Extraction and Characterization of Tunisian Quercus ilex Starch and Its Effect on Fermented Dairy Product Quality.

In this study, a new starch has been isolated from acorn (Quercus ilex) fruits. The chemical composition of acorn flour showed its richness in carbohydrates (64.43%), proteins (8%), and fat (10%). The extraction yield of acorn starch was about 34.5%. Thus, the composition of extracted acorn starch and its physical and functional properties were studied. Acorn starch had high purity represented by low proportions of proteins (0.92%) and lipids (0.51%) with a pH of 5.3. The swelling power was 20.76 g/g, while the solubility was about 64.22% at 90°C which suggests that acorn starch has potential for use in food industries. The FT-IR spectra of isolated native starches have shown the main bands characterizing the starch. However, X-ray diffractograms exhibited an A- and B-type diffraction pattern. Furthermore, the effect of acorn starch incorporation at different levels (0.5%, 1%, 1.5%, and 2%) on the quality parameters of a fermented dairy product was investigated at the beginning of storage. The results demonstrated that the most suitable dose of acorn starch to be incorporated in the fermented dairy product was lower than 1%. This low concentration reduced syneresis, improved functional properties, and enhanced the viscosity of the fermented dairy product.

Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome.

RATIONALE: Little is known about the long-term outcomes and costs of survivors of acute respiratory distress syndrome (ARDS). OBJECTIVES: To describe functional and quality of life outcomes, health care use, and costs of survivors of ARDS 2 yr after intensive care unit (ICU) discharge. METHODS: We recruited a cohort of ARDS survivors from four academic tertiary care ICUs in Toronto, Canada, and prospectively monitored them from ICU admission to 2 yr after ICU discharge. MEASUREMENTS: Clinical and functional outcomes, health care use, and direct medical costs. RESULTS: Eighty-five percent of patients with ARDS discharged from the ICU survived to 2 yr; overall 2-yr mortality was 49%. At 2 yr, survivors continued to have exercise limitation although 65% had returned to work. There was no statistically significant improvement in health-related quality of life as measured by Short-Form General Health Survey between 1 and 2 yr, although there was a trend toward better physical role at 2 yr (p = 0.0586). Apart from emotional role and mental health, all other domains remained below that of the normal population. From ICU admission to 2 yr after ICU discharge, the largest portion of health care costs for a survivor of ARDS was the initial hospital stay, with ICU costs accounting for 76% of these costs. After the initial hospital stay, health care costs were related to hospital readmissions and inpatient rehabilitation. CONCLUSIONS: Survivors of ARDS continued to have functional impairment and compromised health-related quality of life 2 yr after discharge from the ICU. Health care use and costs after the initial hospitalization were driven by hospital readmissions and inpatient rehabilitation.

One-year outcomes in survivors of the acute respiratory distress syndrome.

BACKGROUND: As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed. METHODS: We evaluated 109 survivors of the acute respiratory distress syndrome 3, 6, and 12 months after discharge from the intensive care unit. At each visit, patients were interviewed and underwent a physical examination, pulmonary-function testing, a six-minute-walk test, and a quality-of-life evaluation. RESULTS: Patients who survived the acute respiratory distress syndrome were young (median age, 45 years) and severely ill (median Acute Physiology, Age, and Chronic Health Evaluation score, 23) and had a long stay in the intensive care unit (median, 25 days). Patients had lost 18 percent of their base-line body weight by the time they were discharged from the intensive care unit and stated that muscle weakness and fatigue were the reasons for their functional limitation. Lung volume and spirometric measurements were normal by 6 months, but carbon monoxide diffusion capacity remained low throughout the 12-month follow-up. No patients required supplemental oxygen at 12 months, but 6 percent of patients had arterial oxygen saturation values below 88 percent during exercise. The median score for the physical role domain of the Medical Outcomes Study 36-item Short-Form General Health Survey (a health-related quality-of-life measure) increased from 0 at 3 months to 25 at 12 months (score in the normal population, 84). The distance walked in six minutes increased from a median of 281 m at 3 months to 422 m at 12 months; all values were lower than predicted. The absence of systemic corticosteroid treatment, the absence of illness acquired during the intensive care unit stay, and rapid resolution of lung injury and multiorgan dysfunction were associated with better functional status during the one-year follow-up. CONCLUSIONS: Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. Most patients have extrapulmonary conditions, with muscle wasting and weakness being most prominent.

Relationship between premortem and postmortem diagnosis in critically ill bone marrow transplantation patients.

OBJECTIVES: To determine the relationship between the premortem and postmortem diagnosis in critically ill bone marrow transplantation patients Also, to evaluate the appropriateness of the reliance on clinical diagnosis for withdrawal of active treatment decision-making. DESIGN: Retrospective cohort study. SETTING: Two university-affiliated tertiary care medical surgical intensive care units. PATIENTS: Critically ill bone marrow transplantation patients who died in the intensive care unit between November 1,1994, and June 30,1999, and underwent postmortem examination. INTERVENTION: Review of medical records by two independent data extractors. Clinical diagnosis and cause of death in the intensive care unit were compared with the final autopsy report. MEASUREMENTS AND MAIN RESULTS: Premortem clinical diagnoses were classified according to the Goldman criteria and compared with postmortem findings. Twenty-eight autopsies were done. Ten of 28 (36%) patients had discrepancies uncovered on autopsy; only two discrepancies would have influenced patient management and none would have altered patient outcome. Twenty patients had their active treatment withdrawn and underwent postmortem examination. None of the discrepancies noted would have altered outcome in these patients. CONCLUSION: In the bone marrow transplantation population, there is significant concordance between clinical diagnosis and postmortem findings. Reliance on clinical diagnosis may be valid for withdrawal of active treatment decision-making in these patients.