Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital.

BACKGROUND: Although survival rate in papillary thyroid cancer (PTC) is high, the risk of persistence and recurrence together with the dramatic rise in its incidence cannot be overemphasized. Filipinos are considered to be at greater risk for negative outcomes. A paradigm shift in the management of PTC introduces re-stratification based on response to therapy which was reported to have better correlation with long-term outcome. The study aimed to identify predictors of incomplete response after thyroidectomy and radioiodine therapy among patients with PTC. The results of the study may have important implications in our understanding of the disease process allowing more aggressive treatment and monitoring of certain subgroups of patients. METHODOLOGY: Retrospective review of 225 patients with PTC (59% ATA low risk, 30 % ATA intermediate risk and 11% ATA high risk) who underwent thyroidectomy and radioiodine therapy was performed. Thirteen variables were considered (age, gender, histopathological variant, stage, extent of disease, MACIS score, AMES score, primary tumour size, lymph node, lymphovascular invasion, bilaterality, multifocality and preoperative TSH level). Logistic regression analysis using Backward Wald algorithm was used to identify independent predictors of incomplete response to therapy after 24 months. RESULTS: Of the 225 patients, 69 (31%) had incomplete response. Biochemical and structural (predominantly thyroid bed, lung and bone) incomplete response was observed in 6 and 63 patients, respectively. Incomplete response was documented in 8, 54 and 92% of low-, intermediate- and high-risk patients based on ATA recommendation. Incomplete response was significantly dependent on gender, lymph node involvement and location, extent of malignancy and multifocality taking into account the size of concurrent tumours (p < 0.05). The model was found to have high sensitivity (71%) and specificity (96%). CONCLUSION: A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.

Formulación de barra dietética funcional prebiótica a partir de harina de Yacón (Smallanthus sonchifolius) / Making a functional prebiotic dietetic bar using yacon flour

Se elaboró harina de yacón a partir de raíces con 8 meses de edad de cultivo, variedad blanca, las mismas fueron secadas en estufa con corriente de aire a 70°C por 23 horas; efectuándose una caracterización física, química y sensorial. La harina obtenida se empleó en la formulación de una barra dietética funcional prebiótica (BDFP) determinándose preferencia/aceptabilidad de las formulaciones y composición química. Se obtuvo una harina de 4,5% de humedad con un contenido de fructanos de 70,23 g% (base seca). La BDFP resultó de valor calórico reducido, bajo valor glucídico, alto contenido de proteínas y de alto contenido en fibra; resultando aceptable para el 93% de los consumidores (AU)

Formulación de barra dietética funcional prebiótica a partir de harina de Yacón (Smallanthus sonchifolius) / Making a functional prebiotic dietetic bar using yacon flour

Se elaboró harina de yacón a partir de raíces con 8 meses de edad de cultivo, variedad blanca, las mismas fueron secadas en estufa con corriente de aire a 70°C por 23 horas; efectuándose una caracterización física, química y sensorial. La harina obtenida se empleó en la formulación de una barra dietética funcional prebiótica (BDFP) determinándose preferencia/aceptabilidad de las formulaciones y composición química. Se obtuvo una harina de 4,5% de humedad con un contenido de fructanos de 70,23 g% (base seca). La BDFP resultó de valor calórico reducido, bajo valor glucídico, alto contenido de proteínas y de alto contenido en fibra; resultando aceptable para el 93% de los consumidores

A scale for assessing sleep hygiene: preliminary data.

No reliable measure exists for assessing the nature and scope of adherence or nonadherence to effective sleep hygiene practices. This report details the creation and empirical validation of the Sleep Hygiene Self-test. 52 combat veterans, patients in a treatment program for PTSD, completed the 30-item self-test prior to and after their participation in 5 wks. of group therapy for sleep hygiene. Analysis indicated good internal consistency and suitability as a pre-posttest measure.

The tortilla making properties of two improved maicillo cultivars from Honduras.

Grains of two improved maicillo hybrids (Sorghum bicolor (L) Moench) and their criollo (Landrace) counterparts grown at two farmsites in Honduras were lime-cooked and processed into table tortillas. Kernels from the criollos were less dense and softer than kernels from the improved cultivars. The improved maicillos had straw or red plant and glume colors while the criollos were less dense and softer than kernels from the improved cultivars. The improved maicillos had straw or red plant and glume colors while the criollos had purple colored plants with black or purple glumes. The soft textured criollo kernels required less cooking than their harder improved counterparts. Nixtamals cooked to contain 53-55% moisture were the most suitable for processing into tortillas. Both improved maicillos compared favorably with Sureño (used as positive control during processing). The criollos produced darker, less acceptable tortillas. Masa and tortillas from criollos darkened during lime-cooking especially during baking. All sorghums and their respective tortillas had similar chemical composition. The improved maicillos bred in Honduras have a significantly improved plant and glume color with white pericarp. The sorghum improvement was also observed in the overall tortilla quality.

The tortilla making properties of two improved maicillo cultivars from Honduras

Grains of two improved maicillo hybrids (Sorghum bicolor (L) Moench) and their criollo (Landrace) counterparts grown at two farmsites in Honduras were lime-cooked and processed into table tortillas. Kernels from the criollos were less dense and softer than kernels from the improved cultivars. The improved maicillos had straw or red plant and glume colors while the criollos were less dense and softer than kernels from the improved cultivars. The improved maicillos had straw or red plant and glume colors while the criollos had purple colored plants with black or purple glumes. The soft textured criollo kernels required less cooking than their harder improved counterparts. Nixtamals cooked to contain 53-55 moisture were the most suitable for processing into tortillas. Both improved maicillos compared favorably with Sureño (used as positive control during processing). The criollos produced darker, less acceptable tortillas. Masa and tortillas from criollos darkened during lime-cooking especially during baking. All sorghums and their respective tortillas had similar chemical composition. The improved maicillos bred in Honduras have a significantly improved plant and glume color with white pericarp. The sorghum improvement was also observed in the overall tortilla quality.

Specific digestive deficiency of phagocytes in paracoccidioidomycosis. Its absence in peripheral blood neutrophils of members of the nuclear family of patients. An initial report.

Paracoccidioidomycosis (PARA) affects only a minority of individuals, who have presumably been exposed to the causative fungus (Paracoccidioides brasiliensis). Neutrophils (PMNs) from patients with PARA show a significant and specific digestive deficiency phagocytosed P. brasiliensis in vitro. It is not known whether the defect is acquired after contact with the fungus, or precedes it. We studied the spouses and offspring of three patients with PARA. Individuals studied stayed in the same house as their husband or father. None of the relatives had evidence of PARA, and their PMNs showed no defect in their ability to digest or kill the fungus. Relatives showed no indication of sensitization against P. brasiliensis. These results are compatible with the view that effective contact with P. brasiliensis may occur only under restricted conditions and that the defect in digestive ability is an infrequent and specific occurrence.

[Psychopharmaceuticals in primary care: prescription quality]. / Psicofármacos en atención primaria: calidad de la prescripción.

OBJECTIVE: Using criteria based on the bibliography, to assess drugs prescription in a Health Centre, in order to put forward corrective measures in line with the defects identified. DESIGN: Descriptive and retrospective study. SETTING: Santa Maria de Benquerancia Health Centre (Toledo). PARTICIPANTS: A sample of 40% of the clinical records of patients over 14 produced records of patients treated with drugs for psychic disorders between October 1990 and October 1991. MEASUREMENTS AND MAIN RESULTS: 248 prescriptions for these drugs were found. The most common diagnoses were: neurotic depression (33.1%), anxiety (25.8%) and insomnia (10.1%). Benzodiazepines made up 78.2% of the prescriptions. Of 8 quality criteria assessed, the compliance level was acceptable by WHO standards except in the recording in the notes of the diagnosis or problem for which the drug was prescribed (74.2% non-compliance); Alprazolam and Triazolam were not considered first-choice benzodiazepines (31.3% non-compliance); and there was 44.5% non-compliance by Primary Care physicians with the non-prescription of anti-psychotic or stimulant MAO inhibitor antidepressants. CONCLUSIONS: Quality-control studies, such as this one, in order to identify problems, to take corrective measures and subsequently assess them, are useful in improving care procedures.

Relationship between digestive and killing abilities of neutrophils against Paracoccidioides brasiliensis.

Peripheral blood neutrophils (PMN) from patients with paracoccidioidomycosis killed and digested Paracoccidioides brasiliensis much less than did PMN from normal individuals or from patients with other diseases. However, deficiency in killing ability was less specific than digestive deficiency and correlated poorly with it. We conclude that the capacities of PMN to digest and kill P. brasiliensis are not intimately related phenomena, and that in paracoccidioidomycosis the key deficiency of neutrophil function is that of digestion of P. brasiliensis.

Influence of serum on in vitro digestion of Paracoccidioides brasiliensis by neutrophils.

Serum from patients with paracoccidioidomycosis (PARA) did not block digestive abilities of neutrophils (PMNs) from healthy individuals against Paracoccidioides brasiliensis. Conversely, serum from healthy donors did not enhance digestive capacities of PMNs from patients with PARA vis á vis the causative organism. We conclude that the specific digestive defect present in PMNs from patients with PARA is not mediated by serum factors.

Functions of polymorphonuclear leukocytes and individuality of Jorge Lobo's disease: absence of the specific leukocyte digestive defect against Paracoccidioides brasiliensis.

Peripheral blood neutrophils (PMNs) from a patient with Jorge Lobo's disease (JLD) digested well phagocytosed Paracoccidioides brasiliensis. We found no circulating antibodies against P. brasiliensis in the patient's serum. Such neutrophils showed myeloperoxidase activity and also digested normally phagocytosed Candida albicans. We had previously reported the presence of a specific digestive deficiency of PMNs from patients with paracoccidioidomycosis (PARA) vis à vis P. brasiliensis. Current findings provide new information about leukocyte functions in JLD and bolster the view that JLD, PARA and their respective causative microorganisms are distinct.

Polymorphonuclear leukocyte functions in psoriasis.

Circulating polymorphonuclear leukocyte (CPMN) functions were studied in patients with widespread psoriasis as well as in persons with chronic alcoholic liver disease (CALD), paracoccidioidomycosis, diverse granulomatous diseases, and normal individuals. We were unable to find stimulation or increase in CPMN functions in patients with psoriasis compared to normal individuals. Leukocytes from individuals with CALD had a lowering of their metabolic activation, chemotaxis, random movement, and adherence. CPMNs from patients with paracoccidioidomycosis showed a significant deficiency in their ability to digest Paracoccidioides brasiliensis. Our results are against the concept that functions of circulating PMNs are stimulated in psoriatics.

[Physico-chemical evaluation of products extruded with sorghum-corn-soybean blends]. / Evaluación fisicoquimíca de productos extrudidos con mezclas de sorgo-maíz-soja.

Yellow corn grits (M), brown sorghum (SM), white sorghum (SB) and full fat soy flour (S) blends were extruded in an autogenous Brady Crop Cooker extruder at 195-200 degrees C and 11% moisture content. Binary blends (70:30) made up of M:S, SM:S and SB:S; and ternary blends (30:40:30) made up of SM:M:S and SB:M:S were extruded. Under these conditions, extrudates contained about 19% protein and 6% fat, which are within the specifications given for cereal/oil seed blends. Raw and extruded samples were analyzed for ES, WQI, WSI, MD and paste viscosity. All blends underwent modifications in the starch fraction at granular and molecular level. Brown sorghum extrudates presented higher degradation than those of white sorghum and corn:soy blends, although the last ones gave similar responses to analitical techniques. Extrudates greatly increased their ES, SWI and MD values, suggesting that degradation products, like dextrins, were present. Cooked paste low viscosities (50 degrees C) and micrographs support these findings. Because of their functional characteristics, extrudates could be used in beverages.

[A model for the extrusion of a corn:soybean blend (70:30)]. / Modelo para la extrusión de mezclas maiz:soja (70:30).

Most of the physicochemical and sensorial properties of the extrudates depend on the extent of the starch degradation. A cereal extrudate has physicochemical properties similar to those of a blend of raw, gelatinized and dextrinized starch. Based on this postulate, models of cereal: oilseed blends were prepared, and different analytical techniques for their characterization were applied. Results revealed that the corn:soy (70:30) extruded sample under study, was similar to moderately dextrinized corn:soy blend obtained in the laboratory. Therefore, it could be used to prepare "papillas" or precooked foods.

[Nutritional and stability evaluation during storage of blends extruded with sorghum]. / Evaluación nutricional y de estabilidad durante el almacenamiento de mezclas extruidas con sorgo.

Binary sorghum:soy (70:30) and ternary sorghum:corn:soy (30:40:30) blends using high and low tannin content dehulled sorghum were extruded. The effectiveness of heat treatment was determined by protein dispersion index (PDI) and ureasic activity (delta PH), indicating that proteins were denatured and antinutritional factors reduced. The nutritional evaluation supported the fact that samples were adequately treated, giving ternary blends true digestibility (TD) and biological values (BV) similar to milk casein. Blend stabilities, expressed as peroxide index (PI), revealed a low lipid oxidation rate during the first seven months, and were acceptable up to a year of storage. Extrudates with incorporated sorghum cover protein and energy demands of the growing infant, and provide a high nutritional value and long-life product.

[Dehulling of sorghum in grinding mills]. / Descascarado de sorgo en molino de abrasión.

The efficiency of the dehulling process of sorghum grain was studied in a laboratory abrasive stone mill. Residual tannins as tannic acid and cathequin equivalent, as well as color measurements of the product were determined as control parameters of the procedure. Besides, fiber, ash and fat contents as well as other variables were evaluated. Assays were performed at three stone speeds and at different operation times. According to the results obtained, a stone speed of 1,700 rpm and a 12-minute period, are the best operating conditions, while measurements of color of the product constitute the best method for controlling the dehulling process.

[Peeling of sorghum by a dry method: continuous and discontinuous methods]. / Descascarado de sorgo por vía seca: métodos continuo y discontinuo.

A study was carried out wherein two dry dehulling sorghum grain methods, the continuous and discontinuous types, were quantitatively compared in a laboratory abrasive dehulling device. Reflectance values, expressed as dehulling percentage, the percentage of kernels removed, and of kernel cracking were evaluated. Graphs of the dehulled and removed percentages as function of the contrast time for each method, revealed that the continuous process was the most efficient of both procedures. Analysis of the broken kernels indicated a similar behavior for both methods. The macrocomponent and tannin variations as dehulling advanced, as well as the reflectance values were determined with the continuous method. Findings showed that the greater proportion of tannin, fiber and ashes has been removed at the 85% extraction rate. Thus, abrasion of grains above the 65% extraction rate is not convenient, since an excessive loss of nutrients is produced without any important decrease in polyphenolic pigments and of those imparting color to the sorghum grain milling products.

[Evaluation of the starch fraction in corn products consumed regionally]. / Evaluación de la fracción amilácea en productos de maíz de consumo regional.

The purpose of this study was to evaluate through conventional analytical procedures, the degree of modification of the starch fraction of regional products based on corn, such as grits, flours, precooked grits, flakes, precooked flour, "frangollo" and "locrillo." Based on the interpretation of changes in the starch fraction, the following conclusions are reached. Corn grits, flours, "frangollo" and "locrillo" are raw corn products subjected to physical processes such as shelling, degermination and size reduction. They do not show changes in their physicochemical characteristics. Precooked grits present certain structural modification (among others, changes in their rheologic behavior) and partial molecular change (among others, changes in the insoluble carbohydrate fraction), indicating that they have been subjected to processes wherein factors such as temperature, moisture and/or pressure intervene. Corn flakes and precooked flours show a high enzyme digestibility and a high degree of change in their functional properties (mainly, in regard to solubility, absorption and viscosity). These changes indicate modification at granular and molecular level.

A novel method for estimating killing ability and digestion of Paracoccidioides brasiliensis by phagocytic cells in vitro.

We describe a novel method by which phagocytosis, digestion and killing of Paracoccidioides brasiliensis yeast cells by polymorphonuclear leukocytes or other phagocytic cells may be estimated simultaneously. Suspensions of P. brasiliensis (yeast-like phase) were sonicated, counted and incubated at 37 degrees C with known numbers of phagocytes. Control preparations contained no phagocytic cells. At given intervals samples were incorporated into gelatin nutrient medium and droplets of the mixtures were incubated at room temperature. Live yeast-like P. brasiliensis germinate in vitro and produce filaments. After incubation, droplets may be melted and examined under phase contrast optics, or the cells may be washed and stained by a variation of Papanicolaou's method. Digested P. brasiliensis, intact but non-germinating yeasts and filamented (viable) yeasts may be identified and counted. Killing and digestive abilities of phagocytes may be estimated by the difference between values obtained from phagocyte-containing and control preparations.

[Development of a food of intermediate moistness from extracts of corn and soybean]. / Desarrollo de un alimento de humedad intermedia a partir de extruidos de maíz y soja.

Precooked cereal:oilseed blends have potential use as intermediate moisture food supplements. On this basis, some formulations from corn:soy extrudates, and other ingredients, were prepared and evaluated. The main objective of this work was to develop a prototype intermediate moisture vegetable food, stable at room temperature, of low cost, and inexpensive packaging requirements. The technological process involves thermal and enzymatic modification of corn and soy blends. The final product can be suspended in water and consumed as a high energy-protein beverage. Its proximate composition is similar to that of sweetened condensed milk.