 90%de los casos inferiores a los de su mediana. Se observó correspondencia entre el valor de la mediana y el percentilo 5 de la población norteamericana. Los valores obtenidos para la mediana y percentilo 95 fueron, respectivamente: < 5 años: 25 & 55; 6-8 años: 25 & 57; 9-11 años: 29 & 55; 12-13 años; 29 & 51

[The effect of a protein-free diet on insulin and somatostatin secretion in rats]. / Efecto de una dieta libre de proteínas sobre la secreción de insulina y somatostatina en ratas.

We have used a model of experimental protein-energy malnutrition induced in weaned rats by administration of a protein free diet during 2 weeks. Some malnourished rats were then refed with a control diet for 4, 9 or 30 days. Control rats were fed for the same periods with the balanced control diet. Malnourished rats showed a loss in body weight of approximately 25%. After 30 days of refeeding, the animals gained weight reaching values higher than that of control rats. Insulin secreted by perifused pancreatic slices from malnourished rats, was impaired in first and second glucose-induced secretory phases. Basal secretion was also diminished in incubation of pancreatic slices. When malnourished rats were refed for 4 days, basal insulin secretion reached control values. Stimulated insulin secretion was normalized at 9 and 30 days of refeeding. Our result on somatostatin (SRIF) secretion in malnourished rats showed basal hypersecretion and diminished first and second glucose-induced secretory phases. During refeeding basal SRIF secretion was normalized from day 4. On the contrary stimulated secretion was significantly increased at 4 and 9 days of refeeding, and on day 30 values did not differ from controls. In protein energy malnutrition, the disturbed hormonal state can represent adaptative mechanisms to the protein depletion and hormonal changes have also an essential role in refeeding.