Resumo Este trabalho visa conscientizar sobre os danos causados pelos plásticos despejados no mar e fornecer informações sobre o manejo médico de espécimes de tartarugas verdes do Pacífico sob cuidados humanos, tendo em vista sua necessidade de cuidados. Apresenta-se o caso de uma fêmea adulta de Chelonia mydas resgatada na cidade de Constitución, 200 km a sudoeste do Centro de Reabilitação de Fauna Silvestre (CRFS) do Parque Safari. O espécime apresenta quadro de síndrome de emaranhamento com flutuação caudal, devido ao acúmulo de gases típico de íleo paralítico, ao mesmo tempo em que apresenta lacerações na asa do membro anterior esquerdo. Optou-se por realizar a via diagnóstica com exame clínico e métodos complementares como radiografias, ecografias e análises ao sangue, bem como um processo cirúrgico para acelerar a recuperação das feridas. Após três meses de processo de reabilitação, conclui-se a reinserção do espécime em Chascos Bay, comuna de Caldera, um total de 800 km ao norte do CRFS. Para a reabilitação deste espécime, foram percorridos cerca de 1000 km pelas rotas do Chile desde o seu resgate até a sua reinserção, com colaborações dos setores público e privado para a gestão do seu processo.

Resumen Este trabajo tiene como objetivo concientizar sobre el daño que hacen los plásticos vertidos en el mar y proporcionar información acerca del manejo médico de ejemplares de tortugas verdes del pacifico bajo cuidado humano ante la necesidad de atención de los mismos. Se presenta un caso de un ejemplar hembra adulto de Chelonia mydas rescatado en la ciudad de Constitución a 200 Km al sur poniente del Centro de Rehabilitación de Fauna Silvestre (CRFS) de Parque Safari. El ejemplar evidencia un cuadro de síndrome de embollamiento con flotación caudal, debido al acumulo de gases propio del íleo paralitico, a su vez presenta lesiones lacerativas en aleta de miembro anterior izquierdo. Se decide realizar la ruta diagnóstica con examen clínico y métodos complementarios como radiografías, ecografías y análisis sanguíneos, además de un proceso quirúrgico para acelerar la recuperación de heridas. Luego de tres meses de proceso de rehabilitación se concluye con la reinserción del ejemplar en la bahía Chascos, comuna de Caldera, a un total de 800 km al norte del CRFS. Para la rehabilitación de este ejemplar, se recorrió cerca de 1000 km por las rutas de Chile desde su rescate hasta su reinserción, con colaboraciones desde el sector público y privado para la gestión de su proceso.

Abstract This work aims to raise awareness about the harm caused by plastics dumped in the sea and provide information about the medical management of Pacific green turtle specimens under human care when they require attention. A case is presented of an adult female specimen of Cheloniamydas rescued in the city of Constitución, Chile, 200 km southwest of the Wildlife Rehabilitation Center (CRFS) at Parque Safari. The specimen shows symptoms of impaction syndrome with caudal flotation due to the accumulation of gases characteristic of paralytic ileus, and it also has lacerative injuries on the left anterior limb fin. It was decided to follow a diagnostic route with a clinical examination and complementary methods such as X-rays, ultrasounds, and blood analysis, in addition to a surgical procedure to expedite wound recovery. After three months of rehabilitation, the specimen was successfully reintroduced into Chascos Bay, Caldera, located 800 km north of the CRFS. During the rehabilitation of this specimen, it traveled approximately 1000 km across Chile's routes from its rescue to its reintroduction, with contributions from both the public and private sectors to manage the process.

In the present study was evaluated the efficiency of plant extracts from Larrea tridentata extracted with four solvents in vitro inhibition of radial growth of Penicillium polonicum, Aspergillus niger, Rhizopus oryzae y Alternaria tenuissima. Fungi were identified using colonial, morphological taxonomic keys and the corresponding molecular techniques identified species each. A design was randomly applied altogether with 16 treatments in each mold, corresponding to four solvents: dichloromethane, ethanol, methanol and water, with four concentrations: 0, 250, 500 and 750 ppm to Alternaria sp.; 0, 2000, 2500 and 3000 to Aspergillus sp.; 0, 1500, 1750 and 2000 to Penicillium sp. and 0, 150, 200 and 250 to Rhizopus sp. Each treatment had three replicates. Molecular analysis determined the tenuissima specie to Alternaria, niger to Aspergillus, polonicum to Penicillium and oryzae to Rhizopus. About in vitro testing, inhibition of 100% for three of the study were determined fungi: Alternaria tenuissima EtOH extract to 750 ppm; Aspergillus niger with DCM extract and Rhizopus oryzae 3000 ppm from 150 ppm to 250 ppm of the DCM and EtOH extracts respectively. 82% inhibition at 2000 ppm for Penicillium polonicum was presented. It is concluded that despite the differences in susceptibility between the fungal species, Larrea tridentata extracts obtained with ethanol and dichloromethane are effective for the control of postharvest fungi under in vitro study.

En el presente estudio se evaluó la eficiencia de extractos vegetales de Larrea tridentata obtenidos con diclorometano, etanol, metanol y agua, sobre el crecimiento radial in vitro de cuatro hongos fitopatógenos, los cuales primeramente fueron identificados en género y especie empleando claves taxonómicas y técnicas moleculares. Para los bioensayos in vitro se aplicaron diseños completamente al azar con cuatro tratamientos y tres repeticiones en cada hongo, utilizando las concentraciones: 0, 250, 500 y 750 ppm para Alternaria sp.; 0, 2000, 2500 y 3000 para Aspergillus sp.; 0, 1500, 1750 y 2000 para Penicillium sp. y 0, 150, 200 y 250 ppm para Rhizopus sp. Cada tratamiento tuvo tres repeticiones. El análisis molecular determinó la especie tenuissima para Alternaria, niger para Aspergillus, polonicum para Penicillium y oryzae para Rhizopus. En cuanto a las pruebas in vitro, se determinaron inhibiciones del 100% para tres de los hongos en estudio: Alternaria tenuissima con extracto EtOH a 750 ppm; Aspergillus niger con extracto DCM a 3000 ppm y Rhizopus oryzae a partir de 150 ppm y 250 ppm de los extractos DCM y EtOH respectivamente. Se presentó una inhibición del 82% a 2000 ppm para Penicillium polonicum. Se concluye que a pesar de las diferencias en susceptibilidad entre las especies fúngicas, los extractos de Larrea tridentata obtenidos con etanol y dicloromentano son efectivos para el control de los hongos fitopatógenos bajo estudio in vitro.

Objetivou-se com este trabalho quantificar a composição mineral das folhas de Oliveira a fim de diagnosticar o estado nutricional das plantas cultivadas em sistema convencional. O experimento foi conduzido com sete cultivares Arbequina, MGS Asc 315, MGS Mariense, MGS Grap 541, MGS Grap 561, Grappolo 575 e Leccino, em blocos casualizados com 4 repetições e parcelas com cinco plantas. Em maio de 2010 foram coletadas 60 folhas de cada cultivar (12 por planta) e submetidas a analise foliar. As cultivares apresentaram diferenças significativas entre si quanto aos teores foliares médios de nutrientes. Observou-se também que apesar da analise de solo apontar níveis elevados de Fe e Mn, a análise foliar acusou deficiência para esses elementos em todas as cultivares de Oliveira avaliadas. Os resultados alertam para os altos níveis de Cu, como consequência do uso abusivo de fungicidas a base de oxicloreto e calda bordalesa nos pomares. A concentração elevada desse elemento nas folhas pode causar fitotoxidez às plantas. Desta forma, sugere-se o uso racional de fertilizantes e de produtos fitossanitários no cultivo da oliveira a fim de evitar fitotoxidez ou deficiências nutricionais.

This study aimed to quantify the mineral composition of olive leaves to diagnose nutritional status of plants grown in conventional system. The experiment was conducted with seven cultivars: Arbequina, MGS Asc 315, MGS Mariense, MGS Grap 541, MGS Grap 561, Grappolo 575 and Leccino, in a randomized block design with four replications and five plants perplot. In May 2010, we collected 60 leaves for each cultivar (12 per plant),whichwere dried and subsequently analyzed. The results advert to the high levels of Cu, a consequence of the excessive use of fungicides based on copper oxychloride and Bordeaux mixture in the orchards. The high concentration of this element in the leaves can bephytotoxicity to plants and harmful to human health, since the leaves are used popularly as an aid in procedures for weight loss. Thus, we suggest the rational use of fertilizers and pesticides in the cultivation of olive trees to prevent nutritional deficiency or phytotoxicity and, if the research acknowledges the phytotherapic effect of leaves, the adoption of crops in the differentiated system of production, to obtain raw material with good quality and suitable for consumption in natura.

We determine the presence of plasmonic surface modes under TE polarization in an optical fiber made of a dispersive left handed material. These modes keep clearly localized at a constant frequency within the numerical error, despite strong geometrical changes in the physical system. To prove this fact we analyze systems having random roughness on their surfaces and consider other geometry variations. The electromagnetic field distribution is determined in the region where plasmonic and non plasmonic modes exist.

Determinamos la presencia de modos de superficie plasmónicos para polarización TE en una fibra óptica hecha de un metamaterial izquierdo. Estos modos se mantienen claramente localizados a una frecuencia constante dentro del error numérico de la simulación a pesar de que el sistema físico se somete a grandes cambios en su geometría. Para probar este hecho, analizamos sistemas que poseen rugosidad aleatoria en sus superficies y consideramos otras variaciones en la geometría. Determinamos en la región del espectro donde existen modos plasmónicos y no plasmónicos.

O alumínio é o metal mais abundante e o terceiro elemento mais comum na crosta terrestre, compreendendo aproximadamente 7% da sua massa total, e em solos ácidos, sua toxidez é o fator limitante de maior importância para a produtividade das culturas no mundo. Neste sentido, este trabalho busca determinar um método de avaliação do comportamento de porta-enxertos de videira, Paulsen 1103 e Gravesac, em condições estressantes de alumínio in vitro. As plantas matrizes foram mantidas em casa de vegetação, em condições controladas contra patógenos, e submetidas a fertirrigação com solução nutritiva para videira. Para seleção dos explantes, desinfestação, introdução e manutenção in vitro foram utilizadas metodologias de cultura de tecidos para a videira. Após a desinfestação, os explantes foram inoculados em tubos de ensaio contendo 15 mL de meio de cultura DSD1. As culturas in vitro foram transferidas para salas de crescimento e mantidas sob condições de temperatura de 25°C, fotoperíodo de 16 horas e intensidade luminosa de 40-45 μmol.m-2.s-1. A sustentação dos explantes no meio líquido foi obtida por intermédio de discos de cortiça previamente preparados e esterilizados. Os experimentos foram conduzidos com pH da solução igual a 4,0 e concentrações de Al, adicionadas na forma de AlCl3, variando de 0 a 1,375 mM. Após a autoclavagem do meio de cultivo, as doses de alumínio foram adicionadas ao meio de cultura em câmara de fluxo laminar e os valores de pH corrigidos para 4,0. Foram implantados dois experimentos. No primeiro, os explantes das duas variedades de porta-enxertos foram colocados diretamente no meio de cultura DSD1 líquido com diferentes concentrações de Al, onde ficaram por um período de 60 dias até a avaliação. No segundo experimento, os explantes foram introduzidos em mesmo meio, na ausência de alumínio. Após 30 dias em crescimento, as plantas in vitro foram selecionadas por tamanho e submetidas aos diversos tratamentos até a avaliação. O método para a avaliação dos efeitos fitotóxicos do alumínio sobre a cultura da videira em condições in vitro foi elaborado com base em estudos que tratam da toxidez por alumínio em solução nutritiva e da seleção de videiras in vitro. Avaliaram-se os efeitos dos tratamentos sobre o sistema radicular (número de raízes e massa seca), matéria fresca e seca total e matéria seca das folhas. O delineamento experimental utilizado foi inteiramente casualizado composto por seis vidros, contendo três plantas cada um, num total de sete tratamentos. Os porta-enxertos de videira Gravesac e Paulsen 1103, apresentam mecanismos de exclusão do alumínio via elevação do pH do meio de cultura. A variedade Gravesac apresentou respostas de variação de pH mais rápidas que a variedade Paulsen 1103. Ocorreu variabilidade nas respostas de crescimento de plantas in vitro em condições estressantes de H+ e Al+3. O desenvolvimento in vitro do porta-enxerto Paulsen 1103 foi superior ao do Gravesac para número de folhas, comprimento das raízes, área foliar, peso seco total.

The aluminum is the most abundant metal and the third more common element in the terrestrial crust, with approximately 7% of your total mass and in acid soils, your toxicity is the limiting factor of larger importance for the productivity of cultures in the world. In this sense, this work search to determine a method of evaluation of the behavior of rootstock grapevine ‘Paulsen 1103’ and ‘Gravesac’, in stress conditions of aluminum in vitro. The plants were maintained in a greenhouse, in controlled conditions against diseases, and submitted the irrigation with nutritious solution for grapevine. For selection of the explants, disinfestations, introduction and in vitro maintenance were used methodologies of tissue culture for the grapevine. After the disinfestations, the explants were inoculated in tubes containing 15 mL of culture medium DSD1. The cultures in vitro were transferred for growth rooms and maintained under temperature conditions of 25°C, photoperiod of 16 hours and luminous intensity of 40-45 mol.m-2.s-1. The sustentation of the explants in the liquid culture medium was previously obtained through cork disks prepared and sterilized. The experiments were maintained with pH of the solution same to 4.0 and concentrations of Al, added in the AlCl³ form, varying from 0 to 1.375 mM. After the sterilization of the culture medium, the concentrations of aluminum were added to the culture medium in a laminar camera and the pH values corrected for 4.0. Two experiments were implanted. In the first, the explants of the two varieties of grapevine rootstock were placed directly in the liquid culture medium DSD1 with different concentrations of Al, where were maintained per 60 days until the evaluation. In the second experiment, the explants were introduced in the same culture medium, in the absence of aluminum. After 30 days in growth, the plants in vitro were selected by size and submitted to the several treatments until the evaluation. The method for the evaluation of aluminum fitotoxicity effects on the grapevine culture in vitro was elaborated with base in studies about the toxicity for aluminum in nutrition solution and the selection in vitro of grapevine. The effects of the treatments were evaluated on the radicular system (number of roots and sec mass), fresh mass and sec mass of leaves. The experimental delineate used was randomized composed by six glasses, containing three plants each one, in a total of seven treatments. The rootstock grapevine ‘Gravesac’ and ‘Paulsen 1103’, present mechanisms of aluminum exclusion through elevation of pH in the culture medium. The cv. ‘Gravesac’ presented answers variation of faster pH than ‘Paulsen 1103’. Its happened variability in the answers growth of plants in vitro in stress conditions of H+ and Al+3. The development in vitro of rootstock grapevine Paulsen 1103 was superior to Gravesac for number of leaves, length of roots, foliar area and total dry weight.

We have performed a retrospective study of patients diagnosed with infective endocarditis due to Enterococcus in our hospital for a period of 12 years (1994-2005). We review clinical and microbiological aspects, therapy, and outcome. We found 12 cases that were 6 % of total endocarditis, and 7% of enterococcal bacteremia. Eight cases were male, and 4 were female, aged between 37 and 94 years. The causative organism of endocarditis was E. faecalis in 10 patients and E. faecium in 2. Two E. faecalis were resistant to aminoglycosides. Aortic valve was the most frequently affected with 9 cases, followed by mitral valve (2 cases), and tricuspid valve (1 case). In 10 cases endocarditis affected a native valve, and only in 2 cases a prosthetic valve. Only 5 patients had underlying valve disease. The most frequently used antimicrobial therapy was the combination of ampicillin plus gentamicin (8 patients). Four cases were treated with monotherapy, 2 with ampicillin, and 2 with vancomycin. Seven patients suffered heart failure, and five of them required surgical therapy with aortic valve replacement. All the patients treated with monotherapy had severe complications, that led to death in 2 of them.

Con el objetivo de identificar a los pacientes diagnosticados en nuestro hospital de endocarditis infecciosa por enterococo se ha realizado un estudio retrospectivo durante un período de 12 años (1994-2005), analizando sus características clínicas y microbiológicas, así como el tratamiento y la evolución de la enfermedad. Se encontraron 12 casos de endocarditis por enterococo, lo que representó el 6% del total de endocarditis y el 7% de las bacteriemias por enterococo. Se trataba de 8 hombres y 4 mujeres, con edades comprendidas entre los 37 y los 94 años. El microorganismo causante fue E. faecalis en 10 casos y E. faecium en 2 casos. Dos de los E. faecalis eran resistentes a aminoglucósidos. La válvula afectada con mayor frecuencia fue la aórtica, con 9 casos, seguida de la mitral, con 2 y de la tricúspide, 1 caso. En 10 pacientes la endocarditis se instaló sobre una válvula nativa y sólo en 2 casos sobre válvula protésica. Únicamente 5 pacientes tenían antecedentes de enfermedad valvular cardiaca. El tratamiento antimicrobiano más utilizado fue la combinación de ampicilina y gentamicina, que se empleó en 8 pacientes. Cuatro casos fueron tratados con monoterapia; 2 de ellos con ampicilina y 2 con vancomicina. Siete pacientes se complicaron con insuficiencia cardíaca, cinco de los cuales precisaron tratamiento quirúrgico de sustitución valvular aórtica. Los 4 enfermos tratados con monoterapia presentaron complicaciones graves, que provocaron la muerte de 2 pacientes.

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.

Presentamos el caso de una paciente diagnosticada de quilotórax bilateral y de linfangitis carcinomatosa pulmonar, que evolucionó de forma desfavorable conduciendo al fallecimiento por insuficiencia respiratoria, en el contexto de un adenocarcinoma metastásico de primario desconocido tras el estudio necrópsico. A partir de este caso, revisamos la etiología, el diagnóstico y las opciones disponibles en el tratamiento de los quilotórax.

Objective: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. Patient and methods: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. Results: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5,5), and previous dependent functional status (OR 4.8). Conclusions: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status.

Objetivo: Estudiar la mortalidad y los factores asociados a la misma en las bacteriemias adquiridas en la comunidad que ingresan en el servicio de Medicina Interna de un hospital terciario. Pacientes y métodos: Estudio prospectivo de las bacteriemias ingresadas durante 1 año (mayo 1999-abril 2000). Se han recogido datos demográficos, patología previa, situación funcional, foco infeccioso, complicaciones, constantes vitales, valores de laboratorio, puntuaciones del APACHE II y SOFA, resultados de los hemocultivos, tratamiento y supervivencia a los 28 días. En primer lugar se ha realizado un análisis bivariante con la prueba de la Chi-cuadrado, la t de Student y la prueba no paramétrica de Mann-Whitney, según correspondiera. Las variables significativas se han introducido en un modelo de regresión logística múltiple de exclusión escalonada paso a paso, utilizando la mortalidad como variable dependiente. Resultados: Se han observado 115 casos de bacteriemia en 114 pacientes. El foco urinario supuso el 57,4% de los casos y el microorganismo aislado con mayor frecuencia fue Escherichia coli (54,4% de los aislamientos). La mortalidad a los 28 días fue del 15,3%. Los factores asociados de forma independiente a la misma fueron el shock séptico (OR 10,4), el foco de bacteriemia diferente del urinario (OR 9,3), la puntuación en el APACHE II mayor o igual a 20 (OR 5,5) y la existencia de un estado funcional dependiente previo al episodio (OR 4,8). Conclusiones: Los factores de riesgo de mortalidad fueron el shock séptico, el foco no urinario, la puntuación del APACHE II y el estado funcional previo.

Objectives: To know the prevalence of osteopenia and osteoporosis in alcoholic cirrhotic males from 45 to 65 years old. To prove if the nutritional state is involved in the loss of bone mass in the hepatic disease. Material and methods: Study population: 52 alcoholic cirrhotic males from 45 to 65 years old, with normal kidney function , non-sedentary and with no treatment that could alterate the study. Design and variables: transversal descriptive study finished in 2 years. The nutritional state was evaluated by means of classic anthropometric parameters (weight, height, perimeter of the arm and skin folds) and total body densitometry (DPX plus LUNAR-DEXA with dual energy X-ray absorptiometry. Statistical analysis: Mc Intosh computer (Filemaker PRO program). T Student was used to compare groups and p was significant if alpha α <= 0.05. Clinical severity of cirrhosis: Child-Turcotte classification. Results: Osteopenia was diagnosed if bone mineral density (BMD) was higher than 1 standard deviation (SD) but lower than 3 SD below T score (mean values for adult women) and osteoporosis (OP) if BMD was higher than 3 SD or vertebral compression fractures appeared in simple radiographies. The prevalence of bone disease was 58%. The percentages of fat obtained by means of anthropometric and densitometric measures were higher in non-osteopenic patients. Discussion: The prevalence of bone disease was higher than another studies. The total body densitometry is a more exact method to measure the percentage of body fat. The percentages of fat obtained with both methods were not related to the loss of bone mass. The nutritional state as an isolated factor does not lead to bone disease in these patients.

Objetivos: Conocer la prevalencia de osteopenia y osteoporosis en cirróticos alcohólicos entre 45 y 65 años de edad. Comprobar si el estado nutricional está implicado en la pérdida de masa ósea de la enfermedad hepática. Material y métodos: Población a estudio: 52 varones cirróticos alcohólicos de 45 a 65 años de edad, con función renal normal, no sedentarios y sin ningún tratamiento que pudiera alterar el estudio. Diseño y variables: estudio descriptivo transversal finalizado en 2 años. El estado nutricional se evaluó por medio de parámetros antropométricos clásicos (peso, altura, perímetro braquial y pliegues cutáneos) y densitometría corporal total (absortimetría de doble haz de RX DPX plus LUNAR-DEXA). Análisis de los datos: ordenador Mc Intosh (programa Filemaker PRO). Se usó la t de Student para comparar grupos y p fue significativo si α <= 0,05. Gravedad clínica de la cirrosis: clasificación de Child-Turcotte. Resultados: Se consideró osteopenia si la densidad mineral ósea (DMO) estaba por encima de 1 desviación estándar (DE) pero por debajo de 3 DE respecto a la T score (valores promedio en mujeres adultas) y osteoporosis (OP) si la DMO estaba por encima de 3 DE o existían fracturas de compresión vertebrales. La prevalencia de enfermedad ósea fue del 58%. Los porcentajes de grasa obtenidos por medidas antropométricas y densitométricas fueron superiores en los pacientes no osteopénicos. Discusión: La prevalencia de enfermedad ósea fue superior a la de otros estudios. La densitometría corporal total es un método más exacto para medir el porcentaje de grasa corporal. Los porcentajes de grasa obtenidos con ambos métodos no se relacionaron con la pérdida de masa ósea. El estado nutricional como factor aislado no conlleva desmineralización ósea en estos pacientes.

Eating disorders (anorexia and bulimia nervosa) are present in 1-3% of young female women. A later beginning, prolonged amenorrhea and low body mass index are risk factors of osteopenia in bulimic patients. Bone demineralization in anorexia nervosa is due to a greater resorption than bone formation leading to osteopenia, secondary osteoporosis and increased risk of pathologic fractures. Pathophysiology of bone disease includes factors as long duration of amenorrhea, deficient absorption of calcium, extreme physical exercise, 1,25 vitamin D defficiency, low creatinine clearance, increased blood and urinary cortisol and high levels of GH. Proposed treatments are nutritional improvement and weight gain (the most important), calcium supplementation, moderate exercise, estrogens, antidepressive drugs, fluoride in selected cases, byphosphonates and recombinant human IGF-1. An adequate questionnary is essential in women with slightly decreased weight and mentrual disorders.

Los trastornos de la alimentación (anorexia y bulimia nerviosa)afectan al 1-3% de las mujeres jóvenes adultas. Edad tardía de inicio, duración de amenorrea e índice bajo de masa corporal son factores de riesgo de osteopenia en pacientes bulímicas. Se produce desmineralización cuando la reabsorción sobrepasa a la formación ósea en la AN, lo que lleva al desarrollo de osteopenia, osteoporosis secundaria y mayor riesgo de fracturas patológicas. La patofisiología de la desmineralización se atribuye a diversos factores como duración de la amenorrea, deficiente absorción de calcio, ejercicio físico extremo, déficit de 1,25 (OH) vit D, bajo aclaramiento de creatinina, exceso de cortisol sérico y urinario y niveles altos de GH. Los tratamientos recomendados son rehabilitación nutricional (el más importante), suplementos de calcio, ejercicio moderado, terapia estrogénica cuando esté indicada, tratamiento antidepresivo, flúor en casos seleccionados, bifosfonatos e IGF-1 recombinante humano. Un interrogatorio preciso es esencial en mujeres con peso ligeramente descendido y con transtornos menstruales.