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BACKGROUND Axillary sentinel lymph node biopsy (SLNB) is standard treatment for patients with clinically and pathological negative lymph nodes. However, the role of completion axillary lymph node dissection (cALND) following positive sentinel lymph node biopsy (SLNB) is debated. AIM To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of long-term complications and create a Preoperative Clinical Risk Index (PCRI) that helps us in our clinical practice to optimize the selection of these patients. METHODS Patients with positive SLNB who underwent a cALND were included in this study. Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND. RESULTS From May 2007 to April 2014, we performed 1140 SLN biopsies, of which 125 were positive for tumor and justified to practice a posterior cALND. Pathologic findings at SLNB were micrometastases (mic) in 29 cases (23.4%) and macrometastasis (MAC) in 95 cases (76.6%). On univariate analysis of the 95 patients with MAC, statistically significant factors included: age, grade, phenotype, histology, lymphovascular invasion, lymph-node tumor size, and number of positive SLN. On multivariate analysis, only lymph-node tumor size (≤ 20 mm) and number of positive SLN (> 1) retained significance. A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND. Patients with a PCRI ≤ 15 has low probability (< 10%) of having additional lymph node involvement, a PRCI between 15-17.6 has a probability of 43%, and the probability increases to 69% in patients with a PCRI > 17.6. CONCLUSION The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND. Further prospective studies are necessary to validate PCRI clinical generalization.

Introducción: la hipercolesterolemia es uno de los principales factores de riesgo en la enfermedad cardiovascular. Los esteroles vegetales se han postulado como agentes reguladores y beneficiosos para el control de esta.Objetivo: analizar el efecto de los esteroles vegetales añadidos en una leche en la reducción del colesterol plasmático en adultos jóvenes.Métodos: ensayo clínico, controlado, aleatorizado, doble ciego y cruzado. Los esteroles (2,24 g diarios) fueron administrados en dos tomas de 350 ml de una leche comercial desnatada, durante dos periodos de 3 semanas, separados por una "fase de lavado" de 2 semanas, en el grupo experimental. Al grupo control se le administró la misma cantidad de leche desnatada, sin esteroles. Tanto al inicio como al final de cadaperiodo de intervención se extrajeron muestras sanguíneas. Se analizaron la composición corporal, hábitos de salud y los siguientes marcadores sanguíneos: perfil lipídico, hematológico, inflamación, etc.Resultados: se incluyeron 54 personas en el estudio con una edad media de 38,8 ± 7,3 años. La diferencia porcentual entre los marcadores basales y finales para el colesterol total, colesterol-LDL, colesterol-HDL, triglicéridos y colesterol no-HDL fueron del 9,73%, 12,5%, 1,9%, 3,15% y 13,2%, respectivamente. Se obtuvieron diferencias estadísticamente significativas entre el grupo experimental y el grupo control, para todos los marcadores analizados excepto para los triglicéridos.Conclusión: los esteroles vegetales suministrados en un alimento de consumo habitual, como la leche, pueden ser una estrategia terapéutica no farmacológica para el control de la hipercolesterolemia de alto interés sanitario.

Hypercholesterolemia is one of the most relevant risk factors in cardiovascular disease, where use of plant sterols one strategy evident.To determine the effectiveness of a rich in phytosterols for reducing markers of cardiovascular disease in young adult population milk.A randomized, clinical controlled trial, double-blind crossover study. Sterols (2.24 g per day) were ingested through commercial milk, with two phases and three weeks respectively separated by a washout period of 2 weeks, for those subjects during the "milk of study", and the same amount of skim milk, sterols, for placebo. At the beginning and end of each phase blood draws were performed.. Lipid profile, hematology, inflammation, etc; anthropometric data, health habits and blood laboratory markers were collected.Nineteen people completed the study of 34.68 years (± 6.91). Difference between baseline and final scores were 19.47 (± 29.10) mg/dl, 24.47 (± 30.68) mg/dl, 14.36 (± 44.16) mg/dl for LDL-cholesterol, total Cholesterol and Triglycerides, respectively. Without considerable changes in HDLc. There are significant differences between placebo and milk with sterols for LDL (p=0.009) and total Cholesterol (p=0.003).Sterols supplied in a functional food, such as milk, can be a strategy for non- pharmacological treatment of hypercholesterolemia and therefore a tool for cardiovascular risk reduction globally.Introducción: La hipercolesterolemia es uno de los factores de riesgo relevantes en la enfermedad cardiovascular, siendo el uso de esteroles vegetales una de las estrategias con mayor evidencia. Objetivos: Determinar la eficacia de una leche enriquecida en fitoesteroles para la disminución de marcadores de enfermedad cardiovascular en población joven adulta. Métodos: Ensayo clínico, controlado, aletorizado, doble ciego y cruzado. Los esteroles (2,24 g diarios) fueron ingeridos a través de una leche comercial, administrada en dos fases de 3 semanas respectivamente y separadas por un periodo de lavado de 2 semanas, para aquellos sujetos durante la fase de “leche de estudio”, y la misma cantidad de leche desnatada, sin esteroles, para el placebo. Al inicio y al final de cada fase se realizaron extracciones de sangre. Se recopilaron datos antropométricos, hábitos de salud y marcadores analíticos sanguíneos: perfil lipídico, hematológico, inflamación, etc. Resultados: Diecinueve personas culminaron el estudio de con una edad media de 34,68 años (±6,91). La diferencia entre los marcadores basales y finales para el colesterol- LDL, el Colesterol total y Triglicéridos fueron de 19,47 (±29,10) mg/dl, 24,47 (±30,68) mg/dl, 14,36 (±44,16) mg/dl, respectivamente. Sin cambios considerables en las fracciones de colesterol-HDL. Existen diferencias significativas, entre el placebo y la leche con esteroles para colesterol-LDL (p=0,009) y Colesterol total (p=0,003). Conclusiones: Los esteroles vegetales suministrados en un alimento de consumo habitual, como la leche, pueden ser una estrategia terapéutica no farmacológica de la hipoercolesterolemia y, por ello, una herramienta en la prevención del riesgo cardiovascular a nivel global.

Constipation is an intestinal dysfunction. Prebiotics, such as inulin, can improve bowel function by positively influencing intestinal biota.To analyze the scientific evidence for the role of inulin in improving bowel function in patients with chronic constipation.A meta-analysis of randomized controlled clinical trials was conducted, grounded on a literature search for the period 1995-2013 (descriptors: inulinconstipation) on PubMed, ScieLo and Central Trials Register Cochrane databases. A total of 24 articles were found, 5 of them were selected for this meta-analysis, involving 252 subjects (experimental group: n = 144, control group: n = 108). The quality of the studies was assessed using the Jadad scale.We found a significant overall effect of inulin on stool frequency (DEM = 0.69, 95%CI: 0.04, 1.34), stool consistency (Bristol scale) (DEM = 1.07, 95% CI: 0.70, 1.45), transit time (DEM = -0.57, 95% CI: -0.99, -0.15) and hardness of stool (RR = 0.42, 95% CI: 0.26, 0.70). Pain and bloating do not improve with inulin intake.Inulin intake has a positive effect on bowel function.El estreñimiento es una disfunción intestinal. Los prebióticos, como la inulina, pueden mejorar la función intestinal influyendo positivamente en la biota intestinal.Analizar la evidencia científica del papel de la inulina en la mejora de la función intestinal en sujetos con estreñimiento crónico.se realizó un meta-análisis de ensayos clínicos aleatorizados controlados que fueron seleccionados en una búsqueda bibliográfica en el período 1995-2013 (descriptores: inulinaestreñimiento) en PubMed, ScieLo y el Registro Central de Ensayos Clínicos de Cochrane. Se encontraron 24 artículos, de los que 5 fueron seleccionados para este meta-análisis, que involucran a 252 sujetos (grupo experimental: n = 144; grupo control: n = 108). La calidad de los estudios fue evaluada con la escala Jadad.Se ha encontrado un efecto global significativo de la inulina sobre la frecuencia de las deposiciones (DEM = 0,69, IC 95%: 0,04; 1,34), la consistencia de las heces (Escala de Bristol) (DEM = 1,07, IC 95%: 0,70; 1,45), el tiempo de tránsito (DEM = -0,57, IC 95%: -0,99; -0,15) y la dureza de las heces (RR = 0,42, IC 95%: 0,26; 0,70). El dolor y la distensión abdominal no mejoran con la ingesta de inulina.La ingesta de inulina tiene un efecto positivo sobre la función intestinal.

To estimate the association of household income and provincial income with visits to general practitioners and specialists and with hospitalization and to determine whether waiting times to access these services vary with both economic variables.Data from the 2001 National Health Survey were used. The association was estimated by sex- and age-adjusted odds ratios; in the case of per capita income, odds ratios were also adjusted for household income. Percentiles and the geometric mean of waiting times in each health service were estimated and the statistical significance of their association with both economic variables was evaluated.Subjects with the lowest household income showed the highest frequency of visits to general practitioners and hospitalization, although they waited longer for hospital admission. Subjects with the lowest household income also showed the lowest frequency of specialist visits: the odds ratio in the lowest income quartile with respect to the highest income quartile was 0.73 (95% CI: 0.62-0.87). However, when only visits to specialists working in the public system were analyzed, the lowest frequency of visits was observed in subjects with the highest household income. No differences were found in health services utilization or in waiting times according to provincial income.The frequency of specialist visits according to household income shows a different pattern from that observed for visits to general practitioners and hospitalizations. The longest waiting times for admission to hospital were observed in subjects with the lowest household income.