Desórdenes alimenticios en gimnastas universitarias

Las “Gimnastas” es el nombre con el que se conoce, en algunos países, a las deportistas que realizan acrobacias de alto riesgo y que muestran sus destrezas físicas en el marco de un evento deportivo ...

Desarrollo de competencias a través de un proyecto multidisciplinario

En un esfuerzo conjunto los profesores de las Facultades de Ciencias de la Comunicación y Salud Pública y Nutrición de la Universidad Autónoma de Nuevo León, desarrollamos un proyecto colaborativo en línea, donde los alumnos inscritos en las materias de Desarrollo de Campañas Publicitarias y Posicionamiento de la FCC y Salud Pública y Nutrición de la FaSPyN desarrollaran competencias de trabajo multidisciplinario y aplicación de las tecnologías de información y comunicación, para el diseño de una campaña publicitaria de enfoque social. El fundamento para el presente proyecto ha sido la Visión UANL 2012 en la cual se establece que “las Tecnologías de Información y Comunicación contribuyen a la creación de ambientes para el aprendizaje, entendidos, estos como situaciones educativas centradas en el estudiante, que favorecen el aprendizaje autodirigido y el desarrollo del pensamiento reflexivo y crítico”, así mismo, que el modelo educativo deberá contemplar el rediseño curricular centrado en el aprendizaje, un enfoque transversal de la currícula que incoprpore persepctivas multi, inter y transdisciplinarias y la incorporación del uso de la tecnologías de Información y Comunicación (TIC) en los procesos de enseñanza aprendizaje. De esta manera organizamos el trabajo en 21 equipos multidisciplinarios constituidos por 1 mercadólogo, 1-2 publicistas, 3-4 nutriólogos. Se establecieron 11 temas diferentes tales como: a) Importancia del desayuno, b) Obesidad infantil, c) Actividad física, d) Lectura de etiquetas, etc. Para que los equipos pudieran trabajar en línea, tanto los maestros como los alumnos de Nutrición, recibieron capacitación en el manejo de la plataforma tecnológica Blackboard, no siendo necesario para los alumnos de ciencias de la comunicación ya que ellos se encuentran inscritos en la modalidad en línea. El resultado de este proyecto son 21 campañas publicitarias que incluyen cartel publicitario, spot de radio y comercial de TV, este material fue utilizado por los alumnos de Nutrición durante la visita que realizaron a las escuelas primarias del área metropolitana de Monterrey con motivo de la celebración del día mundial de la alimentación. El proyecto concluyó con la ceremonia de premiación y entrega de reconocimientos tanto para los alumnos, profesores y autoridades que hicieron posible la realización del mismo

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Desarrollo de un método analítico para la cuantificación de acrilamida en tostadas de tortillas de maíz procedentes de Monterrey (México) y estimación de la exposición dietética

La acrilamida es una molécula muy polar altamente soluble en agua. Es un compuesto neurotóxico, genotóxico y carcinógeno, catalogado como probable carcinógeno para humanos por la Agencia Internacional de Investigación en Cáncer. En el 2002 se reportó presencia de niveles muy altos de acrilamida en alimentos ricos en carbohidratos cuando son sometidos al proceso de cocción por horneado, fritura, tostados o asado por encima de 120 °C. Este hallazgo generó gran preocupación a nivel mundial por el riesgo que representa para la salud pública y ha llevado a organismos internacionales a incluir a la acrilamida como un tema prioritario en la seguridad alimentaria. Este trabajo de investigación se centró en tortillas de maíz, por ser un producto base en la alimentación de México, planteando el desarrollo de un método analítico para la cuantificación de acrilamida en tostadas de tortillas de maíz procedentes de Monterrey (Nuevo León, México) y la estimación de la exposición dietética. Para la determinación de acrilamida en tostadas de tortillas de maíz se probaron diversas técnicas y métodos analíticos: cromatografía de gases con detector de masas (GC-MS), GC-MS empleando el N,O-Bis (trimetilsilil) trifluoroacetamida (BSTFA) como agente derivatizante, cromatografía de gases con captura de electrones (GC-ECD) y cromatografía líquida acoplada a masas-masas (LC-MS/MS). Después de revisar las dificultades en cuanto a la aplicación de cada uno de los métodos mencionados se optó por la LC-MS/MS. El método propuesto se validó evaluando linealidad con intervalo de concentraciones de 0,5 a 1000 μg/kg, coeficientes de correlaciones mayores a 0,996. Exactitud expresada como porcentaje de error presentó valores de 1,96%. El límite de detección fue de 3 ppb y de cuantificación de 10 ppb, se obtuvo una recuperación de 101%. La cuantificación fue por el método de adición de estándar. Desarrollando un método preciso, exacto y capaz de cuantificar acrilamida a niveles bajos en tostadas de tortillas de maíz. Analizando un total de 45 muestras comerciales de tostadas de tortillas de maíz, clasificadas como tortillas de maíz, tostadas fritas grandes, tostadas horneadas y tostadas pequeñas, redondas y fritas. Las concentraciones de acrilamida presentadas en las tortillas fritas grandes (n=11) fueron de 114,26-279,19 μg/kg. En el grupo de tostadas horneadas (n=14) se encontró de 154,18-266,53 μg/kg, superando en ambos casos la media recomendada por la Comisión Europea, que sugiere valores indicativos de 200 μg/kg en productos de maíz (Recomendación 2013/647/UE, European Comission, 2013). Las concentraciones más bajas de acrilamida se presentaron en la clasificación del grupo de tostadas pequeñas, redondas y fritas, con un intervalo de concentración de 115,66 a 197,34 μg/kg (n=16). Para la estimación del consumo promedio de acrilamida se tomaron los datos obtenidos de la ingesta diaria del consumo de tostadas de tortillas de maíz por grupo de edad, así como el peso corporal promedio de la población por grupo de edad, y la cantidad de acrilamida determinada en las tostadas de tortillas de maíz (se tomó como referencia las tortillas de maíz horneadas con un contenido medio de acrilamida de 210,36 μg/kg), los resultados obtenidos se compararon con la estimación de referencia propuesta en 2011 por la JECFA para los procesos tumorales y los problemas neurotóxicos. El mayor consumo y así exposición a la acrilamida lo presentó el grupo de adultos jóvenes (20-39 años) con 0,73-0,70 μg/kg, seguido del grupo de adultos (40-59 años) con 0,51-0,47 μg/kg, después el grupo de menores (5-11 años) con 0,19 μg/kg y el grupo de adultos mayores (60+ años) con 0,19-0,14 μg/kg, y finalmente el grupo de adolescentes (12-19 años) con 0,11-0,12 μg/kg. Estos resultados muestran que el mayor riesgo de exposición a la acrilamida lo presentan los adultos jóvenes y adultos.Acrylamide is a polar and highly soluble in water molecule. Is a neurotoxic, genotoxic and carcinogen compound, catalogued as a probably carcinogen for human beings by the International Agency for Research on Cancer. In 2002 the presence of very high levels of acrylamide in rich carbohydrate foods when they are submitted to the process of baked, fried, toasting or roasting over 120 °C, was reported. This finding generated great concern worldwide because of the risk that it represents for the public health, leading international organizations to include acrylamide as a priority topic in food safety. This investigation was focused on the toasted corn tortillas, for being a product of high consumption in Mexico, raising the development of an analytical method for the quantification of acrylamide in toasts of corn tortillas from Monterrey (Nuevo León, Mexico) and the estimation of the dietetic human exposure. For the determination of acrylamide in toasts of corn tortillas diverse technologies and analytical methods were proved: gas chromatography with mass detector (GC-MS), GC-MS using N, O-Bis (trimetilsilil) trifluoroacetamida (BSTFA) as derivatization agent, electron capture gas chromatography (GC-ECD) and mass mass liquid chromatography (LC-MS/MS). After checking the difficulties for the application of each one of the mentioned methods the LC-MS/MS was chosen. The proposed method was validated evaluating the linearity in an interval of concentrations from 0.5 to 1000 μg/kg, with correlations coefficient being bigger than 0.996. The accuracy expressed as error percentage presented values of 1.96%. The detection limit was 3 ppb, the quantification limit was 10 ppb, and a recovery of 101% was obtained. The quantification was for the method of standard addition. Therefore, a precise and exact method, able to quantify acrylamide at low levels in toasted corn tortillas, was developed. The concentrations of acrylamide obtained in the fried big tortillas (n=11) were 114.26-279.19 μg/kg. In the group of baked toasts (n=14) the values were in the range of 154.18-266.53 μg/kg, overcoming in both cases the average recommended by the European Commission, which suggests indicative values of 200 μg/kg in corn products (Recommendation 2013/647/UE, European Comission, 2013). The lower concentrations of acrylamide appeared in the group classified as small, round and fried toasts, with an interval of concentration from 115.66 to 197.34 μg/kg (n=16). For the estimation of the average consumption of acrylamide, the information obtained of the daily ingestion of corn tortillas toasts by group of age, as well as the corporal average weight of the population for group of age, and the quantity of acrylamide in the corn tortillas toasts (we took as a reference the corn tortillas baked with an average content of acrylamide of 210.36 μg/kg) were considered, and the obtained results were compared with the reference estimation proposed in 2011 by the JECFA for the tumour processes and the neurotoxic problems. The biggest consumption and then exposure to the acrylamide was presented by the group of young adults (20-39 years) with 0.73-0.70 μg/kg, followed by the group of adults (40-59 years) with 0.51-0.47 μg/kg, next to under eighteen group (5-11 years) with 0.19 μg/kg and the group of senior citizen (60 + years) with 0.19-0.14 μg/kg, and finally the group of teenagers (12-19 years) with 0.11-0.12 μg/kg. These results showed that the biggest exposure risk to the acrylamide is that presented by the young and adult adults

Desarrollo de un método analítico para la cuantificación de acrilamida en tostadas de tortillas de maíz procedentes de Monterrey (México) y estimación de la exposición dietética /

Departament responsable de la tesi: Departament de Ciència Animal i dels Aliments.La acrilamida es una molécula muy polar altamente soluble en agua. Es un compuesto neurotóxico, genotóxico y carcinógeno, catalogado como probable carcinógeno para humanos por la Agencia Internacional de Investigación en Cáncer. En el 2002 se reportó presencia de niveles muy altos de acrilamida en alimentos ricos en carbohidratos cuando son sometidos al proceso de cocción por horneado, fritura, tostados o asado por encima de 120 °C. Este hallazgo generó gran preocupación a nivel mundial por el riesgo que representa para la salud pública y ha llevado a organismos internacionales a incluir a la acrilamida como un tema prioritario en la seguridad alimentaria. Este trabajo de investigación se centró en tortillas de maíz, por ser un producto base en la alimentación de México, planteando el desarrollo de un método analítico para la cuantificación de acrilamida en tostadas de tortillas de maíz procedentes de Monterrey (Nuevo León, México) y la estimación de la exposición dietética. Para la determinación de acrilamida en tostadas de tortillas de maíz se probaron diversas técnicas y métodos analíticos: cromatografía de gases con detector de masas (GC-MS), GC-MS empleando el N,O-Bis (trimetilsilil) trifluoroacetamida (BSTFA) como agente derivatizante, cromatografía de gases con captura de electrones (GC-ECD) y cromatografía líquida acoplada a masas-masas (LC-MS/MS). Después de revisar las dificultades en cuanto a la aplicación de cada uno de los métodos mencionados se optó por la LC-MS/MS. El método propuesto se validó evaluando linealidad con intervalo de concentraciones de 0,5 a 1000 μg/kg, coeficientes de correlaciones mayores a 0,996. Exactitud expresada como porcentaje de error presentó valores de 1,96%. El límite de detección fue de 3 ppb y de cuantificación de 10 ppb, se obtuvo una recuperación de 101%. La cuantificación fue por el método de adición de estándar. Desarrollando un método preciso, exacto y capaz de cuantificar acrilamida a niveles bajos en tostadas de tortillas de maíz. Analizando un total de 45 muestras comerciales de tostadas de tortillas de maíz, clasificadas como tortillas de maíz, tostadas fritas grandes, tostadas horneadas y tostadas pequeñas, redondas y fritas. Las concentraciones de acrilamida presentadas en las tortillas fritas grandes (n=11) fueron de 114,26-279,19 μg/kg. En el grupo de tostadas horneadas (n=14) se encontró de 154,18-266,53 μg/kg, superando en ambos casos la media recomendada por la Comisión Europea, que sugiere valores indicativos de 200 μg/kg en productos de maíz (Recomendación 2013/647/UE, European Comission, 2013). Las concentraciones más bajas de acrilamida se presentaron en la clasificación del grupo de tostadas pequeñas, redondas y fritas, con un intervalo de concentración de 115,66 a 197,34 μg/kg (n=16). Para la estimación del consumo promedio de acrilamida se tomaron los datos obtenidos de la ingesta diaria del consumo de tostadas de tortillas de maíz por grupo de edad, así como el peso corporal promedio de la población por grupo de edad, y la cantidad de acrilamida determinada en las tostadas de tortillas de maíz (se tomó como referencia las tortillas de maíz horneadas con un contenido medio de acrilamida de 210,36 μg/kg), los resultados obtenidos se compararon con la estimación de referencia propuesta en 2011 por la JECFA para los procesos tumorales y los problemas neurotóxicos. El mayor consumo y así exposición a la acrilamida lo presentó el grupo de adultos jóvenes (20-39 años) con 0,73-0,70 μg/kg, seguido del grupo de adultos (40-59 años) con 0,51-0,47 μg/kg, después el grupo de menores (5-11 años) con 0,19 μg/kg y el grupo de adultos mayores (60+ años) con 0,19-0,14 μg/kg, y finalmente el grupo de adolescentes (12-19 años) con 0,11-0,12 μg/kg. Estos resultados muestran que el mayor riesgo de exposición a la acrilamida lo presentan los adultos jóvenes y adultos.Acrylamide is a polar and highly soluble in water molecule. Is a neurotoxic, genotoxic and carcinogen compound, catalogued as a probably carcinogen for human beings by the International Agency for Research on Cancer. In 2002 the presence of very high levels of acrylamide in rich carbohydrate foods when they are submitted to the process of baked, fried, toasting or roasting over 120 °C, was reported. This finding generated great concern worldwide because of the risk that it represents for the public health, leading international organizations to include acrylamide as a priority topic in food safety. This investigation was focused on the toasted corn tortillas, for being a product of high consumption in Mexico, raising the development of an analytical method for the quantification of acrylamide in toasts of corn tortillas from Monterrey (Nuevo León, Mexico) and the estimation of the dietetic human exposure. For the determination of acrylamide in toasts of corn tortillas diverse technologies and analytical methods were proved: gas chromatography with mass detector (GC-MS), GC-MS using N, O-Bis (trimetilsilil) trifluoroacetamida (BSTFA) as derivatization agent, electron capture gas chromatography (GC-ECD) and mass mass liquid chromatography (LC-MS/MS). After checking the difficulties for the application of each one of the mentioned methods the LC-MS/MS was chosen. The proposed method was validated evaluating the linearity in an interval of concentrations from 0.5 to 1000 μg/kg, with correlations coefficient being bigger than 0.996. The accuracy expressed as error percentage presented values of 1.96%. The detection limit was 3 ppb, the quantification limit was 10 ppb, and a recovery of 101% was obtained. The quantification was for the method of standard addition. Therefore, a precise and exact method, able to quantify acrylamide at low levels in toasted corn tortillas, was developed. The concentrations of acrylamide obtained in the fried big tortillas (n=11) were 114.26-279.19 μg/kg. In the group of baked toasts (n=14) the values were in the range of 154.18-266.53 μg/kg, overcoming in both cases the average recommended by the European Commission, which suggests indicative values of 200 μg/kg in corn products (Recommendation 2013/647/UE, European Comission, 2013). The lower concentrations of acrylamide appeared in the group classified as small, round and fried toasts, with an interval of concentration from 115.66 to 197.34 μg/kg (n=16). For the estimation of the average consumption of acrylamide, the information obtained of the daily ingestion of corn tortillas toasts by group of age, as well as the corporal average weight of the population for group of age, and the quantity of acrylamide in the corn tortillas toasts (we took as a reference the corn tortillas baked with an average content of acrylamide of 210.36 μg/kg) were considered, and the obtained results were compared with the reference estimation proposed in 2011 by the JECFA for the tumour processes and the neurotoxic problems. The biggest consumption and then exposure to the acrylamide was presented by the group of young adults (20-39 years) with 0.73-0.70 μg/kg, followed by the group of adults (40-59 years) with 0.51-0.47 μg/kg, next to under eighteen group (5-11 years) with 0.19 μg/kg and the group of senior citizen (60 + years) with 0.19-0.14 μg/kg, and finally the group of teenagers (12-19 years) with 0.11-0.12 μg/kg. These results showed that the biggest exposure risk to the acrylamide is that presented by the young and adult adults

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research