Children's physiological and behavioural response evoked by the observation, olfaction, manipulation, and consumption of food textures. Part 1: Liquid products.

Children are thought to prefer homogeneous and simple textures that are easy to manipulate in the mouth. Although scientific research has been done on children's acceptance for food textures, there is a lack of knowledge regarding the emotional response elicited by textures in this group of population. Physiological and behavioural methods could be an appropriate approach to measure food-evoked emotions in children since they require a low cognitive effort and allow a real-time measure. In this regard, a study that combined the measure of skin conductance response (SCR) and facial expressions was conducted: (i) to provide a first insight into food-evoked emotions induced by liquid food products that only vary in texture, (ii) to capture the emotional response evoked by the observation, olfaction, manipulation, and consumption of the products, and (iii) to overcome methodological drawbacks that are frequently associated to these methods. To achieve these goals, 50 children (5-12 yrs old) evaluated three liquids designed to only vary in texture (from slightly thick to extremely thick), following four sensory tasks: observation, olfaction, manipulation, and consumption. After each sample was tasted, children rated liking with a 7-pt hedonic scale. Facial expressions and SCR were monitored during the test, and they were analysed as action units (AUs) and basic emotions as well as changes in SCR. Results showed that the extremely thick liquid was less liked by the children and induced a more negative emotional response, whereas the slightly thick liquid was more liked and evoked a more positive emotional response. The combined method used in this study showed good discrimination ability among the three samples tested, obtaining the best discrimination during the manipulation task. The codification of the AUs located in the upper side of the face allowed us to measure the emotional response evoked by the consumption of the liquids, without the artifacts caused by the oral processing of the products. This study provides a child-friendly approach to be used during the sensory evaluation of food products in a broad range of sensory tasks minimising the methodological drawbacks.

[Bronchoalveolar lavage for diagnosing pneumonia in mechanically ventilated patients]. / Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica.

OBJECTIVE: To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients. DESIGN: Descriptive study. SETTING: A 17-bed medical and surgical intensive care unit. PATIENTS: Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL. INTERVENTIONS: BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis. MAIN VARIABLES OF INTEREST: Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed. RESULTS: A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively. CONCLUSIONS: The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.

Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica / C-reactive protein as a marker of mortality in intensive care unit

Objetivo. Evaluar la utilidad diagnóstica del lavado broncoalveolar (LBA) en enfermos en ventilación mecánica con sospecha de neumonía y describir los resultados clínicos de los diferentes tipos de neumonía en enfermos críticos. Diseño. Estudio descriptivo. Ámbito. Unidad de cuidados intensivos (UCI) médico-quirúrgica de 17 camas. Pacientes. Enfermos ingresados en UCI desde noviembre de 2003 a marzo de 2006 con ventilación mecánica y sospecha clínica de neumonía a quienes se realizó LBA. Intervenciones. Se realizó LBA a través de tubo orotraqueal con 150 ml de suero salino fisiológico, repartidos en tres alícuotas de 50 ml; la muestra se procesó para estudio microbiológico. Principales variables de interés. Edad, APACHE II al ingreso, días en ventilación mecánica, estancia en UCI, mortalidad y agentes etiológicos aislados en el LBA. Resultados. Se incluyó a 96 pacientes a quienes se realizó LBA; se distinguieron 4 grupos: neumonía adquirida en la comunidad (NAC), 12 casos; neumonía asociada a ventilación mecánica (NAVM) precoz, 26 casos. NAVM tardía, 43 casos, y neumonía en enfermos inmunodeficientes, 15 casos. El LBA fue positivo (> 10.000 ufc/ml) en 40 (41,7%) pacientes (2 con NAC, 16 con NAVM precoz, 17 con NAVM tardía, 5 con neumonía e inmunodeficiencia). La mortalidad fue del 33,3, el 26,9, el 25,6 y el 73,3% en NAC, NAVM precoz, NAVM tardía e inmunodeficientes, respectivamente. Conclusiones. La escasa sensibilidad del LBA en la NAC corrobora la actitud de limitar su indicación sólo a casos seleccionados. En el grupo de enfermos inmunodeficientes la mortalidad fue muy elevada. El LBA, según nuestra limitada experiencia, tiene su mayor utilidad en el diagnóstico de NAVM

Objective. To evaluate the diagnostic role ofbronchoalveolar lavage (BAL) in mechanicallyventilated patients with suspected pneumoniaand to describe the clinical outcome in the differentkinds of pneumonia in critically ill patients.Design. Descriptive study.Setting. A 17-bed medical and surgical intensivecare unit.Patients. Mechanically ventilated patients admittedto the ICU from November 2003 to March2006 with suspected pneumonia who underwentbronchoscopy with BAL.Interventions. BAL was performed by fiberopticbronchoscopy with three aliquots of 50 ml sterilenormal saline. Recovered BAL fluid was processedfor microbiologic analysis.Main variables of interest. Age, APACHE IIscore within the first 24 hours of admission, timeon mechanical ventilation, ICU length of stay,mortality, and isolated bacteria were analyzed.Results. A total of 96 cases of suspected pneumoniawith BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (>10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively).Mortality was 33.3%, 26.9%, 25.6% and 73.3% inCAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively.Conclusions. The low incidence of positive BALin the CAP group supports using BAL only for particularlysevere, selected cases. Mortality wasvery high in the immunocompromised patients. Inthe light of our personal experience, BAL is mostuseful in the diagnosis of pneumonia in the groupof patients with VAP

[Acute lobar nephronia: Diagnosis, treatment and prognosis]. / Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución.

Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good.

Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución / Acute lobar nephronia: diagnosis, treatment and prognosis

La nefronía focal aguda (NA) es una infección bacteriana aguda localizada en el riñón. La prevalencia de esta enfermedad es escasa. Presentamos 4 casos de nefronía bacteriana aguda. De ellos, 3 pacientes fueron diagnosticados entre 77 pacientes ingresados por pielonefritis aguda y hubo un caso atípico, asociado con una epidermólisis bullosa. El diagnóstico se realizó por ecografía renal y se confirmó con tomografía computarizada ante la mala evolución de dos de los casos, detectando un pequeño absceso en uno de ellos. El urocultivo fue positivo en 3 de los 4 pacientes. La NA es un diagnóstico radiológico que precisa tratamiento más agresivo y seguimiento más estrecho por el riesgo de evolucionar a absceso renal. Dado que la clínica es insidiosa y las pruebas de laboratorio dispares, es preciso sospecharla ante una evolución tórpida de una pielonefritis o alteraciones en la ecoestructura renal. El tratamiento médico es suficiente y el pronóstico, en general, bueno

Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good

Development of a liquid-liquid extraction procedure for five 1,4-dihydropyridines calcium channel antagonists from human plasma using experimental design.

A liquid-liquid extraction method using diethyl ether as organic solvent was optimized simultaneously for five 1,4-dihydropyridines (amlodipine, nitrendipine, felodipine, lacidipine and lercanidipine) belonging to the group of calcium channel blockers. Some experimental tools such as a full factorial design, a central composite design and the Multisimplex program were used to optimise the concentration of NaOH, volume of organic solvent and shaking time as main factors that influence the liquid-liquid extraction procedure. Following the extraction, the quantitation of the 1,4-dihydropyridines concentrations were performed by high-performance liquid chromatography with diode-array detector. Therefore, the studied compounds were separated quantitatively on a Supelcosil ABZ+Plus, 25cmx4.6mm i.d., 5mum column which was set at 30 degrees C, using as mobile phase, a mixture of acetonitrile-water (70:30, v/v) containing 10mM acetate buffer (pH 5) and setting the detector at a wavelength value of 360nm. It was concluded that the main factors that influence in the extraction process were the volume of organic solvent and the shaking time. The Multisimplex program suggested as optimal conditions an average of 6ml of organic solvent and 23min of shaking time. For these values, the optimised liquid-liquid extraction method showed good values of recoveries (80% for amlodipine and higher than 90% for the rest of the compounds) and low values of R.S.D. (<10%) in the reproducibility of the extraction what makes it reliable for the quantification of all the studied compounds in human plasma.