Abstract Ketogenic dietary therapies (KDTs) are a safe and effective treatment for pharmacoresistant epilepsy in children. There are four principal types of KDTs: the classic KD, the modified Atkins diet (MAD), the medium-chain triglyceride (MCT) diet, and the low glycemic index diet (LGID). The International Ketogenic Diet Study Group recommends managing KDTs in children with epilepsy. However, there are no guidelines that address the specific needs of the Brazilian population. Thus, the Brazilian Child Neurology Association elaborated on these recommendations with the goal of stimulating and expanding the use of the KD in Brazil.

Resumo As terapias dietéticas cetogênicas (TDC) são um tratamento seguro e eficaz para epilepsia farmacorresistente em crianças. Existem quatro tipos principais de TDCs: a dieta cetogênica (DC) clássica, a dieta de Atkins modificada (DAM), a dieta de triglicerídeos de cadeia média (DTCM) e a dieta de baixo índice glicêmico (DBIG). O Grupo Internacional de Estudos de Dietas Cetogênicas (International Ketogenic Diet Study Group) propõe recomendações para o manejo da DC em crianças com epilepsia. No entanto, faltam diretrizes que contemplem as necessidades específicas da população brasileira. Assim, a Associação Brasileira de Neurologia Infantil elaborou essas recomendações com o objetivo de estimular e expandir o uso da DC no Brasil.

ABSTRACT Purpose: To evaluate the variables possibly related to actinic keratosis and malignant skin lesions on the eyelid. Methods: A prospective study of patients with suspected eyelid malignancy was conducted. The participants underwent a 2-mm punch biopsy at two opposite sites of the lesion for diagnosis, and the results were compared with those of the histopathological study of the surgical excised specimen. The patients with an actinic keratosis component were divided into two groups (actinic keratosis-associated malignancy and actinic keratosis alone), which were compared for the following variables: age, disease duration, largest diameter, tumor area, Fitzpatrick classification, sex, tumor site and margin involvement. A cluster analysis was also performed. Results: We analyzed 174 lesions, of which 50 had an actinic keratosis component. Actinic keratosis was associated with squamous cell carcinoma in 22% of the cases and to basal cell carcinoma in 38%, which shows that both neoplasms may have contiguous actinic keratosis. Statistical analysis revealed no significant difference among the variables. In a cluster analysis, four groups were identified with malignant lesions in the medial canthus with the largest mean diameter and area. All margin involvements on the lower eyelid were related to malignancy, which means that all cases with margin involvement had an almost 100% risk of malignancy. Conclusions: Larger actinic keratosis lesions in the medial canthus and lesions with margin involvement on the lower eyelid have a greater probability of malignant association.

RESUMO Objetivo: Avaliar as possíveis variáveis relacionadas à ceratose actínica e lesões malignas cutâneas nas pálpebras. Métodos: Estudo prospectivo de pacientes com lesões palpebrais suspeitas de malignidade. Os participantes foram submetidos à biopsia por trépano (punch) de 2-mm em dois pontos opostos da lesão como método diagnóstico e os resultados foram comparados com o estudo histopatológico da peça excisada cirurgicamente. Aqueles que apresentaram ceratose actínica como resultado foram divididos em dois grupos (ceratose actínica associada com malignidade e ceratose actínica isolada) e foram comparados de acordo com as variáveis: idade, tempo de doença, maior diâmetro, área do tumor, classificação de Fitzpatrick, gênero, localização e acometimento da margem palpebral. A análise de cluster também foi realizada. Resultados: Foram analisadas 174 lesões e 50 delas tinham ceratose actínica como componente do tumor. Ceratose actínica esteve associada ao Carcinoma Espinocelular em 22% dos casos e ao Carcinoma Basocelular em 38%, mostrando que ambos podem ter ceratose actínica adjacente. A análise estatística não encontrou diferença entre as variáveis. A análise de cluster identificou quatro grupos e mostrou que lesões malignas no canto medial tinham maiores diâmetro e área. Acometimento da margem na pálpebra inferior relacionou-se em 100% com malignidade, enquanto a ausência de acometimento da margem mostrou menor chance de malignidade. Conclusões: Lesões maiores de ceratose actínica no canto medial e lesões com acometimento da margem palpebral inferior têm maiores chances de associação com malignidade.

OBJETIVO. Determinar los factores de riesgo de infección intrahospitalaria en pacientes críticos atendidos en el Hospital del Niño "Ovidio Aliaga Uría", de diciembre 2017 a diciembre 2018. MATERIAL Y MÉTODOS. Estudio de casos y controles, los casos fueron los que desarrollaron infección intrahospitalaria durante su estadía, los controles los que no desarrollaron infección. Se excluyó a pacientes que presentaron infección desde su ingreso y los atendidos fuera del tiempo establecido de estudio. RESULTADOS. Se obtuvo la información de 49 casos y 50 controles. Los casos tuvieron más desnutrición (63.27%) que los controles (40%). Tener por lo menos una comorbilidad fue mayor en casos (75.5% y 52%), así como el uso previo de antibióticos (57.14% y 26%) y la estancia hospitalaria mayor a 7días (91.8% y 58.9%). Son factores de riesgo para infección: desnutrición (OR 2.5 IC95%1.06-6.3), tener una comorbilidad (OR 2.8 IC95%1.11-7.37), uso previo de antibióticos (OR 3.79 IC95%1.5-9.7), estancia hospitalaria mayor a 7 días (OR 7.8 IC95%2.13-35), uso de catéter venoso central (OR 2.8 IC95%1.04-7.6), acceso venoso periférico (OR 7.4 IC95%1.48-70.9), sondas (OR 14 IC95%3.6-78), tiempo de uso de sondas mayor a 10 días (OR 9 IC95%3.2-26.8) e intervención quirúrgica (OR 8.3 IC95%2.1-46.9). El germen aislado con mayor frecuencia en casos fue Gram Negativo (51%). CONCLUSIONES. Es necesario fortalecer estrategias preventivas como programas de capacitación y supervisión del personal de salud sobre la correcta instalación y cuidado de dispositivos médicos.

OBJECTIVE. To determine risk factors for intrahospital infection in critical patients treated at Ovidio Aliaga Uría Children Hospital from December 2017 to December 2018. MATERIAL AND METHODS. A case-control study was conducted. Cases were those patients who developed intrahospital infection at their staying, and controls were those who did not develop infection. Patients admitted to hospital for infection and those treated outside the study time were excluded. RESULTS. Data collection reflected 49 cases and 50 controls. Cases displayed higher malnutrition (63.27 %) than controls (40 %). At least one comorbidity was observed in most of the cases (75.5 % and 52 %) as well as a prior use of antibiotics (57.14 % and 26 %), and hospital stay was longer than 7 days (91.8% and 58.9%). Infection risk factors were malnutrition (OR 2.5 IC95 % 1.06-6.3), comorbidity (OR 2.8 IC95 % 1.11-7.37), antibiotics prior use (OR 3.79 IC95 % 1.5-9.7), hospital stay longer than 7 days (OR 7.8 IC95 % 2.13-35), use of central venous catheter (OR 2.8 IC95 % 1.04-7.6), peripheral venous access (OR 7.4 IC95 % 1.48-70.9), probes (OR 14 IC95% 3.6-78), probes use longer than 10 days (OR 9 CI95 % 3.2-26.8), and surgical intervention (OR 8.3 CI95 % 2.1-46.9). The most frequently isolated germ in cases was Gram Negative (51%) CONCLUSIONS. Preventive strategies such as training programs and supervision of health personnel on the correct installation and care of medical devices need to be strengthened.

RESUMEN Objetivo: Describir el perfil obstétrico y neonatal de los partos naturales asistidos por enfermeros obstetras en los domicilios. Material y Método: Estudio documental de enfoque cuantitativo-descriptivo y retrospectivo, desarrollado con los registros archivados por los dos únicos equipos de enfermería obstétrica privada de la ciudad de Maceió, estado de Alagoas, Brasil. La recolección de datos fue entre abril y mayo de 2017 y se basó en una media estimada de 140. Finalmente se obtuvieron 72 fichas que cumplieron con todos los requisitos éticos de investigación respecto del consentimiento libre e informado. Resultados: Predominó el grupo de edad de las progenitoras de 20 a 29 años (58,3%), casadas (58,7%) y con nivel escolar superior (83,4%). Multípara (87,5%), con partos en el agua (62,5%), de cuatro apoyos (40,3%), sin laceración perineal (77,8%) y con expulsión espontánea de la placenta (94,4%). El aspecto del líquido amniótico claro (95,8%), con APGAR y el test del corazón satisfactorio para el mantenimiento de la vida (100%). Conclusión: A pesar de que los equipos de enfermería obstétrica actúan en los escenarios hospitalarios y domiciliarios, el público optó por partos domiciliarios y se evidenció que dar a luz en casa es tan seguro como dar a luz institucionalmente, sobre todo si se respeta la opinión femenina.

ABSTRACT Objective: To describe the obstetric and neonatal profile of natural births assisted by obstetric nurses at home. Materials and Methods: Documentary study of quantitative-descriptive and retrospective approach, carried out using the medical records filed by the only two private obstetric nursing teams of Maceió, state of Alagoas, Brazil. Data collection took place between April and May 2017 and, based on an estimated average of 140, 72 available medical records that met all ethical research requirements in relation to the waiver of the informed consent form were used. Results: 72 records were analyzed, with a predominance of the age group of 20- to 29-year-olds (58.3%), married (58.7%) and having higher education level (83.4%). Multicenter (87.5%), water births (62.5%), on four legs (40.3%), no perineal laceration (77.8%) and spontaneous placenta delivery (94.4%). Clear amniotic fluid (95.8%), APGAR and satisfactory heart test for life maintenance (100%). Conclusion: Although obstetrical nursing teams work in the hospital and home settings, people preferred home births and it was shown that giving birth at home is as safe as giving birth institutionally, especially if it takes into account women's opinion.

RESUMO Objetivo: Descrever o perfil obstétrico e neonatal dos partos naturais assistidos por enfermeiros obstetras nos domicílios. Material y Método: Estudo documental de abordagem quantitativo-descritivo e retrospectivo, desenvolvido nos prontuários arquivados pelas duas únicas equipes de enfermagem obstétrica privada de Maceió, Alagoas. A coleta dos dados ocorreu entre abril a maio de 2017 e baseado na media estimada de 140; abordaram-se 72 prontuários disponíveis que cumpriram com todos os requisitos éticos de pesquisa deste cunho em relação à dispensa do termo de consentimento livre e esclarecido. Resultados: Com predomínio da faixa etária das genetrizes de 20 a 29 anos (58,3%), casadas (58,7%) e com nível superior (83,4%). Multípara (87,5%), com partos na água (62,5%), de quatro apoios (40,3%), sem laceração perineal (77,8%) e com delivramento espontâneo (94,4%). O aspecto do liquido amniótico claro (95,8%), com Apgar e o teste do coraçãozinho satisfatório para manutenção da vida (100%). Conclusão: Apesar das equipes de enfermagem obstétrica atuarem nos cenários hospitalar e domiciliar, o público procurou por partos domiciliares e evidenciou-se que parir em casa é tão seguro do que parir institucionalmente e sobretudo se respeita a opinião feminina.

Abstract For this study 47 samples of crude palm oil (CPO) were collected, consisted of what had been used for 4 hours around the city of Salvador-Bahia. To evaluate the quality of CPO were analyzed: Total Polar Compound (TPC; %) by Adsorption Chromatography (AC), Testo 270 and Fricheck; Free fatty acids (FFA; % oleic acid), Color (CIELab); Total Carotenoids (TC; ppm), induction time (IT, h) and fatty acids composition (g 100 g-1). The TPC analysis by Testo 270 and Fricheck showed a poor linear correlation with AC (0.69 and 0.60 respectively). Otherwise 44.70% and 36.95% of samples were completely oxidized, according to CA and IT methods. All samples presented TC (11.01-331.45 ppm) and yellow color predominance. Trans fatty acids, C18:1t in 17.02% and C18:3t in 65.65% of the samples were identified. The results demonstrate the need in the deep frying control, respect to techniques used during process. As well the improvement of the quality of palm oil fresh, can minimize the degradation process during th deep frying.

OBJECTIVES: The aim of this study was to evaluate the histomorphometry of the skin of women during the reproductive period according to the Fitzpatrick classification. METHODS: Thirty women aged 30 to 45 years were included in this study. We studied the surgical sites of extracted nevi. The material was processed for routine histology and then stained with haematoxylin and eosin as well as Picrosirius red. Four-micrometre histological sections were analysed according the Fitzpatrick criteria (skin pigmentation). The skin thickness and collagen concentration were determined for the reticular dermal skin. The data were statistically analysed with ANOVA. RESULTS: Fitzpatrick skin types I and II were thicker than the other skin types. CONCLUSIONS: Our data suggest that white skin may be less thick than dark skin.

Objetivo. Determinar la prevalencia de factores de riesgo para enfermedades crónicas no transmisibles en estudiantes de primer año de Medicina, de la Universidad Mayor de San Andrés, gestión 2015. Material y métodos. Estudio descriptivo de corte transversal. Se evaluó 200 estudiantes de primer año de la carrera de Medicina. Se determinó el peso y talla por procedimientos estandarizados, y se aplicó un cuestionario semiestructurado acerca de los factores de riesgo de sedentarismo, consumo de alcohol, consumo de tabaco y estilo alimentario, que fue autoadministrado. Resultados. El 65% de los estudiantes fue de género femenino y el 35% masculino con un promedio de edad de 19.4±1.39 años. El 55.5% fueron residentes de la ciudad de La Paz. La prevalencia de sedentarismo fue de 23% con mayor porcentaje de mujeres, la prevalencia de sobrepeso fue 17%, obesidad 1%, consumo de alcohol 23%, tabaco 20% y tabaquismo pasivo 65%. En la mayoría de los participantes, se evidenció una alimentación "no saludable", caracterizada por bajo consumo de verduras, frutas y agua; además consumo elevado de carne roja, frituras y golosinas. Conclusión. Los factores de riesgo con mayor prevalencia para enfermedades crónicas no transmisibles en estudiantes de primer año de la Carrera de Medicina fueron sedentarismo, alimentación no saludable, consumo de tabaco y alcohol. Todos estos factores son prevenibles con estilos de vida saludables.

Objective: To determine the prevalence of risk factors for chronic non-communicable diseases in first-year medical students of San Andrés University. This study was conducted during 2015. Material and methods. A descriptive cross-sectional study was conducted. It was studied 200 first-year medical students. Weight and height were determined by standarized procedures, and a semi-structured questionnaire (self-administered) about risk factors of sedentary lifestyle, alcohol consumption, tobacco consumption, passive smoking and food style was applied. Results. Female students were 65% and male 35%, with an average age of 19.4 ±1.39 years old, 55.5% were residents in La Paz city. The prevalence of sedentary lifestyle was 23% predominantly in women, the prevalence of overweight was 17%, obesity 1%, alcohol consumption 23%, tobacco smoking 20% and passive smoking 65%. In most of medical students unhealthy eating habits were evidenced, characterized of vegetables, fruits and water low consumption; furthermore a higher consumption of red meat, junk food and candies was observed. Conclusion. Risk factors for chronic non-communicable diseases with more prevalence in first-year medical students of San Andrés University were sedentary lifestyle, unhealthy diet, tobacco consumption and alcohol consumption. These risk factors are preventable with healthy lifestyles.

RESUMO Objetivo: Desenvolver uma representação gráfica sob a forma de pirâmide alimentar para a dieta cetogênica destinada a crianças e adolescentes com indicação de tratamento dietético da epilepsia refratária. Métodos: A construção foi baseada na estimativa da necessidade energética por faixa etária, na distribuição de macronutrientes, nos grupos alimentares, no número de porções e nas respectivas quantidades de alimentos a serem ofertados de forma a atender as recomendações da dieta cetogênica. O porcionamento dos alimentos foi feito baseado no cálculo da necessidade energética e na distribuição de macronutriente segundo a faixa etária e estado nutricional. Resultados: A pirâmide foi dividida em três estratos e em cinco grupos alimentares (gorduras, proteínas, hortaliças tipo 1, hortaliças tipo 2 e frutas). Foram elaboradas quatro listas de porcionamento para as seguintes faixas etárias 1 a 3 anos, 4 a 6 anos, 7 a 10 anos e 11 a 19 anos. Conclusão: A utilização da pirâmide alimentar da dieta cetogênica facilitará a orientação inicial dos pacientes submetidos a essa terapia nutricional, ilustrando a diversidade de alimentos que podem ser ofertados durante o tratamento e otimizando, assim, a aderência ao mesmo e a manutenção dos efeitos benéficos de controle de crises.

ABSTRACT Objective: To develop a graphical representation in the form of a food pyramid for a ketogenic diet for dietary treatment in children and adolescents with refractory epilepsy. Methods: The pyramid was constructed based on: the estimation of energy requirements for different age groups, macronutrient distribution, food groups, and the number of servings and respective amounts of food according to the ketogenic diet. Serving sizes were based on the calculation of energy and macronutrient requirements according to age and nutritional status. Results: The pyramid was divided into three tiers and 5 food groups (fats, proteins, type 1 vegetables, type 2 vegetables, and fruits). Four portion size lists were defined for the following age groups: 1-3 years, 4-6 years, 7-10 years, and 11-19 years. Conclusion: The ketogenic diet food pyramid can be used as nutritional guidance for patients undergoing this dietary therapy by illustrating the variety of foods that can be eaten during the treatment, optimizing adherence to the treatment, and guaranteeing beneficial effects on seizure control.

Resumo OBJETIVO: descrever os primeiros casos de microcefalia possivelmente relacionados ao vírus Zika em nascidos vivos notificados na Região Metropolitana do Recife, Pernambuco, Brasil. MÉTODOS: estudo descritivo de tipo série de casos (notificados de 1º de agosto a 31 de outubro de 2015), com dados obtidos dos registros médicos e de questionário aplicado às mães. RESULTADOS: foram confirmados 40 casos com microcefalia, distribuídos em oito municípios da Região Metropolitana do Recife, com maior concentração no Recife (n=12); a mediana do perímetro cefálico foi de 29 cm, do perímetro torácico, 31 cm, e do peso, 2.628 gramas; 21/25 casos apresentaram calcificação cerebral, ventriculomegalia ou lisencefalia; entre as 40 mães, 27 referiram exantema na gestação, 20 no primeiro trimestre e sete no segundo, além de prurido, cefaleia, mialgia e ausência de febre. CONCLUSÃO: a maioria dos casos apresentou características de infecção congênita; a maioria das mães apresentou quadro sugestivo de infecção pelo vírus Zika na gestação.

Abstract OBJECTIVE: to describe the first cases of microcephaly possibly related to Zika virus in live born babies reported in the Metropolitan Region of Recife, Pernambuco State, Brazil. METHODS: this was a descriptive case series study (cases reported between August 1st and October 31st 2015), using medical record data and data from a questionnaire answered by the mothers of the babies. RESULTS: 40 microcephaly cases were confirmed, distributed in eight municipalities within the Metropolitan Region, with Recife itself having the highest concentration of cases (n=12); median head circumference was 29 cm, median chest girth was 31 cm and median weight was 2,628 grams; 21/25 cases had brain calcification, ventriculomegaly or lissencephaly; 27 of the 40 mothers reported rash during pregnancy, 20 in the first trimester and 7 in the second trimester, as well as itching, headache, myalgia and absence of fever. CONCLUSION: the majority of the cases bore the characteristics of congenital infection; the clinical condition of the majority of mothers suggested Zika virus infection during pregnancy.

Resumen OBJETIVO: describir los primeros casos de microcefalia en nacidos vivos reportados al Departamento de Salud del Estado de Pernambuco, en la región metropolitana de Recife, Pernambuco, 2015. MÉTODOS: estudio epidemiológico descriptivo de serie de casos (reportados de 1 de agosto a 31 de octubre de 2015), con datos obtenidos de registros médicos y cuestionarios aplicados a las madres. RESULTADOS: 40 casos fueron confirmados con microcefalia, en ocho municipios de la región metropolitana de Recife, con mayor concentración de casos en Recife (n=12); la circunferencia media de la cabeza fue 29 cm, perímetro torácico 31 cm y peso 2.628 gramos; exámenes revelaron que 21/25 casos mostraron calcificación, dilatación ventricular o lisencefalia; de las 40 madres, 27 (68%) informan exantema durante la gestación, 20 (74%) en el primer trimestre y siete (26%) en la segunda, además de prurito, dolor de cabeza, mialgia y ausencia de fiebre. CONCLUSIÓN: la mayoría de los casos presenta características de infección congénita; la mayoría de las madres mostró características que sugieren infección por el virus Zika en el embarazo.

Resumo OBJETIVO: descrever os primeiros casos de microcefalia possivelmente relacionados ao vírus Zika em nascidos vivos notificados na Região Metropolitana do Recife, Pernambuco, Brasil. MÉTODOS: estudo descritivo de tipo série de casos (notificados de 1º de agosto a 31 de outubro de 2015), com dados obtidos dos registros médicos e de questionário aplicado às mães. RESULTADOS: foram confirmados 40 casos com microcefalia, distribuídos em oito municípios da Região Metropolitana do Recife, com maior concentração no Recife (n=12); a mediana do perímetro cefálico foi de 29 cm, do perímetro torácico, 31 cm, e do peso, 2.628 gramas; 21/25 casos apresentaram calcificação cerebral, ventriculomegalia ou lisencefalia; entre as 40 mães, 27 referiram exantema na gestação, 20 no primeiro trimestre e sete no segundo, além de prurido, cefaleia, mialgia e ausência de febre. CONCLUSÃO: a maioria dos casos apresentou características de infecção congênita; a maioria das mães apresentou quadro sugestivo de infecção pelo vírus Zika na gestação.

Abstract OBJECTIVE: to describe the first cases of microcephaly possibly related to Zika virus in live born babies reported in the Metropolitan Region of Recife, Pernambuco State, Brazil. METHODS: this was a descriptive case series study (cases reported between August 1st and October 31st 2015), using medical record data and data from a questionnaire answered by the mothers of the babies. RESULTS: 40 microcephaly cases were confirmed, distributed in eight municipalities within the Metropolitan Region, with Recife itself having the highest concentration of cases (n=12); median head circumference was 29 cm, median chest girth was 31 cm and median weight was 2,628 grams; 21/25 cases had brain calcification, ventriculomegaly or lissencephaly; 27 of the 40 mothers reported rash during pregnancy, 20 in the first trimester and 7 in the second trimester, as well as itching, headache, myalgia and absence of fever. CONCLUSION: the majority of the cases bore the characteristics of congenital infection; the clinical condition of the majority of mothers suggested Zika virus infection during pregnancy.

Resumen OBJETIVO: describir los primeros casos de microcefalia en nacidos vivos reportados al Departamento de Salud del Estado de Pernambuco, en la región metropolitana de Recife, Pernambuco, 2015. MÉTODOS: estudio epidemiológico descriptivo de serie de casos (reportados de 1 de agosto a 31 de octubre de 2015), con datos obtenidos de registros médicos y cuestionarios aplicados a las madres. RESULTADOS: 40 casos fueron confirmados con microcefalia, en ocho municipios de la región metropolitana de Recife, con mayor concentración de casos en Recife (n=12); la circunferencia media de la cabeza fue 29 cm, perímetro torácico 31 cm y peso 2.628 gramos; exámenes revelaron que 21/25 casos mostraron calcificación, dilatación ventricular o lisencefalia; de las 40 madres, 27 (68%) informan exantema durante la gestación, 20 (74%) en el primer trimestre y siete (26%) en la segunda, además de prurito, dolor de cabeza, mialgia y ausencia de fiebre. CONCLUSIÓN: la mayoría de los casos presenta características de infección congénita; la mayoría de las madres mostró características que sugieren infección por el virus Zika en el embarazo.

Introduction: Quality Indicators for Nutritional Therapy (QINT) allow a practical assessment of nutritional therapy (NT) quality. Objective: To apply and monitor QINT for critically ill patients at nutritional risk. Methods: Cross sectional study including critically ill patients > 18 years old, at nutritional risk, on exclusive enteral (ENT) or parenteral nutritional therapy (PNT) for > 72 hours. After three consecutive years, 9 QINT were applied and monitored. Statistical analysis was performed with SPSS version 17.0. Results: A total of 145 patients were included, 93 patients were receiving ENT, among then 65% were male and the mean age was 55.7 years (± 17.4); 52 patients were receiving PNT, 67% were male and the mean age was 58.1 years (± 17.4). All patients (ENT and PNT) were nutritionally screened at admission and their energy and protein needs were individually estimated. Only ENT was early initiated, more than 70% of the prescribed ENT volume was infused and there was a reduced withdrawal of enteral feeding tube. The frequency of diarrhea episodes and digestive fasting were not adequate in ENT patients. The proper supply of energy was contemplated only for PNT patients and there was an expressive rate of oral intake recovery in ENT patients. Conclusion: After three years of research, the percentage of QINT adequacy varied between 55%-77% for ENT and 60%-80% for PNT. The results were only made possible by the efforts of a multidisciplinary team and the continuous re-evaluation of the procedures in order to maintain the nutritional assistance for patients at nutritional risk.

Introducción: los indicadores de calidad en terapia nutricional (ICTN) permiten evaluar la calidad de la terapia nutricional (TN) de forma práctica. Objetivo: implementar y monitorizar los ICTN en pacientes críticos con riesgo nutricional. Métodos: estudio transversal con pacientes críticos > 18 años en riesgo nutricional, en terapia nutricional enteral (TNE) o parenteral (TNP) exclusiva a > 72 horas. Después de 3 años consecutivos, 9 ICTN fueron implementados y monitorizados. El análisis estadístico fue realizado con el software SPSS, versión 17.0. Resultados: fueron incluidos 145 pacientes, siendo 93 en TNE, 65% eran de sexo masculino, con edad promedio de 55,7 años (± 17,4); 52 pacientes que estaban en TNP, 67% eran de sexo masculino, con edad promedio de 58,1 años (± 17,4). Todos los pacientes (TNE y TNP) fueron cribados en la admisión, los cálculos de las necesidades calóricas y proteínicas fueron individualizados. Apenas la TNE fue precoz, > 70% del volumen prescrito fue administrado y fue visto una reducida pérdida de la sonda nasoenteral. Las frecuencias de diarrea y ayuno digestivo no fueron adecuadas en TNE. La administración adecuada de energía fue contemplada apenas en TNP y hubo una significativa tendencia de recuperación en la vía oral en TNE. Conclusión: después de 3 años de estudio, el porcentaje de adecuación de los ICTN varió entre 55%-77% para TNE y 60%-80% para TNP. Los resultados reflejan los esfuerzos del equipo multiprofesional de TN en mantener la calidad de la asistencia nutricional en los pacientes críticos con riesgo nutricional.

OBJETIVO. Determinar la prevalencia de síndrome metabólico y los factores asociados en población trabajadora del área de salud dependiente del Gobierno Municipal de la ciudad de El Alto en la gestión 2013. METODOS. Estudio transversal analítico, en 296 funcionarios de salud dependientes del Gobierno Municipal de la ciudad de El Alto. Para el examen médico se utilizó la historia clínica estandarizada por el SNIS y determinaciones laboratoriales. Para identificar síndrome metabólico se utilizó la definición de la IDF 2005. RESULTADOS. La prevalencia de síndrome metabólico fue de 22%, de 40±11 años de edad, 83% fueron mujeres y 16% varones. Según los criterios de IDF el criterio más frecuente luego del perímetro de cintura que fue del 100%, fue trigliceridemia con 91% y HDL bajo con 89%. Entre los con síndrome metabólico el 92% fueron sedentarios y 16% con eritrocitosis patológica de altura. La ocupación administrativa es un factor asociado a síndrome metabólico (p=0.002, OR 2.44 IC95% 1.30-4.68); así como sedentarismo (p = 0.0052, OR=2.44, IC95% 1.37-12.23) y datos sugestivos de eritrocitosis patológica de altura (p = 0.0002, OR=5.02, IC95% 1.77-14.37). CONCLUSIONES. La prevalencia de síndrome metabólico en prestadores de servicios de salud del Gobierno Municipal en la ciudad de El Alto alcanzó un 22%, los factores asociados a síndrome metabólico fueron ocupación administrativos, el sedentarismo y la eritrocitosis patológica de altura.

AIM. To determine the prevalence of metabolic syndrome and associated factors among workers dependent area health of the municipal government of the city of El Alto in 2013 management. METHODS. Cross-sectional study, 296 officials of the municipal government dependent city of El Alto health. For medical examination medical history standardized by the NHIS and laboratory determinations were used. To identify the definition of metabolic syndrome IDF 2005 it was used. RESULTS. The prevalence of metabolic syndrome was 22%, 40 ± 11 years, 83% were female and 16% male. According to IDF criteria more frequent after that waist circumference itwas 100% criterion was 91% triglycerides and low HDL 89%. Among those with metabolic syndrome, 92% were sedentary, and 16% with pathologic erythrocytosis high. Administrative occupation is a factor associated with metabolic syndrome (p = 0.002, OR2.44 95% CI 1.30-4.68); and physical inactivity (p = 0.0052, OR = 2.44, 95% CI 1.37-12.23) and suggestive of pathologic erythrocytosis in height (p = 0.0002, OR = 5.02, 95% CI 1.77-14.37). CONCLUSIONS. The prevalence of metabolic syndrome in health service providers of municipal government in the city of El Alto reached 22%, the factors associated with metabolic syndrome were administrative occupation, physical inactivity and the pathological eritrocitosis high.

Resumen Objetivo: El objetivo del estudio fue determinar si es factor de riesgo el síndrome metabólico para fenómenos trombóticos y/o alteraciones en el recuento de plaquetas, volumen plaquetario medio (VPM), plaquetocrito (PCT), amplitud de distribución plaquetaria (ADP), tiempo de sangría y tiempo de coagulación en población habitante de gran altura 3600 m.s.n.m. a 4100 m.s.n.m. Material y métodos: Se trata de un estudio observacional analítico de cohorte prospectiva.La población de estudio se constituyó por sujetos diagnosticados con y sin síndrome metabólico en población residente de la ciudad de El Alto y La Paz, Bolivia, cumpliendo criterios de selección para el diseño de cohorte prospectiva. El cálculo de muestra para estudios de Cohorte Prospectiva, fue de 291 pacientes de los cuales 97 son expuestos y 194 no expuestos. Expuestos adultos, residentes de La Paz o El Alto y cumplan con 3 criterios de síndrome metabólico según la NCEP-ATPIII actualizada. No expuestos a personas con 0 a 2 criterios de síndrome metabólico según la NCEP-ATPIII actualizada. Se excluyeron a personas con incapacidad física o mental, mujeres embarazadas, personas con diagnóstico ya definido de cáncer y personas en tratamiento con anticoagulantes. Se utilizaron instrumentos validados para la recolección de datos, la Historia clínica, así como procedimientos pre-analíticos, analíticos y pos-analíticos en hematología y bioquímica sanguínea, para este fin se tomó una muestra de sangre de 15 ml. Resultados: La distribución de variables demográficas y físicas, en varones y mujeres expuestas (Sd. Metabólico) y no expuestas (Sin Sd. Metabólico), muestra diferencia estadística significativa. Las variables hematológicas y bioquímicas, presentan valores p de no significancia en promedio de plaquetas, valor medio plaquetario y amplitud de distribución de plaquetas.

Abstract Objective: The aim of the study was to determine if it is a factor of risk the metabolic syndrome for trombóticos and/or alterations in the of platelets, volume (VPM), plaquetocrito (PCT), wide's platelets distribution (ADP), time ofbleeding and time of coagulation in population inhabitant of high altitude 3600 m.s.n.m. to 4100 m.s.n.m. Methods: It is analytical study prospective cohort. The population of study was composed by subjects diagnosed with and without metabolic syndrome in resident population of the high altitude city of La Paz and El Alto (Bolivia) with selection criteria. The calculation ofsample forstudies of prospective Cohort, belonged 291 patients of which 97 are exposed and 194 not exposed ones. Exposed adults, residents of La Paz or El Alto and expire with 3 criteria of metabolic syndrome according to the updated NCEP-ATPIII. They were excluded to persons by physical or mental disability, pregnant women, with diagnosis already defined of cancer and present in treatment with anticoagulants. There were in use instruments validated for the compilation of information, the clinical History, as well as pre-analytical, analytical and pos-analytical procedures in hematology and blood biochemistry, for this end there took a sample of blood of 15 ml. Results: The distribution of demographic and physical variables, in males and exposed women (Sd. Metabolic) and not exposed (without Sd. Metabolic), sample differentiaes significant statics. The hematologic and biochemical variables, they present values p not significant, in mean platelets volume (VHP), plaquetocrito (PCT), wides platelets distribution (ADP).

OBJECTIVE: To analyze the flow of retrobulbar vessels in retinoblastoma by color Doppler imaging. METHODS: A prospective study of monocular retinoblastoma treated by enucleation between 2010 and 2014. The examination comprised fundoscopy, magnetic resonance imaging, ultrasonography and color Doppler imaging. The peak blood velocities in the central retinal artery and central retinal vein of tumor-containing eyes (tuCRAv and tuCRVv, respectively) were assessed. The velocities were compared with those for normal eyes (nlCRAv and nlCRVv) and correlated with clinical and pathological findings. Tumor dimensions in the pathological sections were compared with those in magnetic resonance imaging and ultrasonography and were correlated with tuCRAv and tuCRVv. In tumor-containing eyes, the resistivity index in the central retinal artery and the pulse index in the central retinal vein were studied in relation to all variables. RESULTS: Eighteen patients were included. Comparisons between tuCRAv and nlCRAv and between tuCRVv and nlCRVv revealed higher velocities in tumor-containing eyes (p<0.001 for both), with a greater effect in the central retinal artery than in the central retinal vein (p=0.024). Magnetic resonance imaging and ultrasonography measurements were as reliable as pathology assessments (p=0.675 and p=0.375, respectively). A positive relationship was found between tuCRAv and the tumor volume (p=0.027). The pulse index in the central retinal vein was lower in male patients (p=0.017) and in eyes with optic nerve invasion (p=0.0088). CONCLUSIONS: TuCRAv and tuCRVv are higher in tumor-containing eyes than in normal eyes. Magnetic resonance imaging and ultrasonography measurements are reliable. The tumor volume is correlated with a higher tuCRAv and a reduced pulse in the central retinal vein is correlated with male sex and optic nerve invasion.