ABSTRACT Objective To develop a scientific consensus on nutrition in cystic fibrosis. Methods Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature. Results Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis. Conclusion This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.

Abstract Introduction: Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient’s age on risk factors for acute kidney injury after cardiac valve surgery. Methods: We evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018. Results: The prevalence of acute kidney injury was 19.5%. Hypertension (P=0.017); RR (95% CI): 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR (95% CI): 1.79 (1.17-2.72), preoperative haematocrit <33% (P=0.009); RR (95% CI): 2.04 (1.19-3.48), glomerular filtration rate <60 ml/min/1.73 m2 (P<0.0001); RR (95%) CI: 2.36 (1.54-3.62) and cardiac catheterization <8 days before surgery (P=0.021); RR (95% CI): 2.15 (1.12-4.11) were identified as independent risk factors. In patients older than 70 years, with no kidney disease diagnosed preoperatively, glomerular filtration rate <70 ml/min/1.73 m2, male gender, cardiopulmonary bypass time, preoperative haematocrit <36% and preoperative therapy with angiotensin-converting enzyme inhibitors were risk factors for acute kidney injury after valve surgery. Conclusions: In elderly patients, postoperative acute kidney injury develops with higher values of preoperative glomerular filtration rate than those observed in a younger population. Preoperative correction of anaemia, discontinuation of angiotensin-converting enzyme inhibitors and surgical techniques reducing cardiopulmonary bypass time would be considered to reduce the prevalence of renal failure. Introduction patient s Methods 93 201 2018 Results 195 19 5 19.5% P=0.017 P0017 P 0 017 (P=0.017) 95% 95 (95 CI CI) 174 1 74 1.7 1.103.48, 110348 1.10 3.48 , 10 3 48 (1.10-3.48) ≥7 P=0.006 P0006 006 (P=0.006) 179 79 1.172.72, 117272 1.17 2.72 17 2 72 (1.17-2.72) 33 <33 P=0.009 P0009 009 (P=0.009) 204 04 2.0 1.193.48, 119348 1.19 (1.19-3.48) 60 <6 mlmin173 mlmin ml min 73 ml/min/1.7 m P<0.0001 P00001 0001 (P<0.0001) 236 36 2.3 1.543.62 154362 1.54 3.62 54 62 (1.54-3.62 8 < P=0.021 P0021 021 (P=0.021) 215 15 2.1 1.124.11 112411 1.12 4.11 12 4 11 (1.12-4.11 7 preoperatively <7 gender <36 angiotensinconverting angiotensin converting Conclusions population anaemia failure 9 20 19.5 P=0.01 P001 01 (P=0.017 (9 1. 103 1.103.48 11034 110 1.1 348 3.4 (1.10-3.48 ≥ P=0.00 P000 00 (P=0.006 172 1.172.72 11727 117 272 2.7 (1.17-2.72 <3 (P=0.009 2. 193 1.193.48 11934 119 (1.19-3.48 6 mlmin17 ml/min/1. P<0.000 P0000 000 (P<0.0001 23 543 1.543.6 15436 154 1.5 362 3.6 (1.54-3.6 P=0.02 P002 02 (P=0.021 21 124 1.124.1 11241 112 411 4.1 (1.12-4.1 19. P=0.0 P00 (P=0.01 ( 1.103.4 1103 34 3. (1.10-3.4 (P=0.00 1.172.7 1172 27 (1.17-2.7 1.193.4 1193 (1.19-3.4 mlmin1 ml/min/1 P<0.00 (P<0.000 1.543. 1543 (1.54-3. (P=0.02 1.124. 1124 41 4. (1.12-4. P=0. P0 (P=0.0 1.103. (1.10-3. 1.172. (1.17-2. 1.193. (1.19-3. ml/min/ P<0.0 (P<0.00 1.543 (1.54-3 1.124 (1.12-4 P=0 (P=0. 1.103 (1.10-3 1.172 (1.17-2 1.193 (1.19-3 ml/min P<0. (P<0.0 (1.54- (1.12- P= (P=0 (1.10- (1.17- (1.19- P<0 (P<0. (1.54 (1.12 (P= (1.10 (1.17 (1.19 P< (P<0 (1.5 (1.1 (P (P< (1. (1

Abstract Fire produces changes in vegetation, soil, fauna, and water quality, and it can even modify atmospheric chemical composition. Changes in soil fertility, microorganisms and vegetation were evaluated after a fire in two municipalities in the State of Hidalgo, Mexico. Inside and outside the burned area, four 100 m2 plots were established. In each of the eight plots, soil samples were collected at two depths (0-5 and 5-20 cm) in the following areas: non-burned area (NBA); 15 days after fire (15DAF); and 12 and 24 months after the fire (MAF). Vegetation quantification was carried out at 30, 180 and 540 DAF. The results at 15DAF showed an increase of alkaline and metallic elements as well as pH in the surface layer, and this trend remained the same to 12MAF. There was greater Fe, Mn and Zn content in Zacualtipán and greater K, Ca, Mg and P in Singuilucan. At 24MAF, due to the nutrient requirements of the herbaceous and scrub growth, this effect was reverted. The fire reduced the organic matter (OM) and total nitrogen (TN) contents, without any recovery during the evaluated period. Bacteria showed greater mortality because of the fire: 76% and 50% at the Zacualtipán and Singuilucan sites, respectively. The canopy opening promoted a 50% increase of species in Zacualtipán. In conclusion, the fire temporarily increased soil fertility and the presence of herbaceous vegetation, but it reduced the bacteria and fungi populations.

Resumen El fuego produce cambios en la vegetación, suelo, fauna, calidad de las aguas e incluso modificaciones en la composición de la atmósfera. Se evaluaron los cambios en la fertilidad del suelo, de microorganismos y de la vegetación después del incendio en dos municipios del estado de Hidalgo, México. Dentro y fuera del área incendiada se ubicaron cuatro parcelas de 100 m2, en cada parcela se colectaron muestras de suelo a dos profundidades 0-5 y 5-20 cm: área no incendiada (ANI), 15 días después del incendio (15DDI), 12 y 24 meses después del incendio (MDI). La cuantificación de la vegetación se realizó a los 30, 180 y 540 DDI. Los resultados a 15DDI mostraron un incremento de elementos alcalinos y metálicos, y de pH en la capa superficial, manteniendo esta tendencia hasta 12MDI, con mayor contenido de Fe, Mn y Zn en el sitio Zacualtipán y de K, Ca, Mg y P en Singuilucan; este efecto se revierte a los 24MDI debido al crecimiento de las herbáceas y matorrales que demandan nutrimentos. El incendio redujo el contenido de materia orgánica (MO) y nitrógeno total (Nt) sin recuperación durante el periodo de evaluación. Las bacterias mostraron mayor mortandad por efecto del fuego, del 76% y 50% para los sitios Zacualtipán y Singuilucan, respectivamente. La apertura de espacios en la cobertura, propició incremento de 50% de especies en sitio Zacualtipán. Se concluye que el fuego incrementó la fertilidad del suelo y la presencia de herbáceas de forma temporal, pero redujo las poblaciones de bacterias y hongos.

Objective Determine the effectiveness of the Integrated Growth and Development Strategy (ECDI, Spanish acronym) of World Vision Peru on anemia, malnutrition, psychomotor development, and child care and protection in children aged <3 years living in three rural communities of Ayacucho Region, Peru. Methods A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Anemia was measured using capillary blood and the HemoCue® analyzer, with hemoglobin values adjusted for altitude. Malnutrition was measured with anthropometric indicators for height and weight, using the World Health Organization’s Anthro software. Psychomotor development was measured with the Abbreviated Test of the Ministry of Health of Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May 2013, midpoint in November 2013, and final in May 2014. In total, 283 children had two or more measurements including the final measurement, and 205 had all three measurements. Results Multivariate analysis for repeated measures showed that ECDI had an estimated 33.1% effectiveness in reducing anemia (95% CI: 1.0%-54.7%), adjusted for age, sex, consumption of iron-rich foods, consumption of iron-absorption-enhancing foods, consumption of iron-absorption-inhibiting foods, having received iron supplementation in the last six months, and having participated in the Cuna Más Program. Conclusions ECDI was effective in improving nutrition in children aged <36 months through anemia reduction and increased consumption of iron-absorption enhancers. Interventions that include educational and community monitoring components could be of great assistance to combating anemia in children aged <36 months in rural communities.

RESUMEN Objetivo Determinar la efectividad de la Estrategia para el Crecimiento y Desarrollo Integral (ECDI) de World Vision Perú sobre la anemia, desnutrición, desarrollo psicomotor y cuidado y protección infantil en niños menores de tres años de edad que residían en tres comunidades rurales de la Región Ayacucho del Perú. Métodos Se realizó un estudio cuasiexperimental en tres distritos rurales de la región Ayacucho, Perú. La medición de anemia se realizó con sangre capilar y el analizador HemoCue®, con ajuste de los valores de hemoglobina según a la altitud. La desnutrición se midió a través de los indicadores antropométricos de talla y peso; para ello se utilizó la herramienta Anthro de la Organización Mundial de la Salud. El desarrollo psicomotor se midió mediante el Test Abreviado del Ministerio de Salud del Perú. El cuidado y protección de los niños se midió a través de una ficha especialmente elaborada para este fin. Se realizaron tres mediciones, la línea basal en mayo del 2013, la medición intermedia en noviembre del mismo año y la final en mayo del 2014. En total, 283 niños tuvieron dos o más mediciones incluida la medición final y 205 tuvieron las tres mediciones. Resultados El análisis multivariado para medidas repetidas mostró una efectividad estimada de la ECDI para reducir la anemia de 33,1% (intervalo de confianza del 95%: 1,0%-54,7%) ajustada para la edad, sexo, consumo de alimentos ricos en hierro, consumo de alimentos potenciadores de la absorción de hierro, consumo de alimento inhibidores de la absorción de hierro, haber recibido suplementación de hierro en los últimos seis meses y haber participado del Programa Cuna Más. Conclusiones La ECDI fue efectiva para mejorar la nutrición de los menores de 36 meses de edad a través de la reducción de la anemia y el incremento del consumo de potenciadores de la absorción de hierro. Las intervenciones que incluyen componentes educativos y de seguimiento comunitarios podrían ser de gran ayuda para combatir la anemia en los niños menores de 36 meses de edad en comunidades rurales.

RESUMO Objetivo Determinar a efetividade da Estratégia de Crescimento e Desenvolvimento Integral (ECDI) da World Vision Peru para anemia, desnutrição, desenvolvimento psicomotor e atenção e proteção infantis em crianças menores de 3 anos de idade em três comunidades rurais. Métodos Foi realizado estudo quase-experimental em três distritos rurais da região de Ayacucho, no Peru. A avaliação da anemia foi realizada em sangue capilar com o uso do analisador HemoCue®, com correção dos valores de hemoglobina segundo a altitude. A desnutrição foi avaliada segundo indicadores antropométricos de tamanho e peso, com o uso da ferramenta Anthro elaborada pela Organização Mundial da Saúde (OMS). O desenvolvimento psicomotor foi avaliado com o Teste Abreviado do Ministério da Saúde do Peru. A atenção e a proteção infantis foram avaliadas com o uso de uma ficha elaborada para esta finalidade. Foram realizadas três avaliações, com a linha de base em maio de 2013, a avaliação intermediária sendo realizada em novembro deste mesmo ano e a avaliação final, em maio de 2014. Ao todo, 283 crianças passaram por duas ou mais avaliações, incluindo a avaliação final, e 205 passaram por três avaliações. Resultados Na análise multivariada de medidas repetidas, a efetividade estimada da ECDI de reduzir a anemia foi de 33,1% (intervalo de confiança de 95%: 1,0%-54,7%), corrigida para idade, sexo, consumo de alimentos ricos em ferro, consumo de alimentos potenciadores da absorção de ferro, consumo de alimentos inibidores da absorção de ferro, suplementação de ferro nos últimos seis meses e participação no Programa Cuna Más (programa nacional de desenvolvimento infantil). Conclusões A ECDI demonstrou efetividade para melhorar a nutrição das crianças menores de 36 meses com a redução da anemia e o aumento do consumo de potenciadores da absorção de ferro. Intervenções com componentes educacionais e acompanhamento comunitário podem contribuir consideravelmente para combater a anemia em crianças menores de 36 meses em comunidades rurais.

Introduction: D-003, an active pharmaceutical ingredient (API) purified from sugar cane (Saccharum officinarum L.) wax with cholesterol-lowering and antioxidant effects, is composed of a mixture of free saturated very long chain fatty acids (VLCFAs), each within specific relative concentration ranges as determined by the gas chromatography (GC). However, the spectroscopic characterization of D-003 had not been previously reported. Objective: to characterize the active pharmaceutical ingredient named D003 in accordance to its ultraviolet (UV), infrared (FTIR), nuclear magnetic resonance (NMR) and mass (MS) spectra. Methods: samples of six batches of D-003 (CNIC, Cuba) were evaluated by UV, FTIR, NMR-¹H, NMR-13C, and GC-MS techniques. For obtaining the mass spectra of D-003 acids, methyl (FAME) and trimethylsilyl ester derivatives were used. Quantification of free very long chain saturated fatty acids , analyzed as methyl ester derivatives, was made by GC with flame ionisation detector (FID). Results: UV, FTIR, and ¹H-NMR, 13C-NMR spectra showed that active pharmaceutical ingredient D-003 was composed of a mixture of free very long chain fatty acids, whereas the GC-MS and GC-FID techniques allowed ensuring the occurrence of 13 VLCFAs in set proportions: C24:0 (0.2-0.6 %), C25:0 (0.4-0.9 %), C26:0 (2.0-3.1 %), C27:0 (2.1-2.7 %), C28:0 (30.0-37.5 %), C29:0 (1.5-1.7 %), C30:0 (17.0-18.6 %), C31:0 (0.9-1.2 %), C32:0 (6.9-8.9 %), C33:0 (0.9-1.3 %), C34:0 (7.2-11.1 %), C35:0 (0.3-0.6 %) and C36:0 (2.2-3.8 %). Conclusions: evidences from the UV, FTIR, NMR and GC-MS spectroscopic techniques prove that D-003 is composed of 13 saturated very long chain fatty acids, including octacosanoic acid as the most abundant one.

Introducción: el D-003 es un ingrediente farmacéutico activo purificado a partir de la cera de caña de azúcar (Saccharum officinarum L.) con efectos como reductor del colesterol y antioxidante, el cual está compuesto por una mezcla de ácidos grasos libres saturados de elevado peso molecular, cada uno dentro de un intervalo de concentración específica determinada por cromatografía de gases (CG). La caracterización espectroscópica del D-003, sin embargo, no ha sido previamente informada. Objetivo: caracterizar el ingrediente farmacéutico activo nombrado D-003 de acuerdo con sus espectros ultravioleta (UV), infrarrojo (FTIR), resonancia magnética nuclear (RMN) y de masas (EM). Métodos: se evaluaron muestras de seis lotes de D-003 (CNIC, Cuba) mediante las técnicas de UV, FTIR, RMN-¹H, RMN-13C y CG-EM. Para obtener los espectros de masas de los ácidos del D-003, estos se derivaron como ésteres metílicos y trimetilsilil. La cuantificación de los ácidos grasos libres saturados de elevado peso molecular, analizados como ésteres metílicos, se llevó a cabo por CG con detector de ionización por llama (DILL). Resultados: los espectros UV, IR, RMN-¹H y RMN-13C mostraron que el ingrediente farmacéutico activo D00-3 está constituido por una mezcla de ácidos grasos libres saturados de elevado peso molecular, mientras las técnicas de CG-EM y CG-DILL permitieron asegurar la presencia de 13 ácidos grasos libres saturados de elevado peso molecular en proporciones definidas: C24:0 (0,2-0,6 %), C25:0 (0,4-0,9 %), C26:0 (2,0-3,1 %), C27:0 (2,1-2,7 %), C28:0 (30,0-37,5 %), C29:0 (1,5-1,7 %), C30:0 (17,0-18,6 %), C31:0 (0,9-1,2 %), C32:0 (6,9-8,9 %), C33:0 (0,9-1,3 %), C34:0 (7,2-11,1 %), C35:0 (0,3-0,6 %) y C36:0 (2,2-3,8 %). Conclusiones: a partir de las técnicas espectroscópicas de UV, FTIR, RMN, y CG-EM se demuestra que el D00-3 está compuesto por 13 ácidos grasos saturados de elevado peso molecular, entre los cuales el ácido octacosanoico es el compuesto mayoritario.