Prevalence of electrocardiographic alterations in athletes associated with cardiovascular risk parameters / Prevalencia de alteraciones electrocardiográficas en deportistas asociadas a parametros de riesgo cardiovascular

Sport induces cardiac adaptations that are manifested with specific electrocardiographic alterations. This study was carried out in view of the need to identify the relationship between these electrocardiographic alterations with cardiovascular and demographic variables and physical exercise performed. Methodology: a descriptive cross-sectional study in 370 individuals, 211 men and 159 women (36 ± 13 years) that were distributed in three groups: male athletes, female athletes, and non-athlete men and women. Results: 51.08% of the studied subjects presented electrographic alterations, more frequent in athletes. Demographic and cardiovascular variables and the time of physical exercise performed were significantly associated with certain electrocardiographic alterations; the risk of presenting any of the alterations in athletes could be estimated based on the variables set out. Conclusion: There are associations between specific electrocardiographic alterations and cardiovascular, demographic and type of exercise variables that could classify athletes according to cardiovascular risk profiles (AU)

El deporte induce adaptaciones cardiacasque se manifiestan con alteraciones electrocardiográficas.Este estudio se realizóante la necesidad de identificar la relación existente entre estas alteraciones electrocardiográficas con variablescardiovasculares, demográficas y tiempo de ejerciciofísico. Metodología: estudio descriptivotrasversal en 370 individuos, 211 hombres y 159 mujeres (36 ±13 años)que se distribuyeron en tres grupos, hombres deportistas, mujeresdeportistas, yhombres y mujeres no deportistas.Resultados:El 51,08% de los sujetos estudiados presentaron alteraciones electrográficas, siendo más frecuentes en deportistas.Determinadas alteraciones electrocardiográficasen deportistas; se asociaron significativamente a las variables planteadaspudiendo estimar el riesgo de presentar alguna de las alteraciones electrocardiográficas en función de estas variables. Conclusión:Existen asociaciones entrealteraciones electrocardiográficas y variables cardiovasculares, demográficas y tiempo de ejercicio realizado que podrían clasificar a los deportistas según perfiles de riesgo cardiovascular (AU)

Shortening replacement by emulsion and foam template hydroxypropyl methylcellulose (HPMC)-based oleogels in puff pastry dough. Rheological and texture properties.

Shortening plays an essential function in the formulation of sweet laminated bakery products, but has a potential health risk due to their high percentage of saturated fatty acids. In this paper, the feasibility of hydroxypropyl methylcellulose (HPMC) oleogels prepared with emulsion template (ET) and foam template (FT) approaches as fat sources in a puff pastry dough was investigated. Spreadability and thermal properties of control shortening, 100% ET and FT oleogels and shortening/oleogel (50/50) blends were measured. The different systems were applied as the fat source in a puff pastry dough, and their effect on rheological and texture properties was investigated. Results showed that partial replacement of shortening with oleogels could significantly decrease the firmness values (from 115 to 26 N) (P < 0.05) and increased the spreadability of shortening. The methodology to prepare the oleogel (FT or ET) also significantly affected the texture parameters. FT blends had the highest spreadability with significantly lower firmness values and area under the curve. Thermal values showed that both oleogels could slightly increase the melting point of shortening from 47 to 50 °C. The replacement of shortening with oleogel decreases the viscoelasticity of puff pastry dough and increases its thermal stability but does not significantly change dough viscoelasticity in the shortening/oleogel mixture. These results indicated that both oleogels have promising potential to replace shortening in puff pastry dough formulations, but the ET oleogel showed a more similar behavior to the control shortening than the FT oleogel.

Rheological properties of emulsion templated oleogels based on xanthan gum and different structuring agents.

Oleogel design based on emulsions using food grade polymers is a potential strategy for replacing saturated and trans fats. The aim of this paper is the characterization of sunflower oil-based oleogels structured by a non-surface-active polysaccharide, xanthan gum (XG), in combination with different structuring agents, through an emulsion template approach, which consists in the dehydration of the continuous phase of an oil/water emulsion. Four types of molecules with different origins were used: a synthetic one, polysorbate Tween 80, and other three from natural sources: a protein (whey protein, WP), a lipid (soy lecithin, SL) and a polysaccharide (locust bean gum, LBG). All the emulsions had a high shear thinning character (s = 0.45) and a weak gel behaviour (tanδ = 0.2). Only the LBG emulsions presented significant differences, with higher values of viscosity and viscoelastic moduli. The resulting oleogels showed high gel strength, exhibiting a marked elastic behaviour typical of structured solid systems (G'>G'' and tanδ = 0.06). SL oleogels stood out for presenting the lowest firmness, although internal structure seems to be similar to the rest. Regarding to stability, measurements indicated a great oil binding capacity (90% approx.) after 24 h. It is concluded that obtaining stable and solid-like oleogels with liquid oil using a hydrophilic polymer (XG) combined with different food-grade structuring agents was possible. These systems have great potential in food reformulation, especially for saturated fat substitution.

Care and treatments related to intensive care unit-acquired muscle weakness: A cohort study.

BACKGROUND: Intensive care unit-acquired muscle weakness (ICUAW) has an incidence of 40-46%. Early mobilisation is known to be a protective factor. OBJECTIVE: The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW. METHODS: A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse-patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3-5 of the ICU stay. RESULTS: The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53-62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00-1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00-1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38-0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95-0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97-0.99]), presence of delirium (OR = 0.98; 95% CI [0.97-0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97-0.99]). CONCLUSIONS: The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.

Microencapsulation of rice bran oil using pea protein and maltodextrin mixtures as wall material.

In this work, the encapsulation of rice bran oil extracted using supercritical CO2 has been studied. In the first stage, the emulsification process by high pressure homogenization was studied and optimized. The effect of the working pressure (60-150 MPa), the composition of the carrier (mixtures of pea protein isolate (PPI) and maltodextrin (MD), from 50 to 90% of PPI) and the carrier to oil ratio (2-4) on the emulsion droplet size (EDS) was studied. To minimize the EDS, moderate pressures (114 MPa), a carrier composed mainly by PPI (64%) and carrier to oil ratios around 3.2 were required. The emulsion obtained in the optimal conditions (EDS = 189 ± 3nm) was dried using different technologies (spray-drying, PGSS-drying and freeze drying). The supercritical CO2 based drying process (PGSS) provided spherical particles that resulted in the smallest average size (but broader distribution) and lower encapsulation efficiency (53 ± 2%).

Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. / La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar.

OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.

Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain. / Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España.

AIM: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. METHOD: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation. The survey was completed using a user-protected application and password. The Student's t-test or Mann-Whitney U test and Pearson's correlation or Spearman's Rho test were used for the inferential analysis. RESULTS: Eighty-nine point five percent of the ICU had a glycaemia control protocol, with a predominating range of 110-140mg/dl. Seventy-four point four percent evaluated sedation levels, although only 36% had sedation protocols. Pain assessment was carried out on communicative patients in 73.7%, and on uncommunicative patients in only 47.5%. Only 37.2% performed daily screening to detect delirium and 31.4% of the ICU had delirium prevention protocols, 26.7% had delirium management protocols and 14% had protocols for early mobilisation. Thirty-four point nine percent requested cross consultation with the rehabilitation department. CONCLUSIONS: The implementation of the different protocols associated with the prevention of ICU-acquired muscle weakness was high in relation to glycaemia control protocols, sedation level and pain assessment in communicative patients, and was low for early mobilisation and delirium screening and prevention. Similarly, the physiotherapist was seldom present in the ICU.

[Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society]. / Sueño saludable: evidencias y guias de actuacion. Documento oficial de la Sociedad Española de Sueño.

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed.

Trastorno de retraso de la fase del sueño y del despertar. Síndrome de retraso de fase / Delayed sleep wake phase disorder (DSWPD)

El trastorno de retraso de la fase del sueño y del despertar o síndrome de retraso de fase (SRF) es la alteración del ritmo circadiano de sueño más frecuente y suele manifestarse en la adolescencia. Se caracteriza por un retraso estable, habitualmente de más de dos horas, del inicio y del final del sueño respecto a los horarios convencionales. Clínicamente los pacientes presentan insomnio a la hora de acostarse, con gran dificultad para levantarse por la mañana en la hora deseada. Entre semana, debido a las obligaciones escolares o sociales, los niños con SRF duermen pocas horas, generándose una privación crónica de sueño que se manifestará con somnolencia diurna, fatiga, falta de atención, afectación del rendimiento escolar o absentismo escolar. Característicamente, el fin de semana o durante las vacaciones, cuando están libres de horarios, retrasan el sueño, siendo este de características normales y levantándose descansados. Es importante realizar un diagnóstico precoz para iniciar un tratamiento temprano que minimice las consecuencias del SRF. Por la imposibilidad de seguir unos horarios regulares de estudio ni de trabajo, son jóvenes a los que se califica de noctámbulos o de vagos, a pesar de sus esfuerzos repetidos por adaptarse a unos horarios convencionales, lo que aboca en altos índices de depresión, ansiedad y abuso de sustancias. El retraso de fase de sueño se confirma mediante las agendas de sueño, la actigrafía y los marcadores de fase circadianos. La higiene del sueño, la cronoterapia, la fototerapia y la administración de melatonina son los posibles tratamientos del SRF (AU)

Delayed sleep wake phase disorder (DSWPD) or delayed sleep phase disorder is the most frequent circadian rhythm sleep disorder and is commonly seen in adolescents. DSWPD is characterized by habitual by sleep onset and wake times that are usually delayed more than two hours relative to conventional sleep-wake times. Clinically, affected subjects experience difficulty falling asleep and arising at socially acceptable wake time. Enforced conventional wake times (during the school or working days), may result in chronically insufficient sleep manifested as excessive daytime sleepiness, fatigue, repetitive school absences with negative impact on their attention and academic performance. When allowed to follow their preferred schedule (during the weekends or vacation periods), the patient’s timing of sleep is delayed with normal and restoring sleep. It is very important to make an early diagnosis to initiate treatments that minimize consequences of DSWPD. Although their repetitive attempts to adapt to conventional times, their difficulties to maintain regular school or work timings leads these adolescents to be seen as lazy and not motivated, which usually results in an increase in mood disorders and drug abuse. Delay sleep phase is demonstrated by sleep log, actigraphy monitoring and in the timing of other circadian rhythms. Sleep hygiene, chronotherapy, bright light therapy or melatonin administration are the most habitual treatment of the DSWPD (AU)

[Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality]. / Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera.

AIMS: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. METHOD: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. FINDINGS: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. CONCLUSIONS: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint.

Advance directives in intensive care: Health professional competences.

OBJECTIVE: To identify knowledge, skills and attitudes among physicians and nurses of adults' intensive care units (ICUs), referred to advance directives or living wills. DESIGN: A cross-sectional descriptive study was carried out. SETTING: Nine hospitals in the Community of Madrid (Spain). PARTICIPANTS: Physicians and nurses of adults' intensive care. INTERVENTIONS: A qualitative Likert-type scale and multiple response survey were made. VARIABLES: Knowledge, skills and attitudes about the advance directives. A descriptive statistical analysis based on percentages was made, with application of the chi-squared test for comparisons, accepting p < 0.05 as representing statistical significance. RESULTS: A total of 331 surveys were collected (51%). It was seen that 90.3% did not know all the measures envisaged by the advance directives. In turn, 50.2% claimed that the living wills are not respected, and 82.8% believed advance directives to be a useful tool for health professionals in the decision making process. A total of 85.3% the physicians stated that they would respect a living will, in cases of emergencies, compared to 66.2% of the nursing staff (p = 0.007). Lastly, only 19.1% of the physicians and 2.3% of the nursing staff knew whether their patients had advance directives (p < 0.001). CONCLUSIONS: Although health professionals displayed poor knowledge of advance directives, they had a favorable attitude toward their usefulness. However, most did not know whether their patients had a living will, and some professionals even failed to respect such instructions despite knowledge of the existence of advance directives. Improvements in health professional education in this field are needed.

[Cuff pressure control at the intersinve care unit: influence of nursing professionals' training]. / El control del neumotaponamiento en cuidados intensivos: influencia de la formación de los profesionales de enfermería.

OBJETIVE: To analyze proper control of endotracheal cuff pressure in an intensive care unit. The specific objective is to verify whether training of nursing professionals improves monitoring endotracheal cuff pressure. BASIC PROCEDURES: the study type is descriptive, observational and retrospective. All patients were admitted to the Critical Unit II of the Clínico San Carlos Hospital between May 2010-November 2011, requiring either a tracheal tube or tracheal cannula. Studied variables were: number of in range measures, number of intubated patients, or with tracheal cannula and register. Four cuts were made on all admitted patients admitted during the study period in order to measure endotracheal cuff pressure. Two cuts were performed before the professional nurses training and the other two cuts after a specific training with respect to endotracheal cuff pressure and Zero pneumonia. RESULTS: There were 74 measurements. The first cut obtained 40.74% of measures in range. In the second cut 61.90% of measures were identified in range. In the third cut, it was found that 85.7% of measures were in range and in the fourth court, it was noted the 89.47% of measures were in range. CONCLUSIONS: Monitoring of the endotracheal cuff pressure was inadequate before specific training of professionals. Nursing professionals training facilitates the correct measurement of the endotracheal cuff pressure, which improves patient safety.

[High-flow nasal cannula oxygen therapy in critical patients. Prospective study]. / La oxigenoterapia de alto flujo con cánula nasal en pacientes críticos. Estudio prospectivo.

OBJECTIVE: To analyze the incidence of use of high-flow nasal cannula oxygen (HFNC) in intensive care and evaluate the procedure. BASIC PROCEDURES: descriptive prospective study. INCLUSION CRITERIA: all participants were patients admitted to the intensive care units of the hospital Clínico San Carlos November 2012 - January 2013 that required HFNC. VARIABLES: socio-demographic; indications, complications, objectives and flows of the therapy. Statistical analysis with average, standard deviation and percentages, with the statistical program SPSS ver18.0. RESULTS: 12 cases of which 58.3% were men, with a mean age 68.66 (± 12) and with NEMS 33.25 (±7). The incidence of HFNC was 0.95%. The indication of HFNC was: 75% moderate respiratory failure or need for oxygen supply greater than 40%, 58.3% hypoxemia without hypercapnia, the 41.7% withdrawal and/or employment with non-invasive mechanical ventilation, the 25% support post-extubation, the 16.7% exacerbations of heart failure, the 16.7% improve respiratory work and the 8.3% acute lung edema. The main complications of the HFNC were: mouth-breathing (8.3%), nasal injury (8.3%) and abundant secretions (8.3%). In the fulfilment of the objectives of the HFNC, there was a 91.7% improvement of oxygen therapy, and in 50% of the cases orotracheal intubation was averted. CONCLUSIONS: There is a low incidence of HFNC in the unit. The main indication is the moderate respiratory failure or the high need for oxygen supply. Almost all patients have improved with oxygen therapy, although it has not been possible to avoid intubation.

[Mechanical restraint: its use in intensive cares]. / Contención mecánica: su uso en cuidados intensivos.

OBJECTIVE: To analyze the impact of the use of mechanical restraint (MR) or physical restraints in a Critical Care unit and to evaluate the procedure. BASIC PROCEDURES: A descriptive, prospective study. INCLUSION CRITERIA: patients who required MR from March to June 2010. VARIABLES: demographic, clinical presentation, indications, techniques and devices. A statistical analysis with mean, standard deviation and percentages using the program SPSS 14.0. RESULTS: A total of 85 cases were studied: 65.9% male, mean age 64.19 (±17.9), NEMS 29.3 (±8.2). Incidence of MR: 15.6%. Main indication for MR: Risk of serious disruption of treatment processes (80%). Decision nurse (94.1%). Urgent action: (85.9%). Registration procedure: 57.6%. Information to the family: 9.4%. Previous actions: verbal containment (100%), pharmacological (48.2%). CONCLUSIONS: There is a relevant incidence of MR. The principal reason is that of avoiding interruption of the therapeutic process. The nurse makes the initial decision. Necessary information/training of professionals for legal and ethical repercussions is needed.

An evaluation of a macroalgal bioassay tool for assessing the spatial extent of nutrient release from offshore fish farms.

In this study we develop and evaluate a macroalgal bioassay tool for monitoring the spatial extent of dissolved wastes loaded from offshore fish farms into the marine coastal ecosystem. This tool is based on the analysis of the nitrogen stable isotope ratio (delta(15)N) in tissues of several benthic primary producers (macroalgae and Posidonia oceanica epiphytes) incubated, by means of incubation devices, in the water column at increasing distances (from 0 m to 1000 m) from the fish cages. The bioassays were performed in three fish farms situated in different geographical locations (the Canary Islands, Murcia and Catalonia) and we test: the suitability of the different macroalgae species used in relation with their resistance to incubation and their sensitivity to fish farm wastes and the most appropriate incubation depth (5 m or approximately 20 m) and incubation time (2, 4 or 6 days) to detect the spatial distribution of delta(15)N around fish farms. In general terms, the results showed a significant increment of delta(15)N values toward the fish cages with respect to the reference (initial) and control values for all the species of macroalgae tested except for the red algae Asparagopsis taxiformis from Canary Islands. The magnitude and shape of the reported spatial responses varied as a function of the experimental settings analyzed as well as a function of the nutrient regime characteristics of each coastal area. The spatial gradient was more consistent in the shallow part of the water column (5 m depth), than in the deeper part ( approximately 20 m) and was statistically significant after an incubation period of four days. These results confirm the effectiveness and reliability of the method proposed, enabling the spatial extent of nutrients derived from fish farms to be assessed in an effective and simple manner, suitable for use in monitoring programs around offshore fish farms.

Sensory properties determined by starch type in white sauces: effects of freeze/thaw and hydrocolloid addition.

The effect of 5 types of starch (rice, potato, waxy corn, corn, and modified waxy corn) on the sensory properties of white sauces was studied. A comparative study was also made of variations resulting from freezing/thawing and effect of replacing 0.15% starch with 2 nonstarchy hydrocolloids, xanthan gum (XG), or locust bean gum (LBG) in samples to be frozen. The sensory properties were studied through descriptive analysis by a panel of 10 trained judges. Principal components analysis and cluster analysis were used to group each of the samples according to the scores for consistency, resilience, graininess, thickness, heterogeneity, creaminess, and mouth coating, the sensory attributes which were chosen to define the sauces under study. Significant differences were found between the different starches employed: the rice and modified starches presented similar behavior to each other, as did the potato starch and corn starch, while the waxy starch sauce stood apart from the rest because of its resilience. The freeze/thaw cycle had the greatest effect on the corn-starch sauce, increasing its graininess and heterogeneity values owing to retrogradation. Adding XG or LBG to the sauces subjected to a period of freezing/thawing did not have a significant effect on the sensory attributes of the reheated sauces made with rice, potato, or waxy or modified starch, but lower graininess and heterogeneity values were observed in the sauce made with corn starch.

[Neonatal outcome of triplets]. / Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria).

OBJECTIVE: To determine the neonatal morbidity and mortality in triplets. METHOD: Retrospective study of 189 triplets born between January'98 and December'04. RESULTS: Mean maternal age was 33 years. Of the pregnancies, 71.4 % were achieved using fertilization techniques, 84 % received antenatal steroids and 96.8 % of births were by caesarean section. The mean gestational age was 32 weeks (246-355), with a mean birth weight of 1,500 g (450-2,650). There 53.4 % were female neonates. Cardiopulmonary resuscitation (CPR) at birth was not required by 82 %, 13.5 % required bag-mask ventilation and 4.9 % required advanced CPR. Low/moderate respiratory distress syndrome was observed in 27 % of the infants (oxygen/CPAP), and 19 % required mechanical ventilation and surfactant. 12 % showed patent ductus arteriosus was seen in 12 %, necrotizing enterocolitis in 4.2 %, sepsis (vertical and nosocomial), 17 %, grade III retinopathy in 1.1 % and 7.4 % had bronchopulmonary dysplasia. Grade III/IV intraventricular haemorrhage was present in 4.2 %, and 3.2 % periventricular leukomalacia. Survival rate at discharge from hospital was 95.2 %. Of those, 10 % showed risk of serious sequelae defined as: grade III-IV intraventricular haemorrhage, periventricular leukomalacia, grade III retinopathy and bronchopulmonary dysplasia. There were no major complications in 64.5 % of the children. Despite a prematurity rate of 100 %, this large series of triplets shows an excellent survival and a relatively low serious associated morbidity. It is also important to point out the intensive perinatological follow-up to which these pregnancies are subject.

Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria) / Neonatal outcome of triplets

Objetivo: Determinar la morbilidad y la mortalidad neonatales de los trillizos. Método: Estudio retrospectivo de 189 trillizos nacidos entre enero de 1998 y diciembre de 2004. Resultados: La edad media materna fue de 33 años. El 71,4 % de las gestaciones se obtuvieron mediante técnicas de reproducción asistida. El 84 % recibió corticoides prenatales. El 96,8 % nació mediante cesárea. La edad gestacional media fue de 32 semanas (246-355), con peso medio de 1.500 g (450-2.650). El 53,4 % fueron niñas. El 82 % no necesitó reanimación al nacer, el 13,5 % requirió reanimación con bolsa autoinflable y el 4,9 %, reanimación avanzada. El 27 % de los neonatos presentaron síndrome de distrés respiratorio leve/moderado (oxígeno/CPAP) y el 19 %, grave (ventilación mecánica/agente tensiactivo). El 12 % presentó ductus arterioso persistente; el 4,2 %, enterocolitis; el 17 %, sepsis (vertical y nosocomial); el 1,1 %, retinopatía de grado III, y el 7,4 %, displasia broncopulmonar. El 4,2 % presentó hemorragia intraventricular (HIV) grado III-IV, y el 3,2 %, leucomalacia periventricular. La supervivencia al recibir el alta fue del 95,2 %, el 10 % mostraron signos de riesgo de secuelas graves, definidas como: HIV grado III-IV, leucomalacia periventricular, retinopatía grado III y displasia broncopulmonar. El 64,5 % de los neonatos no presentaron ninguna complicación destacable durante su ingreso. Aunque la incidencia de prematuridad es del 100 %, esta serie larga de trillizos muestra una excelente supervivencia y una morbilidad grave asociada relativamente baja. Destaca el elevado control perinatológico de estas gestaciones (AU)

Objective: To determine the neonatal morbidity and mortality in triplets. Method: Retrospective study of 189 triplets born between January'98 and December'04. Results: Mean maternal age was 33 years. Of the pregnancies, 71.4 % were achieved using fertilization techniques, 84 % received antenatal steroids and 96.8 % of births were by caesarean section. The mean gestational age was 32 weeks (246-355), with a mean birth weight of 1,500 g (450-2,650). There 53.4 % were female neonates. Cardiopulmonary resuscitation (CPR) at birth was not required by 82 %, 13.5 % required bag-mask ventilation and 4.9 % required advanced CPR. Low/moderate respiratory distress syndrome was observed in 27 % of the infants (oxygen/CPAP), and 19 % required mechanical ventilation and surfactant. 12 % showed patent ductus arteriosus was seen in 12 %, necrotizing enterocolitis in 4.2 %, sepsis (vertical and nosocomial), 17 %, grade III retinopathy in 1.1 % and 7.4 % had bronchopulmonary dysplasia. Grade III/IV intraventricular haemorrhage was present in 4.2 %, and 3.2 % periventricular leukomalacia. Survival rate at discharge from hospital was 95.2 %. Of those, 10 % showed risk of serious sequelae defined as: grade III-IV intraventricular haemorrhage, periventricular leukomalacia, grade III retinopathy and bronchopulmonary dysplasia. There were no major complications in 64.5 % of the children. Despite a prematurity rate of 100 %, this large series of triplets shows an excellent survival and a relatively low serious associated morbidity. It is also important to point out the intensive perinatological follow-up to which these pregnancies are subject (AU)