Impact of Protein Content on the Antioxidants, Anti-Inflammatory Properties and Glycemic Index of Wheat and Wheat Bran.

Conventional wheat milling generates important volumes of wheat bran (WB), which is a concentrated source of polyphenols and insoluble fiber. In terms of health benefits and based on epidemiological and experimental evidence, these compounds contribute to reducing the risk of certain chronic pathologies. Protein concentration is the main quality factor conditioning wheat use in the agroindustry. When turning waste into feasible resources, it is essential to evaluate the variability of the raw material. The aim of this study was the evaluation of the impact of protein content in the valorization of WB based on its antioxidants, anti-inflammatory properties and glycemic index (GI). A significantly (p ≤ 0.05) lower content of phenolic compounds was found in the whole grain (WG) fractions, both free (FP) and bound (BP), as compared to the WB phenolic fractions, differences that ranged from 4- to 6-fold (538 to 561 mg GAE 100 g-1 in WG vs. 1027 to 1236 in WB mg GAE 100 g-1 in FP and 2245 to 2378 vs. 6344 to 7232 mg GAE 100 g-1 in BP). A significant (p ≤ 0.05) effect of the protein content on the resulting phenolic content and antioxidant capacity was observed, especially in WG, but also in WB, although in the latter a significant (p ≤ 0.05) negative correlation was observed, and increasing the protein content resulted in decreasing total phenolic content, antioxidants, and ferric-reducing capacities, probably due to their different types of proteins. The highest protein content in WB produced a significant (p ≤ 0.05) reduction in GI value, probably due to the role of protein structure in protecting starch from gelatinization, along with phytic acid, which may bind to proteins closely associated to starch and chelate calcium ions, required for α-amylase activity. A significant (p ≤ 0.05) effect of the protein content on the GI was also found, which may be explained by the structural effect of the proteins associated with starch, reducing the GI (21.64). The results obtained show the importance of segregation of WB in valorization strategies in order to increase the efficiency of the processes.

Luxación bilateral de cristalino en octogenaria / Bilateral luxation of crystalline lens in an octogenarian

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Particulate wear debris osteolysis, acute urinary retention and delirium as late complications of hip arthroplasty.

Intrapelvic mass formation as a result of particulate wear debris induced osteolysis is a recognised late complication of cementless total hip arthroplasty. Clinical presentation typically involves hip and/or leg pain resulting in functional impairment, and obstructive urinary symptoms developing 3-20 years after surgery. An acute confusional state has never been described in this scenario. We report the case of an 86-year-old gentleman with a diagnosis of dementia brought to our emergency department with an acute confusional state. Abdominal imaging revealed a distended bladder, a large pelvic mass and a lytic lesion within his right acetabulum. Cytological and microbiological examination of fluid obtained with radiologically guided aspiration of the mass was negative for neoplasia and infection.

Síndrome confusional en paciente octogenaria con implante reciente de marcapasos / Confusional state in an octogenarian patient with a recent implantation of pacemaker

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Ortogeriatría: primer registro multicéntrico autonómico de fracturas de cadera en Castilla y León (España) / Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)

Objetivo: El objetivo de este trabajo es describir las características de los pacientes con fractura de cadera en los hospitales públicos de Castilla y León recogidos durante un periodo de tiempo de 3 meses (noviembre del 2014 y octubre y noviembre del 2015). Material y método: El grupo de trabajo de Ortogeriatría de Castilla y León elabora un registro común para recoger datos de las fracturas de cadera. Se incluyen mayores de 74 años ingresados por fractura de cadera, en 13 hospitales públicos de la comunidad, los meses de noviembre del 2014 y octubre-noviembre del 2015. Es un estudio multicéntrico, prospectivo y observacional en el que se recogieron variables clínicas, funcionales, sociales y mortalidad intrahospitalaria. Resultados: Se analizaron 776 pacientes, con una edad media de 86,6±6 años. La demora quirúrgica fue de 4±2,8 días y la estancia media hospitalaria de 10±4,7 días. El riesgo anestésico fue ASA 3±0,6. El 66,5% de los pacientes tuvieron complicaciones médicas intrahospitalarias y precisaron transfusión el 55,5%. Fallecieron durante la hospitalización un 4,6%. La estancia media prequirúrgica se relacionó con la estancia global, con p<0,001. Conclusiones: Los registros de fractura de cadera son una herramienta esencial para evaluar el proceso y mejorar la calidad asistencial de estos pacientes. Este es el primer registro multicéntrico de fracturas de cadera en ancianos realizado en una región de España y puede ser un buen precedente de referencia ante el futuro registro nacional (AU)

Objective: The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). Material and method: The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. Results: The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. Conclusions: Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register (AU)

[Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)]. / Ortogeriatría: primer registro multicéntrico autonómico de fracturas de cadera en Castilla y León (España).

OBJECTIVE: The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). MATERIAL AND METHOD: The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. RESULTS: The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. CONCLUSIONS: Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register.

Síncope por risa: descripción de un caso y revisión de la literatura / Laughter-induced syncope: description of a case and review of the literature

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Actividad ortogeriátrica en los hospitales públicos de Castilla y León: descripción y revisión de la literatura / Orthogeriatric activity in public hospitals of Castilla y León: Description and review of the literature

El beneficio de la colaboración entre traumatología y geriatría en la atención del anciano que ingresa por fractura de cadera está ampliamente demostrado. Para conocer las características de colaboración entre Traumatología y Geriatría en los hospitales públicos de Castilla y León se realizó una encuesta a todos los geriatras de la comunidad, interrogándoles sobre el tipo de colaboración que mantenían con Traumatología para la atención del anciano que ingresa con fractura de cadera y detalles sobre el tratamiento de las complicaciones. Los resultados más relevantes fueron que la mayoría de los hospitales mantienen una colaboración ortogeriátrica con alto grado de implicación por parte de Geriatría y el geriatra atiende las complicaciones médicas de estos pacientes. La estancia media hospitalaria es de 10 d y la estancia prequirúrgica de 3 d. En este artículo se detallan cómo se manejan los problemas clínicos más frecuentes en nuestra comunidad, comparándolo con las recomendaciones actuales de las guías de práctica clínica y de las últimas publicaciones (AU)

The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides (AU)

[Orthogeriatric activity in public hospitals of Castilla y León: description and review of the literature]. / Actividad ortogeriátrica en los hospitales públicos de Castilla y León: descripción y revisión de la literatura.

The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides.

Differences in fear of falling in the elderly with or without dizzines.

To compare prevalence and risk factors associated with fear of falling (FoF) in two groups of elderly people, 109 patients with recurrent dizziness and 109 controls without dizziness. FoF was defined as a positive response to the single question and with Falls Efficacy Scale of >50. The prevalence of FoF was greater (71.6%) in the dizzy group (control, 31.2%; p<0.001). Factors associated with FoF in the dizzy-group were diabetes, high General Health Questionnaire (GHQ-28) score and poor balance score. In the non-dizzy group, female gender, high GHQ, and poor gait score in Tinetti's scale were the association. Further research is needed to explore the relationship between dizziness and FoF.

[Ethical issues in older admitted patients. Experience in the United Kingdom]. / Cuestiones éticas en los pacientes mayores hospitalizados. Experiencia en el Reino Unido.

The United Kingdom is a rapidly aging society. More than half of the hospital beds are occupied by older people. They are considering increasingly themselves as able to flourish, enjoying a fulfilling live and with the same rights and dignity than the rest of the population. Keeping independence is one of their main objectives. However, this society realized that the Health Service were outdated and not suited to the correct needs of the elderly. A new organization of the National Health Service, the National Service Framework was developed in 2001 which led to a health and social care more appropriate. New ethical principles as respect to the person, non-discrimination by age and Person Centred Care were focused in this new organization. This means providing the comprehensive geriatric assessment, rationalization of care with the union of social and health services and the pursuit of high levels of quality of care for the elderly. The ethical principles of action with older people also represent standards of conduct for doctors, nurses and other healthcare professionals aimed at enabling the elderly to make decisions that affect them, to keep their dignity and to be given a fair deal and proper care.

Síndrome de temor a caerse en personas mayores de 65 años con mareos de repetición: estudio descriptivo / Fear of falling in the elderly with recurrent dizziness: A descriptive study

Introducción. Los objetivos de este estudio son analizar la prevalencia y los factores de riesgo del síndrome de temor a caerse (STAC) en personas mayores de 65 años con mareos de repetición. Métodos. Estudio transversal que incluye 109 pacientes derivados desde atención primaria o urgencias extrahospitalarias del centro de salud, desde enero a diciembre de 2008, en Archena (Murcia) por mareos de repetición. Se registra historia clínica, fármacos, grado de temor a caerse a través de pregunta simple y escala Falls Efficacy Scale (FES) y situación social y funcional mediante cuestionarios CUBRECAVI y GHQ-28. Resultados. El STAC ocurre en el 71,5% de esta población con mareos de repetición y afecta más a mujeres que a hombres. Las variables asociadas con alto riesgo para STAC tras análisis multivariante fueron diabetes mellitus (OR: 35,15; intervalo de confianza [IC]: 4,57–270,07; p<0,001) y consumo de antidepresivos (OR: 9,84; IC: 1,48–65,36; p=0,017), mientras que las variables asociadas con bajo riesgo para STAC fueron una mayor frecuencia de relaciones sociales (OR: 0,18; IC: 0,04–0,86; p=0,017) e independencia para las actividades de la vida diaria (OR: 0,17; IC: 0,04–0,76; p=0,021). Conclusiones. Entre pacientes mayores con mareos frecuentes se observa una muy elevada proporción de síndrome de miedo a caerse. Este resultado es uno de los más altos publicados. Los factores asociados al STAC en esta población fueron tener diabetes mellitus y tomar antidepresivos como factores de riesgo; mientras, la mayor frecuencia de relaciones sociales y mayor independencia para las actividades de la vida diaria son factores protectores. En esta población, haber sufrido caídas no se asocia al STAC(AU)

Introduction. The aims of this research are to analyse prevalence and risk factors of the fear of falling in people over 65 years with recurrent dizziness. Methods. This cross-sectional study includes 109 patients sent from General or Emergency Primary Care clinics of a Health Centre from January to December 2008 in Archena (Murcia). Data collected were clinical history, medication, fear of falling using a single question and Falls Efficacy Scale as well as social and functional status using Cubrecavi (Quality of Life Short Questionnaire) and GHQ-28 (General Health Questionnaire). Results. Fear of falling is detected in 71.5% of our elderly population with recurrent dizziness, and it affects women more often than men. The variables associated with fear of falling in the multivariate analysis were, diabetes mellitus (OR: 35.15; 95%CI: 4.57–270.07; P<0,001), taking antidepressants (OR: 9.84;95%CI: 1,48–5.36; P=0.017), and frequency of social relations (OR: 0.18; 95%CI: 0.04–0.86; P=0.017); and independence for activities of daily living (OR: 0.17;95% CI: 0.04–0.76; P=0.021). Conclusion. A very high proportion of fear of falling is observed among elderly patients with frequent dizziness. This is one of the highest proportions published. Associated factors with fear of falling were, having diabetes mellitus and taking antidepressants, as risk factors; and higher frequency of social relationships and higher independence for activities of daily living as protective factors. In this population, having had a fall is not related to fear of falling(AU)

[Fear of falling in the elderly with recurrent dizziness: a descriptive study]. / Síndrome de temor a caerse en personas mayores de 65 años con mareos de repetición: estudio descriptivo.

INTRODUCTION: The aims of this research are to analyse prevalence and risk factors of the fear of falling in people over 65 years with recurrent dizziness. METHODS: This cross-sectional study includes 109 patients sent from General or Emergency Primary Care clinics of a Health Centre from January to December 2008 in Archena (Murcia). Data collected were clinical history, medication, fear of falling using a single question and Falls Efficacy Scale as well as social and functional status using Cubrecavi (Quality of Life Short Questionnaire) and GHQ-28 (General Health Questionnaire). RESULTS: Fear of falling is detected in 71.5% of our elderly population with recurrent dizziness, and it affects women more often than men. The variables associated with fear of falling in the multivariate analysis were, diabetes mellitus (OR: 35.15; 95%CI: 4.57-270.07; P<0,001), taking antidepressants (OR: 9.84;95%CI: 1,48-5.36; P=0.017), and frequency of social relations (OR: 0.18; 95%CI: 0.04-0.86; P=0.017); and independence for activities of daily living (OR: 0.17;95% CI: 0.04-0.76; P=0.021). CONCLUSION: A very high proportion of fear of falling is observed among elderly patients with frequent dizziness. This is one of the highest proportions published. Associated factors with fear of falling were, having diabetes mellitus and taking antidepressants, as risk factors; and higher frequency of social relationships and higher independence for activities of daily living as protective factors. In this population, having had a fall is not related to fear of falling.

Fear of falling among elderly patients with dizziness and syncope in a tilt setting.

The objectives of this study were to assess the prevalence of fear of falling (FOF) among patients over age 60 with dizziness, falls, or syncope; and to analyze risk factors associated with FOF, including data from the tilt table test. This study included 200 older patients referred to a geriatric outpatient clinic specializing in dizziness, falls, and syncope. The primary outcome measure was the proportion of patients who experienced FOF (yes vs. no) and whether FOF restricted leaving home alone or performing activities of daily living. FOF occurred in 50 per cent of patients in this population. Among these, 44 per cent gave up going out alone and 10 per cent stopped doing basic activities of daily living. Beyond age 75, FOF was associated with recurrent dizziness, depression, and symptoms on standing, but not prior falls.

Norfloxacin modulates the inflammatory response and directly affects neutrophils in patients with decompensated cirrhosis.

BACKGROUND & AIMS: Patients with cirrhosis undergoing selective intestinal decontamination with norfloxacin show a reduction in serum cytokine levels, probably because of a combined effect of norfloxacin on bowel flora and neutrophils. METHODS: Thirty-one patients with cirrhosis receiving norfloxacin (400 mg/day) were included. Blood samples were collected at 0.5-4 hours (peak samples group, n = 47) and at 22-24 hours (trough samples group, n = 84) after dose. Fifty-nine ascitic fluid samples were obtained. Single doses of norfloxacin and trimethoprim/sulfamethoxazole were administered to 13 and 5 patients, respectively, (temporal profile group) and samples were collected at 0, 0.5, 1, 1.5, 2, 4, and 24 hours. Norfloxacin, trimethoprim/sulfamethoxazole, cytokines, nitric oxide, expression levels of nuclear factor (NF)-kappaB and inhibitor of NF-kappaB (IkB-alpha), neutrophil oxidative burst, and rate of apoptotic events were determined. RESULTS: All samples were bacterial DNA negative and had no significant levels of lipopolysaccharide. Serum and ascitic levels of tumor necrosis factor-alpha, interferon-gamma, interleukin-12, and nitric oxide were significantly lower in peak than in trough samples. A correlation was present between serum norfloxacins concentrations and tumor necrosis factor-alpha (r = -0.68; P < .001), interferon-gamma (r = -0.66; P < .001), interleukin-12 (r = -0.66; P < .001), and nitric oxide (r = -0.68; P < .001). Serum norfloxacin's highest concentrations (1 +/- 0.5 microg/mL) were achieved at 1-2 hours and concurred in time with the lower levels of cytokines and nitric oxide. Intracellular norfloxacin's highest levels (2 +/- 1 microg/mL/10(7) cells) were observed at 2 hours and concurred with a lower NF-kappaB expression, a reduced anion superoxide generation, and apoptotic rate in response to phorbol myristate acetate. Trimethoprim/sulfamethoxazole did not significantly modulate cytokine expression. CONCLUSIONS: Norfloxacin but not trimethoprim/sulfamethoxazole modulates inflammatory response and directly affects neutrophils in patients with cirrhosis.