Suplementos nutricionales gelatinizados: una alternativa válida para la disfagia / Gelatinous nutritional supplements: a useful alternative in dysphagia

La disfagia orofaríngea es un síndrome muy prevalente en la población mayor, más aún entre ancianos institucionalizados. La causa más frecuente de disfagia son las enfermedades neurodegenerativas y vasculares cerebrales, especialmente la demencia, cuyas fases más avanzadas se acompañan de trastornos de glutorios frecuentes que exigen texturas espesas, tipo pudin en su alimentación. Los suplementos nutricionales de consistencia pudin no están financiados por el sistema de salud, por lo que, encaso de precisar su uso, hay que afrontar su coste o espesarlos suplementos líquidos financiables, habitualmente de forma individualizada, con espesantes comerciales en polvo. Éste es un proceso laborioso, altamente variable en la consistencia obtenida y de apariencia poco homogénea ,por lo que es difícil de aplicar en los centros geriátricos grandes. Presentamos otra forma de usar estos suplementos financiados, mezclándolos con gelatina comercial que permite obtener una apariencia pulida, con textura homogénea y que permanecen estables en su composición y seguros para su consumo durante 5 días (AU)

The oropharingeal dysphagia is a very prevalent syndrome among the elderly, and even more among institutionalized individuals. Dysphagia is frequently caused by neurodegenerative and cerebrovascular conditions, the dementia syndrome being the most common of them, where the latest stages of the process are often accompanied by frequent swallowing problems requiring to incorporate thick foodstuffs in the diet of the elderly, such as the pudding. Nutritional supplements with a pudding like consistency are not financed by the National Health System. Therefore, when they are needed, patients must either pay their full price for them or thicken the liquid supplements financed by the National Health System. This is normally done in an individualized way, through the powder thickeners in the market. It is a very laborious and highly changeable process regarding the resulting consistency, with a poor homogeneous aspect; thus, it is complicated to implement this method in big community dwelling. We here by present a different way to use these financed supplements, this is: mixing them up with commercial jelly resulting in a refined product with a homogeneous texture. These supplements will remain stable in their composition and safe to be used within 5 days (AU)

[Gelatinous nutritional supplements: a useful alternative in dysphagia]. / Suplementos nutricionales gelatinizados: una alternativa válida para la disfagia.

The oropharingeal dysphagia is a very prevalent syndrome among the elderly, and even more among institutionalized individuals. Dysphagia is frequently caused by neurodegenerative and cerebrovascular conditions, the dementia syndrome being the most common of them, where the latest stages of the process are often accompanied by frequent swallowing problems requiring to incorporate thick foodstuffs in the diet of the elderly, such as the pudding. Nutritional supplements with a puddinglike consistency are not financed by the National Health System. Therefore, when they are needed, patients must either pay their full price for them or thicken the liquid supplements financed by the National Health System. This is normally done in an individualized way, through the powder thickeners in the market. It is a very laborious and highly changeable process regarding the resulting consistency, with a poor homogeneous aspect; thus, it is complicated to implement this method in big community dwelling. We hereby present a different way to use these financed supplements, this is: mixing them up with commercial jelly resulting in a refined product with a homogeneous texture. These supplements will remain stable in their composition and safe to be used within 5 days.

Suitability of PCR fingerprinting, infrequent-restriction-site PCR, and pulsed-field gel electrophoresis, combined with computerized gel analysis, in library typing of Salmonella enterica serovar enteritidis.

Strains of Salmonella enterica (n = 212) of different serovars and phage types were used to establish a library typing computerized system for serovar Enteritidis on the basis of PCR fingerprinting, infrequent-restriction-site PCR (IRS-PCR), or pulsed-field gel electrophoresis (PFGE). The rate of PCR fingerprinting interassay and intercenter reproducibility was low and was only increased when DNA samples were extracted at the same time and amplified with the same reaction mixtures. Reproducibility of IRS-PCR technique reached 100%, but discrimination was low (D = 0.52). The PFGE procedure showed an intercenter reproducibility value of 93.3%. The high reproducibility of PFGE combined with the previously determined high discrimination directed its use for library typing. The use of PFGE with enzymes XbaI, BlnI, and SpeI for library typing of serovar Enteritidis was assessed with GelCompar 4.0 software. Three computer libraries of PFGE DNA profiles were constructed, and their ability to recognize new DNA profiles was analyzed. The results obtained pointed out that the combination of PFGE with computerized analysis could be suitable in long-term epidemiological comparison and surveillance of Salmonella serovar Enteritidis, specially if the prevalence of genetic events that could be responsible for changes in PFGE profiles in this serovar was low.

Typing of Salmonella enteritidis of different phage types of PCR fingerprinting.

Fifty-nine isolates of Salmonella spp. were typed by PCR fingerprinting using three single primers: ERIC2, M13 and OPS-19. First, their discrimination power in a group of nine different serotypes were studied and considerable differences in the band patterns were obtained. Further, a panel of 51 isolates of Salmonella enteritidis with eight different phage types were analysed with the three primers. The discriminating power increased by combining the patterns of the three primers, and in this case it was possible to distinguish between some phage types of Salm. enteritidis, but not all of them were differentiated.

Phage typing combined with pulsed-field gel electrophoresis and random amplified polymorphic DNA increases discrimination in the epidemiological analysis of Salmonella enteritidis strains.

Phage typing (PT) combined with pulsed-field gel electrophoresis (PFGE) and a random amplified polymorphic DNA (RAPD) fingerprinting method was used to characterize Salmonella enteritidis strains. Twenty-four epidemiologically unrelated isolates, sampled from diverse ecological niches and fifteen isolates from four well-defined outbreaks of foodborne gastroenteritis, were studied. Seven phage types, with a predominance of PT 4 (63% of isolates), were observed when analysing the epidemiologically unrelated group. PT 4 was detected in all of the ecological niches studied, including food and fecally polluted river and beach water. The discriminatory power for phage typing, the average probability that the typing system will assign a different type to two unrelated strains randomly sampled in the microbial population, was 0.62. Ten PFGE pattern types were obtained with Xba I restriction endonuclease enzyme among the unrelated isolates; thirteen isolates belonged to PFGE pattern type 1 and the rest of the PFGE types were assigned to one or two isolates. The Dice coefficient clustered the similarities of the PFGE patterns between 80-100%. PFGE showed a discriminatory power of 0.72. Five clearly distinct RAPD patterns were observed with the OPS-19 oligonucleotide, but the discrimination obtained was low (0.46). The combination of the three typing methods increased the number of types to seventeen, giving high discrimination (0.92). Seven of the isolates recovered from various ecological niches belonged to the combination PT 4/PFGE 1/RAPD A and other combinations were unique or included only two strains. The four epidemiologically well-defined foodborne outbreaks were associated with the PT 4 phage type. In two of the outbreaks, other phage types (PT 7a and RDNC) were also observed in two isolates. Most of the isolates belonging to the foodborne outbreaks had an identical PFGE pattern (PFGE pattern type 1), but a difference in a restriction band was observed in an isolate belonging to an outbreak. Two RAPD patterns were observed in the outbreaks; RAPD pattern type A was detected in three of the four outbreaks. When the combined typing method was applied to the study, high concordance was observed and most of the outbreak strains belonged to the combination PT 4/PFGE 1/RAPD A. It is concluded that the combination of phage type with PFGE and RAPD provides a powerful discriminatory tool for the epidemiological analysis of unrelated and related strains of S. enteritidis.