Análisis químico y sensorial de maní tostado cubierto con arrope de tuna y de algarrobo

The objective of this work was to determine the chemical composition, sensory attributes and consumer acceptance of roasted peanuts coated with prickly pear (RP-P) and “algarrobo” pod syrups (RP-A). Roasted peanuts (RP) without coating had the highest oil content (50.4%) in comparison with the coated products RP-P and RP-A (45.3% and 46.7%, respectively). RP-P and RP-A showed lower protein percentage and higher carbohydrate content than RP. These results affected the energy values of the products: 6.14 kcal/g in RP-P, 6.24 kcal/g in RP-A and 6.42 kcal/g in RP. In the consumer test, RP and RP-P had higher consumer acceptance for the attributes of color, texture and flavor than RP-A. In the descriptive analysis, RP-P and RPA showed higher intensity ratings in brown color, roughness, glossy, powdery, sweetness, and salty sensory attributes and lower intensity ratings in raw/beany flavor than in RP. The intensity of roasted peanutty flavor and the texture attributes in the descriptive analysis were not affected for the pod syrup coating.El objetivo del trabajo fue determinar la composición química, atributos sensoriales y la aceptabilidad del maní tostado cubierto con arrope de tuna (RP-P) y de Algarrobo (RP-A). El maní tostado sin cobertura presentó el mayor contenido de aceite (50,4%) en comparación con los maníes cubiertos, RPP y RP-A (45,3% y 46,7%, respectivamente). RP-P y RP-A mostraron menor porcentaje de proteína y mayor contenido de hidratos de carbonos que RP. Estos resultados afectaron los valores energéticos de los productos: 6,14 kcal/g in RP-P, 6,24 kcal/g in RP-A y 6,42 kcal/g in RP. En la prueba de consumidores, RP y RP-P tuvieron mayor aceptabilidad para los atributos color, textura y sabor que en RP-A. En la prueba descriptiva, RP-P y RP-A mostraron mayores intensidades en los atributos sensoriales de color marrón, rugosidad, brillo, pulverulencia, dulzor y salado y menor intensidad en sabor crudo/ poroto que en RP. Las intensidades del sabor a maní tostado y de los atributos de texturas en el análisis descriptivo no fueron afectadas por la presencia de la cobertura de arrope

Chemical composition and sensory analysis of roasted peanuts coated with prickly pear and algarrobo pod syrups

The objective of this work was to determine the chemical composition, sensory attributes and consumer acceptance of roasted peanuts coated with prickly pear (RP-P) and “algarrobo” pod syrups (RP-A). Roasted peanuts (RP) without coating had the highest oil content (50.4%) in comparison with the coated products RP-P and RP-A (45.3% and 46.7%, respectively). RP-P and RP-A showed lower protein percentage and higher carbohydrate content than RP. These results affected the energy values of the products: 6.14 kcal/g in RP-P, 6.24 kcal/g in RP-A and 6.42 kcal/g in RP. In the consumer test, RP and RP-P had higher consumer acceptance for the attributes of color, texture and flavor than RP-A. In the descriptive analysis, RP-P and RPA showed higher intensity ratings in brown color, roughness, glossy, powdery, sweetness, and salty sensory attributes and lower intensity ratings in raw/beany flavor than in RP. The intensity of roasted peanutty flavor and the texture attributes in the descriptive analysis were not affected for the pod syrup coating.El objetivo del trabajo fue determinar la composición química, atributos sensoriales y la aceptabilidad del maní tostado cubierto con arrope de tuna (RP-P) y de Algarrobo (RP-A). El maní tostado sin cobertura presentó el mayor contenido de aceite (50,4%) en comparación con los maníes cubiertos, RPP y RP-A (45,3% y 46,7%, respectivamente). RP-P y RP-A mostraron menor porcentaje de proteína y mayor contenido de hidratos de carbonos que RP. Estos resultados afectaron los valores energéticos de los productos: 6,14 kcal/g in RP-P, 6,24 kcal/g in RP-A y 6,42 kcal/g in RP. En la prueba de consumidores, RP y RP-P tuvieron mayor aceptabilidad para los atributos color, textura y sabor que en RP-A. En la prueba descriptiva, RP-P y RP-A mostraron mayores intensidades en los atributos sensoriales de color marrón, rugosidad, brillo, pulverulencia, dulzor y salado y menor intensidad en sabor crudo/ poroto que en RP. Las intensidades del sabor a maní tostado y de los atributos de texturas en el análisis descriptivo no fueron afectadas por la presencia de la cobertura de arrope

Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study

Background: High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated real-world PC-ECLS clinical practices. Methods: This cross-sectional, multi-institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC-ECLS monitoring, and transfusion practices. Twenty-nine questions were distributed among 34 hospitals participating in the Post-cardiotomy Extra-Corporeal Life Support Study. Results: Of the 32 centers [16 low-volume (50%); 16 high-volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty-six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patients bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged from 7 to 10 g/dL. Most centers used cardiac venting on a case-by-case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols, including daily echocardiography (87.5%), Swan-Ganz catheterization (40.6%), cerebral near-infrared spectroscopy (53.1%), and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d-dimer (59.4%), lactate dehydrogenase (56.3%), and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis. Conclusions: This study shows remarkable heterogeneity in clinical practices for PC-ECLS management. More standardized protocols and better implementation of the available evidence are recommended

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe