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Introduction: The daily protein recommendation for adults is 0.8 g/kg/day; however, several studies argue that an intake of 1.0-1.5 g protein/kg/day could benefit the health of the elderly., Objective: We evaluated the protein intake and serum lipid levels in elderly patients with hip fracture, determining their correlation with the grip strength in both hands., Methods: The study included 47 adult patients aged 65-85 years hospitalized for recent hip fracture. Weight, height, lipid profile and muscle strength of both hands were measured, and MNA was also used to evaluate the nutritional status., Results: The elderly, predominantly women and with a homogeneous age of 80 years on average, were malnourished or at risk of malnutrition in 93% of cases according to the MNA. Men consumed significantly more protein than women. Muscle strength negatively associated with triglyceride levels; 36% of the elderly had triglyceride levels above 150 mg/dl., Conclusions: TG levels associated inversely with muscle strength in elderly patients with hip fracture. According to these results, which should be validated in other populations, elevated TG levels are a factor of metabolic syndrome and are associated with low muscle strength in the elderly. This is relevant because obesity prevention and metabolic syndrome are one priority through the promotion of healthier lifestyles and nutrition policies that could be widely implemented.

Background: The heart rate variability (HRV) is a prognostic value of cardiovascular risk. It is unknown the correlation between HRV and coronary severity on patients with chronic angina. The objective was to determine the correlation between HRV and the SYNTAX II score in chronic angina., Methods: Cross-sectional study in patients of 18 years or older with stable angina and indication of coronary angiography who went to a third level center. The SYNTAX II score was established by using coronary angiography, while HRV was obtained by a 24-hour Holter ECG. The correlation between SYNTAX II and HRV was performed with Pearson's test. Values of SDNN < 100 ms and RMSSD < 15 ms were considered risk factors., Results: 61 patients were included. 45 had a decreased value of SDNN (73.77%) and eight had a decreased value of RMSSD (13.11%). There was no correlation between HRV and SYNTAX II score. There were more events of ventricular tachycardia in the group of patients with low SDNN than in those with normal SDNN (15.5% vs. 0.0%; p = 0.04)., Conclusions: There was no correlation between HRV and the severity of coronary artery disease in stable chronic ischemic heart disease. However, those patients with low HRV showed more events of ventricular tachycardia.

Background: The tympanoplasty for high-risk tympanic membrane perforation is a challenge. It is necessary to compare the most useful and feasible surgical technics in our environment for these patients. The objective was to compare the cartilage island tympanoplasty for the treatment of high-risk tympanic membrane perforations versus the use of temporalis fascia., Methods: Randomized controlled clinical trial in 69 patients of ten years or older, diagnosed with high-risk tympanic membrane perforation in a third level hospital. The MERI index was determined and an initial audiometry was obtained. 7, 30 and 60 days after the tympanoplasty the tympanic graft integrity was evaluated. The audiometry was only repeated at 60 days., Results: 69 patients were included, 33 received cartilage island (group 1) and 36 temporalis fascia (group 2). 93.9% was the success rate for group 1 at 30 and 60 days and 83.3% for group 2 (p = 0.17). Hearing improvement was neither different between groups (33.1 vs. 33.6 dB; p = 0.88), for group 1 and 2, respectively., Conclusion: No difference in morphological and audiological outcomes using cartilage island tympanoplasty or temporalis fascia for the treatment of high-risk tympanic membrane perforation was found.

Introduction: Visceral fat has deleterious metabolic effects and has been associated with myocardial ischemia., Objective: To compare epicardial fat thickness in diabetic versus non-diabetic patients with acute myocardial infarction with ST-segment elevation., Material and Methods: We performed a cross-sectional study in 60 patients with acute myocardial infarction with ST-segment elevation (30 diabetic and 30 non-diabetic). Cardiovascular risk factors and Thrombolysis in Myocardial Infarction (TIMI) score were registered. Using echocardiography, left ventricle ejection fraction and epicardial fat measured in the interventricular septum, right ventricle outflow tract, apex, and right ventricle free wall was evaluated., Results: Epicardial fat at the apex (6.1 vs. 5.8 mm; p = 0.038) and in the interventricular septum (7.0 vs. 5.7 mm; p = 0.033) was higher in diabetic versus non-diabetic patients. In diabetic patients, plasmatic glucose correlated with TIMI score (R: 0.49; p = 0.005) and body mass index (R: -0.50; p = 0.004). The TIMI score (4.5 vs. 3.4; p = 0.04), body mass index (29.3 vs. 26.4; p = 0.008), epicardial fat in the interventricular septum (6.8 vs. 4.7; p = 0.000004) and in the right ventricle outflow tract (6.8 vs. 5.0; p = 0.000042) were higher in patients with fat in apex ≥ 6 mm., Conclusions: In diabetic patients with acute myocardial infarction with ST-segment elevation, interventricular septum and apex epicardial fat was higher compared with non-diabetic patients.

Background: The mirror laryngoscope blade (Siker blade) is used often in patients with anatomical variations, because it improves the visibility of epiglottis, shortening the intubation time. The objective was to compare the degree of difficulty in intubation with Macintosh blade versus Siker blade in a simulator, among anesthesiologists and residents in training., Methods: A comparative study in 29 medical residents in training and 21 anesthesiologists was conducted. They had three attempts of 30 seconds to perform intubation with each laryngoscope in two different stages. The time and the intubation attempt, in which a successful intubation was performed, were registered. The data were processed using Statistica software, version 6., Results: there was no difference for intubation between anesthesiologists and residents. Siker blade required more number of attempts (normal airway p 〈 0.001, difficult airway p = 0.02) and longer time for intubation (normal airway p 〈 0.0001, difficult airway p = 0.003). With a greater proportion of anesthesiologists, 20 % of the sample failed the intubation with Siker blade., Conclusions: It was more difficult for anesthesiologists and residents in training the use of the Siker blade in both stages, with normal or difficult airway on a simulator.

Introduction: Blood pressure levels in childhood influence these levels in adulthood, and breastfeeding has been considered such as a cardioprotective. We evaluated the association between blood pressure levels and feeding type in a group of infants., Material and Methods: We conducted a comparative cross-sectional study in term infants with appropriate weight at birth, to compare blood pressure levels in those children with exclusively breastfeeding, mixed-feeding and formula feeding. The comparison of groups was performed using ANOVA and multiple regression analysis was used to identify variables associated with mean arterial blood pressure levels. A p value < 0.05 was considered significant., Results: We included 20 men and 24 women per group. Infant Formula Feeding had higher current weight and weight gain compared with the other two groups (p < 0.05). Systolic, diastolic and mean blood pressure levels, as well as respiratory and heart rate were higher in the groups of exclusively formula feeding and mixed-feeding than in those with exclusively breastfeeding (p < 0.05). Multiple regression analysis identified that variables associated with mean blood pressure levels were current body mass index, weight gain and formula feeding., Conclusions: Infants in breastfeeding show lower blood pressure, BMI and weight gain.

Objective: To determine if an educational and dietetic program diminish the risk factors of diabetes mellitus type 2 in obese children., Design: quasi-experimental trial., Material and Methods: We performed a study in 28 obese children. They received instruction in diabetes mellitus, participated in a nutritional education group, and received an individual dietetic treatment during six months. There was used a 24-hour recall about dietary intake, body mass index and blood pressure measure monthly. Glucose, leptin, and insulin levels were measured at baseline and after the six months of treatment. Kruskal-Wallis and Wilcoxon tests were used., Results: We studied 13 female and 15 male obese children with an age average of 9.7 years. Body mass index (29.0 versus 25.6), blood pressure (121/80 versus 118/78 mm Hg), fasting glucose (95 versus 92 mg/dL), total cholesterol (166 versus 155 mg/dL), triglycerides (144 versus 142 mg/dL), insulin resistance index (5.9 versus 4.9), leptin (56.1 versus 57.3 ng/mL), and energy intake (3409 versus 2243 kcal) decreased, at the begin and at the end of the study. Nutriment and sufficiency balance were lower too (p<0.05)., Conclusions: The program diminished the risk factors for diabetes mellitus and cardiovascular disease.

Objective: To know the relationship between bone turnover markers and urinary calcium excretion with and without oral calcium load in postmenopausal and young women., Patients and Method: A cross-sectional study in 100 women (50 with normal menstrual cycle and 50 postmenopausal). After 5 days with a specific diet, urine of 24 hours, 2 hours in fasting, and 4 hours after oral calcium load was collected (the last urine collection was only done in 20 patients in each group. In these patients, an x-ray absorptiometry of distal forearm and vitamin D levels were evaluated too). Calcium, alkaline phosphatase, calcitonin, parathormone, N-telopeptides of type I collagen, and osteocalcin serum levels were measured in fasting. Creatinine and calcium were measured in urine to obtain the Ca/cr index., Results: Postmenopausal women had lower calcitonin levels while the Ca/cr index of 2 hours in fasting was higher than the eumenoreic women. We found significant correlation between Ca/cr index of 2 hours with age (R = .21; p = .04), parathormone (R = .21; p = .04), and calcitonin levels (R = -.29; p = .005). There was not correlation with the urinary calcium excretion including the 4 hour postload collection with the biochemical markers of bone turnover or mineral bone density of distal forearm., Conclusions: The urinary Ca/Cr index of 2 hours in fasting is related to parathormone levels and has a negative relationship with calcitonin levels in postmenopausal women. However, the urinary calcium excretion after oral calcium load was not related with the bone turnover grade.