RESUMO

El tratamiento de la alergia a las proteínas de la leche de vaca se basa en la eliminación completa de las proteínas de leche de vaca de la dieta del niño y de la madre en los que reciben leche materna. Para lograr la remisión de los síntomas y la tolerancia futura, la exclusión debe ser total. En los niños que reciben fórmula, esta deberá tener hidrolizado extenso de proteínas en las formas leves o moderadas, mientras que aquellas a base de aminoácidos se reservan para los casos más graves. El tiempo de tratamiento, la adquisición de tolerancia y el momento para la prueba de provocación oral van a variar según el cuadro clínico, el mecanismo inmunológico implicado y la edad del paciente. El objetivo de este consenso ha sido reflejar el conocimiento actualizado junto con la experiencia de neonatólogos, pediatras, especialistas en alergia, nutrición y gastroenterología.

The treatment of cow's milk protein allergy is based on the complete elimination of cow's milk protein from the diet. To achieve remission of symptoms and future tolerance, exclusion must be total. In formula fed infants the extensively hydrolysed formula is the most appropriate option in mild or moderate forms, while those based on amino acids are reserved for the most severe cases. The treatment time, the acquisition of tolerance and the moment for the oral provocation test will vary according to the clinical picture, the immunological mechanism involved and the age of the patient. The aim of this consensus has been to reflect the updated knowledge together with the experience of neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology

Assuntos

RESUMO

Las proteínas de la leche de vaca pueden causar alergia alimentaria. Los distintos mecanismos de acción involucrados y la variabilidad clínica según la etapa de la vida pediátrica en la que se manifieste ocasionan dificultades en su abordaje, con riesgo de sub- o sobrediagnóstico. En este proceso, intervienen profesionales de diversas áreas y es recomendable su interacción. Es por ello que el objetivo de este consenso ha sido reflejar el conocimiento actualizado desde la interdisciplina, generando recomendaciones para su correcto diagnóstico. Hemos trabajado con el método de Delphi para sumarle a la evidencia científica, la experiencia proveniente de neonatólogos, pediatras, especialistas en alergia, nutrición y gastroenterología. Pensamos que este enfoque interdisciplinario de trabajo va a resultar de utilidad práctica y promoverá una atención más integral de estos pacientes.

Cow's milk protein can cause food allergy. The different mechanisms of action involved, the clinical variability depending on the stage of pediatric life in which it manifests, leads to difficulties in its approach, with the risk of under- or over-diagnosis. Professionals from various areas intervene in this process and their interaction is recommended. That is why the objective of this consensus has been to reflect the updated knowledge in an interdisciplinary mode, generating recommendations for its correct diagnosis. We have worked with the Delphi method to add to the scientific evidence, the experience from neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology. We think that this interdisciplinary approach will be of practical use and will promote more comprehensive care for these patients.

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The aim of this work was to assess the effect of in vitro human digestion on the chemical composition (carbohydrates and phenolic compounds) and bioactivity of hydro-alcoholic-acid pomace extracts from two mandarin varieties (Clemenule and Ortanique) by measuring their antioxidant, antidiabetic, anti-glycative, hypolipidemic, and anti-inflammatory properties. The phenolic compound profile showed that nobiletin was the main flavonoid found in the extracts and digests of Clemenule pomace and extract, while isosinensetin/sinensetin/tangeretin were the ones in the Ortanique samples. The digests of Clemenule and Ortanique extracts showed Folin reaction values of 9.74 and 9.20 mg gallic acid equivalents (GAE)/g of sample, ABTS values of 83.2 and 91.7 µmol Trolox equivalents (TE)/g of sample, and ORAC-FL values of 142.8 and 891.6 µmol TE/g of sample, respectively. Extracts (50-500 µg/mL) inhibited intracellular reactive oxygen species (ROS) formation in CCD-18Co cells under physiological and oxidative-induced conditions. Clemenule and Ortanique extract digests showed IC50 values of 13.50 and 11.07 mg/mL for α-glucosidase, 28.79 and 69.64 mg/mL for α-amylase, and 16.50 and 12.77 mg/mL for AGEs, and 2.259 ± 0.267 and 0.713 ± 0.065 mg/mL for pancreatic lipase inhibition, respectively. Ortanique extract (250-1000 µg/mL) inhibited the production of nitric oxide in RAW264.7 macrophages under inflammation-induced conditions, and intracellular ROS formation. In conclusion, altogether, the results supported the potential of mandarin extracts to be used as health promoters by reducing the risk of non-communicable chronic diseases.

Assuntos

RESUMO

The treatment of cow's milk protein allergy is based on the complete elimination of cow's milk protein from the diet. To achieve remission of symptoms and future tolerance, exclusion must be total. In formula fed infants the extensively hydrolysed formula is the most appropriate option in mild or moderate forms, while those based on amino acids are reserved for the most severe cases. The treatment time, the acquisition of tolerance and the moment for the oral provocation test will vary according to the clinical picture, the immunological mechanism involved and the age of the patient. The aim of this consensus has been to reflect the updated knowledge together with the experience of neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology.

El tratamiento de la alergia a las proteínas de la leche de vaca se basa en la eliminación completa de las proteínas de leche de vaca de la dieta del niño y de la madre en los que reciben leche materna. Para lograr la remisión de los síntomas y la tolerancia futura, la exclusión debe ser total. En los niños que reciben fórmula, esta deberá tener hidrolizado extenso de proteínas en las formas leves o moderadas, mientras que aquellas a base de aminoácidos se reservan para los casos más graves. El tiempo de tratamiento, la adquisición de tolerancia y el momento para la prueba de provocación oral van a variar según el cuadro clínico, el mecanismo inmunológico implicado y la edad del paciente. El objetivo de este consenso ha sido reflejar el conocimiento actualizado junto con la experiencia de neonatólogos, pediatras, especialistas en alergia, nutrición y gastroenterología.

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RESUMO

INTRODUCTION: Despite improvements in health care, pneumonia-associated mortality remains high. The objective of this study was to analyze the factors associated with mortality in bacteremic pneumonia caused by pneumococcus. METHODS: Retrospective cohort study in adult patients with pneumonia diagnosis and isolation of pneumococcus in blood cultures, between January 2012 and May 2021, was carried out. Clinical and laboratory variables, radiological involvement, evolution and mortality during hospitalization were analyzed. The group of deceased patients was compared with that of survivors. RESULTS: 152 patients were included. Median age: 58 years; men: 58.9%; 33% presented a CURB-65 > than 2 at admission. Overall mortality: 34% (n=52). Deceased patients were more tachypneic on admission (respiratory rate 26 vs. 22; p=0.003), presented sensory alteration more frequently (58% vs. 14%; p< 0.001), PaO2/fraction of inspired oxygen ratio < 250 (58% vs. 22%; p<0.001), bilateral radiological compromise (50% vs. 32%; p=0.03), needed mechanical ventilation (50% vs 12%; p< 0.001), higher blood creatinine values (1.6 vs. 1.15; p=0.01), lower white blood cell count (10 900 vs 17 400; p=0.002), a lower glucose dosage (111 vs. 120; p=0.01), and fewer days of hospital stay (6 vs. 9; p=0.015). In logistic regression model, significant differences were maintained in the following factors associated with mortality: mechanical ventilation (OR=3.54), altered mental status (OR=5.95), chest X-ray with bilateral compromise (OR 3.20) and PAFI less than 250 (OR=3.62). CONCLUSION: In our series, the factors related to mortality, despite the presence of bacteremia, do not differ from those published in the literature and which are part of the different prognostic scores used in routine practice.

Introducción: A pesar de las mejoras en los cuidados de la salud, la mortalidad asociada a neumonía continúa siendo alta. El objetivo de este estudio fue analizar los factores asociados a mortalidad en neumonía bacteriémica por neumococo. Métodos: Estudio de cohorte retrospectiva en pacientes adultos con diagnóstico de neumonía y neumococo aislado en hemocultivos, entre enero 2012 y mayo 2021. Se analizaron: variables clínicas y de laboratorio, compromiso radiológico, evolución y mortalidad durante la internación. Se comparó el grupo de pacientes fallecidos con el de sobrevivientes. Resultados: Se incluyeron 152 pacientes. La mediana de edad fue de 58 años y el 58.9% fueron hombres. El 33% presentó un CURB-65 mayor a 2 al momento de internación. La mortalidad global fue 34% (n=52). Los pacientes fallecidos se encontraban más frecuentemente taquipneicos al ingreso (frecuencia respiratoria 26 vs. 22; p=0.003), presentaban más frecuentemente alteración del sensorio (58% vs. 14%; p< 0.001), PaO2/fracción inspirada de oxígeno (PAFI) < 250 (58% vs. 22%; p<0.001), compromiso radiológico bilateral (50% vs. 32%; p=0.03), necesidad de asistencia respiratoria mecánica (ARM) (50% vs. 12%; p< 0.001), mayor valor de creatinina en sangre (1.6 vs. 1.15; p=0.01), menor recuento de glóbulos blancos (10 900 vs. 17 400; p=0.002), menor valor de glucemia (111 vs. 120; p=0.01) y menos días de estancia hospitalaria (6 vs. 9; p=0.015). En el análisis de regresión logística multivariable se mantuvieron diferencias significativas en los siguientes factores asociados a mortalidad: ventilación mecánica (OR=3.54), confusión (OR=5.95), radiografía con compromiso bilateral (OR= 3.20) y PAFI < 250 (OR=3.62). Conclusión: Los factores relacionados con mortalidad, a pesar de la presencia de bacteriemia, no difieren de los publicados en la literatura y forman parte de los scores pronósticos de práctica habitual.

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RESUMO

Cow's milk protein can cause food allergy. The different mechanisms of action involved, the clinical variability depending on the stage of pediatric life in which it manifests, leads to difficulties in its approach, with the risk of under- or over-diagnosis. Professionals from various areas intervene in this process and their interaction is recommended. That is why the objective of this consensus has been to reflect the updated knowledge in an interdisciplinary mode, generating recommendations for its correct diagnosis. We have worked with the Delphi method to add to the scientific evidence, the experience from neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology. We think that this interdisciplinary approach will be of practical use and will promote more comprehensive care for these patients.

Las proteínas de la leche de vaca pueden causar alergia alimentaria. Los distintos mecanismos de acción involucrados y la variabilidad clínica según la etapa de la vida pediátrica en la que se manifieste ocasionan dificultades en su abordaje, con riesgo de sub- o sobrediagnóstico. En este proceso, intervienen profesionales de diversas áreas y es recomendable su interacción. Es por ello que el objetivo de este consenso ha sido reflejar el conocimiento actualizado desde la interdisciplina, generando recomendaciones para su correcto diagnóstico. Hemos trabajado con el método de Delphi para sumarle a la evidencia científica, la experiencia proveniente de neonatólogos, pediatras, especialistas en alergia, nutrición y gastroenterología. Pensamos que este enfoque interdisciplinario de trabajo va a resultar de utilidad práctica y promoverá una atención más integral de estos pacientes.

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RESUMO

Enteral formulas containing fiber, designed to be administered orally or by gavage, have been used for decades. Although their indication in the pediatric population does not have a global consensus, knowledge about the benefits of using fiber to promote healthier microbiota has grown in recent years. Different fiber types' physicochemical characteristics (solubility, viscosity, fermentability) determine their functions. The impact of fiber use on preventing specific chronic pathologies (cardiovascular disease, cancer, diabetes) has been reported in epidemiological studies. In controlled studies, changes in stool consistency, intestinal transit, and the composition and function of the microbiota have been observed since fiber produces fermentation metabolites such as short-chain fatty acids, which improve metabolic and immunological aspects. Different pediatric pathologies could benefit from the use of fiber.

Las fórmulas enterales que contienen fibra, diseñadas para ser administradas de forma oral o por sonda, han sido utilizadas durante décadas. Si bien su indicación en población pediátrica no cuenta con un consenso global, el conocimiento sobre los beneficios de la utilización de fibra en relación con el intestino, para promover una microbiota más saludable, ha crecido en los últimos años. Los diferentes tipos de fibra tienen características fisicoquímicas (solubilidad, viscosidad, fermentabilidad) que determinan sus funciones. El impacto del uso de fibra sobre la prevención de ciertas patologías crónicas (enfermedad cardiovascular, cáncer, diabetes) ha sido reportado en estudios epidemiológicos. En estudios controlados, se han observado cambios en la consistencia de las heces, en el tránsito intestinal y en la composición y función de la microbiota, ya que la fibra produce metabolitos de fermentación tales como ácidos grasos de cadena corta, lo cual mejora aspectos metabólicos e inmunológicos. Diferentes patologías pediátricas podrían verse beneficiadas por el uso de fibra.

RESUMO

Grape pomace, the main by-product of wine process, shows high potential for the development of functional foods, being a natural source of bioactive compounds and dietary fiber. Thus, the present study proposes the development of five potential functional biscuits. The five formulations were achieved by varying the Tannat grape pomace powder (TGP, 10-20% w/w total wet dough) and sweetener sucralose (2-4% w/w total wet dough) content through a factorial design with central points. TGP microbiological and pesticides analysis were performed as a food safety requirement. Identification of bioactive compounds by HPLC-DAD-MS, in vitro bioactivity (total phenol content, antioxidant by ABTS and ORAC-FL, antidiabetic and antiobesity by inhibition of α-glucosidase and pancreatic lipase, respectively) and sensory properties of the biscuits were evaluated. TGP microbiological and pesticides showed values within food safety criteria. Sensory profiles of TGP biscuits were obtained, showing biscuits with 20% TGP good sensory quality (7.3, scale 1-9) in a cluster of 37 out of 101 consumers. TGP addition in biscuits had a significant (p < 0.05) effect on total phenolic content (0.893-1.858 mg GAE/g biscuit) and bioactive properties when compared to controls: 11.467-50.491 and 4.342-50.912 µmol TE/g biscuit for ABTS and ORAC-FL, respectively; inhibition of α-glucosidase and pancreatic lipase, IC50 35.572-64.268 and 7.197-47.135 mg/mL, respectively. HPLC-DAD-MS results showed all the identified phenolic compounds in 20/4% biscuit (TGP/sucralose%) were degraded during baking. Malvidin-3-O-(6'-p-coumaroyl) glucoside, (+)-catechin, malvidin-3-O-glucoside, and (-)-epicatechin were the main phenolic compounds (in descendent order of content) found. The bioactive properties could be attributed to the remaining phenolic compounds in the biscuits. In conclusion, TGP biscuits seemed to be a promising functional food with potential for ameliorating oxidative stress, glucose and fatty acids levels with good sensory quality.

RESUMO

Objective. To analyze academic production about nursing models and theories in intercultural contexts applied to the field of education. Methods. State-of-the-art study, which examined 50 articles from research. Results. Application of the cultural competence model was found as a trend at disciplinary level, and in at interdisciplinary level, critical pedagogy was used. Regarding the curriculum, it is observed that cultural competency is a subject that is taught, but it is not treated in transversal manner. The principal didactics was cultural immersion, which permits acquiring skills and aptitudes to care for diverse population. The evaluation in the educational act centered on characterizing the level of acquisition of cultural competency. The gaps indicate the difficulty of applying the models and theories in practice scenarios, while the recommendations focus on the importance of teacher training in cultural competency. Conclusion. Interculturality is approached as a borrowed theory that, from education, contributes to the nursing practice from training that vindicates situational knowledge and its articulation with ethics permits developing skills to relate with others who have their own views regarding health care.

Objetivo. Analizar la producción académica sobre modelos y teorías de enfermería en contextos interculturales aplicados al campo de la educación. Métodos. Estado del arte donde se examinaron 50 artículos producto de investigación. Resultados. Se encontró como tendencia a nivel disciplinar la aplicación del modelo de competencia cultural y en cuanto a interdisciplinar se trabajó con la pedagogía crítica. Respecto al currículo, se observa que la competencia cultural es una temática que se imparte, pero no es tratada de forma trasversal. La principal didáctica fue la inmersión cultural, que permite la adquisición de habilidades y aptitudes para la atención con población diversa. La evaluación en el acto educativo se centró en caracterizar el nivel de adquisición de competencia cultural. Los vacíos señalan la dificultad de la aplicación de los modelos y teorías en los escenarios de la práctica, mientras que las recomendaciones se centran en la importancia de la formación docente en competencia cultural. Conclusión. La interculturalidad es abordada como una teoría prestada que, desde la educación, contribuye a la práctica enfermera desde una formación que reivindica los saberes situacionales y su articulación con la ética permite el desarrollo de habilidades para relacionarse con los otros que tienen visiones propias respecto al cuidado de la salud.

Objetivo. Analisar a produção acadêmica sobre modelos e teorias de enfermagem em contextos interculturais aplicados ao campo da educação. Métodos. Estado da arte onde foram examinados 50 artigos de produtos de pesquisa. Resultados. A aplicação do modelo de competência cultural foi encontrada como uma tendência ao nível disciplinar e em termos de interdisciplinaridade, utilizou-se a pedagogia crítica. Em relação ao currículo, observa-se que a competência cultural é uma disciplina que se ensina, mas não é tratada de forma transversal. A principal didática foi a imersão cultural, que permite a aquisição de habilidades e aptidões para o atendimento a uma população diversificada. A avaliação no ato educativo centrou-se na caracterização do nível de aquisição da competência cultural. As lacunas apontam para a dificuldade de aplicação dos modelos e teorias em contextos de prática, enquanto as recomendações centram-se na importância da formação de professores em competência cultural. Conclusão. A interculturalidade é abordada como uma teoria emprestada que, a partir da educação, contribui para a prática de enfermagem a partir de um treinamento que reivindica o conhecimento situacional e sua articulação com a ética permite o desenvolvimento de habilidades para se relacionar com outras pessoas que têm suas próprias visões em relação à assistência à saúde.

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Resumen El síndrome de intestino corto es una entidad de baja incidencia en los pacientes pediátricos, pero se asocia con elevadas tasas de morbimortalidad. El abordaje de estos pacientes por un equipo interdisciplinario de expertos enfocados en la rehabilitación intestinal mejora los resultados a corto y a largo plazo. Entre los recursos disponibles para el tratamiento se incluye el teduglutide, un análogo del péptido similar al glucagón tipo 2 (GLP-2) elaborado mediante técnicas recombinantes. Por medio de la aplicación del método Delphi, a partir de la evidencia disponible y de la experiencia de los autores, se proponen recomendaciones para el uso de teduglutide, dirigidas a los profesionales de la salud que tratan a los pacientes pediátricos con síndrome de intestino corto, así como a las autoridades sanitarias.

Abstract Short bowel syndrome is a low-incidence disorder among pediatric patients, but it is associated with high morbidity and mortality rates. Management of these patients by an interdisciplinary team of experts focused on intestinal rehabilitation improves short- and long-term outcomes. Available resources for treatment include teduglutide, a glucagon-like peptide type 2 (GLP-2) analog made by recombinant techniques. Considering the available evi dence and the authors' experience, Delphi-based recommendations for the use of teduglutide are suggested for healthcare professionals who treat pediatric patients with short bowel syndrome, as well as for health authorities.

RESUMO

La desnutrición secundaria a enfermedad afecta no solo el crecimiento y desarrollo del niño, sino que impacta sobre el pronóstico y la sobrevida. Estos efectos son más graves y dejan secuelas permanentes si la desnutrición afecta el primer año de vida. La definición de esta entidad fue revisada recientemente por asociaciones científicas para identificar mejor a los pacientes, comprender la fisiopatología de la desnutrición y sumar herramientas de diagnóstico y abordaje. El objetivo de la presente revisión es describir aspectos específicos de la desnutrición secundaria a enfermedad y ofrecer pautas para un adecuado diagnóstico, interpretación de su fisiopatología y abordaje de niños pequeños en la práctica clínica pediátrica

Disease-associated undernutrition affects not only the child's growth and development, but also has impact on prognosis and survival. These effects are more severe and produce permanent sequelae if undernutrition affects the first year of life. The definition of this entity has recently been revised by scientific associations to better identify patients, understand the pathophysiology of undernutrition and add diagnostic and management tools. The objective of this review is to describe specific aspects of disease-associated undernutrition secondary to disease and offer guidelines for an adequate diagnosis, interpretation of its pathophysiology, and management of children in clinical practice

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BACKGROUND AND AIM: The selection of appropriate criteria is essential to accurately identify cancer patients eligible for home parenteral nutrition (HPN). In this study, the association between Karnofsky Performance Status (KPS) Scale scores and outcomes in cancer patients on HPN was evaluated. METHODS: Retrospective-observational-longitudinal-analytical study of a database of adult cancer patients on HPN. The variables analyzed were sex, age, cancer diagnosis, cancer location (digestive tract and genitourinary), nutritional status, including initial weight (IW), at the start of HPN), usual weight (UW) and IW/UW ratio, and body mass index (BMI) at the start of HPN. Performance status was assessed with the KPS scale. Type of catheter used, number of days on HPN and clinical progression of cancer patients were also studied. RESULTS: Data of 41 cancer patients (60.8% female) were evaluated. Mean age at the start of HPN was 60.45 years. Cancer location was digestive tract (n = 36; 87.8%); gynecologic (n = 4; 9.7%), urinary tract (n = 1; 2.4%). Median IW was 55 kg (45; 64) and BMI was 20 (17.58; 22.84). The IW/UW ratio was -15 kg (-20;-10). The catheters used were peripherally inserted central catheter (n = 30; 73.2%), tunneled (n = 9; 22%) and port (n = 2; 4.8%). The median duration of HPN was 72 days (30; 159). The KPS results showed that 16 cancer patients (39%) had KPS scores ≤50, 17 (41.5%) requiring HPN were discharged and 24 (58.5%) died. The association between disease progression and KPS scores ≤50 was significant (p = 0.025; OR (95% CI): 5.28 (1.07; 36.18). CONCLUSION: The KPS scale is a reliable tool to identify cancer patients eligible for HPN. Cancer patients with ≤50 scores had a five-fold increased risk of death than patients with >50 scores.

Assuntos

RESUMO

Short bowel syndrome is a low-incidence disorder among pediatric patients, but it is associated with high morbidity and mortality rates. Management of these patients by an interdisciplinary team of experts focused on intestinal rehabilitation improves short- and long-term outcomes. Available resources for treatment include teduglutide, a glucagon-like peptide type 2 (GLP-2) analog made by recombinant techniques. Considering the available evidence and the authors' experience, Delphi-based recommendations for the use of teduglutide are suggested for healthcare professionals who treat pediatric patients with short bowel syndrome, as well as for health authorities.

El síndrome de intestino corto es una entidad de baja incidencia en los pacientes pediátricos, pero se asocia con elevadas tasas de morbimortalidad. El abordaje de estos pacientes por un equipo interdisciplinario de expertos enfocados en la rehabilitación intestinal mejora los resultados a corto y a largo plazo. Entre los recursos disponibles para el tratamiento se incluye el teduglutide, un análogo del péptido similar al glucagón tipo 2 (GLP-2) elaborado mediante técnicas recombinantes. Por medio de la aplicación del método Delphi, a partir de la evidencia disponible y de la experiencia de los autores, se proponen recomendaciones para el uso de teduglutide, dirigidas a los profesionales de la salud que tratan a los pacientes pediátricos con síndrome de intestino corto, así como a las autoridades sanitarias.

Assuntos

RESUMO

Objective: To analyze academic production about nursing models and theories in intercultural contexts applied to the field of education. Methods: State-of-the-art study, which examined 50 articles from research. Results: Application of the cultural competence model was found as a trend at disciplinary level, and in at interdisciplinary level, critical pedagogy was used. Regarding the curriculum, it is observed that cultural competency is a subject that is taught, but it is not treated in transversal manner. The principal didactics was cultural immersion, which permits acquiring skills and aptitudes to care for diverse population. The evaluation in the educational act centered on characterizing the level of acquisition of cultural competency. The gaps indicate the difficulty of applying the models and theories in practice scenarios, while the recommendations focus on the importance of teacher training in cultural competency. Conclusion: Interculturality is approached as a borrowed theory that, from education, contributes to the nursing practice from training that vindicates situational knowledge and its articulation with ethics permits developing skills to relate with others who have their own views regarding health care.

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RESUMO

Introducción: La malnutrición y la deficiencia de micronutrientes son complicaciones frecuentes en los pacientes con parálisis cerebral (PC). Objetivo: Analizar los niveles de vitamina D (VitD) en pacientes PC en Nutrición Enteral Domiciliaria (NED). Material y Métodos: Estudio retrospectivo analítico de corte transversal. Se incluyeron pacientes PC, e/ 2-18 años, con dosaje de VitD al final del invierno 2021. Se analizó: sexo, edad, discapacidad por Gross Motor Scale (GMS), estado nutricional, drogas antiepilépticas, fórmula, aporte de VitD, volumen, vía de acceso, gasto energético basal (GEB). Se agruparon: Grupo I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Resultados: se incluyeron 34 pacientes PC, 15 femeninos (44,11 %), edad media 10,87 años (DS 4,78), todos fueron grado V (GMS). La media de Z score de IMC (OMS) fue -1,33 (DS 3,14). Todos recibieron NE diaria. El aporte medio fue de 1270 Kcal (DE:243), 1,16 (Kcal sobre lo estimado según Schofield). Las fórmulas aportaron el 80% del requerimiento de VitD. Los niveles sanguíneos de VitD mostraron: 16 pacientes ≥ de 30 ng/ml y 18 ≤ 29 ng/ml. 14 fueron deficientes y 4 insuficientes. El 59% (20) de los pacientes recibían medicación anticonvulsivante. No se encontraron diferencias significativas entre G1 y G2 para sexo, edad, Z score de IMC, aporte de VitD, calorías recibidas/ GMB y medicación anticonvulsivante. Conclusión: El alto porcentaje de pacientes PC pediátricos con niveles subóptimos de VitD muestra que se trata de una población de riesgo y sugiere la necesidad del chequeo sistemático para una adecuada prevención y tratamiento

Introduction: Malnutrition and micronutrient deficiencies are frequent complications in patients with cerebral palsy (CP). Objective: to analyze the levels of vitamin D (VitD) in CP patients receiving Home Enteral Nutrition (HEN). Material and Methods: Retrospective analytical cross-sectional study. CP patients, from 2 to 18 years old, with measured VitD at the end of winter 2021, were included. The following study variables were analyzed: sex, age, disability by Gross Motor Scale (GMS), nutritional status, antiepileptic drugs, formula, VitD intake, volume, access route, basal energy expenditure (BEE), according to Schofield P/T. They were grouped: Group I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Results: 34 CP patients were included, 15 female (44.11 %), mean age 10.87 years (SD 4.78), all grade V (GMS). The mean BMI Z score (WHO) was -1.33 (SD 3.14). EN was daily in all, 33 due to gastrostomy and 1 due to SNG. The average contribution 1270 Kcal (DS243), 1.16 (Kcal received according to Schofield). The formulas provided 80 % of the VitD requirement. VitD blood levels showed: 16 patients (47 %) ≥ 30 ng/ml and 18 (52 %) ≤ 29 ng/ml. 14 (41.17 %) were deficient and 4 insufficient (11.76 %). 59 % (20) of the patients received anticonvulsant medication. No significant differences were found between G1 and G2 for sex, age, BMI Z score, VitD intake, calories received/GMB and anticonvulsant medication. Conclusion: The high percentage of pediatric CP patients with suboptimal levels of Vit D shows that it is a population at risk and suggests the need for systematic check-up for adequate prevention and treatment

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Type 2 diabetes (T2D) has been linked to the expression of Human Leukocyte Antigens, principally to the Major Histocompatibility Complex Class II, with only scarce reports of Major Histocompatibility Complex Class I in specific populations. The objective of the present work was to explore the presence of polymorphisms in the MHC Class I related to T2D in the Mexican population using the Genome-Wide Association Studies Slim Initiative in Genomic Medicine of the Americas (GWAS SIGMA) database. This database contains information on 3848 Mexican individuals with T2D and 4366 control individuals from the same population without a clinical or hereditary history of the disease. The searching criteria considered a p-value of <0.005 and an odds ratio (OR) of >1.0. Ten novel, statistically significant nucleotide variants were identified: four polymorphisms associated with HLA-A (A*03:01:01:01) and six with HLA-C (C*01:02:01:01). These alleles have a high prevalence in Latin American populations and could potentially be associated with autoimmunity mechanisms related to the development of T2D complications.

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In the present work the feasibility of Tannat grape skin (TGS) as a functional ingredient in the formulation of two snacks (yogurt and biscuits) was studied. The research provided novel information on the effects of the food matrix and digestion process, under simulated human oral gastrointestinal conditions, in the bioaccessibility of TGS bioactive compounds composing of the snacks with health promoting properties (antioxidant, anti-inflammatory, and antidiabetic). TGS polyphenolic profile was analyzed by ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) finding mainly flavonoids, phenolic acids, and anthocyanins, which may exert antioxidant, anti-inflammatory, and carbohydrase inhibition capacities. TGS digest showed antioxidant and antidiabetic potential compared to the undigested sample (p < 0.05). Yogurt and biscuits with TGS were developed with the nutrition claims "no-added sugars" and "source of fiber" and were digested in vitro to evaluate the bioaccessibility of compounds with health promoting properties after food processing and digestion. After in vitro simulation of digestion, bioactive properties were enhanced for control and TGS snacks which may be attributed to the formation/release of compounds with health-promoting properties. Biscuits showed significant increase in ABTS antioxidant capacity and yogurt showed increased α-glucosidase inhibition capacity by the addition of TGS (p < 0.05). Polyphenols from TGS and bioactive peptides from snacks which may be released during digestion might be responsible for the observed bioactivities. Consumer's acceptance of TGS yogurt and biscuits showed scores of 6.3 and 5.1 (scale 1−9), respectively, showing TGS yogurt had higher overall acceptance. Sensory profile assessed by check-all-that-apply + just-about-right (CATA+JAR) showed most of the attributes were evaluated as "just about right", supporting good food quality. The developed yogurt presented adequate shelf-life parameters for 28 days. TGS yogurt with higher acceptability showed reduced ROS formation (p < 0.05) induced by tert-butyl hydroperoxide (1 mM) in CCD-18Co colon cells and RAW264.7 macrophages when pre-treated with concentrations 500−1000 and 100−500 µg/mL of the digests, respectively. Moreover, TGS yogurt digest pre-treatment reduced nitric oxide (NO) production (p < 0.05) in lipopolysaccharide (LPS)-induced RAW264.7 macrophages, showing anti-inflammatory potential. Bioactive peptides generated during lactic fermentation and digestion process may be contributors to intracellular effects. In conclusion, yogurt and biscuits with Tannat grape skin addition were obtained with nutrition claims "no-added sugars" and "source of fiber" with the potential to modulate key biochemical events associated with diabetes pathogenesis.

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La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.

Lactose is the main carbohydrate present in humanmilk. It is a disaccharide made up of glucoseand galactose. It is produced in the mammaryglands, regardless of maternal diet. In addition toproviding energy, it is the only source of dietarygalactose, necessary for macromolecule synthesis,including oligosaccharides, glycoproteins, andglycolipids. It favors calcium, magnesium, andzinc absorption and retention. Its digestion bylactase and subsequent absorption occurs inthe small intestine. Lactase deficiency may beclassified into congenital primary (very rare),late-onset primary or secondary due to an injuryof the intestine; it may cause intolerance withpain, abdominal distension, abdominal gas, anddiarrhea. In the colon, it may be hydrolyzed bybifidobacteria and lactobacilli. The nutritionalmanagement of intolerance should alwayspreserve breastfeeding. Lactose reduction orelimination should be transient, and eliminatedfood should be replaced with other similar incalorie, protein, mineral, and vitamin content.

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Lactose is the main carbohydrate present in human milk. It is a disaccharide made up of glucose and galactose. It is produced in the mammary glands, regardless of maternal diet. In addition to providing energy, it is the only source of dietary galactose, necessary for macromolecule synthesis, including oligosaccharides, glycoproteins, and glycolipids. It favors calcium, magnesium, and zinc absorption and retention. Its digestion by lactase and subsequent absorption occurs in the small intestine. Lactase deficiency may be classified into congenital primary (very rare), late-onset primary or secondary due to an injury of the intestine; it may cause intolerance with pain, abdominal distension, abdominal gas, and diarrhea. In the colon, it may be hydrolyzed by bifidobacteria and lactobacilli. The nutritional management of intolerance should always preserve breastfeeding. Lactose reduction or elimination should be transient, and eliminated food should be replaced with other similar in calorie, protein, mineral, and vitamin content.

La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.

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Objetivo: caracterizar la producción científica relacionada con los aprendizajes de los estudiantes de salud en tiempos de pandemia por COVID-19. Metodología: revisión integrativa por medio de la búsqueda y análisis de literatura en nueve bases de datos científicas de acceso libre. Se incluyeron cuarenta artículos de investigación teniendo en cuenta los Descriptores en Ciencias de la Salud (DeCs) para su búsqueda, no se limitó el periodo de publicación al tratarse de un tema emergente. La investigación se realizó entre diciembre de 2020 y marzo de 2021. Resultados: se identifica la tendencia a estudiar el tema en el nivel de pregrado y específicamente, en la profesión de medicina. El abordaje metodológico con enfoque cuantitativo se presentó más en Asia. Las tendencias temáticas fueron: 1) percepción de los estudiantes en relación con el entorno de aprendizaje en línea y 2) factores para un entorno de aprendizaje. Conclusión: parece haber un acuerdo en la necesidad de un aprendizaje significativo en la educación virtual, sin embargo, todavía se discute cómo y para qué hacerlo.

Objective: to characterize the scientific production related to health students' learning in times of COVID-19 pandemic. Methodology: integrative review by means of literature search and analysis in nine open access scientific databases. Forty research articles were included taking into account the Descriptors in Health Sciences (DeCs) for their search, the period of publication was not limited as it was an emerging topic. The research was conducted between December 2020 and March 2021. Results: the tendency to study the topic at the undergraduate level and specifically in the medical profession is identified. The methodological approach with a quantitative focus was more present in Asia. The thematic trends were: 1) students' perception of the online learning environment and 2) factors for a learning environment. Conclusion: there seems to be an agreement on the need for meaningful learning in virtual education, however, how and for what to do it is still discussed.

Objetivo: caracterizar a produção científica relacionada à aprendizagem dos discentes da área da saúde em tempo de pandemia por COVID-19. Metodologia: revisão integrativa por meio da busca e análise da literatura em nove bases de dados científicas de acesso livre. Incluíram-se quarenta artigos de pesquisa considerando Descritores em Ciências da Saúde (DeCs) para sua busca, não se limitou o período de publicação por se tratar de um tema emergente. A pesquisa foi realizada entre dezembro de 2020 e março de 2021. Resultados: Foi identificada a tendência a estudar o tema no nível de graduação e especificamente na profissão de medicina. A abordagem metodológica com enfoque quantitativa apresentou-se mais na Ásia. As tendências temáticas foram: 1) percepção dos alunos em relação ao ambiente de aprendizagem online e 2) fatores para um ambiente de aprendizagem. Conclusão: parece haver consenso sobre a necessidade de uma aprendizagem significativa na educação virtual, porém, como e por que fazê-lo ainda está sendo discutido.

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