Aislamiento de Clostridium difficile en niños hospitalizados con diarrea / Clostridium difficile isolation in children hospitalized with diarrhea

Introducción: Clostridium difficile es la principal causa de diarrea nosocomial en adultos, y su incidencia está aumentado en los últimos años. Es difícil determinar su impacto en niños debido a las altas tasas de colonización. Material y métodos: Estudio retrospectivo en menores de 15 años ingresados con diarrea a lo largo de un año. Se estudiaron las características epidemiológicas, clínicas, analíticas y la evolución de los niños con infección por Clostridium difficile (ICD) en comparación con otros aislamientos. Los factores predictores de ICD fueron determinados mediante análisis multivariante. Resultados: Se identificaron 250 niños con diarrea, realizándose estudio microbiológico completo en 174. En 79 (45,4%) se llegó al diagnóstico: 25,6% ICD (n=19; 13 enterotoxigénicos); 28,6% otras bacterias (n=21) y 45,8% virus (n=34; rotavirus n=31; adenovirus n=3). Un 68,4% fueron menores de 2 años, y un 15,8% fueron adquiridos en la comunidad. En comparación con otras causas de diarrea, la ICD se asoció a comorbilidad (p<0,0001), contacto reciente con el sistema sanitario (p<0,0001), estancia en UCI (p=0,003) y exposición reciente a antibióticos (p<0,0001). Los pacientes con ICD cursaron de forma oligosintomática. No hubo diferencias clínicas entre las ICD productoras o no de toxina, siendo la comorbilidad el principal asociado con la ICD (OR 40,02; IC 95% 6,84-232,32; p<0,0001). Conclusiones: El aislamiento de Clostridium difficile es frecuente en niños hospitalizados con diarrea en nuestro medio. La ICD resultó más frecuente en niños pequeños con comorbilidad y contacto reciente con el sistema sanitario, presentado, en su mayoría, un curso clínico oligosintomático. Se necesitan más estudios para conocer la epidemiología de esta infección en niños (AU)

Introduction: Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. Material and methods: A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. Results: Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). Conclusions: The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers (AU)

[Clostridium difficile isolation in children hospitalized with diarrhea]. / Aislamiento de Clostridium difficile en niños hospitalizados con diarrea.

INTRODUCTION: Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. MATERIAL AND METHODS: A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. RESULTS: Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). CONCLUSIONS: The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers.

Pacientes con fractura de pelvis inestables hemodinámicamente in extremis ¿packing pélvico o arteriografía? / Patients with hemodynamic unstable pelvic fractures in extremis: Pelvic packing or angiography?

El manejo multidisciplinar de los pacientes con traumatismo pélvico ha mejorado su pronóstico, sin embargo la mortalidad sigue siendo muy elevada. La estrategia de un tratamiento adecuado es aún controvertida, sobre todo respecto al control de la hemorragia en pacientes cuya situación clínica es extrema mediante el uso de arteriografía o packing pélvico. Planteamos mediante una herramienta de medicina basada en evidencia (CAT) el beneficio de la realización del packing pélvico en relación a una pregunta clínica específica desde una situación concreta, ¿qué es mejor para el manejo del sangrado, packing pélvico extraperitoneal o arteriografía, en pacientes con fractura de pelvis inestables hemodinámicamente in extremis? De este estudio podemos concluir que la arteriografía puede mejorar el control de la hemorragia en los pacientes con sangrado arterial y hemodinámicamente estables, pero el packing tiene prioridad en los pacientes con fracturas de pelvis e inestabilidad hemodinámica (AU)

The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing. We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis? From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability (AU)

[Patients with hemodynamic unstable pelvic fractures in extremis: pelvic packing or angiography?]. / Pacientes con fractura de pelvis inestables hemodinámicamente in extremis ¿packing pélvico o arteriografía?

The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing. We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis? From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability.

Secuela de fractura de pelvis. A propósito de un caso y revisión de la literatura / Pelvis fracture sequelae. A case report and literature review

Objetivos: Presentación y análisis crítico de paciente con secuela post-fractura de pelvis que permita exponer la complejidad de su manejo y tratamiento. Caso clínico: Mujer de 29 años con dolor invalidante en región sacroilíaca a la sedestación y la marcha. Exploración: Deformidad externa pélvica con repercusión estética, dismetría de miembro inferior izquierdo de 4 cm y dolor sacroilíaco a la apertura pélvica o al apoyo monopodal izquierdo. Limitación funcional a la marcha con cojera y problemas de sedestación (sitting imbalance). Estudio radiográfico convencional y TAC con signos de asimetría pélvica, elevación de hemipelvis izquierda y pseudoartrosis sacra y de ramas ilioisquiopubianas izquierdas post-fractura. Diagnóstico: Secuela compleja de Fractura de Pelvis con deformidad, tipo III de Mears y Velyvis. Tratamiento: Secuenciado en 2 fases. (1) Liberación Anterior: Desarticulación sinfisaria, esqueletización de ramas y osteotomía sacra anterior. Liberación Posterior: Liberación ligamentos suelo pélvico y osteotomía sacra posterior. Tracción progresiva de la extremidad izquierda 2 semanas. (2) Osteosíntesis Anterior: Fijación sacroilíaca anterior con placa de reconstrucción, doble placa anterior sinfisaria y aporte de autoinjerto. Osteosíntesis Posterior: Fijación posterior mediante barra transilíaca. Evolución: Infección herida quirúrica posterior que se resolvió con curas quirúrgicas y antibioterapia. Se consiguió disminución del nivel de dolor, resolución del trastorno de sedestación y mejora de la cojera. SF-36 con PCS 60 y MCS de 50, Majeed-Score excelente. Discusión: La pseudoartrosis y la deformidad son entidades infrecuentes generadas por tratamientos conservadores o inadecuados en lesiones con gran inestabilidad pélvica. El tratamiento puede ser realizado de forma directa o en varias fases. Los pacientes deben ser informados de que el tratamiento implica riesgos más elevados que respecto a la cirugía aguda convencional. Suele obtener mejoras en resultados de consolidación y funcionalidad. El paciente aquí referido ha sido tratado de forma análoga a lo establecido por la comunidad científica, a pesar de ello, no existe evidencia clínica respecto a protocolos de manejo en dicha enfermedad. La realización de estudios multicéntricos ayudaría a la comprensión de los patrones lesionales y al desarrollo de herramientas estandarizadas de tratamiento. Conclusión: La secuela de la fractura pélvica es una entidad compleja de dificultosa resolución y difícil manejo incluso para expertos en dicha materia. Es preciso un abordaje multidisciplinar de dichos paciente en centros de tercer nivel para la obtención de los mejores resultados en esta patología (AU)

Objectives: Critical assessment of a case report related to complications in pelvis fracture. The aim is to determine the complexity in management and treatment of pelvic sequelae. Case Report: 29 years old woman with disabling pain in sacroiliac joint when sitting and walking. External pelvic deformity with aesthetic evidence, left lower limb with 4 cm dysmetria and sacroiliac pain pelvic when examination maneuvers opening pelvis or standing on one foot. Functional limitation with sitting and gait problems. Conventional X-rays and CT-scan reveal pelvic asymmetry, upper left hemipelvis and nonunions in sacrum and left ilioischiopubic ramus fractures. Diagnosis: Pelvic fracture complication Velyvis and Mears type III. A two phases sequenced treatment was performed: (1) Anterior Release: Symphyseal disjoint, branches skeletonization and anterior sacral osteotomy. Posterior Release: Posterior sacroiliac complex and pelvic floor ligaments release with posterior sacral osteotomy. Progressive left extremity traction 2 weeks. (2) Anterior Osteosynthesis: Anterior sacroiliac fixation with reconstruction plate, double symphyseal plate and patient bonegrafting. Posterior Osteosynthesis: Transiliac bar. Outcome with surgical wound infection solved with antibiotics and surgical treatment. A pain decrease, sitting disorder resolution and improvement of lameness was achieved. SF-36 with 60 PCS and 50 MCS. Excelent Majeed-Score. Discussion: Pelvic malalignement and nonunions are rare entities, usually associated with initial conservative or inadequate treatment in pelvic instable fractures. Treatment may be accomplished directly or in stages. Patients should be informed that treatment involves higher risks than over conventional acute surgery. It often obtains improved consolidation and functionality results. The patient here referred has been treated similarly to that established by the scientific community, nevertheless, there is no clinical evidence regarding management protocols in the disease. Multicenter studies would help the understanding about patterns and development of standardized treatment algorithms. Conclusion: Pelvic fracture complications are complex entities. It involves a hard resolution and difficult management even for expert surgeons. A multidisciplinary approach of these patients in tertiary centers is needed to obtain the best results in this pathology (AU)

Spray nebulization for sample introduction in ion mobility spectrometry.

A new sample introduction system based on spray nebulization has been successfully developed to perform direct analysis of liquid samples by IMS. The system comprises a concentric nebulizer that generates a spray plume which is introduced in the ionization region of the IMS instrument through a temperature controlled transfer line. This system avoids previous problems of direct injection of liquid samples and maintains the countercurrent flow of inert gas necessary for the operation of the IMS instrument. Evaluation of the qualitative and quantitative capabilities of the methodology has been performed after a carefully study of the main variables affecting the spray nebulization and the transport of the analyte molecules through the transfer line. To demonstrate the usefulness of the new sample introduction system, direct analysis of drugs and drug metabolites in saliva or urine samples have been performed, obtaining accurate, reliable and sensitive results. Moreover, analytes with physico-chemical properties that limited the capability of thermal desorption as sample introduction method such as amino acids can be analyzed by using the spray nebulization methodology.

Biomechanical analysis of a new minimally invasive system for osteosynthesis of pubis symphysis disruption.

INTRODUCTION: We analysed the effectiveness of a new percutaneous osteosynthesis system for the treatment of pelvis fractures with rotational instability. METHODS: A pre-clinical cross-sectional experimental study wherein Tile type B1 injuries (open-book fractures) were produced in 10 specimens of fresh human cadavers, including the L4-5 vertebrae, pelvic ring, and proximal third of the femur, keeping intact the capsular and ligamentous structures, is presented in this paper. The physiological mobility of the intact pelvis in a standing position post-injury was compared to that following the performance of a minimally invasive osteosynthesis of the symphysis with two cannulated screws. A specially designed test rig capable of applying loads simulating different weights, coupled with a photogrammetry system, was employed to determine the 3D displacements and rotations in three test cases: intact, injured and fixed. RESULTS: After applying an axial load of 300 N, no differences were observed in the average displacement (mm) of the facet joints of the intact pubic symphysis in comparison to those treated with screws (p >0.7). A statistical difference was observed between the average displacements of the sacroiliac facet joints and pelvises with symphyseal fractures treated with screws after the application of a load (p <0.05). CONCLUSION: The symphyseal setting with two crossed screws appears to be an effective alternative to osteosynthesis in pelvic fractures with rotational instability.

Nitric oxide beam intensity oscillations induced by the combined action of a static and a radio frequency electric field.

This paper details an experimental and theoretical investigation in which a simplified version of the molecular beam electric resonance technique is employed that requires the use of a C-field only. In the experiment the forward intensity of a NO beam is measured as a function of the frequency of the oscillating electric field over the 900-1460 kHz range. Specifically, the interaction of the NO beam with a radio frequency (rf) field of 1.12 kV/m amplitude and -610 kV/m (2) of gradient at the horizontal plane during 72 micros produces a series of oscillations in the transmitted beam intensity. The theoretical analysis shows how the interaction between a beam of NO molecules and both a static and oscillating rf field produces interferences in the forward beam intensity and how the observed interferences are due to superposition of molecular internal states. Furthermore, the interference model reproduces satisfactorily the observed beam intensity oscillations. The present technique could be useful for the development of new schemes to achieve coherent control of molecular processes using radiowaves.

Inductively coupled plasma optical emission spectroscopy determination of trace element composition of argan oil.

A methodology based on inductively coupled plasma optical emission spectroscopy (ICP-OES) after microwave assisted acid digestion has been developed to determine the trace element content of Moroccan argan oil. Limit of detection values equal or lower than few mg/kg were obtained for all elements under study. To assure the accuracy of the whole procedure, recovery studies were carried out on argan oil samples spiked at different concentration levels from 10 to 200 µg/L. Quantitative average recovery values were obtained for all elements evaluated, demonstrating the suitability of this methodology for the determination of trace elements in argan oil samples. Aluminum, calcium, chromium, iron, potassium, lithium, magnesium, sodium, vanadium and zinc were quantitatively determined in Moroccan argan oils being found that their concentration is different of that found in other edible oils thus offering a way for authentication and for the evaluation of possible adulterations.

Interferences in the transverse profile of a toluene beam induced by a resonant RF electric field.

In this work, the interaction of a supersonic beam of toluene diluted in He with a resonant oscillating RF field is investigated both experimental and theoretically. It is shown how the resonant field induces a peak structure in the transverse beam profile which can be explained by the onset of molecular interferences. Specifically, the interaction of a toluene beam of 0.12 eV of translational energy with a resonant RF field of 1.12 kV/m amplitude, and -610 kV/m(2) of gradient at the horizontal plane, during 160 micros produces a series of maxima in the transverse beam profile. The observed structure was satisfactorily reproduced by a quantum interference model based on the interaction of two coherent superpositions induced by the resonant RF field. It appears the present experimental technique could be useful to investigate the spectroscopy and dynamical behavior of coherent beams of polar molecules.

Ultrasound-assisted extraction for rapid determination of Zn, Cu, Fe, Mg and Mn in liver of diabetic rats under different antioxidant treatments.

The metabolism of several essential elements is altered in diabetes mellitus and these nutrients might have specific roles in the pathogenesis and progress of this disease, nevertheless, the mechanisms are still far from known. Variations in Zn, Cu, Fe, Mg and Mn in rat liver have been measured both in control and diabetic rats which have been given antioxidants (either synthetic or natural extracts) or a placebo. Classical contaminant and time-consuming digestion methods for sample pre-treatment have been substituted by ultrasound-assisted liquid extraction (USLE). The effect of several parameters was studied, the best results being obtained for: 0.2 g of sample in 10 mL 10% HNO(3) and 8 min of sonication with 19 kHz frequency. The complete analytical method was validated regarding linearity, precision, accuracy and limits of detection (LOD) and quantification (LOQ). Values for LOD ranged from 0.6 for Mn to 12.5 for Mg, and LOQ ranged from 1.8 for Mn and to 62.5 for Mg expressed as microg g(-1) in sample. Results showed an increase of all the metal assayed in the liver of diabetic rats as compared to controls. Nevertheless, when animals were treated either with antioxidants or Dunaliella extracts in a short term assay, Fe increase in liver of diabetic rats was lower than with the other treatments, while Rosmarinus (rosemary) extracts were the only treatment producing a decrease in Mn on diabetic rats.

A review of non-chromatographic methods for speciation analysis.

This manuscript overviews relevant scientific literature concerning speciation of trace elements by using non-chromatographic methods. The main principles of the different strategies proposed in the published works and their advantages and drawbacks are discussed in order to provide to the readers an appropriate picture of the state-of the-art of fast and cheap methodologies available to obtain information about the presence of different chemical forms of trace elements in environmental, clinical and food samples. A selection of the methods proposed for the speciation of the different elements studied was also provided together with their main features.

Searching the most appropriate sample pretreatment for the elemental analysis of wines by inductively coupled plasma-based techniques.

Different sample preparation methods were evaluated for the simultaneous multielement analysis of wine samples by inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS). Microwave-assisted digestion in closed vessel, thermal digestion in open reactor, and direct sample dilution were considered for the determination of Li, Be, Na, Mg, Al, K, Ca, Sc, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Sr, Y, Mo, Cd, Ba, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, Lu, Tl, Pb, and Bi in 12 samples of red wine from Valencia and Utiel-Requena protected designation of origin. ICP-MS allows the determination of 17 elements in most of the samples, and using ICP-OES, a maximum of 15 elements were determined. On comparing the sample pretreatment methodology, it can be concluded that the three assayed procedures provide comparable results for the concentration of Li, Na, Mg, Al, K, Ca, Mn, Fe, Zn, and Sr by ICP-OES. Furthermore, ICP-MS data found for Cu, Pb, and Ba were comparable. Digestion treatment provides comparable values using both total decomposition in open system and microwave-assisted treatment for Cu by ICP-OES and for Cr, Ni, and Zn by ICP-MS. Open vessel total digestion provides excess values for Cr, Mn, Fe, and Zn by ICP-OES and defect values for Se. However, direct measurement of diluted wine samples provided uncomparable results with the digestion treatment for Mn, Cu, Pb, Zn, Ba, and Bi by ICP-OES and for Mg, Cr, Fe, Ni, and Zn by ICP-MS. Therefore, it can be concluded that microwave-assisted digestion is the pretreatment procedure of choice for elemental analysis of wine by ICP-based techniques.

[The effect of a fibre enriched dietary milk product in chronic primary idiopatic constipation]. / Efecto de la ingesta de un preparado lácteo con fibra dietética sobre el estreñimiento crónico primario idiopático.

BACKGROUND: fibre is effective in some types of constipation. Our objective was to determine if the administration of an enriched dairy preparation with a supplement of soluble fibre (Naturfibra) [inulin and digestion resistant maltodextrin (Fibersol 2)], improves primary chronic constipation. METHODS: Prospective, randomized, double blind clinical trial randomized with dietary intervention in 32 subjects with constipation according to the Rome II criteria. Thirty two subjects (men 4; women 28) with an average age of 47 +/- 15 years were randomly divided in two homogeneous groups. A type of milk (A or B) was assigned to each group. Group A received fibre enriched semi-skimmed milk; Group B received semi skimmed milk. The subjects drank half a litre of milk per day during 20 days, meaning that those who drank the enriched milk ingested 20 grams of fibre a day. RESULTS: The subjects that presented straining at defecation (p < 0.001), sensation of incomplete evacuation (p < 0.001), sensation of obstruction in the evacuation (p < 0.001) and days between bowel movements, diminished significantly after the intake of milk supplemented with fibre. CONCLUSION: The intake of a dairy preparation with a supplement of fibre containing 20 grams of soluble fibre (inulin and digestion resistant maltodextrin), improves the situation of idiopathic primary chronic constipation based on the Rome II criteria.

Elemental composition of seasoning products.

The elemental composition of seasoning products, like spices garlic and onion, has been reviewed paying special attention to methods proposed in the literature to determine specific elements or as much as possible components of these products which are widespread used in food preservation or food flavouring and can contribute to the intake of both, essential and toxic elements. Sample treatment and metal speciation aspects have been critically revised concerning onion, garlic and pepper (the most commonly studied products).

Validated flow-injection method for rapid aluminium determination in anti-perspirants.

A flow-injection (FI) method for the rapid determination of aluminium in anti-perspirants has been developed. The method is based on the spectrophotometric detection at 535nm of the complex formed between Al ions and the chromogenic reagent eriochrome cyanine R. Both the batch and FI methods were validated by checking the parameters included in the ISO-3543-1 regulation. Variables involved in the FI method were optimized by using appropriate statistical tools. The method does not exhibit interference from other substances present in anti-perspirants and it shows a high precision with a R.S.D. value (n=6) of 0.9%. Moreover, the accuracy of the method was evaluated by comparison with a back complexometric titration method, which is currently used for routine analysis in pharmaceutical laboratories. The Student's t-test showed that the results obtained by both methods were not significantly different for a significance level of 95%. A response time of 12s and a sample analysis time, by performing triplicate injections, of 60s were achieved. The analytical figures of merit make the method highly appropriate to substitute the time-consuming complexometric method for this kind of analysis.

Trace elemental composition of curry by inductively coupled plasma optical emission spectrometry (ICP-OES).

A methodology based on inductively coupled plasma optical emission spectrometry (ICP-OES) after microwave-assisted acid digestion was developed to determine the content of traces elements in curry samples from the Spanish market. The methodology was validated in terms of accuracy by the analysis of citrus and tomato leaf reference materials achieving comparable results with the certified values. The trace metal content of curry samples was compared with data available from previously published reports concerning Indian samples, especially in terms of heavy metal composition, in order to guarantee the quality of the commercially available spices in the European countries. Values found for the analysis of arsenic, lead and cadmium were significantly lower than the maximum limit allowed by European Union statutory limits for heavy metals and lower than those obtained for Indian curry leaves reported by Indian research teams by using neutron activation and γ-ray analysis.

Capillary electrophoresis for short chain organic acids in faeces Reference values in a Mediterranean elderly population.

There is increasing evidence that gut microflora and fermentation processes in the large intestine are important for health, and that health-promoting effects are mediated by fermentation products. Usually analytical methods for these compounds are tedious. A simple and rapid procedure of aqueous extraction from the stools has been optimized. After extraction, an aliquot of the aqueous layer was directly injected into the capillary electrophoresis equipment. Oxalic, formic, fumaric, 2-ketoglutaric, succinic, citric, acetic, propionic, 2-ketoisovaleryc, butyric, isovaleric lactic, glyceric 2-hydroxybutyric, and valeric acids were separated and identified. Electrophoretic conditions were: phosphate buffer 234 mM pH 6.10 with 12% (v/v) methanol with a coated capillary at -10 kV of applied potential. The method was validated for a representative group of compounds: acetic, propionic butyric, 2-hydroxybutiric, isovaleric, and oxalic acids, including the comparison of results with ionic chromatography. Finally 136 samples from healthy humans aged 60-80, both male and female living in Spain, were measured. They could be used as reference values for further studies.

Estudio de la disolución del calcio a partir de una nueva formulación de comprimidos bucodispersables y su comparación con formulaciones masticables convencionales / Study of the dissolution of calcium contained in a novel orodispersible tablet formulation and its comparison with conventional chewable formulations

Los suplementos de calcio con vitamina D constituyen un componente habitual de los tratamientos de la osteoporosis. La absorción del calcio suministrado requiere su disolución previa. Sin embargo, las sales de calcio habitualmente utilizadas son muy poco solubles y dependen del ácido gástrico para liberar el calcio en forma biodisponible. Se ha desarrollado una nueva formulación bucodispersable de calcio y vitamina D (Natecal D Flas). Esta formulación no sólo facilita el cumplimiento terapéutico del tratamiento, sino también la disolución del calcio y, por tanto, su biodisponibilidad. En este estudio se ha comparado la disolución del calcio de comprimidos masticables convencionales con la nueva formulación bucodispersable, tanto en medio gástrico artificial (pH ácido) como en agua (ausencia de ácido). Los resultados indican que en medio gástrico artificial, simulando condiciones fisiológicamente normales, los comprimidos bucodispersables producen una disolución significativamente más rápida del calcio que los comprimidos masticables. En el caso del agua, simulando una condición de aclorhidria absoluta, no se produce disolución del calcio en el caso de los comprimidos masticables mientras que existe una disolución parcial, pero significativa, en el caso de los comprimidos bucodispersables. Estos resultados indican que la nueva formulación bucodispersables de carbonato cálcico y vitamina D (Natecal D Flas) contribuye a una mejor absorción del calcio en aquellos pacientes en la que ésta puede estar disminuida por circunstancias fisiológicas (AU)

Calcium supplements with vitamin D are standard components of treatments for osteoporosis. The absorption of the calcium provided requires its prior dissolution. However, the solubility of the calcium salts usually employed is limited and the release of the calcium in a bioavailable form depends on gastric acid. A novel orodispensible formulation of calcium and vitamin D (Natecal D Flas) has been developed. This formulation not only facilitates treatment compliance, but the dissolution of the calcium as well, thus enhancing its bioavailability. In this study, the authors have compared the dissolution of the calcium contained in conventional chewable tablets with that of the new orodispersible formulation, both in artificial gastric juice (acidic pH) and in water (absence of acid). The results indicate that, in artificial gastric juice, simulating normal physiological conditions, the orodispersible tablets produce a significantly more rapid dissolution of calcium than the chewable tablets. In the case of water, simulating conditions of absolute achlorhydria, there is no dissolution of the calcium contained in the chewable tablets, whereas partial, but significant, dissolution is observed with the orodispersible tablets. These findings indicate that the novel orodispersible formulation of calcium carbonate and vitamin D (Natecal D Flas) contributes to better absorption of calcium in those patients in whom this process may be compromised by physiological circumstances (AU)