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The western diet is characterized by a high consumption of n-6 polyunsaturated fatty acids (PUFAs) and reduced n-3PUFAs, this phenomenon has been parallel to the increase in the prevalence of obesity. The studies that have analyzed the association between serum PUFAs and the influence on the development of adiposity in children is limited and the findings are controversial. The present study compared the ARA/EPA (arachidonic/eicosapentaenoic) PUFA ratio in children with healthy weight vs. obesity in a cross-sectional study. Thirty children were diagnosed with obesity and 32 children with healthy weight determined through the age-specific body mass index (BMI) Z score, according to the WHO. The variables included were weight, BMI, waist circumference (WC), and the serum ARA/EPA ratio. The Student's t test and Pearson correlation were performed and statistical significance was set at a p <0.05. The project was approved by the local ethics committee of the hospital Instituto Mexicano del Seguro Social. The serum ARA/EPA ratio was significantly higher in children with obesity compared with healthy weight (9.0 vs 5.4; p = 0.012). A statistically significant difference was observed between healthy weight boys and obese boys (p=0.003). Furthermore, the ARA/EPA ratio correlated positively with weight (r=0.336; p=0.008), BMI (r=0.373; p=0.003), WC (r=0.319; p=0.012) and cardio-metabolic risk (r=0.302; p=0.017). When performing a multivariate regression analysis, we identified that BMI was the only variable that remained significant and predicted the ARA/EPA ratio. In conclusion, the serum ARA/EPA ratio differed significantly in relation to weight and was higher in the obese children(AU)

La dieta occidental se caracteriza por un alto consumo de ácidos grasos poliinsaturados n-6(AGPI) y AGPIn-3 reducidos, fenómeno que ha sido paralelo al aumento en la prevalencia de la obesidad. Los estudios que han analizado la asociación entre AGPN en suero y adiposidad en niños son limitados y con hallazgos inconsistentes. El presente estudio comparó la relación ARA/EPA (ácido araquidónico/eicosapentaenoico) AGPI en niños con peso normal vs. obesidad. Es un estudio transversal donde treinta niños fueron diagnosticados con obesidad y 32 niños con peso normal determinado mediante el puntaje z del IMC para la edad, de acuerdo a la OMS. Las variables incluidas fueron peso, IMC, circunferencia de cintura (CC) y la relación ARA/EPA en suero. Se realizó prueba de t de Student y correlación de Pearson, la significación estadística se estableció en p <0,05. El proyecto fue aprobado por el comité de ética local del Hospital del Instituto Mexicano del Seguro Social. La relación ARA/EPA en suero fue significativamente mayor en niños con obesidad en comparación con el peso normal (9,0 frente a 5,4; p = 0,012). Además, la relación ARA/EPA se correlacionó positivamente con el peso (r = 0.336; p = 0.008), IMC (r = 0.373; p = 0.003), CC (r = 0.319; p = 0.012). Al realizar un análisis de regresión multivariable, identificamos que el IMC fue la variable predictora que permaneció significativa. En conclusión, la relación de suero ARA/EPA fue significativamente mayor en los niños con obesidad(AU)

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Introducción: la resistencia a la insulina es una condición metabólica que afecta múltiples tejidos entre ellos al músculo esquelético. El propósito del presente trabajo es analizar si la resistencia a la insulina inducida experimentalmente en ratas, modifica la excitabilidad y las propiedades contráctiles del músculo esquelético. Métodos: se incluyeron 22 ratas Sprague Dawley sanas para formar 2 grupos: Al grupo experimental (n=10) se le indujo resistencia a la insulina mediante la administración oral de prednisona (45mg/Kg.) durante 7 días. Al grupo control (n=12) se le administró solo agua. En ambos grupos se compararon principalmente los parámetros de la contractura muscular: tensión al pico, tensión total, activación contráctil y grado de excitabilidad muscular mediante una curva de umbrales así como su respuesta a una infusión continua de insulina intravenosa. Los experimentos fueron realizados en músculo gastrocnemio utilizando registros de tensión isométrica y estimulación eléctrica. Se analizaron las varianzas entre grupos para utilizar prueba t de Students o U de Mann Whitney, determinándose diferencias significativas entre ambos grupos cuando p<0.05. Resultados: (Control vs. Experimental): 1) Excitabilidad muscular: Reobase: 0.59± 0.12 V vs. 0.27 ± 0.03V (p = 0.19); Cronaxia: 0.07 ms vs. 0.08 ms. 2) Parámetros de la contractura muscular: Tensión al pico: 58.5±5.1 g vs. 48.3±4.3 g (p =0.19). Tensión total: 0.55±0.13 V/ms vs. 0.44±0.05 V/ms (p=0.45). Activación contráctil: 9.13±1.3 ms vs. 10.5±1.6 ms (p=0.19). Conclusiones: los resultados del presente estudio sugieren que la resistencia a la insulina al parecer modifica parcialmente la excitabilidad de la fibra muscular además de favorecer el desarrollo de contracciones musculares de menor intensidad y mas lentas, lo que sugiere una posible afección del acople excitación-contracción del músculo esquelético.

Introduction: Insulin resistance is a metabolic condition that affects many tissues including skeletal muscle tissue. The objective of the present study was to analyze whether or not experimentally induced insulin resistance modifies skeletal muscle excitability and contraction in the rat. Methods : Twenty-two healthy Sprague-Dawley rats were used to form two groups. In the experimental group (n=10) insulin resistance was induced by means of oral prednisone administration (45mg/Kg) over a period of 7 days. The control group (n=12) received only water. The following muscle contraction parameters were compared between groups: peak tension, contractile activation, total tension, degree of muscle excitability during threshold curve and response to continuous intravenous insulin infusion. Experiments were carried out in gastrocnemius muscle, utilizing isometric tension registers and electrical stimulation. Variance between groups was analyzed to determine use of Student t test or Mann Whitney U test. Difference between groups was considered statistically significant when P<0.05. Results : (Control group vs Experimental group): 1) Muscle excitability: Rheobase: 0.59± 0.12 V vs 0.27 ± 0.03V (P = 0.19); Chronaxie: 0.07 ms vs 0.08 ms. 2) Muscle contraction parameters: Peak tension: 58.5±5.1 g vs 48.3±4.3 g (P =0.19). Total tension: 0.55±0.13 V/ms vs 0.44±0.05 V/ms ( P=0.45). Contractile activation: 9.13±1.3 ms vs 10.5±1.6 ms (P=0.19). Conclusions: In the results of the present study insulin resistance appears to partially modify muscle fiber excitability in addition to favoring the development of slow, low intensity muscle contractions, suggesting a possible affectation of excitation-contraction coupling in skeletal muscle.

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BACKGROUND: Obesity in children is now an increasing health risk worldwide in which the insulin-resistance can be present. Studies have linked a diet rich in n-3 fatty acids with a lower prevalence of insulin-resistance. OBJECTIVE: To compare the levels of eicosapentaenoic acid among obese children with and without insulin-resistance. MATERIALS AND METHODS: In 56 randomly school-age children with obesity, insulin-resistance was determined by the homeostasis model assessment for insulin-resistance index and the serum levels of eicosapentaenoic acid were determined by gas chromatography. Insulin-resistance was established when the index was >6.0, non- insulin- resistance when that index was within the range of 1.4-5.9. The serum levels of eicosapentaenoic acid were compared with the Kruskal-Wallis and Mann-Whitney U tests, as needed. RESULTS: No differences in age or sex were identified among the groups studied. The anthropometric parameters were significantly higher in the group of children with insulin-resistance than in the other two groups. The children with insulin- resistance had significantly lower levels of eicosapentaenoic acid than the non- insulin-resistance group [12.4% area under the curve vs. 37.4%, p = 0.031], respectively. CONCLUSION: Obese primary school-aged children with insulin-resistance had lower plasma levels of eicosapentaenoic acid.

Introducción: La obesidad en los niños es un problema de salud pública en todo el mundo y la resistencia a la insulina puede estar presente. Existen estudios publicados que han relacionado una dieta rica en n-3 ácidos grasos con una menor prevalencia de resistencia a la insulina en sujetos obesos. Objetivo: Comparar los niveles de ácido eicosapentaenoico en niños escolares obesos con y sin resistencia a la insulina. Métodos: Se eligieron al azar 56 niños en edad escolar con obesidad, a los cuales se les determinó resistencia a la insulina mediante la evaluación del modelo de homeostasis para el índice de resistencia a la insulina y se determinaron los niveles séricos de ácido eicosapentaenoico por cromatografía de gases. La resistencia a la insulina se estableció cuando el índice fue> 6,0, no resistencia a la insulina cuando ese índice fue.

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INTRODUCTION: This study evaluated the association between obesity and the K109R, Q223R, and K656N polymorphisms of the leptin receptor (LEPR) locus. Such polymorphisms cause changes in the extracellular extreme of the LEPR gene product and appear to be related to signal transduction toward the cell. SUBJECTS AND METHODS: A total of 128 participants between 6 and 17 years of age from a Mexican Mestizo population were included in the study. Individuals were classified as overweight-obese (n = 76) and normal (n = 52), based on anthropomorphic measurements. The K109R, Q223R, and K656N polymorphisms of the LEPR were determined by the size of restriction fragments obtained from polymorphic fragment amplification (polymerase chain reaction-restriction fragment length polymorphism) obtained from genomic DNA. Allele frequency was compared using the chi-square test. Odds ratio was calculated to determine allele obesity risk factor. RESULTS: Variant allele frequency was 109R = 0.35, 223R = 0.49, and 656N = 0.11 for the K109R, Q223R, and K656N polymorphisms, respectively. No statistically significant association with obesity was found in any of the alleles. The N allele of the K656N polymorphism was associated with nonobesity markers, such as high concentrations of high-density lipoproteins, normal body mass index, less thickness of skinfolds, and body perimeters. None of the alleles studied were shown to be obesity risk factors. CONCLUSIONS: Our results suggest that there is no association between the K109R, Q223R, and K656N polymorphisms of the LEPR gene with obesity, and none of the alleles of the LEPR gene K109R, Q223R, and K656N polymorphisms are an obesity risk factor.

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OBJECTIVE: To identify the existence of significant differences in the degrees of mal-alignment of the mechanical axis of the knee between a traditional measuring method and an alternative method. MATERIALS AND METHODS. One hundred mechanical axes of the knee were determined in patients of both sexes. The degree of axis mal-alignment was obtained first using the traditional measuring method and subsequently using the alternative method. The results obtained from the two methods were then compared. The measurement variable control was standardised by positioning the patients in the same place during radiography when beginning mechanical axis determination. A wooden ruler on which each centimetre was indicated by a metal strip and numbered at every 10-centimeter interval was used to evaluate the degree of pelvic mal-alignment. The ruler was then used as a mechanical axis correction reference in accordance with the characteristics of each patient. RESULTS: The following results were obtained from 100 mechanical axes evaluated by the traditional method and by the alternative method, respectively: varus deformity of the right pelvic segment was 21 degrees +/- 16 degreesuv. 7 ++/-6. degrees varus deformity of the left pelvic segment was 22 _+/-170 degreesvs. 8 ++/-50 degrees valgus deformity of the right pelvic segment was 21 - /-150 degreess. 8 + +/-; and valgus deformity of the left pelvic segment was 16 +/- 11 vs. 6 +/- 5 degrees. CONCLUSIONS: Our results suggest that the proposed method provides more accurate mechanical axis measurement and that the correction is exponential: the greater the angle measured traditionally, the greater the correction with our proposed method.

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BACKGROUND: Varicocele is cause of fertility disorders. The objective was to evaluate usefulness of testicular percutaneous biopsy in the fertility prognosis in patients, who undergone varicocelectomy. METHODS: A cohort study of 50 patients having undergone varicocelectomy due to varicocele was carried out. Five groups were formed according to testicular damage evaluated by percuta-neous biopsy (stage I through V histological lesions). Pregnancy rate and sperm count results were evaluated per group. ANOVA and Fisher exact test were used. RESULTS: Patients aged 30.5 +/- 5 years. Spermatic density and motility had improved one year after varicocelectomy. Pregnancies were achieved 13 +/- 9 months later. Fifteen patients impregnated their partners. Fourteen of them (93 %) had stage I, II or III histological damage and only one case had stage IV. Pregnancy probability was greater in the stage I, II or III testicular damage (OR = 9.3, 95 % CI = 11-79, p < 0.021). CONCLUSIONS: The proposed histological classification of testicular damage allows evaluating fertility prognosis as well as the magnitude of testicular damage in patients with varicocele.

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Introducción: El Método de Aprendizaje Basado en Problemas se fundamenta en las teorías constructivistasdel aprendizaje, en los principios del aprendizaje de los adultos y en el desarrollo de modelos andragógicos.Tiene el propósito de ayudar a los estudiantes a desarrollar habilidades para dirigir su propio aprendizaje.Objetivo: Analizar el papel de los profesores en su rol de facilitadores del aprendizaje autodirigido de los estudiantes de Licenciatura en Enfermería de la Universidad de Colima, México. Metodología: Estudiodescriptivo y transversal; se utilizó una muestra por conveniencia de 121 estudiantes. Para evaluar si los profesores facilitan la formación de habilidades,se diseñó un instrumento tipo inventario con 20 reactivos, los cuales fueron integrados en tres áreas: administración de la información, proceso de grupo, reflexión y pensamiento crítico. Por medio del alpha de Cronbach se obtuvo una confiabilidad de 0.96. Resultados: Al aplicar la prueba Kruskal-Wallis se encontraron diferencias estadísticamente significativas sólo para la dimensión “Proceso de grupo” entre los grupos de 4º y 6º semestres (H = 6.77; P < 0.05). Sin embargo, aunque en las otras dimensiones no se encontraron diferencias estadísticamente significativas, sí se logra identificar cambios en la tendencia de la opinión de los estudiantes hacia el rol de los tutores. Conclusiones: La evaluación sobre las tareas del tutor es favorable; los estudiantes afirman que “casi siempre” facilita, ayuda, promueve o colabora en el desarrollo de las habilidades que les permitirán ser estudiantes autodirigidos

Problem-Based Learning method is based on constructivist theories of learning, the principles of adult learning and the development of andragogical models. Its objective is to help students develop skills to direct their own learning. Objective: to analyse the role of professors of the bachelor’s degree in nursing as facilitators of self-directed learning Licenciatura in nursing of the University of Colima Mexico. Methodology: with the use of a descriptive survey integrated with 20 items answered by 121 students, we assessed the role of the professors of a bachelor’s degree in nursing. The 20 items assessed three areas of the facilitation process: Management of information, group process and reflection and critical thinking. These items were verified with Cronbach’s alpha and a reliability of 0.96. Results: when the Kruskal-Wallis survey was conducted, statistically significant differences were found only with regard to the “Group processing” dimension among sophomores and juniors (H = 6.77; P < 0.05). Even though no statistically significant differences were found with regard to the other dimensions, it is possible to detect shifts in the students’ opinion trend about the role of tutors. Conclusion: The overall average score per scale makes it possible to conclude that the “the work of the tutor” is viewed favourably, considering that the students report that their tutor “almost always” facilitates, assists, promotes or collaborates on the development of the skills for being a self directed learner

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OBJECTIVE: To determine the causes of non postpartum contraceptive use among adolescent mothers. PATIENTS AND METHODS: We conducted a cross-section descriptive study. We included women who asked for attention of an obstetric event in 2002, we identified those were in immediate postpartum period, and we selected those that did not began a birth-control method. Data were collected directly with an interview and revision of the file, later on they were coded and processed manually; the causes of non contraceptive use were classified in: attributable causes to patient: personal, religious, moral, familiar, cultural, etc. Reasons, when they received information and advice or when they did not assist to educational actions; attributable causes to hospital: technique administrative factors, insufficient educational communication activities by service provider; and attributable causes to medical indication: presence of risk factors for health women. The statistical analysis was carried out using frequencies and percentages. RESULTS: We found 261 women, we identified 160 (61%) in immediate postpartum period, 52 (32%) they did not began contraceptive use. CONCLUSION: The causes of non postpartum contraceptive use among adolescent mothers were attributable to themselves in 75%, in 21% to the medical unit, and 4% to medical indication.

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Objetivo. Describir la proporción de práctica de tamizaje para CaCu y características epidemiológicas en trabajadoras de la salud a fin de comparar estas variables con las mostradas por derechohabientes de una institución de salud. Material y método. Estudio transversal analítico que describe los resultados de una encuesta aplicada a derechohabientes y trabajadoras de un hospital (96 por grupo) seleccionadas en forma aleatoria. Análisis estadístico. X2 con corrección de Yates. Resultados. Las características de derechohabientes y trabajadoras, respectvamente, fueron: edad 35 ñ 10 vs. 41 ñ 5 años (p < 0.001), escolaridad: 8.3 ñ 5 vs. 12.0 ñ 1 años (p < 0.001), número de pruebas de tamizaje realizadas en los últimos dos años: 1.2 ñ 0.4 vs. 1.0 ñ 0.1 (p < 0.001), tiempo transcurrido del último examen: 13.6 ñ 15 vs. 12.2 ñ 13 meses (p= 0.52), apego adecuado a la realización del tamizaje según se indicó por un médico 55 (57 por ciento) vs. 72 (75 por ciento), (p < 0.001). Las derechohabientes y trabajadoras que no se realizaron el tamizaje fue por indolencia 13 (14 por ciento) vs. 13 (14 por ciento) y falta de tiempo 7 (7 por ciento) vs. 2 (2 por ciento) respectivamente. Conclusiones. Las trabajadoras se realizan el tamizaje para CaCu en mayor proporción que las derechohabientes. Los motivos para no someterse al tamizaje son similares entre ambos grupos.

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El incremento en la frecuencia de cesáreas notado a partir de la década de los setenta no disminuyó como se esperaba la morbilidad y mortalidad perinatales. Las principales indicaciones de cesárea son distocias, cesárea previa y sufrimiento fetal. En 1998 la frecuencia de cesáreas en nuestro hospital fue de 35 por ciento de los embarazos atendidos. Mediante un estudio de casos y controles se determinaron los factores de riesgo para cesárea en nuestra unidad hospitalaria. Se seleccionaron 165 casos (cesáreas) y 328 controles (partos). Se determinó razón de momios (OR) y fracción atribuible (FA) de los factores de riesgo. Se analizaron los datos mediante X2. Las indicaciones más importantes de cesárea fueron: distocias (39 por ciento, n= 64); cesárea previa (23 por ciento, n=41) y sufrimiento fetal (11 por ciento, n=21). No hubo diferencias significativas en edad, estatura y tiempo de rotura de membranas entre ambos grupos. El antecedente de cesárea confirió mayor riesgo para una nueva intervención quirúgica (OR= 12.7, p= < 0.0001, FA= 92 por ciento). Ser nulípara (OR= 6.6, p < 0.001, FA= 85 por ciento), secundigesta (OR= 1.8, p= 0.002, FA= 19 por ciento) o con antecedente de abortos (OR= 1.8, p= 0.04, FA= 45 por ciento) fueron factores mayormente asociados a cesárea. Concluimos que deben replantearse las indicaciones precisas de esta intervención quirúrgica ,sobre todo en casos de nuliparidad o de cesárea previa para disminuir su elevada frecuencia.

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La mortalidad perinatal 1 (MP1) comprende defunciones ocurridas desde la semana 28 de gestación hasta la primera semana de vida extrauterina. El objetivo de nuestro estudio fue describir, a partir de expedientes clínicos, las características clínicoepidemiológicas de 19 casos y 36 controles de MP1 ocurridos en 1998 en nuestro Hospital General de Zona. Resultados. Las causas más frecuentes de MP1 fueron: interrupción de la circulación fetoplacentaria, cardiopatías y hemorragias ventriculares. Los casos y controles fueron similares en cuanto a edad materna 27.6 ñ 7 vs 28.8 ñ 5 años (p = 0.52), edad gestacional por amenorrea: 39.2 ñ 1.4 vs 39.0 ñ 1.4 semanas (p = 0.82) y peso al nacer: 2892 ñ 769 vs 3352 ñ 549 gramos (p = 0.03) respectivamente. En nuestro estudio, el riesgo de MP1 estuvo incrementado cuando hubo antecedentes de uno a cuatro partos previos (OR = 4.67, p = 0.03) y estuvo disminuido cuando hubo antecedente de nuliparidad (OR = 0.21, p = 0.03). De los 19 casos, 10 fueron mortinatos y nueve fueron casos de muerte hebdomadal. Sus características fueron similares: edad materna 26.1 ñ 5 vs 29.6 ñ 8 años (p = 0.34), edad gestacional 37.7 ñ 3 vs 34.1 ñ 3 semanas (p = 0.05) y peso 3025 ñ 699 vs 2780 ñ 853 gramos (p = 0.53) respectivamente. Los casos de muerte hebdomadal ocurrieron a las 44 ñ 5 horas de su nacimiento. Con lo anterior se concluye que es importante mejorar la atención prenatal sobre todo durante las últimas semanas de la gestación aun en embarazos considerados como normales.

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