Corrigendum to "Dispersal syndromes of Vachellia caven: Dismantling introduction hypotheses and the role of man as a conceptual support for an archaeophyte in South America"

[This corrects the article DOI: 10.1016/j.heliyon.2023.e17171.].

Enhancing restoration success of rare plants in an arid-tropical climate through water-saving technologies: a case study of Scalesia affinis ssp. brachyloba in the Galapagos Islands

Arid tropical archipelagos, such as the Galapagos Islands, host a high concentration of endemic plant species, many of which require restoration intervention to recover from past environmental degradation. Water-saving technologies (WSTs) have potential for hastening restoration by providing plants with additional water during the early stages of growth. However, it remains unclear whether such technologies provide an advantage for plant species of arid-tropical regions. This study examined the effect of the water-saving technology Groasis Waterboxx® (Groasis) on the rare endemic plant species Scalesia affinis ssp. brachyloba during early stages of restoration. Survival was monitored for 374 individuals planted across six sites on Santa Cruz Island, Galapagos (326 with technology and 48 as controls). Kaplan-Meier survival analysis showed that the use of Groasis reduced mortality during the first two years of the seedling survival. A mixed-effect logistic regression that modelled plant survival as a function of total precipitation, maximum temperature, and WST treatment (Groasis and no-technology control) found that despite low overall survival rates, plants grown with Groasis exhibited a three-fold higher predicted survival by the end of the 3.7 year duration of the study. Finally, through a resampling method, we demonstrate that the effect of the WST treatment is not dependent on the unbalanced design typical of a restoration project framework. We conclude that water-saving technologies such as the Groasis Waterboxx® can enhance survival of rare plant species such as S. affinis ssp. brachyloba in restoration programs in arid-tropical regions.

Climatic niche convergence through space and time for a potential archaeophyte (Acacia caven) in South America

Based on the niche conservatism hypothesis, i.e. the idea that niches remain unchanged over space and time, climatic niche modelling (CNM) is a useful tool for predicting the spread of introduced taxa. Recent advances have extended such predictions deeper in time for plant species dispersed by humans before the modern era. The latest CNMs successfully evaluate niche differentiation and estimate potential source areas for intriguing taxa such as archaeophytes (i.e., species introduced before 1492 AD). Here, we performed CNMs for Acacia caven, a common Fabaceae tree in South America, considered an archaeophyte west of the Andes, in Central Chile. Accounting for the infraspecific delimitation of the species, our results showed that even when climates are different, climatic spaces used by the species overlap largely between the eastern and western ranges. Despite slight variation, results were consistent when considering one, two, or even three-environmental dimensions, and in accordance with the niche conservatism hypothesis. Specific distribution models calibrated for each region (east vs west) and projected to the past, indicate a common area of occupancy available in southern Bolivia-northwest Argentina since the late Pleistocene, which could have acted as a source-area, and this signal becomes stronger through the Holocene. Then, in accordance with a taxon introduced in the past, and comparing regional vs continental distribution models calibrated at the infraspecific or species level, the western populations showed their spread status to be mostly in equilibrium with the environment. Our study thus indicates how niche and species distribution models are useful to improve our knowledge related to taxa introduced before the modern era.

Dispersal syndromes of Vachellia caven: Dismantling introduction hypotheses and the role of man as a conceptual support for an archaeophyte in South America

Vachellia caven has a disjunct distribution at the southern cone of South America, occupying two major ranges: west of Andes (Central Chile) and east of them (mainly the South American Gran Chaco). For decades, the species has been subject to various ecological and natural history studies across its distribution, but questions concerning its origin in the western range remain unresolved. Thus far, it is unclear whether Vachellia caven was always a natural component of the Chilean forests, and "how" and "when" the species arrived in the country. In this study, we revised the dispersal syndromes of the species and contrast the two main hypotheses of dispersion to the west of Andes that have been proposed in the 90's, namely animal versus human-mediated dispersal. For this, we reviewed all scientific literature on the species and explored the available information on morphology, genetics, fossil records and distribution patterns of closely related species. Here we illustrate how the collected evidence provides support for the human-mediated dispersal hypothesis, by including a conceptual synthesis that summarizes the outcomes of different dispersal scenarios. Lastly, and regarding the positive ecological effects this species has in the introduced area, we suggest reconsidering the (underappreciated) historical impacts of archaeophytes and rethinking the role that indigenous human tribes may have had in the dispersion of different plants in South America.

Mail and Telephone Outreach from Electronic Health Records for Research Participation on Cognitive Health and Aging

OBJECTIVES

This report describes the efficacy and utility of recruiting older individuals by mail to participate in research on cognitive health and aging using Electronic Health Records (EHR).

METHODS

Individuals age 65 or older identified by EHR in the Mount Sinai Health System as likely to have Mild Cognitive Impairment (MCI) were sent a general recruitment letter (N=12,951). A comparison group of individuals with comparable age and matched for gender also received the letter (N=3,001).

RESULTS

Of the 15,952 individuals who received the mailing, 953 (6.0%) responded. 215 (1.3%) declined further contact. Overall rate of expression of interest was 4.6%. Of the 738 individuals who responded positively to further contact, 321 indicated preference for further contact by telephone. Follow-up of these individuals yielded 30 enrollments (0.2% of 15,952). No differences in response rate were noted between MCI and comparison groups, but the comparison group yielded higher enrollment. 6 individuals who were not the intended recipients of mailing but nevertheless contacted our study were also enrolled.

CONCLUSIONS

Mailings to individuals identified through a trusted source, such as a medical center from which they have received clinical care, may be a viable means of reaching individuals within this age group as this effort yielded a low rejection rate. However, EHR information did not enhance study enrollment. Implications for improving recruitment are discussed.

GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community

RATIONALE

This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.

METHODS

In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications.

RESULTS

A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories.

CONCLUSION

A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.

GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community

RATIONALE

This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.

METHODS

In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications.

RESULTS

A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories.

CONCLUSION

A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.

[Current evidence on health benefits of the mediterranean diet]

The Mediterranean diet is currently considered a functional diet with an increasing amount of scientific evidence that supports its beneficial effects in human health. Several observational cross-sectional and prospective cohort studies show an association between this diet and a lower prevalence and incidence of chronic diseases, such as cardiovascular disease, cancer, metabolic syndrome, diabetes, and neurodegenerative diseases as well as a reduced overall mortality. Additionally, clinical interventional studies, particularly the PREDIMED (Prevención con Dieta Mediterránea) initiative, have shown, with high quality scientific evidence, that a Mediterranean diet -supplemented either with olive oil or nuts- can lower by 30% the incidence of cardiovascular disease, reverse the metabolic syndrome, and prevent the development of diabetes and aging-related cognitive decline. Chile has one of the five Mediterranean ecosystems in the world, and therefore the implementation of this food pattern and lifestyle in our country may determine large benefits to the health status and quality of life in the Chilean population.

The Mediterranean diet, hepatic steatosis and nonalcoholic fatty liver disease

PURPOSE OF REVIEW

The purpose of this review is to present the pathophysiological mechanisms and most recent clinical evidence regarding the role of the Mediterranean diet in preventing and treating nonalcoholic fatty liver disease (NAFLD).

RECENT FINDINGS

Several components of the Mediterranean diet have proven benefits in controlling the pathophysiological mechanisms involved in NAFLD. However, the few clinical studies that have assessed the diet have involved low numbers of patients and lacked methodological rigor. The results of these studies suggest that the Mediterranean diet attenuates the progression of NAFLD once it is established, but does not contribute to preventing the disease in patients at risk.

SUMMARY

Although there is a lack of clinical evidence derived from studies with high-quality methodology, the pathophysiological mechanisms of NAFLD shared with other associated pathologies suggest that there is a role for the Mediterranean diet in managing NAFLD. Studies with better methodology are needed to confirm the impact of the diet.

[Physical activity and cardiovascular risk factors among Chilean young men and women]

BACKGROUND

Physical activity (PA) has a protective role in cardiovascular diseases.

AIM

To quantify PA in young adults and to correlate it with cardiovascular risk factors.

MATERIAL AND METHODS

A cross-sectional study was performed employing the international physical activity questionnaire (IPAQ), to measure the PA of 983 randomly selected young adults from Valparaiso region born between 1974 and 1978. Its results were associated with levels of obesity, insulin resistance and cardiovascular risk factors defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP- ATP III) RESULTS: Mean physical activity among men and women was 3731 ± 3923 and 1360 ± 2303 METs-minutes/week, respectively (p < 0.001). Fifty percent of women and 21.5% of men had an insufficient level of physical activity (p < 0.001). Sixty percent of men and 23.4% of women had an intense level of physical activity (p < 0.001). There was an inverse association of physical activity and insulin resistance. A high physical activity was protective, specially among men, against a low HDL cholesterol level and high triglyceride levels with Odds Ratios of 0.59 (confidence interval (CI): 0,35-0.98) and 0.49 (CI: 0,27-0,87) respectively, after adjusting for body mass index and age.

CONCLUSIONS

In this sample, men had higher levels of physical activity, that was protective against insulin resistance and the presence of cardiovascular risk factors.

[Clinical and metabolic features of subjects with glucose intolerance and high fasting glucose levels]

BACKGROUND

Subjects with glucose intolerance or high fasting glucose levels have a higher cardiovascular risk and frequently become diabetic.

AIM

To assess clinical and metabolic characteristics of patients with glucose intolerance or high fasting glucose levels.

MATERIAL AND METHODS

Fasting and post glucose load serum glucose and insulin levels were measured in 1404 people, aged 42,0 +/- 14,2 years (81% women) with high diabetic risk. We categorized subjects in different alterations of blood glucose, according to 2006 American Diabetes Association categories. Insulin resistance (RI), insulin secretion (beta %) and insulin disposition (ID), were calculated using fasting blood glucose and insulin levels, using the homeostasis model assessment (HOMA I and II).

RESULTS

Sixty percent of studied subjects had first grade relatives with diabetes mellitus and 1097 (78%) were categorized as normal (N), 45 (3%) as Diabetes Mellitus (DM), 161 (11%) as high fasting glucose levels (GAA) and 103 (7%) as glucose intolerant (ITG). Fifty three of the 106 subjects with GAA (50%), were also glucose intolerant. Subjects with GAA had similar insulin sensitivity and lower beta cell function than N (insulin disposition 58 +/- 12 and 111 +/- 32%, respectively p < 0.01). ITG had less insulin sensitivity than N (HOMA-IR 2.6 +/- 1.50 +/- and 2.0 +/- 1.30, respectively) and only a mild decrease in beta cell function (insulin disposition 96 +/- 26 and 111 +/- 32% respectively, p < 0.01). Patients GAA plus ITG had similar alterations than those with DM (HOMA-IR 3.8 +/- 2.2 and 4.4 +/- 3.7 respectively; insulin disposition 57 +/- 10 and 56.0 +/- 26% respectively.

CONCLUSIONS

Patients with higher fasting glucose levels behave differently from those with glucose intolerance. High fasting glucose levels are highly prevalent in subjects with high risk of DM and must be considered as risk indicator in preventive programs for diabetes mellitus.

[Gut barrier in the critically ill patient: facts and trends]

The disturbances of gut barrier in critically ill patients may influence their outcome and prognosis. Experiments in animals show that fasting and stress collaborate to produce intestinal atrophy and translocation of microorganisms and toxins. This fact is one of the main arguments to promote the use of early enteral feeding in critically ill patients. However, the intestinal barrier behaves differently in humans than in animals. The human enteral cells have a good tolerance to fasting and stress, mucosal atrophy is mild and it is not always associated with changes in intestinal permeability. Moreover, the relationship between intestinal permeability with sepsis and bacterial translocation is controversial. This last phenomenon also happens in normal subjects and may be a mechanism to build immunological memory. One of the most important factors that influence bacterial translocation is the microorganism, that under stress conditions can adhere to the intestinal cell and penetrate the intestinal barrier. Splanchnic ischemia and reperfusion is one of the main pathogenic factors in the failure of intestinal barrier. Finally, the fact that the small bowel is an inflammatory target of extra intestinal injuries, explains several clinical situations. The pathophysiology of the intestinal barrier definitely requires more research.

Antineutrophil cytoplasmic antibody-associated necrotizing crescentic glomerulonephritis in a patient receiving treatment with etanercept for severe rheumatoid arthritis

Etanercept is a tumor necrosis factor inhibitor used in the treatment of rheumatoid arthritis and, increasingly, in a range of other diseases. We report a case of necrotizing crescentic glomerulonephritis, associated with a positive antineutrophil cytoplasmic antibody, causing acute renal failure in a woman receiving treatment with etanercept for severe rheumatoid arthritis. Our patient was treated with steroids and cyclophosphamide following withdrawal of etanercept, with a good clinical response. Although reports of vasculitis in patients receiving treatment with etanercept are rare, this drug has been shown to up-regulate some aspects of immune function, and the possibility that this agent may precipitate or exacerbate vasculitis in some individuals has to be considered.

[Improvement of medical student's academic performances in times of curricular reform]

BACKGROUND

During the last decade, academic life at the medical school of the Pontificia Universidad Católica de Chile has been thoroughly affected by a curricular reform process. Changes started in 1993 and have continued up until now. This reform did not have an experimental design to allow for a scientific evaluation of its effects. However, it seems interesting to study the evolution of indices of academic performance of our students during this period.

AIM

To evaluate the academic performance of medical students between 1989 and 1999.

SUBJECTS AND METHODS

All undergraduate students enrolled between 1989 and 1999. Academic performance was evaluated by 1) failure to pass one or more courses, 2) delay to complete the third year of studies, 3) withdrawal from school and 4) medical school grades.

RESULTS

All indices of academic performance changed during the period of study. Failure to pass, delay and withdrawal from school significantly decreased, whereas medical school grades improved, particularly in basic and pre-clinical subjects.

CONCLUSIONS

Academic performance of medical students improved consistently between 1989 and 1999. While specific causal relationships cannot be established, we believe that this improvement is likely related to the curricular reform. This reform included horizontal and vertical integration of academic contents, greater emphasis in problem-based learning and additional instances of evaluation such as the repetition exam.

Influence of polymeric enteral nutrition supplemented with different doses of glutamine on gut permeability in critically ill patients

OBJECTIVES

To evaluate the effect of glutamine-supplemented polymeric enteral formulas on the recovery of gut-permeability abnormalities in critically ill patients.

METHODS

Twenty-three patients were randomized to receive a conventional casein-based enteral formula (ADN), ADN plus glutamine in a dose of 0.15 g x kg(-1) x d(-1) or ADN plus 0.30 g x kg(-1) x d(-1) of glutamine for 8 d. The lactulose mannitol permeability test (L/M) was performed at baseline and at the end of the study. Nineteen healthy volunteers served as controls for the L/M test.

RESULTS

An increase in permeability compared with control subjects was observed in patients at baseline (mean +/- standard error of the mean; L/M ratio: 0.11 +/- 0.03 and 0.025 +/- 0.004, respectively; P < 0.02). The L/M ratio improved after the period of enteral nutrition as a whole (initial L/M: 0.11 +/- 0.03, final L/M: 0.061 +/- 0.01; P < 0.03), but no difference was found between groups.

CONCLUSIONS

Even though polymeric enteral nutrition was associated with a significant improvement in the L/M ratio, glutamine supplementation did not show a specific influence in improving recovery of gut permeability in critically ill patients.

[Prevalence of calorie protein malnutrition among patients in chronic hemodialysis]

BACKGROUND

Malnutrition has been strongly associated with morbidity and mortality in hemodialysis patients. In the other hand, dialysis allows a nutritional improvement in patients with more than 12 months in dialysis.

AIM

To study the prevalence of malnutrition among patients in hemodialysis.

PATIENTS AND METHODS

We measured clinical, anthropometric and biochemical parameters of nutritional status in chronic hemodialysed patients. Results were related to individual time in dialysis. Patients with more and less than 12 months in dialysis were compared.

RESULTS

Twenty nine patients (18 male) aged 14 to 65 years old, were studied. Mean caloric intake was 23.8 Cal/Kg and protein intake was 0.7 g/Kg. Mean body mass index was 21.7 +/- 3.7 kg/m2 Thirty eight percent of patients had a body mass index of less than 20 kg/m2. Mean serum albumin was 4.1 +/- 0.7 g/L; mean prealbumin was 33.5 +/- 7.9 mg% and creatinine was 9.6 +/- 2.8 mg%. Serum cholesterol was 182 mg% and triacylglycerol 129 mg%. PCR was 42.2 +/- 18.8 and Kt/V was 1.45 +/- 0.3. We did not find a correlation between nutritional markers and time in dialysis or a difference in nutritional parameters between patients with less or more than 12 months in dialysis.

CONCLUSIONS

These patients in chronic dialysis have a high prevalence of caloric malnutrition, which may be due to a poor caloric intake. Protein malnutrition parameters were normal in most patients. The absence of abnormal lipid levels, common in chronic renal failure, is noticeable.

[Academic performance of medical students: a predictable result?]

BACKGROUND

Traditionally, medical schools demand their students a high dedication in time, responsibility and integrity.

AIM

To assess the predictive capacity of several specific variables, on the academic performance of medical students.

MATERIAL AND METHODS

All students who entered during 1984-1995 period were studied. The academic performance was assessed using two indices: an overall evaluation of successfulness as determined by the approval rate in different courses and grade-point average obtained during the first three years at the Medical School. The variables used to predict academic performance were year of enrollment, high school grades, university admission test scores, biomedical and demographic characteristics. All these were measured at the time when the student was enrolled.

RESULTS

Eight hundred and eight students were studied at the end of the third year. The most important predictive variables selected for both performance indices were: high school grades, admission biology test scores, place were high school studies were done, and previous university studies. In addition verbal and mathematics admission academic performance tests scores were selected for grade-point average index. Although, the overall admission score and high school academic performance were significantly associated with the two outcomes, they were not selected in the final models.

CONCLUSIONS

The best predictors of an optimal academic performance in these medical students were high school grades, admission biology test scores, residing in Metropolitan Santiago and previous university studies.

Gut mucosal atrophy after a short enteral fasting period in critically ill patients

PURPOSE

The purpose of this study was to evaluate the presence of gut mucosal atrophy and changes in mucosal permeability in critically ill patients after a short fasting period.

MATERIALS AND METHODS

Fifteen critically ill patients underwent a period of enteral fasting of at least 4 days (mean 7.8 days). We took the following measurements the day before initiating enteral nutrition: indirect calorimetry, serum albumin, prealbumin, and lymphocyte count. We also performed a duodenal endoscopic biopsy with histopathological and mucosal morphometric analysis including villus height and crypt depth. The lactulose-mannitol test was performed to assess gut permeability. A total of 28 healthy volunteers served as controls for duodenal biopsy or lactulose-mannitol test. Clinical data, such as length of fasting, severity score, and previous parenteral nutritional support, were recorded.

RESULTS

We found gut mucosal atrophy, expressed as a decrease in villus height and crypt depth, in patients compared with controls. The patients also exhibited an abnormal lactulose-mannitol test. Morphometric changes did not correlate with permeability. Further, we found no correlation between the results of the lactulose-mannitol test and of mucosal morphometry with clinical data.

CONCLUSIONS

We found that a short period of enteral fasting was associated with significant duodenal mucosal atrophy and abnormal gut permeability in critically ill patients.

[Transcranial cytokine gradient and intestinal permeability in acute severe brain injury]

BACKGROUND

Acute brain injury is associated with a bimodal hypermetabolic state probably caused by cytokine secretion and high hormone and catecholamine concentrations. In a first stage, the brain would produce these substances and afterwards, another production source, most probably the splanchnic territory, would perpetuate the hypermetabolic state.

AIM

To investigate the cytokine production source and to assess intestinal permeability in acute brain injury in the absence of cerebral ischemia and systemic oxygen deficit.

PATIENTS AND METHODS

Arterial systemic and cerebral venous bulbar interleukin 1 beta and interleukin 6 levels were measured during the first seven days of evolution in 15 patients with acute brain injury. Serum lactate, the oxygen/lactate ratio, gastric intramucosal pH and intestinal permeability using the lactulose/mannitol test were also assessed in the same period.

RESULTS

High arterial and venous interleukin 1 beta and interleukin 6 levels were detected. A positive gradient for interleukin 6 levels was detected throughout the study period with normal intramucosal pH, lactate and oxygen/lactate ratio. There was also an early impairment of intestinal permeability in these patients.

CONCLUSIONS

High arterial and venous cytokine concentrations were detected in patients with acute brain injury. The positive gradient for interleukin 6 suggests a brain origin for this cytokine. Intestinal permeability is also altered in these patients.

Low-dose vitamin K1 versus short-term with holding of acenocoumarol in the treatment of excessive anticoagulation episodes induced by acenocoumarol. A retrospective comparative study

BACKGROUND

No consensus exists about the management of iatrogenically induced excessive hypocoagulability episodes.

OBJECTIVE

To compare the two most common therapeutic approaches in such situations (discontinuation of the oral anticoagulant vs. low-dose subcutaneous vitamin K1) when acenocoumarol is the normally used anticoagulant.

PATIENTS AND METHODS

The study was retrospective and comparative. Patients received antithrombotic therapy using acenocoumarol. Anticoagulant plasmatic activity was assessed through the international normalized ratio (INR) recorded from December 1994 to December 1997 at two medical centers.

RESULTS

INR is brought faster to a safe range in patients treated with low-dose vitamin K1 (p = 0.01). Their long-term behavior is also more stable and predictable and no resistance to the oral anticoagulant was found.

CONCLUSION

Low-dose vitamin K1 is a safer therapeutic option compared to simply withholding the oral anticoagulant. Its best scheme of administration, however, has yet to be defined.

[Diabetic neuropathy: thermal sensation and metabolic control in non-insulin-dependent diabetics]

BACKGROUND

The early detection of peripheral neuropathy in diabetics is important since it is the main risk factor for lower limb trophic lesions in diabetics.

AIM

To assess the relationship between feet thermal sensation threshold and metabolic control in ambulatory non-insulin-dependent diabetics.

PATIENTS AND METHODS

A random sample of 34 non-insulin-dependent diabetics followed for more than five years in a special clinic, out of 368 patients, was selected. Warmth sensation thresholds were measured in the dorsum of both feet using a MSTP-III thermostimulator. The average value of all glycosylated hemoglobins obtained during the 9.7 +/- 5.3 years of follow up for each patient was calculated. A multiple stepwise regression analysis was performed between thermal sensation as the dependent variable and glycosylated hemoglobin, fasting blood glucose, age and diabetes duration.

RESULTS

The regression model disclosed glycosylated hemoglobin as the only independent predictor of warmth sensation threshold (partial r = 0.385; p = 0.043). Fifteen diabetic patients with good metabolic control, defined as those with a mean glycosylated hemoglobin of less than 9.5%, had a warmth sensation threshold of 35.6 +/- 3.7 degrees C, whereas 19 diabetics with a had control (glycosylated hemoglobin > or = 9.5%) had a threshold of 39 +/- 3.8 degrees C (p = 0.017).

CONCLUSIONS

In this group of diabetics, there is a relationship between the severity of distal polyneuropathy and the metabolic control, assessed with glycosylated hemoglobin levels.

[Undergraduate curriculum reform at the Pontifical Catholic University Medical School: aims, methodology and advance status]

The Medical School of the Pontifical Catholic University is devoted to a reform process aiming to adequate undergraduate training to scientific, technological, cultural and social changes in medical practice in Chile and to incorporate novel teaching methodology. One of the main modifications is the change of the resulting professional from "a general physician capable of resolving most medical problems of rural or urban populations" to "a physician with a solid general training but qualified for a subsequent specialization". This requires curricular flexibility to obtain different professional profiles. Other important changes are a reduction in curricular contents and their vertical and horizontal integration, modernization of teaching methodologies with the incorporation of computing techniques and problem oriented teaching and the incorporation of new subjects such as molecular biology, clinical genetics, health economics. To achieve these objectives, a semi-flexible curriculum was devised, the curricular mesh has been modified extensively, an outpatient and a nine months elective internship were added. Most modifications have been implemented, remaining changes in 4th and 5th years. These changes required a reorganisation of academic structure, the use of new selection, training and perfecting criteria for teachers, better salaries for outstanding professors and improvement of teaching infrastructure. This reform must be seen as a medium term integral change in the context of an integral academic development plan.

[Anorexigenic drugs in the treatment of obesity]

Obesity is highly prevalent and has several adverse effects on health. Its treatment is thus warranted and must aim to modify dietary and physical activity habits. The opinion of this association is that anorexigenic drugs with cathecolaminergic action (diethylpropion, phentermine, mazindol and phenylpropanolamine) or serotoninergic action (fenfluoramine and fluoxetine) may be used in moderate or severe obesity (BMI > 30 kg/m2) after a complete clinical assessment and in the context of an integral medical treatment. This association recommends a close surveillance of the use of these drugs, specially when formulated as non-proprietary prescriptions.

[Variability of measured energy expenditure in patients with acute pancreatitis: is it possible to obtain a reliable pathology factor for these cases?]

Energy expenditure was measured in 55 patients with acute pancreatitis, during variable periods ranging from 1 to 5 weeks and it was compared with estimated energy expenditure according to Harris Benedict equations. Patients with severe pancreatitis had similar measured and measured/estimated energy expenditure rations, compared to those with mild pancreatitis (1678 +/- 349.6 kcal/day and 1.1 +/- 0.19 vs 1632 +/- 383 kcal/day and 1.06 +/- 0.19). There was a high dispersion of measured/estimated rations (0.67 - 1.7) that precluded the calculation of a reliable energy expenditure correction factor for this disease. It is concluded that energy expenditure must be measured and not estimated, when planning an adequate nutritional support in patients with acute pancreatitis.

[Non-insulin-dependent diabetics with secondary failure: insulin therapy at bedtime combined with glibenclamide]

Secondary failure and the requirement is common in patients with non-insulin dependent diabetes mellitus. The combination of sulfonylureas with NPH insulin at bedtime has been proposed to avoid high doses of insulin. We treated 18 patients (2 men, age range 47-76 yr) non respondent to diet and glibenclamide, combining NPH insulin in an average dose of 0.3 +/- 0.03 U/kg BW at bedtime for 6 months. Fasting serum glucose improved from 256 +/- 11 to 132 +/- 6 mg/dl and HbA1C from 13.6 +/- 0.4 to 9.9 +/- 0.2%. Four patients achieved a good control (defined as a HbA1C < 9), 9 a fair control (HbA1C 9.1-10) and 5 persisted with a bad control (HbA1C > 10). Well controlled patients were younger, had a shorter duration of diabetes and had a non significantly higher body mass index. Fasting serum insulin and C peptide levels achieved after glucagon injection were not predictors of the metabolic response to combined therapy. Tolerance to treatment was good, without changes in blood pressure or serum lipids and with a low incidence of hypoglycemia. There was a mean increase of 3.6 kg in body weight. After 6 months of therapy, maximum achieved C peptide values after glucagon increased from 3.3 +/- 0.3 to 4.5 +/- 0.4 ng/ml. It is concluded that combined glibenclamide and NPH insulin at bedtime is useful to treat secondary failure in non-insulin dependent diabetic patients, but their response in variable and non dependent on their beta insular secretion.

[Dyslipidemic patients with coronary cardiopathy. Effect of different doses of OMEGA-3 fatty acids on serum lipids and lipoproteins]

Twenty one male patients aged 35 to 70 years, with coronary artery disease and dislipidemia refractory to dietary treatment, were assigned to three parallel groups of 7 individuals each that received a supplemental dose of 2, 4 and 6 g/day of omega-3 fatty acids during 60 days. After a 30 days wash-out period and 60 of supplementation, subjects were weighed, a dietary survey was performed, serum levels of total cholesterol and triglycerides, the lipid content of serum lipoproteins and the content of EPA+DHA in plasma phospholipids were measured. A dose dependent increase in EPA+DHA content of phospholipids and no changes in weight or nutrient intake were observed during the supplementation period. With the 6 g dose, a significant reduction in total cholesterol, with a reduction in VLDL and increase in LDL cholesterol and a decline in VLDL triglycerides was observed. With the 4 g dose a reduction in total cholesterol at the expense of VLDL and HDL cholesterol and a reduction in VLDL triglycerides but no changes in total triglycerides was observed. No changes in serum lipids were observed with 2 g dose. In patients with type IIA hyperlipidemia, a significant positive correlation was observed between DHA+EPA content of plasma phospholipids and LDL cholesterol, this correlation was not observed in patients with IIB or IV phenotypes. It is concluded that omega-3 fatty acids are ineffective as the only treatment for dislipidemias refractory to diet.

[Estimation of energy expenditure in clinical practice: applicability to individual multiple injury cases]

In 37 multiple trauma patients the estimated and measured energy expenditures were compared. Predicted energy expenditure overestimated it in 89% of patients. The correction factor for the different pathologies was the principal source of error, since the measured/predicted basal energy expenditure ratio was 1.19 +/- 0.17. This ratio had a wide range of values (0.84-1.61) which renders the prediction of individual energy expenditure highly unreliable. Since the overestimation of energy requirements in the critically ill patients may convey important complications, the direct measurement of such requirements is recommended.

Whole-body protein kinetics in elective surgical patients receiving peptide or amino acid solutions

We compared the efficacy of two enteral solutions that were isonitrogenous and of identical amino acid composition but differed in that one solution contained only free amino acids whereas the other contained a mixture of free amino acids and peptides. Protein kinetics and nitrogen balance were evaluated in a group of six elective surgical patients. Primed-constant infusion with 15N-glycine was started 24h after gynecologic surgery and sustained over 3 days. During the first postoperative day, patients received enteral 0.45% saline. During postoperative days two and three, the patients received either the free amino acid solution or the mixture of peptides and free amino acids in a crossover design. There were no differences in protein kinetics or nitrogen balance with the two treatments.

Comparison of three methods for the estimation of total nitrogen losses in hospitalized patients

Since the measurement of total nitrogen output (TNO) is not routinely determined in the clinical setting, its level is frequently estimated using formulas based on the urinary urea nitrogen excretion (UUN). We measured TNO in 124 surgical patients over 990 days (TNO, 19.22 +/- 8.72 g N/day; total urinary nitrogen (TUN) 18.17 +/- 8.70 g N/day; UUN, 15.17 +/- 7.70 g N/day; mean gastrointestinal nitrogen (MGIN) 0.68 +/- 0.49 g N/day; integumental nitrogen (ITGN), 0.34 +/- 0.08 g N/day) and compared the results with the daily estimations using three different formulas: formula A, UUN + 4; formula B, UUN x 1.20 + 1.05, where 1.20 is the reciprocal of the mean ratio UUN/TUN and 1.05 the mean extraurinary nitrogen losses; and formula C, UUN x 1.0986 + 2.55, derived from the regression analysis of UUN vs TNO. TNO estimated by these formulas were 19.17 +/- 7.70, 19.26 +/- 9.24, and 19.22 +/- 8.70 g N/day, respectively. The regression analyses of the estimated TNO from the three formulas versus the measured TNO indicated that formulas A, B and C were equally accurate in estimating TNO over the entire range of UUN. However, when only values of UUN greater than or equal to 30 g N were considered, a modified formula A (UUN + 6) was the best predictor of TNO. Daily audits of the differences between the estimated and measured TNO showed comparable results for the three formulas. In 28.4 to 31.1% of the observed days the differences were higher than +/- 2 g N/day, an error which is not acceptable when estimating the protein requirements in many clinical conditions.(ABSTRACT TRUNCATED AT 250 WORDS)