ABSTRACT
The reaction of arylidene-α-amino esters with electrophilic alkenes to yield Michael-type addition compounds is optimized using several phosphines as organocatalysts. The transformation is very complicated due to the generation of several final compounds, including those derived from the 1,3-dipolar cycloadditions. For this reason, the selection of the reaction conditions is a very complex task and the slow addition of the acrylic system is very important to complete the process. The study of the variation in the structural components of the starting imino ester is performed as well as the expansion of other electron-poor alkenes. The crude products have a purity higher than 90% in most cases without any purification. A plausible mechanism is detailed based on the bibliography and the experimental results. The synthesis of pyroglutamate entities, after the reduction of the imino group and cyclization, is performed in high yields. In addition, the hydrolysis of the imino group, under acidic media, represents a direct access to glutamate surrogates.
ABSTRACT
Acute gastroenteritis is one of the most common diseases in children and an important cause of morbidity and mortality worldwide. No specific treatment is available; therefore, management is exclusively symptomatic. Xyloglucan has been approved in Europe as a class IIa medical device for restoration of the physiological functions of the intestinal wall. Our objective was to assess efficacy and safety of xyloglucan for the treatment of acute gastroenteritis in children. We performed a triple-blind, randomized placebo-controlled clinical trial in four primary care centers and one continued care hospital center. The study population comprised children with acute gastroenteritis aged >3 months and <5 years. Our primary endpoint was time (in hours) of resolution of diarrhea, defined as the time to resolution of stool consistency (Bristol Stool Form Scale ≤5 or Amsterdam Stool Form Scale B or C) or time until deposition frequency resumes to normality, whichever occurred first. We also recorded intravenous rehydration, hospitalization, stools per day, Vesikari scale, vomiting, relapse, weight loss, drugs prescribed, and adverse events. Eighty children were included in the intention-to-treat population (43 xyloglucan and 37 placebo) and 74 (93%) in the per-protocol population. Time to resolution of diarrhea was similar in both groups with (median, 95% CI) 24, 17-24 h in the xyloglucan group versus 24, 19-24 h in the placebo group, p = .680. Significant differences were observed for patients with moderate-to-severe diarrhea (Vesikari scale ≥9): xyloglucan group (20 [15-24] h) versus placebo group (85 [51-120] h) (p = .04). No other significant differences were found. Xyloglucan can be considered safe and other studies should be performed to confirm the usefulness in patients with moderate-to-severe diarrhea.
ABSTRACT
Objetivo. Evaluar la efectividad de la educación grupal estructurada en personas con diabetes mellitus tipo 2, como complemento de la educación individual recibida en las consultas de enfermería, sobre los conocimientos adquiridos de la enfermedad y la mejora en el control metabólico. Método. Diseño casiexperimental antes-después, realizado en 5 centros de atención primaria de Girona. Muestra formada por 73 personas diabéticas tipo 2 controladas en las unidades básicas asistenciales de cada centro. Se administraron encuestas de conocimiento de la enfermedad y de satisfacción del curso. Se midieron los valores metabólicos (HbA 1c ) antes del curso, a los 6 meses y a 1 año de éste. Resultados. La asistencia a los talleres fue muy alta (72,6%). Hubo una mejora sustancial en los controles metabólicos (HbA 1c ) a los 6 y 12 meses posteriores al curso (HbA 1c previa, 6,95%; a los 6 meses, 6,2%, y al año, 6,5%). En las encuestas de conocimiento se observó que éstos ya eran elevados antes de la intervención y se mantuvieron durante toda ella. También se observó que la satisfacción de las personas diabéticas que han participado es elevada, al igual que la opinión de los profesionales de enfermería que atendían a los participantes en el taller. Conclusiones. La educación grupal estructurada, como complemento de la educación individual, mejora de modo significativo el control metabólico de la diabetes y, por tanto, podría disminuir las complicaciones microvasculares. Por ello, debería incluirse en las actividades de los profesionales de enfermería. Las encuestas de satisfacción tanto de los usuarios como de los profesionales de enfermería demuestran que están de acuerdo con la organización y el contenido del curso
Objective. To assess the effectiveness of structured group education in individuals with type 2 diabetes (DM2) as a complement to the individual education given by nurses in consulting rooms. Method. A quasi-experimental, before-and-after study was performed in five primary care centers in Girona. The sample consisted of 73 individuals with DM2 managed in the Basic Care Units of each health center. Questionnaires on knowledge of the disease and patient satisfaction with the course were administered. Metabolic values (HbA1c) were measured before the course, 6 months after the course and after 1 year. Results. Attendance at workshops was high (72.6%). Metabolic control was substantially improved at 6 and 12 months after the course (HbA1c before the course, 6.95%; at 6 months, 6.2%, and at 1 year, 6.5%). The questionnaires revealed that knowledge of the disease was already high before the workshop and remained high. Satisfaction with the workshop among participating patients and nurses was high. Conclusions. Structured group education, as a complement to individual education, significantly improves metabolic control of diabetes and therefore it could also reduce microvascular complications. Consequently, structured group education should be included in nursing activities. Both patients and nurses were satisfied with the course contents and organization
