Empleo de CO2 presurizado como tecnología no térmica en la conservación de zumos

Póster presentado en: 9ª Reunión de Expertos en Tecnologías de Fluidos Supercríticos (Flucomp), 13 a 15 de junio de 2018, Madrid. Jornada Academia-Empresa (one‐to‐one)Este trabajo se centra en la aplicación de la tecnología no térmica HPCD (High Pressure Carbon Dioxide), basada en el empleo del dióxido de carbono a alta presión, generalmente inferior a 50 MPa, para la conservación de alimentos. Se ha estudiado específicamente su aplicación en el proceso de pasteurización de zumos con pH ácido como el de naranja1, manzana2 y tomate. Para ello se han determinado las cinéticas de inactivación de diferentes enzimas como polifenoloxidasa (PPO), responsable del pardeamiento enzimático y pectinmetilesterasa (PME), que junto con poligalacturonasa (PG) juegan un papel importante en la viscosidad de los zumos. El grado de inactivación enzimática encontrado depende tanto de la fuente de la enzima, como de las condiciones de procesado, tiempo, presión y temperatura. Así, en el caso del zumo de manzana se consiguieron actividades residuales en torno a 10 % para la PPO, mientras que para la PME fueron en torno a 65 % en las mismas condiciones de procesado, 60 min, 45ºC y 20 MPa. En este caso, la estructura más compleja de la PME, con tres subunidades frente a una de la PPO, la hace más resistente al tratamiento. Otra de las variables importantes en el tratamiento mediante HPCD es la relación CO2:volumen tratado. Se realizaron estudios con diversas enzimas comerciales (PPO y PME), encontrando que relaciones superiores a 3 g CO2:mL no conllevan un mayor grado de inactivación, pudiendo así optimizar el proceso desde un punto de vista económico. Estudios de espectroscopía de fluorescencia en estas enzimas comerciales tratadas mediante HPCD correlacionaron cambios en la estructura terciaria de la enzima con la pérdida de actividad enzimática de la mismas a diferentes condiciones de presión y temperatura.MINECO y FEDER, proyecto CTQ2015-64396-R y el contrato de AEI. MINECO, contrato FPI (BES-2013-063937) de RM y JCyL y FEDER, contrato de OBR (BU055U16)

Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición

Introducción: La evaluación de la calidad en las actividades sanitarias exige la elección de unos indicadores acordes con los resultados que queremos medir. De todos los posibles, debemos priorizar aquellos que nos permitan obtener la información más relevante sin sobrecargar el trabajo habitual de nuestras Unidades. Objetivo: Conocer la opinión de los socios de SENPE respecto a la relevancia y la viabilidad del uso de una selección de indicadores de calidad para su aplicación en nutrición clínica. Métodos: Encuesta remitida mediante correo electrónico a los socios de SENPE solicitando a los mismos su opinión sobre 12 indicadores de calidad, valorándose cada uno en cuanto a su relevancia y factibilidad de la aplicación en su medio. Resultados: Contestaron 40 encuestados de 40 centros diferentes de 12 comunidades autónomas. En general, los indicadores fueron considerados más relevantes que factibles. Los indicadores mejor puntuados fueron: “identificación en las bolsas de nutrición artificial”, “posición semi-incorporada del paciente con nutrición enteral por sonda nasogástrica” y “protocolos clínicos básicos”. Considerando los indicadores por grupos (de estructura, proceso o resultado) los mejor valorados fueron: “identificación del paciente en las bolsas de nutrición artificial” (estructura), “posición semi-incorporada” y “protocolos clínicos básicos” (proceso), y “cumplimiento del objetivo calórico” (resultado). Conclusión: Los resultados de la encuesta permiten seleccionar indicadores prioritarios para su aplicación en las Unidades de NutriciónIntroduction: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. Objective: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. Methods: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. Results: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: “identification in artificial nutrition bags, “semi-recumbent position in patient with nasogastric tube feeding” and “basic clinical protocols”. Considering the type of indicator: “patient identification in the bags of artificial nutrition (structure),” a semi-incorporated “and” basic clinical protocols (process), and “fulfillment of the caloric goal” (result). Conclusion: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Uni

Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial

<p>Abstract</p> <p>Background</p> <p>Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.</p> <p>The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS.</p> <p>Method/design</p> <p>A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment.</p> <p>Discussion</p> <p>This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving the tendons.</p> <p>Trail Registration</p> <p>ISRCTN Number: 30907460</p

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Procesos de silicificación y dolomitización en el Turoniense (provincia de Cuenca)

En la región manchega aparecen sílex nodulares y en niveles discontinuos, asociados frecuentemente con el frente de dolomitización que afecta a los materiales turonienses. Estos sílex se encuentran incluidos tanto en calizas fosilíferas como en dolomías, parcialmente dedolomitizadas, cuya textura deposicional no se ha conservado. Se han diferenciado distintos tipos de sílex en función de las microfacies calcárea afectadas. El análisis textural del sílex demuestra que, aunque el mineral constituyente actual es cuarzo, las silicificaciones fueron en gran parte de ópalo. La alteración del continente bajo un clima templado a cálido y húmedo condujo a la formación de disoluciones enriquecidas en sílice. Pensamos que la silificación y dolomitización se produjeron casi simultáneamente, y directamente relacionadas con la zona de mezcla de aguas continentales y marinas, creada por el inicio de las condiciones regresivas que separan los dos subciclos sedimentarios del Cretácico Superior.N

Comunicación de experiencia del CEAS de Tetuán (CAM).

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