Claudia M. Velásquez

Treatment of severe malnutrition in children: experience in implementing the World Health Organization guidelines in Turbo, Colombia.

Objective: To evaluate the implementation of the World Health Organization guidelines for the treatment of children with severe acute malnutrition in a class I hospital. Paitents and Methods: Descriptive and prospective study of 335 children under the age of 6, admitted between 2001 and 2005 for severe acute malnutrition (83%) and moderate acute malnutrition associated with illness (17%). The care of the children was provided by clinicians and medical staff trained under World Health Organization guidelines. Results: Kwashiorkor was a common result in children with severe acute malnutrition (60.8%); 58% were younger than 1 year old. Complications upon admission were diarrhea (68.4%) and anemia (51.1%), and the most common complication during hospital stay was sepsis (9%). Overall, 61.7% attained −1 standard deviation of weight for height after an average stay of 3 weeks in the hospital; 5.1% were sent to tertiary care hospitals. Overall, mortality during the 5 years was 5.7%, with sepsis the most common cause. In the first year, the mortality rate was 8.7%; it decreased to 4.0% in the last year. The mortality rate was significantly higher in children with edema. Children with moderate acute malnutrition had similar complications and mortality when compared with children with severe acute malnutrition (5.3%). Conclusions: Once the World Health Organization guidelines were implemented, low mortality rates were achieved in children with severe acute malnutrition in class I hospitals.

Variations in the Prevalence of Metabolic Syndrome in Adolescents According to Different Criteria Used for Diagnosis: Which Definition Should Be Chosen for This Age Group?

BACKGROUND Despite the increasing prevalence of metabolic syndrome in adolescents, there is no consensus for its diagnosis. METHODS A cross-sectional study was conducted to compare the prevalence of metabolic syndrome in adolescents by different definitions, evaluate their concordance, and suggest which definition to apply in this population. A total of 851 adolescents between 10 and 18 years of age were evaluated. Anthropometric (weight, height, waist circumference), biochemical (glucose, lipid profile), and blood pressure data were taken. The prevalence of metabolic syndrome was determined by the definitions of the International Diabetes Federation (IDF) and four published studies by Cook et al., de Ferranti et al., Agudelo et al., and Ford et al. Concordance was determined according to the kappa index. RESULTS The prevalence of metabolic syndrome was 0.9%, 3.8%, 4.1%, 10.5%, and 11.4%, according to the IDF, Cook et al., Ford et al., Agudelo et al., and de Ferranti et al. definitions, respectively. The most prevalent components were hypertriglyceridemia and low high-density lipoprotein cholesterol, whereas the least prevalent components were abdominal obesity and hyperglycemia. The highest concordance was found between the definitions by Cook et al. and Ford et al. (kappa=0.92), whereas the greatest discordance was between the de Ferranti et al. and IDF definitions (kappa=0.14). CONCLUSIONS Metabolic syndrome and its components were conditions present in the adolescents of this study. In this population, with a high prevalence of dyslipidemia and a lower prevalence of abdominal obesity and hyperglycemia, the recommendation to diagnose metabolic syndrome would be that used by Ford et al.

Inflammatory response in Colombian children with severe protein-energymalnutrition before and after nutritional intervention

Aim: To evaluate the changes in C-reactive protein and pro-inflammatory cytokines in severely malnourished children, before nutritional intervention and at the moment of restoring appetite. Methodology: To assess changes in inflammatory mediators, 20 severely malnourished children under 5 years of age, 10 with kwashiorkor and 10 with marasmus were studied. Hemoglobin, total serum proteins, albumin, ferritin, transferrin, ceruloplasmin, C-reactive protein and pro-inflammatory cytokines (IL-8, IL-1β, IL-6,IL-10,TNF-α, and IL-12p70) were determined. Results: Upon hospital admission, the mean values of C-reactive protein in kwashiorkor and marasmus patients (16.3±19.0 mg/L and 23.1±27.9 mg/l, respectively) indicated an inflammatory response process with no difference between both groups (p=1.0). Total protein, albumin, transferrin and ceruloplasmin in children with kwashiorkor were significantly lower than in marasmic children (p=0.003, p=0.007, p=0.035, p=0.007, respectively). All cytokines, except IL-12p70, showed significantly higher concentrations in kwashiorkor than in marasmic children. After the stabilization phase, concentrations of C-reactive protein decreased significantly in both groups and albumin increased to normal values, but cytokines remained high. Conclusion: These results show that malnourished children are able to synthesize C-reactive protein in response to an infectious process. Additionally, higher levels of pro-inflammatory cytokines and depletion of albumin in children with kwashiorkor suggest that these inflammatory mediators could be critical biomarkers during clinical phases of kwashiorkor.

In Vitro Effect of Fatty Acids Identified in the Plasma of Obese Adolescents on the Function of Pancreatic β-Cells

Background The increase in circulating free fatty acid (FFA) levels is a major factor that induces malfunction in pancreatic β-cells. We evaluated the effect of FFAs reconstituted according to the profile of circulating fatty acids found in obese adolescents on the viability and function of the murine insulinoma cell line (mouse insulinoma [MIN6]). Methods From fatty acids obtained commercially, plasma-FFA profiles of three different youth populations were reconstituted: obese with metabolic syndrome; obese without metabolic syndrome; and normal weight without metabolic syndrome. MIN6 cells were treated for 24 or 48 hours with the three FFA profiles, and glucose-stimulated insulin secretion, cell viability, mitochondrial function and antioxidant activity were evaluated. Results The high FFA content and high polyunsaturated ω6/ω3 ratio, present in plasma of obese adolescents with metabolic syndrome had a toxic effect on MIN6 cell viability and function, increasing oxidative stress and decreasing glucose-dependent insulin secretion. Conclusion These results could help to guide nutritional management of obese young individuals, encouraging the increase of ω-3-rich food consumption in order to reduce the likelihood of deterioration of β-cells and the possible development of type 2 diabetes mellitus.

La concepción psicoanalítica de los sueños. The psychoanalytic conception of dreams.

The psychoanalytic conception of dreams. Resumen Este articulo presenta un recorrido amplio por los principales aportes al estudio de los suenos realizado por Sigmund Freud, el creador del psicoanalisis. Inicia con una presentacion de la concepcion de los suenos previa a la aparicion del psicoanalisis, epoca en que los suenos tenian un caracter magico y aun premonitorio. Se pasa, entonces, al proposito freudiano del estudio de los suenos entendidos como una produccion psiquica de la persona misma; dicho proposito es hacer del sueno un objeto de estudio posible de abordar con el rigor cientifico y que, ademas, se constituyen en la via primordial para acceder al saber del inconsciente. Posteriormente, la autora expone el procedimiento que sigue el psiquismo para la produccion de los suenos, a partir de las vivencias diurnas, presentes y pasadas, y los procesos que sobre ella recaen, de tal forma que da lugar a un contenido manifiesto del sueno; aquel que aparece al sonante una vez despierta y que toma la forma de un relato basado en las imagenes percibidas en el dormir. Y un contenido latente que es aquel que emerge a partir de la asociacion libre que el sonante realice en union con las interpretaciones del analista, un contenido hasta ese momento desconocido para el sonante, pero que paradojicamente le pertenece. Si bien la tarea de interpretacion es ardua, dado que los suenos son presa del olvido, he ahi el fenomeno que el presente articulo examina con algunas proposiciones explicativas. Para terminar, la autora plantea dos tipos de interpretacion posible para los suenos, aquella que se basa en un simbolismo universal, y la que Freud concibe, que se basa en lo singular del sonante y se obtiene a partir de sus dichos y del levantamiento de las represiones de sus pulsiones mas ocultas. Palabras clave: inconsciente, contenido manifiesto, contenido latente, interpretacion, asociacion libre, represion y simbolismo. Abstract. This article presents a comprehensive tour for the main contributions to the study of dreams by Sigmund Freud, the founder of psychoanalysis. It begins with a presentation of the concept of dreams previous to the advent of psychoanalysis, a time when dreams were still a magical and premonitory. It goes, then, to the purpose of Freuds study of dreams understood as a psychic production of the person itself; the purpose is to make the dream a possible object of study to address with the scientific rigor and that also constitute the essential way to access the knowledge of the unconscious. Subsequently, the author explains the procedure followed by the psyche for the production of dreams, from day experiences, past and present, and processes that fall on it, so giving rise to a dream content manifest ; the one that appears once the dreamer awakes and takes the form of a narrative based on images collected during the sleep. And a latent content is the one that emerges from the dreamers free association conducts in conjunction with the analysts interpretations, so far an unknown content to the dreamer, but paradoxically it belongs to him/her. Although the task of interpretation is difficult, since dreams are forgotten, behold the phenomenon that this article examines with some explanatory propositions. Finally, the author suggests two types of possible interpretation for dreams that are based on a universal symbolism, and the one, which Freud conceives, based upon the singularity of the dreamer and is derived from his statements and the lifting of repression of its most hidden pulsions. Keywords: unconscious, manifest content, latent content, interpretation, free association, repression and symbolism.