In El Salvador, chronic kidney disease had reached epidemic proportions towards the end of this century’s first decade. In 2011–2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fatalities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity. In 2009, El Salvador’s Ministry of Health, Cuba’s Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%–14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4–2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hypertension, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional alterations and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon reflexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physiopathologic, clinical and histopathologic characterization of chronic kidney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which particularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. Chronic kidney disease; chronic renal failure; tubulointerstitial nephritis; epidemiology; histopathology; international cooperation; agrochemicals; environmental pollutants, noxae, and pesticides; occupational health; PAHO; El Salvador; Cuba

ABSTRACT Objective Determinate the frequency and the risk factors for Metabolic Syndrome in adults with diabetes mellitus, Hypertension and without Diabetes- Hypertension. Materials and Methods We realized a cross-sectional study in patients of both sexes and older than 20 years of the "Hospital General de Zona 1 IMSS" in Colima, Mexico. The variables studied were: age, BMI, waist circumference, cigarette smoking, and family history of diabetes and hypertension, and biochemical parameters, such as glucose, HDL cholesterol and triglycerides. Results A total of 417 persons were enrolled (170 men and 247 women), with an age average of 53.2 ± 13.4 years (age range, 20 to 86 years). The global frequency of the metabolic syndrome was 52.3 % (56 % in women and 46.4 % in men). While the MS frequency was 50 % in DM2, 42 % in hypertension, 80 % in DM2+hypertension and 28.2 % without DM2 and hypertension. The cigarette smoking frequency was 27.8 %, and it was an important risk factor for the totally of patients with MS, in DM2 and in DM2+hypertension. Conclusions The frequency of MS in adults was 52.3 %, women were the most affected, and cigarette smoking was the most important risk factor.

RESUMEN Objetivo Determinar la frecuencia y factores de riesgo para Síndrome Metabólico (SM) en adultos con Diabetes mellitus, hipertensión arterial y sin diabetes-hipertensión. Material y Métodos Se realizó un estudio transversal analítico en derechohabientes de ambos sexos y mayores de 20 años de los servicios de consulta externa del HGZ No. 1 IMSS Colima, México. Las variables estudiadas fueron edad, IMC, diámetro de la cintura, grado de escolaridad, estado socioeconómico, grado de actividad física, tabaquismo, antecedentes familiares para diabetes e hipertensión arterial (HTA) y parámetros bioquímicos como glucosa, colesterol HDL, triglicéridos. Resultados Se estudiaron 417 pacientes (170 hombres y 247 mujeres), con un promedio de edad 53,2 ± 13,4 años (intervalo 20 a 86 años). La frecuencia global del SM fue del 52,3 % (56 % mujeres y 46,4 % hombres). Mientras que la frecuencia del SM fue de 50 % en DM2, 42% en HTA, 80 % DM2 + HTA y 28,2 % sin DM o HTA. La frecuencia del tabaquismo fue del 27,8 % y fue un factor de riesgo importante para la totalidad de pacientes con SM, en DM2 y en DM2+HAT. Conclusiones La frecuencia del SM en adultos fue del 52,3 %, las mujeres fueron más afectadas y el tabaquismo fue el factor de riesgo más importante.

RESUMEN Objetivo Determinar la frecuencia y factores de riesgo para Síndrome Metabólico (SM) en adultos con Diabetes mellitus, hipertensión arterial y sin diabetes-hipertensión. Material y Métodos Se realizó un estudio transversal analítico en derechohabientes de ambos sexos y mayores de 20 años de los servicios de consulta externa del HGZ No. 1 IMSS Colima, México. Las variables estudiadas fueron edad, IMC, diámetro de la cintura, grado de escolaridad, estado socioeconómico, grado de actividad física, tabaquismo, antecedentes familiares para diabetes e hipertensión arterial (HTA) y parámetros bioquímicos como glucosa, colesterol HDL, triglicéridos. Resultados Se estudiaron 417 pacientes (170 hombres y 247 mujeres), con un promedio de edad 53,2 ± 13,4 años (intervalo 20 a 86 años). La frecuencia global del SM fue del 52,3 % (56 % mujeres y 46,4 % hombres). Mientras que la frecuencia del SM fue de 50 % en DM2, 42% en HTA, 80 % DM2 + HTA y 28,2 % sin DM o HTA. La frecuencia del tabaquismo fue del 27,8 % y fue un factor de riesgo importante para la totalidad de pacientes con SM, en DM2 y en DM2+HAT. Conclusiones La frecuencia del SM en adultos fue del 52,3 %, las mujeres fueron más afectadas y el tabaquismo fue el factor de riesgo más importante.

ABSTRACT Objective Determinate the frequency and the risk factors for Metabolic Syndrome in adults with diabetes mellitus, Hypertension and without Diabetes- Hypertension. Materials and Methods We realized a cross-sectional study in patients of both sexes and older than 20 years of the "Hospital General de Zona 1 IMSS" in Colima, Mexico. The variables studied were: age, BMI, waist circumference, cigarette smoking, and family history of diabetes and hypertension, and biochemical parameters, such as glucose, HDL cholesterol and triglycerides. Results A total of 417 persons were enrolled (170 men and 247 women), with an age average of 53.2 ± 13.4 years (age range, 20 to 86 years). The global frequency of the metabolic syndrome was 52.3 % (56 % in women and 46.4 % in men). While the MS frequency was 50 % in DM2, 42 % in hypertension, 80 % in DM2+hypertension and 28.2 % without DM2 and hypertension. The cigarette smoking frequency was 27.8 %, and it was an important risk factor for the totally of patients with MS, in DM2 and in DM2+hypertension. Conclusions The frequency of MS in adults was 52.3 %, women were the most affected, and cigarette smoking was the most important risk factor.

Asclepias mellodora St. Hil. é uma espécie nativa de aguda toxicidade, frequente nos campos da província de Buenos Aires, Argentina. A sua toxicidade não foi avaliada até agora. Este estudo avalia a dose mínima letal desta espécie, para os ovinos, bem como a possibilidade de reconhecer microscopicamente seus fragmentos no conteúdo gastrointestinal como uma ferramenta complementar de diagnóstico em necropsias. Três ovinos Frisona (PV média = 55±4,5 kg) foram dosados através de uma sonda esofágica em cada uma das seguintes doses de Asclepias: 8,0, 5,0, 2,0 e 0,8 g DM.kg PV-1. Ovinos intoxicados com as três maiores doses morreram entre 10-85 h após a intoxicação, mas não aqueles que receberam a dose menor. Durante as necropsias se: 1) determinou o peso seco do conteúdo do rúmen + retículo, omaso + abomaso e intestino grosso, 2) estimou as porcentagens de fragmentos de Asclepias por microanálise, fazendo a correção para efeitos de digestão no reconhecimento dos fragmentos, e 3) calculou a massa total de Asclepias no trato digestivo de cada animal. Para as três doses maiores, a massa de Asclepias identificada na ingesta total foi de 12,3±3,4% da quantidade fornecida, possivelmente por causa da forte diarréia produzida pela sua ingestão. As porcentagens de Asclepias no rúmen + retículo não diferiram da média quantificada para o trato completo. Os resultados deste estudo indicam que a dose letal mínima de Asclepias em ovinos é de entre 2,0 e 0,8 g kg PV • DM-1, e que a análise micro-histológica do rúmen + retículo, a região mais fácil de amostrar, pode ser usada para confirmar a ingestão desta espécie tóxica, embora a percentagem estimada não será um bom estimador da porcentagem ingerida.

Asclepias mellodora St. Hil. is a native acute toxic species frequent in the grasslands of the Buenos Aires province, Argentina, whose toxicity had not been assessed until now. This study evaluates the minimal lethal dose of this species for sheep, and the possibility of microscopically recognizing its fragments in gastrointestinal contents as a complementary diagnostic tool in necropsies. Three Frisona sheep (average LW=55±4.5 kg) were dosed via an esophageal tube with each one of the following doses of asclepias: 8.0, 5.0, 2.0 and 0.8 g DM.kg LW-1. Sheep poisoned with the three higher doses died between 10 and 85 h after intoxication, but those receiving the lower dose did not. During necropsies we: 1) determined the dry weight of the contents of rumen+reticulum, omasum+abomasum, and large intestine, 2) estimated the percentages of asclepias fragments by microanalysis correcting for digestion effects on fragment recognition, and 3) calculated the total mass of asclepias in the digestive tract of each animal. For the three higher doses, the mass of asclepias identified in the total ingesta was 12.3±3.4% of the amount supplied, possibly because of the strong diarrhea its ingestion produced. The percentages of asclepias in rumen+reticulum did not differ from the average quantified for the entire tract. The results of this study indicate that the minimal lethal doses of asclepias for sheep is between 2.0 and 0.8g DM·kg LW-1, and that the microhistological analysis of the rumen+reticulum, the easiest region to sample, can be used to confirm the ingestion of this toxic species, although the estimated percentage will be not a good estimator of the ingested percentage.

The application of three indicators of evaluation and prognosis in acute pancreatitis (AP) were analyzed in the Intermediate Surgical Care Service of “Luis Díaz Soto” Higher Institute of Military Medicine from 2000 to 2004 to assess the behavior of rates of Apache II, Ranson, and Balthazar-Hill, which served to predict the evolution and prognosis of cases at discharge. The research-action method was used with a descriptive and retrospective character. We concluded that with indicators of Apache II and Ranson of 6 points or more there was a worse prognosis and evolution, coinciding with an increase of the scoring in those patients that had complications and died during hospitalization.

Se analizó la aplicación de 3 indicadores de evaluación y pronóstico en la pancreatitis aguda en el Servicio de Cuidados Intermedios Quirúrgicos del Instituto Superior de Medicina Militar “Dr. Luis Díaz Soto”, durante los años 2000-2004, con el objetivo de evaluar el comportamiento de los índices de: Apache II, Ranson y Balthazar-Hill, que sirvieron para predecir cuál sería la evolución y el pronóstico de los casos al egreso. Se empleó el método de investigación-acción con un carácter descriptivo y retrospectivo. Se concluye que con indicadores de Apache II y Ranson de 6 o más puntos hubo un peor pronóstico y evolución, con la coincidencia en el aumento de la puntuación en aquellos pacientes que presentaron complicaciones y fallecieron durante la hospitalización.