Microbial lipids from organic wastes: Outlook and challenges.

Microbial lipids have recently drawn a lot of attention as renewable sources for biochemicals production. Strong research efforts have been addressed to efficiently use organic wastes as carbon source for microbial lipids, which would definitively increase the profitability of the production process and boost a bio-based economy. This review compiles interesting traits of oleaginous microorganisms and highlights current trends on microbial- and process-oriented approaches to maximize microbial oil production from inexpensive substrates like lignocellulosic sugars, volatile fatty acids and glycerol. Furthermore, downstream processes such as cell harvesting or lipid extraction, that are decisive for the cost-effectiveness of the process, are discussed. To underpin microbial oils within the so demanded circular economy, associated challenges, recent advances and possible industrial applications that are also identified in this review.

Referral Criteria for Asthma: Consensus Document.

Asthma is one of the most prevalent chronic diseases in Spain. Current treatments ensure that the disease is controlled in most cases. However, disease is often uncontrolled in daily clinical practice, mainly owing to underdiagnosis, loss to follow-up, and poor adherence to therapy. In order to improve this situation, we must coordinate all those health professionals who intervene in patient care. Therefore, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG), and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) have drawn up a consensus document in which they establish criteria for referral and guidelines for the diagnosis, control, and follow-up of patients with asthma. The document aims to facilitate continuing and improved care in this area.

Referral criteria for asthma: consensus document

Asthma is one of the most prevalent chronic diseases in Spain. Current treatments ensure that the disease is controlled in most cases. However, disease is often uncontrolled in daily clinical practice, mainly owing to underdiagnosis, loss to follow-up, and poor adherence to therapy. In order to improve this situation, we must coordinate all those health professionals who intervene in patient care. Therefore, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG), and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) have drawn up a consensus document in which they establish criteria for referral and guidelines for the diagnosis, control, and follow-up of patients with asthma. The document aims to facilitate continuing and improved care in this area

El asma es una de las enfermedades crónicas más prevalentes en España. Los tratamientos disponibles permitirían tener controlados a la mayoría de los pacientes; aunque, en la práctica diaria, no se alcanza en muchos casos debido, fundamentalmente, al infradiagnóstico, pérdida de seguimiento y escasa adhesión terapéutica. Para mejorar esta situación es fundamental la coordinación de todos los profesionales que intervienen en la atención del paciente asmático. La Sociedad Española de Alergología e Inmunología Clínica (SEAIC), la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Sociedad Española de Médicos Generales y de Familia (SEMG) y la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) han consensuado un documento donde se establecen criterios de derivación y pautas de actuación en el diagnóstico, control y seguimiento del paciente asmático que faciliten la continuidad asistencial y una mejor atención en cada ámbito

Substrate-Independent Epitaxial Growth of the Metal-Organic Framework MOF-508a.

Plasmachemical deposition is a substrate-independent method for the conformal surface functionalization of solid substrates. Structurally well-defined pulsed plasma deposited poly(1-allylimidazole) layers provide surface imidazole linker groups for the directed liquid-phase epitaxial (layer-by-layer) growth of metal-organic frameworks (MOFs) at room temperature. For the case of microporous [Zn (benzene-1,4-dicarboxylate)-(4,4'-bipyridine)0.5] (MOF-508), the MOF-508a polymorph containing two interpenetrating crystal lattice frameworks undergoes orientated Volmer-Weber growth and displays CO2 gas capture behavior at atmospheric concentrations in proportion to the number of epitaxially grown MOF-508 layers.

Quejas cognitivas subjetivas: hacia una identificación precoz de la enfermedad de Alzheimer / Subjective cognitive impairment: Towards early identification of Alzheimer disease

Introducción: La neurodegeneración en enfermedad de Alzheimer (EA) empieza décadas antes que la demencia y algunos pacientes con deterioro cognitivo leve presentan una importante carga lesional. La ausencia de información sobre la fisiopatología temprana de la enfermedad dificulta la búsqueda de estrategias terapéuticas. La queja cognitiva subjetiva (QCS) agrupa a sujetos con quejas mnésicas sin déficits significativos en test neuropsicológicos. Es un síndrome heterogéneo sobre el que no existe consenso, pero algunos de estos pacientes podrían representar el estadio más precoz de EA. Método: Realizamos una revisión bibliográfica para resumir el estado del conocimiento actual sobre quejas cognitivas subjetivas. Resultados: Aunque a nivel individual no presenten enfermedad objetivable, a nivel de grupo los pacientes con QCS rinden peor en test neuropsicológicos que la población general y tienen mayor incidencia de declive cognitivo futuro. La depresión y la comorbilidad psiquiátrica desempeñan un papel pero no son la única causa de quejas cognitivas. Estudios con resonancia magnética muestran un patrón de atrofia hipocampal similar al del deterioro cognitivo leve amnésico y en resonancia funcional hay aumento de activación en tareas cognitivas que podrían representar una compensación ante pérdida de función. Los pacientes con QCS presentan un patrón tipo EA de marcadores betaamiloide (A 42) y tau con mayor frecuencia que la población general. Conclusiones: Las quejas mnésicas son un síntoma relevante y podrían predecir EA. La heterogeneidad de los pacientes y de los ensayos clínicos ha dificultado la definición del síndrome. En el futuro, una definición estandarizada y estudios longitudinales con un seguimiento suficiente, y centrados en variables cuantificables, podrían clarificar aspectos tempranos de la EA

Introduction: Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies. Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD. Method: We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment. Results: Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (A 42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population. Conclusions: Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD

Qué no hacer en la EPOC. Análisis metodológico / No disponible

Objetivo: Identificar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) prácticas diagnósticas, terapéuticas y de autocuidado que resultan inadecuadas, de dudosa efectividad o que no son coste-efectivas, tanto en fase estable como durante una agudización. Material y método: El estudio se ha organizado en 3 fases y diseñado para identificar prácticas que no aportan valor o que deben desaconsejarse en el manejo de la EPOC estable y agudizada, y en los autocuidados llevados a cabo por estos pacientes. La primera fase se realizó mediante la técnica Metaplan en la que se puntuaron y seleccionaron las prácticas que con más frecuencia claramente debían desaconsejarse. La segunda fase se hizo a través de la web mediante una técnica de conferencia de consenso que permitió la valoración y la selección jerarquizada de las recomendaciones en función de la frecuencia en que ocurren y la intensidad en el que esa práctica resultaba inútil o perjudicial. En la tercera fase se elaboró una ficha descriptiva de cada una de las recomendaciones finales, que incluye la descripción de la práctica a erradicar, el nivel de evidencia y grado de recomendación y los indicadores de la medida en que se ha logrado un cambio en la práctica. Resultados: Los resultados se mostrarán en una tabla que recogerá las prácticas ‘no hacer’ en la EPOC, con la frecuencia con que se produce la práctica que se desaconseja y la intensidad con que la práctica resulta inadecuada, tanto en la EPOC estable como en la EPOC agudizada y en las prácticas realizadas por los pacientes. Además, se desarrollará en una ficha técnica para cada recomendación en el que se expondrá la denominación, la justificación y el nivel de evidencia de la recomendación. También se elaborarán indicadores que permitan evaluar los datos recogidos y que se haya logrado cambiar la práctica inadecuada, ineficaz o no coste-efectiva. Conclusiones: Las recomendaciones 'Qué no hacer en la EPOC' mejorarán el manejo de esta patología al reducir las prácticas diagnósticas, terapéuticas o de cuidados que sean inadecuadas o no coste-efectivas

Objective: To identify diagnostic, therapeutic and self-care practices in chronic obstructive pulmonary disease (COPD) patients which are inadequate, of dubious effectiveness or non cost-effective, both in stable phase and during an exacerbation. Material and Methods: The study was performed in 3 phases and designed to identify practices which do not add value or must be discouraged in the management of stable COPD and its exacerbations, and also in self-care carried out by the patients. The first phase was carried out by the Metaplan technique in which the most frequent practices which had to be clearly discouraged were rated and selected . The second phase was made through the web by a consensus conference technique that allowed to evaluate and select hierarchically recommendations based on the frequency of occurrence and intensity of the practices which were found useless or harmful. In the third phase a technical file on each of the final recommendations was created. It includes the description of the practices which must be eradicated, evidence levels and recommendation degrees, as well as indicators of the measure achieved thanks to the change in practice. Results: The results are shown in a table that summarizes ‘do not do’ practices in COPD, the frequency with which the practice is discouraged and the intensity with which the practice is inadequate, both in stable and exacerbated COPD and in practices carried out by patients. In addition, there will be a technical file developed for each recommendation with denomination, justification and evidence level of the recommendation. Indicators, permitting to evaluate collected data and the improvements reached by decreasing inadequate, ineffective or non cost-effective practices, will also be developed. Conclusions: 'Do not do' recommendations in COPD will improve the management of this patology by reducing inadequate or non cost-effective diagnostic, therapeutic or care practices

Subjective cognitive impairment: Towards early identification of Alzheimer disease. / Quejas cognitivas subjetivas: hacia una identificación precoz de la enfermedad de Alzheimer.

INTRODUCTION: Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies.Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD. METHOD: We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment. RESULTS: Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (Aß42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population. CONCLUSIONS: Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD.

[Transient ischemic attack: the only presenting syndrome of dural sinus thrombosis]. / Ataque isquémico transitorio como expresión de trombosis de senos venosos durales.

INTRODUCTION: Intracranial hypertension (ICHT) is the most frequent presenting syndrome of dural vein sinus thrombosis (CVT). A transient ischemic attack as an acute mode of onset is exceptional. CASE REPORT: A right handed, forty years old man with a medical history of recurrent headaches, microcephalia and calcifications in his brain, presenting to the emergency department with left paresis that lasted a few minutes and with a complete recovery. The cerebral and neck magnetic resonance (MR) including MR angiography showed superior sagittal sinus, both transverse sinuses and right sigmoid sinus thrombosis with an increase in size of superficial cerebral venous that drained to the left sigmoid sinus. There was no evidence of intracranial dural malformations. The cerebral MR did not show any abnormal parenchymal enhancement (edema, arterial or venous infarctions, hemorrhage) including diffusion-weighted IMR. The digital subtraction angiography (ADC) confirmed the same findings as the MR angiography. The diagnosis was a chronic CVT. We studied stroke in a young adult and we did not find other irregularities. The neurological examination was normal when the patient left the hospital with an antiplatelet drug. CONCLUSIONS: Focal neurological deficit is an exceptional event of a chronic vein sinus thrombosis during follow-up. Isolated cases regarding an acute time course have been described. The interest of this case lies in the fact that venous sinus thrombosis rarely has transitory focal deficit in its course and we found no such description as onset symptoms.

[Neurotransmitters in Alzheimer's disease]. / Neurotransmisores en la enfermedad de Alzheimer.

AIM: To review the current state of the art in neurotransmission in Alzheimer's disease (AD) and its involvement in the pathophysiology of the disease. INTRODUCTION: AD is a neurodegenerative disorder that is estimated to affect 15 million people around the world. Since the cholinergic hypothesis of AD was put forward 20 years ago, numerous studies have been conducted in an attempt to determine the role that neurotransmitters play in AD. Among other things, this has made it possible to develop drugs based on the inhibition of acetylcholinesterase. DEVELOPMENT: The monoaminergic neurotransmission systems are examined, with special attention given to the cholinergic system, and their anatomical distribution, function, receptors, activity and degradation systems are also described. Peptidergic neurotransmission systems are only briefly discussed, since they are not the main objective of this report. We also review the cholinergic hypothesis and the possible interrelations between cholinergic neurotransmission and beta-amyloid metabolism, as well as the potential involvement of acetylcholinesterase inhibitor drugs in more fundamental pathophysiological mechanisms, which act with a neuroprotective component.

Ataque isquémico transitorio como expresión de trombosis de senos venosos durales / Transient ischemic attack: the only presenting syndrome of dural sinus thrombosis

Introducción. La forma más frecuente de expresión de la trombosis de senos venosos (TSV) durales es la hipertensión intracraneal (HTIC). Excepcionalmente puede manifestarse clínicamentre como déficit neurológico focal. Caso clínico. Paciente varón de 40 años, con antecedentes personales de cefaleas recurrentes, microcefalia y calcificaciones cerebrales que consultó por dos episodios de hemiparesia izquierda de minutos de duración con recuperación completa. La resonancia magnética (RM) craneal y cervical, incluyendo secuencias de angio-RM most´ró trombosis del seno sagital superior, ambos senos transversos y seno sigmoide derecho con marcado aumento del tamaño de venas cerebrales superficiales que drenaban en el seno sigmoide izquierdo, sin existencia de malformaciones durales intracraneales. No presentó alteración del parénquima cerebral en forma de edema, infartos, hemorragia ni infartos venosos en ninguna de las secuencias (incluida la difusión). La angiografía por sustracción digital (ADC) confirmó los hallazgos de angio-RM. Se interpretó como TSV de curso crónico, procediendo al estudio de ictus en paciente joven, no encontrando otras alteraciones significativas. La exploración neurológica a alta fue normal, pautándose tratamiento antiagregante. Conclusiones. La sintomatología focal transitoria como manifestación clínica de una TSV de curso crónico es excepcional. Se han descrito casos aislados con referencia a un curso temporal agudo. El interés del caso reside en que la trombosis de senos venosos rara vez presenta clínica focal transitoria deficitaria en su evolución y no hemos encontrado tal descripción como sintomatología de inicio

Introduction. Intracranial hypertension (ICHT) is the most frequent presentig syndrome of dural vein sinus thrombosis (CVT). A transient ischemic attack as an acute mode of onset is exceptional. Case report. A right handed, forty years old man with a medical history of recurrent headaches, microcephalia and calcifications in his brain, presenting to the emergency department with left paresis that lasted a few minutes and with a complete recovery. The cerebral and neck magnetic resonance (MR) including MR angiography showed superior sagital sinus, both transverse sinuses and right sigmoid sinus thrombosis with and increase in size of superficial cerebral venous that drained to the left sigmoid sinus. There was no evidence of intracranial dural malformations. the cerebral MR did not show any abnormal parenchymal enhancement (edema, arterial or venous infarctions, hemorrhage) including diffusion-weighted IMR. The digital subtration angiography (ADC) confirmed the same findings as the MR angiography. the diagnosis was a chronic CVT. We studied stroke in a young adult and we did not find other irregularities . the neurological examination was normal when the patients left the hospìtal with and antiplatelet drug. conclusions. focal neurological deficit is an exception event of a chronic vein sinus thrombosis during follow-up. Isolated cases regarding an acute time course have been described. The interest of this case lies in the fact that venous sinus thrombosis rarely has transitory focal deficit in its course and we found no such description as onset symptoms

Neurotransmisores en la enfermedad de Alzheimer / Neurotransmitters in Alzheimer’s disease

Objetivo. Revisar el estado actual de los conocimientos sobre la neurotransmisión en la enfermedad de Alzheimer (EA) y su implicación en la fisiopatología de la enfermedad. Introducción. La EA es un trastorno neurodegenerativo que se estima que afecta a 15 millones de personas en todo el mundo. Desde que se postuló hace 20 años la hipótesis colinérgica de la EA, se han realizado múltiples estudios para intentar conocer el papel que desempeñan los neurotransmisores en la EA. Entre otras cosas, esto ha permitido el desarrollo de fármacos basados en la inhibición de la acetilcolinesterasa. Desarrollo. Se revisan los sistemas de neurotransmisión monoaminérgicos, con especial atención en el sistema colinérgico, describiendo su distribución anatómica, función, receptores, actividad y sistemas de degradación. Se citan brevemente, ya que no es el objetivo primario de esta revisión, los sistemas de neurotransmisión peptidérgicos y se revisan la hipótesis colinérgica y las posibles interrelaciones entre la neurotransmisión colinérgica y el metabolismo del b-amiloide, así como la posible implicación de los fármacos inhibidores de la acetilcolinesterasa en mecanismos fisiopatológicos más básicos, con un componente neuroprotector (AU)

Aim. To review the current state of the art in neurotransmission in Alzheimer’s disease (AD) and its involvement in the pathophysiology of the disease. Introduction. AD is a neurodegenerative disorder that is estimated to affect 15 million people around the world. Since the cholinergic hypothesis of AD was put forward 20 years ago, numerous studies have been conducted in an attempt to determine the role that neurotransmitters play in AD. Among other things, this has made it possible to develop drugs based on the inhibition of acetylcholinesterase. Development. The monoaminergic neurotransmission systems are examined, with special attention given to the cholinergic system, and their anatomical distribution, function, receptors, activity and degradation systems are also described. Peptidergic neurotransmission systems are only briefly discussed, since they are not the main objective of this report. We also review the cholinergic hypothesis and the possible interrelations between cholinergic neurotransmission and β-amyloid metabolism, as well as the potential involvement of acetylcholinesterase inhibitor drugs in more fundamental pathophysiological mechanisms, which act with a neuroprotective component (AU)

Síndrome de encefalopatía posterior reversible / Posterior reversible encephalopathy syndrome

No disponible

Prevalencia y factores asociados a malnutrición en ancianos hospitalizados / Prevalence and risk factors associated to malnutrition in elderly inpatients

Fundamento: La malnutrición en ancianos que son ingresados en los hospitales es un hecho frecuente y ocasiona un deterioro en distintos órganos y sistemas que condiciona un aumento de la estancia hospitalaria, costes sanitarios y mortalidad. Los factores de riesgo de malnutrición en este grupo de enfermos no están bien estudiados. Método: Se realizó un estudio transversal de pacientes mayores de 70 años que ingresaron en una sala de hospitalización de medicina interna para conocer la prevalencia de malnutrición al ingreso y sus posibles factores de riesgo. Se consideró que un paciente padecía malnutrición si el pliegue tricipital o el perímetro braquial se situaba por debajo del percentil 10 y/o presentaba valores inferiores a la normalidad en al menos dos de los siguientes parámetros: albúmina plasmática (menor de 3,5 mg/dl), transferrina plasmática (menor de 150 mg/dl) o recuento linfocitario en sangre periférica (menor de 1500/mm3). Resultados: El promedio de edad de los 105 pacientes incluidos en el estudio fue de 83,0 ± 6,4 años, con un predominio de pacientes del sexo femenino (61 por ciento). Treinta y tres pacientes (31 por ciento) procedían de residencias de ancianos. Un 35 por ciento que presentaban un deterioro grave del estado funcional. Cincuenta y ocho pacientes presentaron malnutrición en el momento del ingreso (prevalencia = 57,1 por ciento; IC95 por ciento 47,1 - 66,8 por ciento). Los únicos factores asociados a malnutrición al ingreso fueron presentar una enfermedad infecciosa y padecer enfermedad pulomonar obstructiva crónica (EPOC, razones de prevalencia 1,4 y 0,5 respectivamente). Conclusiones: La prevalencia de malnutrición en los ancianos hospitalizados de más de 70 años es muy elevada. Las enfermedades infecciosas en el momento del ingreso y la EPOC se asocian positiva y negativamente al riesgo de presentar malnutrición (AU)

[Evaluation of medical reports received from the second level of care]. / Valoración de los informes médicos recibidos del segundo nivel.

OBJECTIVES: To quantify the monthly inter-clinic rate (MIR), the medical reports received, their quality and the period of delay until the first second-level consultation. DESIGN: Cross-sectional, descriptive study. SETTING: Rural health centre. SAMPLE: 498 first consultations requested of the second level by three family medicine lists between June and November 1999. 132 were excluded for presenting a criterion of exclusion (consultations within the second level, check-ups, appointments missed by the patient and consultations that could not be recorded), which left a sample size of 366. MEASUREMENTS AND RESULTS: Mean MIR was 34 . Ophthalmology (21.9%), gynaecology (15.3%) and traumatology (13.9%) were the most commonly requested services. 69 reports (18.8%) were received, leaving 297 (81.2%) not received. Pneumology (100%) and internal medicine (81.8%) services sent through most reports, whereas haematology and rehabilitation (0%) sent through least. The mean score on the reports was 8 +/- 2 out of a maximum of 10. Mean delay was 73 +/- 46 days. CONCLUSION: The monthly inter-clinic rate found was within the figures cited in the literature. The percentage of reports received was way below what was found in the literature, but their quality was good.