Development of a convenience and safety chilled sous vide fish dish: Diversification of aquacultural products.

The dynamic expansion of the ready-to-eat seabream sector in its adaptation to new lifestyles has led to the search for new presentation formats in seabream (Sparus aurata). Green sauce (olive oil, wine vinegar, garlic, fresh parsley, black pepper, basil and salt) and 60 ℃ of cooking temperature were chosen by the panellists for the sous vide cooking process. Seabream fillet and sauce were packaged in polypropylene trays, cooked, chilled and stored at 2 ℃. Microbiological (total viable counts,Enterobacteriaceae,lactic acid bacteria, anaerobic psychrotrophic, moulds and yeasts, Salmonella and Listeria monocytogenes), chemical (pH and TBARs) and sensory parameters were determined at 0, 7, 17, 34, 48 and 62 days. In the conditions used, the microbiological counts remained stable, and Salmonella and Listeria monocytogenes were absent. The acidic sauce had a positive effect on the pH of the product, and low TBARs were obtained throughout storage. The processing conditions used in the present study allowed a chilled ready-to-eat seabream product of consistently high quality up to 62 days of storage to be obtained, representing an expansion of the products offered by the aquacultural industry.

[Medical comorbidity in elderly patients with dementia. Differences according age and gender]. / Aspectos de comorbilidad en pacientes ancianos con demencia. Diferencias por edad y género.

BACKGROUND: Prevalence of dementia in elderly patients is high. The goal of the study was to assess some aspects of comorbidity in the patients with dementia. We also analyzed comorbidity differences according to age and gender. PATIENTS AND METHODS: A total of 311 patients older than 64 years old with dementia were prospectively evaluated. Data were collected on sociodemographic endpoints, type of dementia, Barthel Index (BI), Lawton Index (LO), Mini-Mental State Examination (MMSE), Charlson Index, total number of drugs, history of high blood pressure (HT), diabetes (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. RESULTS: The sample consisted of 222 women (71.4%) and 89 men. Mean age (standard deviation [SD]) was 80.6 (6) years. Patients were taking an average of 5.8 (2.6) drugs. The mean of Charlson Index was of 2.1 (1.3). Fifty-one percent had HT, 24% DM, 24% DL, 13% HF, 11% COPD and 8% cancer. We found better scores in the MMSE, higher comorbidity and percentage of married people and prevalence of vascular dementia in men with respect to women, who had higher percentage of Alzheimer disease, and widowers. When differences were analyzed according to age, we found a higher percentage of widowers and HF diagnosis, a lower LI values and DL percentage in the patients older than 84 years with respect to younger subjects. CONCLUSIONS: Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences in comorbidity according to age and gender that must be taken into account.

Resultados de la aplicación en atención primaria de un protocolo de valoración geriátrica integral en ancianos de riesgo / Outcomes of the application of a protocol of comprehensive geriatric assessment in elderly persons at risk in primary care

OBJETIVO: Analizar los resultados de la aplicación en atención primaria de un protocolo de valoración geriátrica integral en ancianos de riesgo. DISEÑO: Estudio transversal descriptivo realizado durante los meses de mayo y junio de 1998 en un centro de salud urbano. MÉTODO: Aplicación de un protocolo de valoración geriátrica integral a las personas con 65 o más años que cumplían al menos uno de los criterios de inclusión: a) todos los sujetos de 80 o más años, y b) el grupo de personas entre 65 y 79 años y que presentaran una o más de las condiciones siguientes: toma de tres o más fármacos al día, consumo de psicofármacos, comorbilidad generadora de dependencia funcional, caídas durante el último año, alta hospitalaria en los 6 meses previos, personas que viven solas o que han enviudado en el último año. En el protocolo de valoración geriátrica integral estaban incluidos una serie de instrumentos que permitían la realización de la valoración funcional (Lawton, Katz), del equilibrio (posición unipodal tándem y semitándem), afectiva (Geriatric Depression Scale reducido), mental (Pfeiffer) y nutricional (Mini Nutritional Assessment reducido). Adicionalmente, se realizaron acciones dirigidas a la detección de problemas sensoriales, del sueño y del ritmo deposicional, y se registró el nivel de actividad física. PACIENTES: Un total de 126 personas, de las 817 que acudieron de manera espontánea durante el período del estudio, cumplían los criterios de inclusión. MEDICIONES Y RESULTADOS PRINCIPALES: El 15,4 per cent (n = 126; 75 mujeres y 51 varones) cumplían criterios de anciano frágil. El 88,9 per cent tenían entre 65-79 años. El 76,2 per cent presentaban más de 2 motivos de inclusión. Tras la aplicación de la valoración geriátrica integral destacan los siguientes hallazgos: el 7,9 per cent eran dependientes para alguna de las actividades de la vida diaria instrumentales y el 16,7 per cent lo eran para alguna de las actividades de la vida diaria básicas. El 32,6 per cent presentaban alteración de la marcha y el 30,2 per cent del equilibrio. Se detectaron un total de 176 síndromes geriátricos, aproximadamente 1,4 por persona. El más frecuente para el total de la muestra fue la inestabilidad (36,5 per cent), seguido de los trastornos afectivos y depresivos (22,2 per cent). Casi un 16 per cent del total presentaron incontinencia urinaria. CONCLUSIONES: La aplicación de un protocolo de valoración geriátrica integral en atención primaria permite introducir el concepto de valoración geriátrica sistemática en ese ámbito y detectar problemas no conocidos en ancianos de riesgo. Resultados de la aplicación en atención primaria de un protocolo de valoración geriátrica integral en ancianos de riesgo (AU)

Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury.

Because it is often difficult to diagnose accurately the structurally intact cervical spine after acute trauma, a series of patients was evaluated with magnetic resonance (MR) imaging to assess its efficacy for the evaluation and clearance of the cervical spine in a trauma victim in the early posttrauma period. Ultralow-field MR imaging was used to evaluate 174 posttraumatic patients in whom physical findings indicated the potential for spine injury or minor radiographic findings indicated injury. This series includes only those patients who did not appear to harbor disruption of spinal integrity on the basis of a routine x-ray film. None had clinically obvious injury. Of the 174 patients, 62 (36%) had soft-tissue abnormalities identified by MR imaging, including disc interspace disruption in 27 patients (four with ventral and dorsal ligamentous injury, three with ventral ligamentous injury alone, 18 with dorsal ligamentous injury alone, and two without ventral or dorsal ligamentous injury). Isolated ligamentous injury was observed in 35 patients (eight with ventral and dorsal ligamentous injury, five with ventral ligamentous injury alone, and 22 with dorsal ligamentous injury alone). One patient underwent a surgical fusion procedure, 35 patients (including the one treated surgically) were placed in a cervical collar for at least 1 month, and 27 patients were placed in a thermoplastic Minerva jacket for at least 2 months. All had a satisfactory outcome without evidence of instability. The T2-weighted sagittal images were most useful in defining acute soft-tissue injury; axial images were of minimal assistance. Posttraumatic soft-tissue cervical spine injuries and disc herniations (most likely proexisting the trauma) are more common than expected. A negative MR image should be considered as confirmation of a negative or "cleared" subaxial cervical spine. Diagnostic and patient management algorithms may be appropriately tailored by this information. Thus, MR imaging is useful for early acute posttrauma assessment in a very select group of patients.

Metallic foreign bodies in the orbits of patients undergoing MR imaging: prevalence and value of radiography and CT before MR.

OBJECTIVE: The purpose of this study was to measure the prevalence of metallic foreign bodies in the orbits of 15,024 patients who were scheduled for MR imaging during a 4-year period and to determine if screening by plain radiography, CT, or both before MR imaging is efficacious. MATERIALS AND METHODS: Records of 15,024 patients scheduled for MR imaging were reviewed. A total of 1593 patients who had identified themselves as being at risk for an intraorbital metallic foreign body had undergone plain radiography or CT of the orbits. Plain radiographs and/or CT scans of patients reported as having orbital metal were reviewed to confirm the presence of a metallic foreign body and to identify its location. RESULTS: Metallic foreign bodies were discovered in 40 patients. Six of these patients had impaired vision in the involved eye. Ten patients had a metallic foreign body in or near the orbit but well away from the globe and were thought to be at low risk for movement of the foreign body as a result of MR imaging. The other 24 patients had metallic foreign bodies adjacent to or within the globe and were thought to be at risk for movement of the metallic foreign body as a result of MR imaging. CONCLUSION: The prevalence of intraorbital metallic foreign bodies in our study population was low (0.27%). Even in those patients identified as being at risk, the prevalence was only 2.5%. Based on the number of MR examinations performed annually in the United States and on data indicating that no radiographic screening is performed at 5% of institutions, we extrapolate that more than 2400 patients with intraorbital metallic foreign bodies have undergone MR imaging since 1986 without report of injury. These data allow us to infer that the risk of eye damage for patients who have intraorbital metal is low and that radiographic screening before MR imaging is not needed as often as it is done.

Blinded comparison of cranial CT and MR in closed head injury evaluation.

PURPOSE: To compare CT and MR in the evaluation of acute head injury. METHODS: One hundred seven consecutive patients who were referred to the emergency department and underwent both MR and CT cranial examinations within 48 hours were retrospectively reviewed. The films were interpreted by two neuroradiologists blinded to all patient information. RESULTS: The sensitivity of MR was significantly higher than that of CT for the detection of contusion, shearing injury, subdural and epidural hematoma, and sinus involvement. The sensitivity of CT was significantly higher than that of MR for the evaluation of fracture. The sensitivities of MR and CT were statistically equivalent for the detection of superficial soft-tissue injury. The overall sensitivity of MR for the detection of abnormalities in acute head trauma was 96.4%, and for CT was 63.4%. CONCLUSIONS: CT and MR are complementary studies in the evaluation of acute head trauma. MR is necessary to define or exclude contusions, deep shearing injury, and extraaxial fluid collections in acute head trauma.

Magnetic resonance imaging in minor head injury.

STUDY OBJECTIVES: To investigate the role of cranial magnetic resonance (MR) imaging in evaluating patients discharged from the emergency department after minor head injury. DESIGN: A prospective blinded cohort study. SETTING: University hospital ED. TYPE OF PARTICIPANTS: Fifty-eight patients with minor head injury who were discharged from the ED with written head injury instructions. Patients admitted to the hospital were excluded. INTERVENTIONS: Ultra-low-field cranial MR scans were performed on patients within 24 hours of discharge. Scans were read blindly by two radiologists. MEASUREMENTS AND MAIN RESULTS: Fisher's exact test was used to compare symptoms in patients with abnormal and normal MR scans. There was no significant difference in symptoms between patients with abnormal and those with normal scans (P greater than .10). The proportion of abnormal MR scans was analyzed using the binomial distribution. Six of the 58 patients (10.3%) had traumatic intracranial abnormalities (proportion, 0.103; SD, 0.04; 95% CI, 0.04-0.21). Three had cortical contusions, and three had small subdural hematomas. Two of the six patients with abnormal MR scans, both with small subdural hematomas, had normal computed tomography scans. CONCLUSION: Ten percent of patients discharged from the ED after minor head injury had abnormal ultra-low-field cranial MR scans. Additional research is needed to establish the clinical importance of this unexpected observation.

Comparison of CT, low-field-strength MR imaging, and high-field-strength MR imaging. Work in progress.

To assess objectively the sensitivity and specificity of low-field-strength (0.064 T) magnetic resonance (MR) imaging, a prospective blind study of 280 examinations was performed to compare low-field-strength MR imaging with computed tomography (CT) and with high-field-strength (1.5-T) MR imaging of the cranium. The sensitivity (defined as the true-positive rate) with high-field MR imaging was superior to that with low-field MR imaging and CT in helping detect overall abnormalities. Sensitivities were generally similar over a broad range of specific cranial central nervous system diseases. Low-field and high-field MR imaging were equivalent in the blind diagnoses of neoplasms and white matter disease, whereas low-field MR and CT were equivalent in the blind diagnoses of contusion, subdural and epidural hematoma, sinus disease, normality, and abnormality. The specificities with low-field MR imaging and CT were substantially better than those with high-field MR imaging.

Osteomyelitis: sensitivity of 0.064 T MRI, three-phase bone scanning and indium scanning with biopsy proof.

We compared the ability of magnetic resonance imaging (MRI) using a 0.064 T permanent magnet, three-phase bone scanning, and indium-labeled white blood cell (111In-WBC) scanning, to diagnose osteomyelitis. Twenty-three patients underwent biopsy. All patients were examined at presentation with all three modalities. Sensitivities for each modality were calculated using biopsy as a gold standard. The results were 72% for MRI, 68% for bone scan, and 45% for 111In-WBC. Specificities were not calculated because of lack of negative biopsies. MRI was as sensitive as bone scanning in the diagnosis of osteomyelitis. All modalities had lower than previously reported sensitivities for imaging osteomyelitis.