Resumen Escherichia coli O157:H7 es un patógeno transmitido por alimentos implicado en numerosos brotes en todo el mundo y es capaz de causar complicaciones extraintestinales en humanos. La sección de «Enteropatógenos» del Laboratorio Central de Salud Pública trabaja en mejorar la caracterización genómica de STEC, de modo de potenciar la vigilancia laboratorial y la investigación de brotes de enfermedades transmitidas por alimentos. La secuenciación de genoma completo (WGS, por sus siglas en inglés) se propone a nivel mundial como una herramienta de alta resolución para ser utilizada en el laboratorio de rutina, ya que permite obtener todos los resultados en un único proceso. El objetivo de este trabajo fue llevar a cabo, por primera vez, la caracterización genómica por WGS de nueve cepas STEC O157:H7 aisladas en Paraguay a partir de muestras de origen humano. Pudimos identificar los factores de virulencia, los mecanismos de resistencia, el subtipo MLST, e incluso pudimos establecer la relación filogenética entre los aislamientos. Además, detectamos que la mayoría de las cepas pertenecían al clado hipervirulento 8.

Abstract Escherichia coli O157:H7 is a foodborne pathogen implicated in numerous outbreaks worldwide that has the ability to cause extra-intestinal complications in humans. The Enteropathogens Division of the Central Public Health Laboratory (CPHL) in Paraguay is working to improve the genomic characterization of Shiga toxin-producing E. coli (STEC) to enhance laboratory-based surveillance and investigation of foodborne disease outbreaks. Whole genome sequencing (WGS) is proposed worldwide to be used in the routine laboratory as a high-resolution tool that allows to have all the results in a single workflow. This study aimed to carry out for the first time, the genomic characterization by WGS of nine STEC O157:H7 strains isolated from human samples in Paraguay. We were able to identify virulence and resistance mechanisms, MLST subtype, and even establish the phylogenetic relationships between isolates. Furthermore, we detected the presence of strains belonging to hypervirulent clade 8 in most of the isolates studied.

ABSTRACT In the last decade, other quality attributes have emerged as the main aspects that impact pork consumers acceptance, such as environmentally friendly production, nutritional value, and animal welfare. This study applies a Check-All-That-Apply (CATA) questionnaire for sensory characterization of loins from genetically lean immunocastrated male pigs fed diets containing either a standard commercial diet with 1.5 % soybean oil (control) or 3 % oil from either soybean oil (SO), canola oil (CO), or fish oil (FO) during the growing-finishing phases. Twenty CATA attributes for loin samples were generated. We interviewed 101 consumers to select all the CATA terms that they considered suitable to characterize sensory attributes of longissimus lumborum muscle samples of pigs from each dietary treatment. The CATA results indicated differences among pork loin samples depending on the source and inclusion level of dietary oil. Loins from pigs fed 3 % SO were characterized by a higher frequency of the “juicy texture” attribute (p < 0.05) and a lower frequency of the “dry texture” attribute (p < 0.05) compared to loins from 3 % FO-fed pigs. Moreover, loins from pigs fed 3 % SO had a lower citation frequency of the “tasteless” attribute (p < 0.05) compared to loins from 3 % FO-fed pigs. The attributes “cooked pork meat-like taste”, “juicy texture”, “tender texture”, and “brightness” were placed close to the overall liking. “Tender texture”, “juicy texture”, “pork meat-like” (odor and taste), and “cooked pork meat-like taste” attributes were considered drivers of liking. Feeding genetically lean immunocastrated male pigs with diets containing 3 % SO may be advisable from a pork sensory quality perspective.

ABSTRACT Antineutrophil cytoplasmic antibodies (ANCA) are useful as markers for systemic vasculitis. PR3-ANCA antibodies have been also identified in association with chronic inflammatory and infectious conditions, other autoimmune diseases, malignancy, and certain drugs. The association of PR3 and minimal change disease (MCD) without vasculitis is not an expected finding. We report a case of MCD with PR3-ANCA positive title and no histopathological findings of vasculitis. This reports to an 86-year-old Caucasian woman without relevant past medical history and a normal renal function one month before presentation with sudden-onset nephrotic syndrome and rapidly progressive renal failure. Renal ultrasound was normal. Autoimmune screening using enzyme-linked immunosorbent assay (ELISA) revealed PR3-ANCA high titers (238.7UQ). Renal biopsy did not show vasculitis or crescentic glomerulonephritis. The glomeruli were normal. Autoimmune, inflammatory, infectious and malignant diseases were excluded. MCD was assumed and she started prednisolone with clinical and analytical improvement. ANCA-associated glomerular disease can coexist with a variety of other glomerular diseases including membranous nephropathy, lupus nephritis, IgA nephropathy, and bacterial infection-related glomerulonephritis. This association could be an incidental finding, but there may be an association with MCD not previously reported. Our case emphasizes the importance of performing renal biopsies before embarking on a full-scale immunosuppression therapy based on ANCA title alone.

Resumen Introducción: Las vacunas contra la COVID-19 son efectivas. Sin embargo, un porcentaje de personas con esquema completo de vacunación tiene riesgo de contagiarse y enfermar por COVID-19. Estos casos se conocen como "casos de infección en vacunados". Objetivo: Identificar las características clínicas de los pacientes con infección por SARS-COV-2 con antecedente de vacunación para COVID-19. Métodos: Estudio de cohorte retrospectivo, con 271 vacunados y positivos que acudieron a las unidades médicas en Baja California Sur, con esquema completo o sin él, y registrados en el SINOLAVE. Se analizaron características clínicas, abordaje, secuelas y mortalidad. Se utilizó estadística descriptiva y medidas de asociación. El estudio fue autorizado por los comités de ética e investigación. Resultados: Edad: 48.5 ± 12.1 años; 19.5% cumplieron con la definición de infección en vacunados; 93% con tratamiento ambulatorio; mortalidad del 3.7%; la comorbilidad más frecuente: diabetes/hipertensión. El 92% de los casos vacunados con CanSino® presentaron COVID-19, seguidos por los que recibieron Pfizer®, con el 26%. Existe mayor riesgo de hospitalización y mortalidad en pacientes con esquema incompleto. Conclusiones: Las vacunas son efectivas; la mayoría de los casos fueron ambulatorios. Los pacientes vacunados con CanSino® mostraron mayor infección por SARS-CoV-2; el refuerzo de esta vacuna podría disminuir la enfermedad en los pacientes ya vacunados. De los individuos que murieron, la mayoría no tenía esquema completo de vacunación.

Abstract Introduction: Vaccines against COVID-19 are effective. However, a percentage of people with a complete vaccination scheme are at risk of contracting and becoming ill from COVID-19. These cases are known as "vaccinated cases of infection". Objective: To identify the clinical characteristics of patients with SARS-CoV-2 infection with a history of vaccination for COVID-19. Methods: Retrospective cohort study in 271 vaccinated and positive patients who attended medical units in Baja California Sur, with or without a complete scheme and registered in SINOLAVE. Clinical characteristics, management, sequelae and mortality were analyzed. Descriptive statistics and association measures were used. Authorized by the ethics and research committees. Results: Age 48.5 ± 12.1 years, 19.5% met the definition of infection in vaccinated, 93% with outpatient management, 3.7% mortality, the most frequent comorbidity: diabetes/hypertension. 92% of the cases vaccinated with CanSino® had COVID-19, followed by Pfizer® with 26%. There is a higher risk of hospitalization and mortality in patients with an incomplete scheme. Conclusions: The vaccines are effective, most of the cases were ambulatory. Patients vaccinated with CanSino® showed a higher COVID-19 infection, the reinforcement of this vaccine could reduce the disease in patients already vaccinated. Of the patients who died, the majority did not have a complete vaccination schedule.

Resumen Objetivo Presentar la resolución quirúrgica de un caso clínico poco frecuente en un paciente pediátrico luego de haber sufrido la herniación traumática de la Bola Adiposa de Bichat. Caso clínico Un paciente de 3 años concurre a la guardia del Hospital Interzonal Especializado Materno Infantil “Don Victorio Tetamanti” de Mar del Plata, luego de haber sufrido un traumatismo que le provocó el desplazamiento parcial de la Bola Adiposa de Bichat. Si bien este tipo de urgencias es poco frecuente, es importante tener los conocimientos para un correcto diagnóstico y tratamiento.

Abstract Aim To present the surgical resolution of an infrequent clinical case in a pediatric patient who suffered traumatic herniation of Bichat’s fat pad. Clinical case A 3-year-old patient who visited the Emergency Service at the “Don Victorio Tetamanti” Hospital in Mar del Plata after suffering a trauma which caused the partial displacement of Bichat’s fat pad. Although this type of emergency is quite rare, it is important to know how to perform proper diagnosis and treatment.

RESUMO Introdução: A taxa estimada de filtração glomerular (TFGe) com base na cistatina-C sérica (Cis-C) parece ser tão precisa quanto aquela baseada na creatinina sérica (Cr), mas cis-C parece ser um melhor preditor de resultados adversos. Nosso objetivo foi avaliar se a cis-C poderia ser uma ferramenta confiável para a previsão de desfechos adversos em pacientes idosos com doença renal crônica grave (DRC). Métodos: Um grupo de 348 pacientes idosos com DRC em estágio não terminal (estágios 1-4, de acordo com TFGe-EPI Cr e/ou Cis-C), encaminhados para nossa unidade de consulta durante 2016, foi estudado retrospectivamente e dividido em quatro categorias exclusivas: DRC_estágio 4 nenhum (TFGe-Cr≥30mL/min; TFGe -Cis-C≥30mL/min), DRC_estágio 4_Cr apenas (TFGe-Cr <30mL/min), DRC_estágio 4 _Cis-C_apenas (TFGe-Cis-C <30 mL/min), DRC_estágio4_combinado (TFGe-Cis-C <30mL/min. TFGe-Cr <30mL/min). Características basais, preditores de óbito e eventos clínicos (eventos cardiovasculares e internações por doenças cardiovasculares, lesão renal aguda ou eventos infecciosos) foram explorados até dezembro de 2018. Resultados: Uma coorte de 77 ± 7,4 anos, com índice de comorbidade de Charlson modificado (mCCI) de 3 (IQR: 1-4), foi acompanhada durante 29 (IQR: 26-33) meses. Não houve diferenças significativas entre as características dos grupos no estágio 4. A análise de sobrevida foi estratificada pelo acompanhamento aos 12 meses, sendo que no primeiro ano, as curvas de sobrevida dos grupos DRC_estágio4_Cis-C_apenas e DRC_estágio4_ combinado foram significativamente inferiores quando comparadas com os restantes grupos (p = 0,028). Ajustando para idade, sexo e mCCI, DRC_estágio4_Cis-C_apenas, ao contrário do grupo DRC_estágio4_Cr_apenas, teve maiores taxas de eventos clínicos (p <0,05) do que o grupo DRC_estágio4_nenhum. Conclusão: Em pacientes idosos com estadiamento discordante da DRC, a TFGe baseada na Cis-C parece ser um melhor preditor de resultados adversos do que a TFGe baseada na Cr. Pacientes com DRC em estágio 4, definida apenas por Cr, parecem se comportar de forma semelhante àqueles com DRC menos grave.

ABSTRACT Introduction: Estimated glomerular filtration rate (eGFR) based on serum cystatin-C (sCys) seems as accurate as when based on serum creatinine (sCr), but sCys seems a better predictor of adverse outcomes. We aimed to study whether sCys could be a reliable tool for the prediction of adverse outcomes in elderly patients with severe chronic kidney disease (CKD). Methods: A group of 348 elderly patients with non-end-stage CKD (stages 1-4, according to eGFR-EPI sCr and/or sCys), referred to our consultation unit during 2016, was retrospectively studied and divided into four exclusive categories: CKD_stage4_neither (eGFR-sCr≥30mL/min; eGFR-sCys≥30mL/min), CKD_stage4_sCr_only (eGFR-sCr<30mL/min), CKD_stage4_sCys_only (eGFR-sCys<30mL/min) and CKD_stage4_combined (eGFRsCr<30mL/min; eGFR-sCys<30mL/min). Baseline characteristics, predictors of death, and clinical events (cardiovascular events and admissions for cardiovascular, acute kidney injury or infectious events) were explored until December 2018. Results: A 77±7.4 year-old cohort, with a modified Charlson Comorbidty Index (mCCI) of 3 (IQR:1-4), was followed-up during 29 (IQR: 26-33) months. There were no significant differences between the characteristics of the stage 4 groups. Survival analysis was stratified by follow-up at 12 months, and in the first year, survival curves of CKD_stage4_sCys_only and CKD_stage4_combined groups were significantly lower than the other groups (p=0.028). Adjusting for age, sex, and mCCI, CKD_stage4_sCys_only, conversely to CKD_stage4_sCr_only, had higher rates of clinical events (p<0.05) than CKD_stage4_neither group. Conclusion: In elderly patients with discordant CKD staging, sCys-based eGFR seems to be a better predictor of adverse outcomes than sCr-based eGFR. Patients with stage 4 CKD defined by sCr alone seem to behave similar to those with less severe CKD.

Abstract Education is an important factor in the formation of behaviors and social postures that an individual adopts every day and in their participation in important events. There is a severe education problem in Mexico, according to data from INEGI (2015) 93% of the 15-year-old population is illiterate. which leads to think that the educational level of the population influences attitudes and postures regarding the preventive guidelines of the pandemic. Aim. Describe how the education of society influences to be able to correctly carry out sanitary measures and prevent the Covod-19 disease from spreading and not affecting more than it has already affected the whole world. Material and methods. A cross-sectional, descriptive, observational study was conducted by applying a google survey in the states of Hidalgo, Chiapas and Estado de México to a total of 128 people. Results. A total of 128 individuals participated in this research: 63 women and 61 men. Of the total number of individuals, 46% reported having completed some degree, while 54% did not report having done so. 100% of the participants reported belief in the pandemic and 99.2% consider that there is COVID 19 in Mexico. Conclusion. In Mexico, it has been shown that education does influence health guidelines, so it is important to invest in education, this allows greater knowledge to avoid contagions and at the same time prevent future diseases or new outbreaks. Otherwise, we will continue with negative results.

Resumen La educación es un factor importante en la formación de conductas y posturas sociales que adopta un individuo día a día y en su participación en eventos de consideración. Existe un severo problema de educación en México, según datos de INEGI (2015) el 93% de la población de 15 años es analfabeta. lo que lleva a pensar que el nivel educativo de la población influye en las actitudes y posturas frente a los lineamientos preventivos de la pandemia. Objetivo. Describir cómo influye la educación de la sociedad para poder llevar acabo correctamente las medidas sanitarias y evitar que la enfermedad Covid-19 se propague y no afecte más de lo que ya ha afectado a todo el mundo. Material y métodos. Se realizó un estudio observacional descriptivo de carácter transversal mediante la aplicación de una encuesta en google en los estados de Hidalgo, Chiapas y Estado de México, a un total de 128 personas. Resultados. Se contó con la participación de 128 individuos en la presente investigación, 63 mujeres y 61 hombres. Del total de personas, el 46% refiere haber cursado algún grado de licenciatura, mientras que el 54% no refirió haberlo hecho. El 100% de los participantes refirieron creer en la pandemia y el 99,2% considera que existe COVID 19 en México. Conclusión. En México se ha demostrado que la educación si influye respecto a los lineamientos de sanidad, por eso es importante invertir en educación, esto permite mayor conocimiento para evitar contagios y al mismo tiempo prevenir para enfermedades futuras o nuevos rebrotes. De no hacerlo así, continuaremos con resultados negativos.

Resumen: Por obvia e insignificante, la ropa tendida pasa la mayor parte del tiempo desapercibida en nuestro deambular cotidiano. Sin embargo, asomada por las ventanas o flotando con el viento, es parte del paisaje urbano de nuestras ciudades. Más aún, en su supuesta insignificancia, la ropa tendida sugiere múltiples aspectos de la vida actual: restricciones e inadecuaciones del espacio; rutinas laborales y de descanso; identidades sociales y coordinaciones comunitarias. ¿Qué vemos cuando vemos la ropa tendida? ¿Seguimos viendo nuestra vestimenta? ¿O comenzamos a ver colores, formas, historias, intimidades? Des-guardar y exponer nuestra vestimenta puede interpelarnos en varios registros: ¿qué es lo que decidimos exponer? ¿Qué es legítimo hacer visible? ¿Qué cosas escondemos del escrutinio de los otros? En este texto, indagamos sobre cómo la presencia de la ropa tendida puede procesarse como una serie de gestos, las cuales remiten a diferentes acercamientos a las materialidades que conforman nuestra experiencia cotidiana de la ciudad. Estos vinculan lo funcional con lo poético y lo expuesto con lo íntimo. Inspirados en la noción de “lo infraordinario” de Perec, y apoyándonos en la comprensión de la importancia de los gestos cotidianos y la sociología de los objetos, exploramos la potencia sensible, pública y política de la ropa tendida en entornos urbanos.

Abstract: Obvious and insignificant, hanging clothes spend most of the time unnoticed in our daily wanderings. However, leaning out of the windows or floating in the wind, they are part of the urban landscape of our cities. Moreover, in its supposed insignificance, hanging clothes suggest multiple aspects of current life: restrictions and inadequacies of space; work and rest routines; social identities and community coordinations. What do we see when we see hanging clothes? Do we still see our clothes? Or do we begin to see colors, shapes, stories, intimacies? Des-save and expose our clothes can interpellate us in several ways: what do we decide to expose? What is it legitimate to make visible? What things do we hide from the scrutiny of others? In this text we inquire about how the presence of hanging clothes can be understood as a series of gestures that refer to different approaches to the materialities that make up our daily experience of the city. Gestures that link the functional with the poetic and exposed with the intimate. Inspired by the notion of Perec’s “infraordinary” and based on the understanding of the importance of everyday gestures and the sociology of objects, we explore the sensitive, public and political power of hanging clothes in urban environments.

Background and objectives: To evaluate RRT benefits and risks and to inform patients and their families about ESRD treatment options, we have developed a prognostic score to predict 6-month mortality in elderly ESRD patients initiating dialysis. Five independent predictors were identified and a point system was constructed: age 75 years or older (2 points), coronary artery disease (2 points), cerebrovascular disease with hemiplegia (2 points), time of nephrology care before dialysis [< 3.0 months (2 points); ≥ 3 to < 12 months (1 point)], serum albumin levels [3.0 - 3.49 g/dL (1 point); < 3.0 g/dL (2 points)]. Model performance was good in both discrimination and internal validation. Before adopting our risk score into practice, our aim is to externally validate this initial predictive model by assessing its performance on a new data set. Methods: We apply the predictive score developed in a cohort of CKD patients, aged 65 years and over who started dialysis between 2009 and 2016, to an independent cohort of ESRD patients, aged 65 years and over who started dialysis between 2017 and 2019, in our Nephrology department. The performance of the prediction equation created in development cohort, was assessed using discrimination and calibration metrics in the validation cohort. Results: Our validation study cohort included 168 individuals, with a mortality rate of 12.5% (n=21) within 6-months of dialysis initiation. Model performance in the validation cohort had an acceptable discrimination [AUC of 0.79; (95% confidence interval, 0.70 to 0.88)]. The Hosmer and Lemeshow goodness-of-fit test was not statistically significant, indicating good calibration of the model (χ2, 5 degrees of freedom = 2.311; P = 0.805). Conclusions: Our predictive simple score based on readily available clinical and laboratory data demonstrates a good performance when externally validated, namely with respect to discrimination and calibration. Model validation is crucial for adequately informing patients and their families about ESRD treatment options and providing a more patient-centered overall approach to care. Before we start general implementation in clinical practice, our score needs further validation in larger patient cohorts.

Abstract The level of student satisfaction is an indicator considered a measure of quality control of teaching-learning processes. Therefore, the objective of this study was to evaluate the level of student satisfaction of neurodidactic teaching strategies applied in a university course of Biochemistry of the Medical Career of the Technical University of Manabí, Ecuador. The research was mixed (quantitative-qualitative), descriptive, non-experimental, transactional, field approach. An 18-item questionnaire was applied in a population of 90 students of both sexes, with an open final question analyzed under the research-action method. Quantitative data were processed using the statistical program for social sciences, through descriptive analysis and analysis of variance. The results showed that the highest level of student satisfaction in both men and women was the design and analysis of mind maps. The least prominent, although high-level, corresponded to cooperative work and the elaboration of scientific articles. In conclusion, although the overall level of satisfaction of the apprentices was high, the qualitative results externalized the need to continue improving the techniques, with longer as reinforcement and constant innovation of strategies.

Resumen El nivel de satisfacción estudiantil es un indicador considerado como una medida de control de calidad de los procesos de enseñanza-aprendizaje. Por ello, el objetivo del presente estudio fue evaluar el nivel de satisfacción estudiantil de las estrategias docentes neurodidácticas aplicadas en un curso universitario de Bioquímica II de la carrera de Medicina de la Universidad Técnica de Manabí, Ecuador. La investigación fue de enfoque mixto, descriptivo, no experimental, transeccional, de campo. Se aplicó un cuestionario en una población de 90 estudiantes de ambos sexos, con pregunta final abierta, analizada bajo el método de investigación-acción. Los datos cuantitativos fueron procesados utilizando el Programa Estadístico para Ciencias Sociales, a través de análisis descriptivos y análisis de varianza. Los resultados mostraron que el nivel de satisfacción estudiantil tanto en hombres como en mujeres, más alto fue el diseño y análisis de mapas mentales. Los menos destacados, aunque de nivel alto correspondieron al trabajo cooperativo y elaboración de artículos científicos. En conclusión, aunque el nivel de satisfacción global de los aprendices fue alto, los resultados cualitativos exteriorizaron, la necesidad de continuar mejorando las técnicas, con mayor tiempo como refuerzo e innovación constante de las estrategias.

RESUMO Introdução: Doença renal crônica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular (DCV), particularmente em idosos, o segmento de crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT. Neste artigo caracterizamos uma coorte de idosos com DRC, referenciados para a nefrologia, com particular ênfase para o risco e carga de doença cardiovascular. Métodos: Foram incluídos todos os pacientes com DRC com 65 anos ou mais encaminhados ao nosso departamento em 2012. Os dados basais incluíram: demografia, estágio da DRC, medicação e comorbidades. A taxa de filtração glomerular (TFGe) foi calculada pela fórmula CKD-EPI. Resultados: Metade dos 416 pacientes incluídos foram encaminhados por médicos da atenção primária; sua idade era 77 ± 7 anos; 52% eram homens; a TFGe mediana era de 32 mL /min/1,73 m2. Metade tinha diabetes (DM), 85% dislipidemia, 96% hipertensão; 26% eram fumantes atuais/ antigos; 24% tinham índice de massa corporal > 30 kg/m2. A prevalência de DCV foi de 62%, sendo maior entre pacientes nos estágios 4-5; em diabéticos, aumentou gradualmente com a progressão da DRC (estágio 3a < estágio 3b < estágio 4-5) (39%, 58%, 82%; p < 0,001). Conclusões: A coorte de idosos com DRC apresentava inicialmente maior carga de DCV. A prevalência de DCV foi maior que em outras coortes europeias com DRC. Níveis menores de TFGe foram associados a carga maior de DCV e foram mais pronunciados entre diabéticos, destacando a importância de objetivar estrategicamente a redução do risco cardiovascular nesses pacientes.

ABSTRACT Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.

RESUMO INTRODUÇÃO: Este artigo busca fazer referência a alguns aspectos do luto recente considerados fatores de risco para a doença cardiovascular, específicamente a cardiomiopatia de Takotsubo. Objetivou-se descrever o estresse proveniente da morte do ente querido aliando-o à possibilidade de ocorrência da cardiomiopatia de Takotsubo, mediante a percepção de um evento traumático pelo córtex que aciona o circuito cerebral subcortical tendo repercussões na resposta endócrina. Dado o crescente reconhecimento dessa cardiomiopatia, torna-se viável contextualizar as condutas nutricionais e as decisões que as norteiam, cujos benefícios devem ultrapassar a condição de disfunção cardíaca temporária e se estender às escolhas alimentares que exercem alguma influência no sistema límbico. Trata-se de uma análise descritiva que objetiva problematizar a temática em reflexões pautadas nessa vivência, considerando o alicerce com a ciência da nutrição.

SUMMARY This article aims to make reference to some recent mourning aspects considered risk factors for cardiovascular disease, specifically the Takotsubo cardiomyopathy. The objective was to describe the stress from the death of a loved one combining it to the possibility of occurrence of Takotsubo cardiomyopathy through the perception of a traumatic event by the cortex, which triggers the subcortical brain circuit affecting the endocrine response. Given the growing acknowledgement of this cardiomyopathy, it is possible to contextualize the nutritional behaviours and decisions surrounding it, whose benefits must exceed the condition of temporary cardiac dysfunction and extend to food choices that have some influence in the limbic system. It is a descriptive analysis that aims to problematize the theme into reflections based on this experience, considering the foundation with the science of nutrition.

RESUMO Doppler transcraniano (DTC) é um componente estratégico da prevenção primária do acidente vascular cerebral (AVC) em crianças com doença falciforme (DF). Este estudo foi realizado para examinar as características do DTC de crianças com DF em nove centros médicos diferentes no Brasil. Métodos: DTC foi realizado de acordo com o protocolo de Stroke Prevention Trial in Sickle Cell Anemia Protocol (STOP). Resultados: Dos 396 pacientes avaliados, 69,5% eram homozigotos para hemoglobina SS. DTC foi anormal em 4,8%, condicional em 12,6%, inadequado em 5,3% e anormalmente baixo em 1%. As máximas velocidades de fluxo médio foram 121 ± 23,83cm/s e 124 ± 27,21 cm/s nas artérias cerebrais media esquerda e direita, respectivamente. Um total de 28,8% dos pacientes (média de 9,19 ± 5,92 anos) foram avaliados com o DTC pela primeira vez. Conclusões: Pacientes com DF foram avaliados com DTC numa idade considerada avançada, o que representa uma importante oportunidade perdida para a prevenção de AVC nessa população. Uma vez que a triagem com DTC em pacientes com DF é essencial para detectar aqueles com alto risco de AVC, recomenda-se que essa triagem seja amplamente disponível no país.

ABSTRACT Transcranial doppler (TCD) is a strategic component of primary stroke prevention in children with sickle cell disease (SCD). This study was conducted to examine the TCD characteristics of children with SCD in nine different medical centers in Brazil. Methods: Transcranial doppler was performed in accordance with the Stroke Prevention Trial in Sickle Cell Anemia Protocol. Results: Of the 396 patients, 69.5% had homozygous SS hemoglobin. The TCD result was abnormal in 4.8%, conditional in 12.6%, inadequate in 4.3% and abnormally low in 1% of patients. The highest mean flow velocities were 121±23.83cm/s and 124±27.21cm/s in the left and right middle cerebral artery respectively. A total of 28.8% patients (mean age 9.19±5.92 years) were evaluated with TCD for the first time. Conclusions: The SCD patients were evaluated with TCD at an older age, representing an important missed opportunity for stroke prevention. Since TCD screening in patients with SCD is important to detect those at high risk for stroke, it is recommended that this screening should be made more readily available.

Introduction: Malnutrition causes alterations in the structure and function of organs and systems, thus increasing morbidity, mortality and costs of hospitalization. Objective: To determine the prevalence of malnutrition risk in hospitalized patients and evaluate the relation between nutritional risk and age, gender and hospital services. Methods: A cross sectional study was designed. The Malnutrition Screening Tool (MST) was used to evaluate 272 patients hospitalized in the "Prof. Dr. Ramón Carrillo" Hospital, from July 2013 to January 2014. Results: The average age was 58.9 (±20.5) years old. The survey showed that 31.7% of patients had nutritional risk. Female gender was significantly associated with presence of nutritional risk (p <0.002) and subjects aged 65 and over had the same association (p <0.001). The frequency of nutritional risk was more than double in general medical service compared with other services (OR = 2.60). Conclusion: In the admission of patients to hospital, it is necessary to carry out an early assessment of their nutritional risk, identify the factors associated with malnutrition risk and define an adequate nutritional treatment that improves the prognosis of hospitalization and the costs of hospital stay in these patients. The MST is a simple and effective screening tool to achieve these objectives.

Introducción: La desnutrición causa alteraciones en la estructura y función de órganos y sistemas, aumentando la morbilidad, mortalidad y costos de internación. Objetivos: Determinar la prevalencia del riesgo de desnutrición en pacientes hospitalizados. Evaluar la relación entre el riesgo nutricional, la edad, el género y el servicio de internación. Materiales y Método: Se realizó un estudio transversal analítico. Mediante el Malnutrition Screening Tool (MST) se evaluó a 272 pacientes internados en el HIGA Prof. Dr. Ramón Carrillo, entre julio del 2013 a enero del 2014. Resultados: La edad media fue de 58.9 años (±20.5). El 31.7% de los pacientes presentó riesgo nutricional. El género femenino se asoció significativamente a riesgo nutricional (p <0.002) y los sujetos de 65 años o más tuvieron la misma asociación (p <0.001). La frecuencia de riesgo nutricional fue mayor al doble en el servicio de clínica médica con respecto al resto de los servicios de internación (OR = 2.60). Conclusión: Es necesario realizar una valoración del riesgo nutricional al ingreso de los pacientes al nosocomio, identificar los factores asociados al riesgo de desnutrición y definir un tratamiento nutricional adecuado que mejore el pronóstico clínico y los costos de la estadía hospitalaria de esos pacientes. El MST es una herramienta de tamizaje simple y efectiva para dichos objetivos.