Soporte nutricional basado en la evidencia en la enfermedad inflamatoria intestinal

Patients with inflammatory bowel disease are at risk for malnutrition. Consequently all patients with inflammatory bowel disease should undergo nutritional screening to identify those who require thorough nutritional evaluation. When nutritional support is indicated, enteral nutrition (oral or through a tube) should be used. There are no significant differences between elemental and non-elemental enteral diets in inducing remission of Crohn's disease (CD). Nevertheless, given that non-elemental diets are better tolerated, most authors prefer polymeric diets. Enteral nutrition should not be used as the primary treatment of choice in patients with CD, since they are less effective in inducing remission than steroid therapy. Although dietary fat (quantity and type of fat) might influence the course of the disease, recommendations cannot be made on the basis of the available studies. Equally, there is insufficient evidence that glutamine is effective in inducing remission in CD. The use of probiotics presents a high level of evidence in maintenance treatment and in the prevention of postoperative pouchitis, although the level of evidence is lower in ulcerative colitis and CD. Further studies are required to investigate several issues such as dose, treatment duration, the separate or combined use of several strains, as well as the concomitant use of prebiotics, symbiotics or antibiotics.     

Colombianas en la Vanguardia

Colombianas en la Vanguardia. Lucy M. Cohen. Medellín: Universidad de Antioquia, 2001. 351 pp.     

Recomendaciones nutricionales en las distintas etapas de la vida basadas en la evidencia

We review the scientific evidence available on nutritional recommendations in the distinct stages of life through 10 key questions relating to dietary modifications throughout the life cycle, namely: how long should breast-feeding last? What are the best methods for promoting breast-feeding? Should soya infant formulas be used to prevent allergic diseases in infants at high risk? Is micronutrient supplementation indicated in infants? How should childhood obesity be prevented? Are there any valid strategies for preventing eating disorders in adolescents? Which type of diet should be recommended in pregnant and breast-feeding women? Should nutritional supplements be used in elderly individuals at risk of malnutrition? Should micronutrient supplements be used in the elderly to prevent or treat degenerative diseases?     

Estudio de la sensibilidad especifica en residentes de un area endemica a la Paracoccidioidomicosis en Venezuela

Resumen Se presenta el estudio de la reacción a la Paracoccidioidina de los habitantes de un área de alta incidencia de Micosis de Lutz y Splendore, encontrándose positividad en el 52% de los residentes. Se hizo simultáneamente intradermo-reacciones al P.P.D., Histoplasmina y Esporotriquina, encontrándose cierta correlación de resultados sólo con la Histoplasmina. Con fines de comparación se hizo encuesta en pequeño grupo de habitantes de otra área del pais, encontrándose una diferencia estadisticamente significante con los resultados de la zona en estudio. Se hacen varios comentarios.

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Cutaneous sensitivity to paracoccidiodin was tested in 686 persons of an endemic area of Paracoccidioidomicosis in Venezuela. The antigen was prepared in our laboratory according to the technique used byFava Netto (Brasil). Skin-testing such as histoplasmin, sporotrichin and P.P.D. also were performed. Due to the high percentage obtained in the reading of the paracoccidioidin (52%) an inquiry was made in a not endemic area obtaining a percentage of 6,1%; this difference is statistically significant. Significant results are also obtained for the two remaining antigens of mycotic origin.Emphasis is laid on the importance of working with the same antigen used in Brasil.Commentaries are made on the common reactions that occur between paracoccidioidin and histoplasmin, and on the possibility of interpreting them as crossed reactions or that the same person is sensitive to the two agents which are in the environment of the place where they live.No crossed reactions were found between sporotrichin and paracoccidioidin in a significant number of cases, nor between the latter and the P.P.D. and this is considered very important in connection with the active or residual possible pulmonary lesions that could be seen in the persons with negative P.P.D.The appearance of positive reactions to paracoccidioidin was observed by beginning at the age of 10 and becoming more intense at 20 and it is higher in males than in females.

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Trabajo realizado con la ayuda económica de la FundaciónJose Maria Vargas.     

Efectividad de la vacuna antigripal en la prevención de la gripe en personas mayores de 65 años

IntroductionInfluenza is one of the diseases with the greatest epidemiological impact and of maximum relevance in the management of health services. The flu vaccine can have great variability each season, so our objective was to find out the effectiveness of the flu vaccine for the 2017/2018 season for the prevention of severe cases of flu in people over 65 years of age in a 385-bed acute general hospital.Material and methodStudy of cases and controls. All hospitalized patients with laboratory-confirmed influenza older than 65 years during the 2017/2018 season were included. Those who met the criteria for a severe case of influenza were considered cases. Those who did not meet the severity criteria were considered controls. Factors associated with the development of severe influenza were calculated.ResultsThe median age was 68 years (SD 91.87). The attack rate was 0.23 per hundred inhabitants and the vaccine effectiveness was 38%. The vaccinated and unvaccinated groups were different in terms of age (p < 0.0481). Vaccination status against severe influenza was found to be an independent protective factor (OR = 0.840; 0.746-0.913).ConclusionsThe effectiveness of influenza vaccination provided greater protection against infection and reduced the severity of influenza in older hospitalized patients. These findings should be taken into account to improve vaccination strategies and achieve better vaccination coverage in the population at risk.     

La Voz del Kultrun en la Modernidad: Tradicion y Cambio en la Terapeutica de Siete Machi Mapuche

La Voz del Kultrun en la Modernidad: Tradicion. Cambio en la Terapeutica de Siete Machi Mapuche(The voice of the drum in modernity: Tradition and change in the therapy of seven Mapuche machi). Ann Mariella Bacigalupo. Santiago: Ediciones Universidad Catolica de Chile,2001 .271pp.