The impact of extrusion on the nutritional composition, dietary fiber and in vitro digestibility of gluten-free snacks based on rice, pea and carob flour blends.

Consumers and the food industry are demanding healthier products. Expanded snacks with a high nutritional value were developed from different rice, pea and carob flour blends. The proximate composition, starch (total and resistant), amylose and amylopectin, dietary fiber (soluble and insoluble) contents, and the in vitro protein digestibility of different rice-legume formulations, were evaluated before and after the extrusion process. Compared with the corresponding non-extruded blends (control), the extrusion treatment did not change the total protein content, however, it reduced the soluble protein (61-86%), the fat (69-92%) and the resistant starch contents (100%). The total starch content of all studied blends increased (2-19%) after extrusion. The processing increased the in vitro protein digestibility, reaching values around 88-95% after extrusion. Total dietary fiber was reduced around 30%, and the insoluble fraction was affected to a larger extent than the soluble fraction by the extrusion process. Because of its balanced nutritional composition, high dietary fiber content, as well as low energy density, these novel gluten-free snack-like foods could be considered as functional foods and a healthier alternative to commercially available gluten-containing or gluten-free and low nutritional value snacks.

Resultados obstétricos y perinatales de las gestantes adolescentes atendidas en el Hospital Central de la Defensa Gómez Ulla / Obstetrical and perinatal results of pregnant adolescents attended at Hospital Central de la Defensa Gómez Ulla

Antecedentes y objetivos: La gestación adolescente es un problema de salud mundial con repercusión sobre la madre y el feto. El ob-jetivo de este estudio es analizar la prevalencia de embarazo adolescente en el área sanitaria del HCDGU, y comparar las variables obstétricas y perinatales de gestantes adolescentes (menos de 20 años) con gestantes de 20-30 años. Material y métodos: Se trata de un estudio descriptivo retrospectivo de los partos entre 2011-2013 atendidos en el Hospital Central de la Defensa Gómez Ulla. Se analizaron 1358 partos, siendo 81 de gestantes adolescentes y 634 de gestantes del grupo control. Los datos se obtuvieron del Libro de Partos del hospital y fueron analizados mediante el software SPSS 16.0. Resultados: La gestación adolescente supuso el 6% de los partos atendidos en dicho periodo, con una edad media materna de 17,7 años. La procedencia de las gestantes estudiadas fue mayoritariamente extranjera, predominando las latinoamericanas (91,2% vs 66,6%). La mayoría de los partos se atendieron vía vaginal (81,5% vs76,7%), siendo la media de edad gestacional al parto a término en ambos grupos y sin diferencias estadísticamente significativas (39+4 semanas vs 39+5 semanas). El peso de los recién nacidos mostró diferencias significativas siendo inferior en las adolescentes (3224gr vs 3369gr). Conclusiones: La prevalencia de embarazo adolescente en nuestro hospital fue casi tres veces superior a la nacional. No se obtuvieron diferencias en el tipo de parto, la edad gestacional y el pH de los recién nacidos entre las adolescentes y las gestantes control. La tasa de cesáreas y el peso perinatal fueron menores en gestantes adolescentes (AU)

Antecedents and objectives: Adolescent pregnancy is a world-wide health problem of ample impact upon both mother and foetus. The aim of this research is to analyse the prevalence of adolescent pregnancy in the sanitary area of the HCDGU and compare the obtetrical and perinatal variables of pregnant adolescents (under 20) with those of pregnant women between 20 and 30 years old. Materials and methods: this is a retrospective and descriptive research of the births that have taken place at Hospital Central de la Defensa Gómez Ulla in the period between 2011 and 2013. 1358 were analysed; 81 of pregnant adolescents and 634 of the women of the control group. Data were gathered from the hospital birth records and were studied with the SPSS 16.0 software. Results: adolescent pregnancy implied the 6% of the births in the period considered, with a mothers’ average age of 17.7 years old. Most of these adolescent mothers were of foreign origin, with a special predominance of Latin American (91.2% vs 66.6%). Most deliveries were vaginal (81.5% vs 76.7%) with no significant differences between both groups on the average pregnancy period at the moment of the delivery (39+4 weeks vs 39+5 weeks). On the other hand, newly born children from adolescent mothers differences showed significantly lower weight. Conclusions: the prevalence of adolescent pregnancy in our hospital was almost three times higher than the national average. No differences in the delivery type, the gestational age and the newly borns’ pH were detected between the adolescents and the control group women. The rate of Caesarean sections and perinatal weight was lower in pregnant adolescents (AU)

Predictors of urinary and rectal toxicity after external conformed radiation therapy in prostate cancer: Correlation between clinical, tumour and dosimetric parameters and radical and postoperative radiation therapy. / Factores predictivos de toxicidad urinaria y rectal tras radioterapia externa conformada en el cáncer de próstata: correlación de parámetros clínicos, tumorales y dosimétricos con radioterapia radical y postoperatoria.

OBJECTIVE: To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors. METHOD: A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumour and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance. RESULTS: The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented haemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (P=0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses >45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45 Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy. CONCLUSIONS: The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy.

[Ecographic viewing and prenatal diagnosis of infradiaphragmatic total anomalous pulmonary venous drainage: report of a case]. / Visualización ecográfica y diagnóstico prenatal de drenaje venoso pulmonar anómalo total infradiafragmático: a propósito de un caso.

Anomalous pulmonary venous connection is a rare pathology, both partial and total forms, according to the number of pulmonary veins draining into the left atrium, respectively. Total forms are classified into four groups, depending upon the anomalous connections to the systemic veins: supra, intracardiac or below, and finally a mixed form, the less frequent. Prenatal, even postnatal diagnose is difficult, especially in partial isolated forms. The association with chromosomal abnormalities is low, however is highly associated with complex heart malformations, especially total forms, often in the context of heterotaxy syndromes. We present a case of infracardiac APVC, in the context of complex heart disease, associated with complete atrioventricular canal and conotruncal anomaly, that came to surgery at 48 hours of life with poor outcome. We described the ultrasound and magnetic resonance angiography of this anomaly and its perinatal prognosis and management.

Impacto de una TAC en inspiración adicional al protocolo convencional de la PET-TAC con 18F-FDG en la detección de nódulos pulmonares de pequeño tamaño / Impact of an additional inspiration CT scan on the conventional protocol of the 18F-FDG PET-CT in the detection of small pulmonary nodes

Objetivo. Determinar el impacto de una TAC en inspiración adicional al protocolo convencional de la PET-TAC con 18F-FDG en la detección de nódulos pulmonares de pequeño tamaño. Método. Hemos estudiado consecutivamente 100 pacientes que presentaban uno o varios nódulos pulmonares radiológicos. A todos los pacientes se les practicó un PET/TAC (Gemini, Philips). Los parámetros de adquisición fueron los mismos para la TAC no inspiratoria/fusión y la TAC en inspiración: 120kV, 25mAs. Resultados. Un total de 188 nódulos fueron detectados en la TAC inspiratoria, con tamaño entre 0,3 y 3cm. Resultados. La TAC no inspiratoria no evidenció 20/188 nódulos (10,6%) con tamaño entre 0,3 y 1cm: correspondiendo a 17 pacientes. La localización más frecuente en la que no se evidenciaron nódulos en la TAC fue en lóbulos inferiores. Resultados. La PET visualizó hipercaptación de 18F-FDG en el 83,9% y el 72% de los nódulos >1cm y entre 0,7 y 1cm, respectivamente. Sin embargo, únicamente el 10,5% de los nódulos <0,7cm mostraron aumento de actividad metabólica. Conclusiones. En pacientes seleccionados, la práctica de una TAC inspiratoria adicional al estudio PET/TAC aumenta de forma significativa la detección de pequeños nódulos pulmonares (10,6%), especialmente de los localizados en lóbulos inferiores, debido a los movimientos respiratorios y puede tener un impacto en el manejo del paciente(AU)

Aim. To determine the impact of an additional inspiration CT scan on the conventional 18F-FDG PET-CT protocol in the detection of small pulmonary nodules. Method. One hundred consecutive patients who presented with one or various nodules were studied. Whole-body PET-CT was performed using Gemini (Philips). CT acquisition parameters were 120Kv/25mAs, the same as those for the transmission/fusion CT (mild expiration) and inspiratory CT. Results. A total of 188 nodules were detected in the inspiratory CT with sizes between 0.3–3cm. Non-inspiratory CT did not show 20/188 nodules (10.6%) with sizes between 0.3–1cm, this corresponding to 17 patients. The most frequent localization of non-detectable nodules in non-inspiratory CT was the lower lobes.18F-FDG uptake was detected by the PET in 83.9% and 72% of nodules with >1cm and between 0.7 and 1cm, respectively. However, only 10.5% of nodules <0.7cm showed increased metabolic activity. Conclusion. In selected patients, inspiratory CT added to conventional PET-CT significantly improves the detection of small nodules (10.6%), especially in those lesions located in the lower lobes, due to respiratory movements, and may have an impact on patient management(AU)

[Impact of an additional inspiration CT scan on the conventional protocol of the ¹8F-FDG PET-CT in the detection of small pulmonary nodes]. / Impacto de una TAC en inspiración adicional al protocolo convencional de la PET-TAC con (18)F-FDG en la detección de nódulos pulmonares de pequeño tamaño.

AIM: To determine the impact of an additional inspiration CT scan on the conventional ¹8F-FDG PET-CT protocol in the detection of small pulmonary nodules. METHOD: One hundred consecutive patients who presented with one or various nodules were studied. Whole-body PET-CT was performed using Gemini (Philips). CT acquisition parameters were 120 kV/25 mAs, the same as those for the transmission/fusion CT (mild expiration) and inspiratory CT. RESULTS: A total of 188 nodules were detected in the inspiratory CT with sizes between 0.3-3 cm. Non-inspiratory CT did not show 20/188 nodules (10.6%) with sizes between 0.3-1cm, this corresponding to 17 patients. The most frequent localization of non-detectable nodules in non-inspiratory CT was the lower lobes. ¹8F-FDG uptake was detected by the PET in 83.9% and 72% of nodules with > 1 cm and between 0.7 and 1cm, respectively. However, only 10.5% of nodules <0.7 cm showed increased metabolic activity. CONCLUSION: In selected patients, inspiratory CT added to conventional PET-CT significantly improves the detection of small nodules (10.6%), especially in those lesions located in the lower lobes, due to respiratory movements, and may have an impact on patient management.

Pancreatitis aguda, adenopatías mesentéricas y diarrea / No disponible

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[Rare diseases. Concept, epidemiology and state of the question in Spain]. / Enfermedades raras. Concepto, epidemiología y situación actual en España.

Rare diseases are those whose prevalence is below 5 cases per 10,000 inhabitants in the European Community. Most cases are diagnosed during paediatric age due to their genetic origin, while some others are congenital malformations. Nevertheless, a higher prevalence is seen during adulthood as most of the former diseases are very severe and patients die during childhood. At the same time, higher survival rates are related to some chronic rare diseases in adults. The Spanish Network of Research Epidemiology for Rare Diseases (REpIER) developed the first atlas showing the geographical distribution of rare diseases in Spain, assessed the Spanish rare disease registries, contributed to the further development of regional plans on rare diseases, as well as to social and health actions, and established the real group of needs to be solved. These have been included in the Communication of the European Commission on Rare Diseases as well as in the Spanish Senate Presentation.

Enfermedades raras. Concepto, epidemiología y situación actual en España / Rare diseases. Concept, epidemiology and state of the question in Spain

Enfermedad rara es aquella cuya prevalencia esinferior a 5 casos por cada 10.000 personas en la ComunidadEuropea. La mayoría de los casos aparecen en laedad pediátrica, dada la alta frecuencia de enfermedadesde origen genético y de anomalías congénitas. Noobstante, la prevalencia es mayor en los adultos que enlos niños, debido a la excesiva mortalidad de algunasenfermedades infantiles graves y a la influencia de ciertasenfermedades que aparecen a edades más tardías.La Red Epidemiológica de Investigación en EnfermedadesRaras (REpIER) desarrolló el primer atlas dedistribución geográfica de las enfermedades raras enEspaña, evaluó la existencia de registros de enfermedadesraras existentes, facilitó el ulterior desarrollo deplanes autonómicos y acciones sociosanitarias y planteóun marco de necesidades a desarrollar, que mástarde han llegado a ser reconocidos como necesidadesa resolver en el marco del Comunicado de la ComisiónEuropea sobre Enfermedades Raras y en la propiaPonencia del Senado

Rare diseases are those whose prevalence is below5 cases per 10,000 inhabitants in the EuropeanCommunity. Most cases are diagnosed duringpaediatric age due to their genetic origin, while someothers are congenital malformations. Nevertheless, ahigher prevalence is seen during adulthood as most ofthe former diseases are very severe and patients dieduring childhood. At the same time, higher survivalrates are related to some chronic rare diseases inadults.The Spanish Network of Research Epidemiologyfor Rare Diseases (REpIER) developed the first atlasshowing the geographical distribution of rarediseases in Spain, assessed the Spanish rare diseaseregistries, contributed to the further development ofregional plans on rare diseases, as well as to socialand health actions, and established the real group ofneeds to be solved. These have been included in theCommunication of the European Commission on RareDiseases as well as in the Spanish SenatePresentation

Estudio de la disolución del calcio a partir de una nueva formulación de comprimidos bucodispersables y su comparación con formulaciones masticables convencionales / Study of the dissolution of calcium contained in a novel orodispersible tablet formulation and its comparison with conventional chewable formulations

Los suplementos de calcio con vitamina D constituyen un componente habitual de los tratamientos de la osteoporosis. La absorción del calcio suministrado requiere su disolución previa. Sin embargo, las sales de calcio habitualmente utilizadas son muy poco solubles y dependen del ácido gástrico para liberar el calcio en forma biodisponible. Se ha desarrollado una nueva formulación bucodispersable de calcio y vitamina D (Natecal D Flas). Esta formulación no sólo facilita el cumplimiento terapéutico del tratamiento, sino también la disolución del calcio y, por tanto, su biodisponibilidad. En este estudio se ha comparado la disolución del calcio de comprimidos masticables convencionales con la nueva formulación bucodispersable, tanto en medio gástrico artificial (pH ácido) como en agua (ausencia de ácido). Los resultados indican que en medio gástrico artificial, simulando condiciones fisiológicamente normales, los comprimidos bucodispersables producen una disolución significativamente más rápida del calcio que los comprimidos masticables. En el caso del agua, simulando una condición de aclorhidria absoluta, no se produce disolución del calcio en el caso de los comprimidos masticables mientras que existe una disolución parcial, pero significativa, en el caso de los comprimidos bucodispersables. Estos resultados indican que la nueva formulación bucodispersables de carbonato cálcico y vitamina D (Natecal D Flas) contribuye a una mejor absorción del calcio en aquellos pacientes en la que ésta puede estar disminuida por circunstancias fisiológicas (AU)

Calcium supplements with vitamin D are standard components of treatments for osteoporosis. The absorption of the calcium provided requires its prior dissolution. However, the solubility of the calcium salts usually employed is limited and the release of the calcium in a bioavailable form depends on gastric acid. A novel orodispensible formulation of calcium and vitamin D (Natecal D Flas) has been developed. This formulation not only facilitates treatment compliance, but the dissolution of the calcium as well, thus enhancing its bioavailability. In this study, the authors have compared the dissolution of the calcium contained in conventional chewable tablets with that of the new orodispersible formulation, both in artificial gastric juice (acidic pH) and in water (absence of acid). The results indicate that, in artificial gastric juice, simulating normal physiological conditions, the orodispersible tablets produce a significantly more rapid dissolution of calcium than the chewable tablets. In the case of water, simulating conditions of absolute achlorhydria, there is no dissolution of the calcium contained in the chewable tablets, whereas partial, but significant, dissolution is observed with the orodispersible tablets. These findings indicate that the novel orodispersible formulation of calcium carbonate and vitamin D (Natecal D Flas) contributes to better absorption of calcium in those patients in whom this process may be compromised by physiological circumstances (AU)

Peritonitis neumocócica espontánea en un cirrótico sin foco respiratorio / Spontaneous pneumococcal peritonitis in a cirrhotic patient without respiratory focus

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Alternative splicing generates a novel non-secretable resistin isoform in Wistar rats.

Resistin is a secreted adipose tissue hormone that belongs to the resistin-like molecule family. We report here a new alternatively spliced isoform of the rat resistin gene, named S-resistin (short resistin), detected in adipose tissue by reverse transcription-polymerase chain reaction (RT-PCR). A comparison of this cDNA variant and genomic sequences indicates the lack of the second exon containing the secretory consensus signal. Both cDNAs, resistin and S-resistin, were carboxy-tagged with FLAG epitope and transiently expressed in cultured cell lines. While the resistin-FLAG construct gives the expected pattern for a secretion protein, the S-resistin-FLAG construct yielded a predominant nuclear staining. These results indicate that this splicing event regulates the fate and probably the function of the mature protein.

La incapacidad temporal: hacia un modelo de gestión / Temporary incapacity: towards a management model

El actual modelo de gestión de la incapacidad temporal cuenta con tres organizaciones con competencias sobre la misma. Se ha creado un modelo con ambiente turbulento que hace a dichas organizaciones menos aptas para la consecución de sus objetivos. Apartándonos de modelos cuantitativos y economistas, proponemos un modelo de gestión basado en criterios científicos que nace y termina en el propio Sistema Sanitario como lo hace efectivamente la propia incapacidad temporal. Considerando la incapacidad temporal como una prescripción médica, su evaluación y control debería recaer en el propio Sistema Sanitario, el mejor conocedor de su origen, evolución y de todos sus factores asociados (AU)

Ageing increases SOCS-3 expression in rat hypothalamus: effects of food restriction.

Aged Wistar rats are characterized by leptin and insulin resistance. The expression of SOCS-3 in hypothalamus increases with ageing. Food restriction during 3 months decreases obesity Lee index in aged rats with respect to their ad libitum aged-mates and brings serum leptin concentrations to values close to those of young rats. Food restriction partially reverts the increases in SOCS-3 mRNA levels associated with ageing. These results suggest that SOCS-3 may be a mediator of hypothalamic leptin resistance in the aged Wistar rat and that the hyperleptinemia associated with ageing is, at least in part, responsible for the increase of SOCS-3 expression in hypothalamus.

Long-term food restriction prevents ageing-associated central leptin resistance in wistar rats.

AIMS/HYPOTHESIS: Ageing is associated with insulin and leptin resistance in mammals. These alterations might be caused by the increased adiposity associated with ageing, by ageing alone or both. We studied whether leptin resistance occurs at the central level in the Wistar rat and we aimed to discriminate between the effects of ageing from those of the increased adiposity associated with ageing. METHODS: Leptin was infused intracerebroventricularly at a constant rate in young adult, old and old Wistar rats fasted for 3 months, using osmotic pumps. The effects on body weight, daily food intake, Lee index, adiposity and serum leptin values were analysed. The effect of food restriction on the expression of the long form of leptin receptor in the hypothalamus was also studied. RESULTS: Leptin decreased daily food intake and body weight in young and old Wistar rats. With a dose of 10 microg/day similar responses were obtained in young and old rats but with a dose of 0.2 microg/day, only young rats showed decreases in these parameters. Food-restriction in old rats lowered adiposity and serum leptin to values close to those of young rats, recovered responsiveness to i.c.v. administration of leptin at the dose of 0.2 microg/day and increased leptin receptor expression in the hypothalamus. CONCLUSION/INTERPRETATION: Our data show that old Wistar rats have a decreased response to leptin at the central level. Food-restriction recovers leptin responsiveness and increases leptin receptor in the hypothalamus suggesting that adiposity plays a key role in the development of leptin resistance associated with ageing.

Decreased leptin uptake in hypothalamic nuclei with ageing in Wistar rats.

Leptin interacts with specific receptors in hypothalamic nuclei and modulates energy balance. Growing evidence has shown the association of obesity and hyperleptinaemia with non-insulin-dependent diabetes mellitus and insulin resistance. The aged Wistar rat shows peripheral insulin resistance in the absence of obesity and alterations of glucose homeostasis. However, it is not known whether, in these animals, the leptin action is altered. Here we studied the effect of ageing on plasma leptin concentration and the ability of hypothalamic nuclei to capture i.c.v.-injected digoxigenin-labelled leptin. Our data indicate that 24-month-old animals are hyperleptinaemic. However, daily food intake was greater in old animals, suggesting that they are leptin resistant. Leptin uptake in the hypothalamus was reduced in old rats. This uptake was a receptor-mediated process as demonstrated by displacement. Leptin accumulation in hypothalamic nuclei was partially colocalized with neuropeptide Y fibres. Immunohistochemical and western blot analyses showed a lower amount of the long form of leptin receptors in the hypothalamus of aged rats. Analysis by RT-PCR also demonstrated a decreased expression of leptin receptor mRNA in old animals. We conclude that the lower leptin uptake may be explained, at least in part, by a decreased amount of receptors in hypothalamic neurones of the aged rats.

Identification of priorities for nursing research in Spain: a Delphi study.

AIM: The aim of this work was to identify priorities for nursing research in Spain. The Co-ordination and Development of Nursing Research Centre (Investén-isciii group) carried out the study using the Delphi technique during the period April 1998 to January 1999. METHODS: Study subjects were professionals involved in different nursing activities. From 1250 eligible professionals initially contacted, 452 (38%) responded in round 1 and 258 (57%) in round 2. But only 189 filled out correctly the questionnaires from both rounds of data collection (overall response rate was 21.6%). RESULTS: The participants identified priorities related to continuity and co-ordination of nursing care, quality of nursing care, impact of invasive techniques and treatments on the quality of life of patients, needs of the primary care givers, quality of life among elders, satisfaction of customers and needs of terminal patients and their families.