Sustitución parcial de la harina de trigo (Triticun aestivum L.) por harina de chocho (Lupinus mutabilis) en la elaboración de galletas

Cookies are a bakery product generally made with industrial wheat flour. The goald of the present investigation was to evaluate the incidence of the partial substitution of wheat flour (Triticun aestivum L.) by chocho flour (Lupinus mutabilis) in the manufacture of cookies and how it influences the textural, physicochemical and sensory characteristics. A complete randomized design (C.R.D.) was applied and a Tukey's test (p < 0.05) was used to determine significant differences. All treatments showed statistical differences, establishing values for the variables analyzed: hardness (29,89 - 19,04 N), fracturability (0,49 to 0,24 KgF), moisture (4,83 - 2,93 %), protein (21,65 - 8,16 %), ash (2,28 - 1,57 %), crude fiber (9,38 - 4,39 %), fat (26,25 - 37,12 %), carbohydrates (59,49 to 25,57 %) and energy (563,00 -506,6 kcal). In relation to the sensory profile, T4 (25 % chocho flour + 75 % wheat flour) obtained better acceptance by the tasters, as well as better odor, color, flavor and crunchiness. Thus, it is concluded that the incorporation of chocho flour in the formulation of cookies is an excellent alternative to reduce the dependence on wheat in its production, being also a source of high nutritional value.Las galletas son un producto del área de panificación elaborados generalmente con harina de trigo industrial. El objetivo de la presente investigación consistió en evaluar la incidencia de la sustitución parcial de la harina de trigo (Triticun aestivum L.) por la harina de chocho (Lupinus mutabilis) en la elaboración de galletas y cómo influye en las características texturales, fisicoquímicas y sensoriales. Se aplicó un diseño completo al azar (D.C.A) y para determinar diferencia significativa se utilizó la prueba de Tukey (p < 0,05). Todos los tratamientos arrojaron diferencias estadísticas, estableciendo valores para las variables analizadas: dureza (29,89 - 19,04 N), fracturabilidad (0,49 a 0,24 KgF), humedad (4,83 - 2,93 %), proteína (21,65 - 8,16 %), cenizas (2,28 - 1,57 %), fibra cruda (9,38 - 4,39 %), grasa (26,25 - 37,12 %), carbohidratos (59,49 a 25,57 %) y energía (563,00 – 506,6 kcal). En relación con el perfil sensorial, el T4 (25 % de harina de chocho + 75 % de harina de trigo) obtuvo mejor aceptación por parte de los catadores, así como también, un mejor olor, color, sabor y crujencia. Se concluye que la incorporación de harina de chocho en la formulación de galletas es una excelente alternativa para disminuir la dependencia del trigo en su elaboración, siendo también una fuente de alto valor nutricional

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Nutrición en la defensa inmunitaria, el papel de la leche y sus componentes naturales, revisión sistemática

Introduction: The World Health Organisation (WHO) stresses the fundamental importance of exclusive breastfeeding. This approach helps prevent diseases that cause infant mortality, while decreasing the risk of breast and ovarian cancer, diabetes, and heart disease and hypertension in women.Objective: To analyse the importance of maternal nutrition by studying the components of milk in order to prevent pathologies in the short term.Methodology: A systematic search was carried out by reviewing the literature in scientific databases such as Pubmed, Elsevier, Springer, Scopus, Scielo published in the last 5 years, considering significant contributions in the areas of paediatrics and neonatology, as well as theoretical approaches, with the aim of reflecting the controversies that arise around avoidable pathologies in exclusive breastfeeding.Results: Breastfeeding provides essential nutrients and immunological components that strengthen infant health and protect against disease by offering benefits such as protection against infectious diseases and allergies, and promotes optimal cognitive development. Although breastmilk substitutes have improved, they cannot match its unique benefits. Conclusion: Exclusive breastfeeding for the first six months is critical to the health of the newborn, providing essential nutrients and strengthening the immune system. Although breast substitutes have advanced, they cannot match the benefits of breastfeeding. The importance of promoting breastfeeding to improve infant health and prevent disease is emphasized.Introducción: La Organización Mundial de la Salud (OMS) subraya la importancia fundamental de la lactancia exclusiva. Este enfoque ayuda a prevenir enfermedades que son causa de mortalidad infantil, al mismo tiempo que disminuye el riesgo de cáncer de mama y ovario, diabetes, y enfermedades cardíacas e hipertensión en las mujeres.Objetivo: Analizar la importancia de la nutrición materna mediante el estudio de los componentes de la leche para prevenir patologías a corto plazo.Metodología: Se realizó una búsqueda sistemática mediante la revisión de bibliografía en bases científicas como Pubmed, Elsevier, Springer, Scopus, Scielo publicada en los últimos 5 años, considerando aportes significativos en áreas de pediatría y neonatología, como planteamientos teóricos, con el propósito de reflejar las controversias que surgen en torno a las patologías evitables en la lactancia materna exclusiva.Resultados: La lactancia materna proporciona nutrientes y componentes inmunológicos esenciales que fortalecen la salud del lactante y lo protegen contra enfermedades ofreciendo beneficios como la protección contra enfermedades infecciosas y alergias, y promueve un desarrollo cognitivo óptimo. Aunque los sustitutos de la leche materna han mejorado, no pueden igualar sus beneficios únicos. Conclusión: La lactancia materna exclusiva durante los primeros seis meses es fundamental para la salud del neonato, proporcionando nutrientes esenciales y fortaleciendo su sistema inmunológico. Aunque los sucedáneos han avanzado, no pueden igualar los beneficios de la lactancia materna. Se destaca la importancia de promoverla para mejorar la salud infantil y prevenir enfermedades

Nutrición en la defensa inmunitaria, el papel de la leche y sus componentes naturales, revisión sistemática

Introduction: The World Health Organisation (WHO) stresses the fundamental importance of exclusive breastfeeding. This approach helps prevent diseases that cause infant mortality, while decreasing the risk of breast and ovarian cancer, diabetes, and heart disease and hypertension in women.Objective: To analyse the importance of maternal nutrition by studying the components of milk in order to prevent pathologies in the short term.Methodology: A systematic search was carried out by reviewing the literature in scientific databases such as Pubmed, Elsevier, Springer, Scopus, Scielo published in the last 5 years, considering significant contributions in the areas of paediatrics and neonatology, as well as theoretical approaches, with the aim of reflecting the controversies that arise around avoidable pathologies in exclusive breastfeeding.Results: Breastfeeding provides essential nutrients and immunological components that strengthen infant health and protect against disease by offering benefits such as protection against infectious diseases and allergies, and promotes optimal cognitive development. Although breastmilk substitutes have improved, they cannot match its unique benefits. Conclusion: Exclusive breastfeeding for the first six months is critical to the health of the newborn, providing essential nutrients and strengthening the immune system. Although breast substitutes have advanced, they cannot match the benefits of breastfeeding. The importance of promoting breastfeeding to improve infant health and prevent disease is emphasized.Introducción: La Organización Mundial de la Salud (OMS) subraya la importancia fundamental de la lactancia exclusiva. Este enfoque ayuda a prevenir enfermedades que son causa de mortalidad infantil, al mismo tiempo que disminuye el riesgo de cáncer de mama y ovario, diabetes, y enfermedades cardíacas e hipertensión en las mujeres.Objetivo: Analizar la importancia de la nutrición materna mediante el estudio de los componentes de la leche para prevenir patologías a corto plazo.Metodología: Se realizó una búsqueda sistemática mediante la revisión de bibliografía en bases científicas como Pubmed, Elsevier, Springer, Scopus, Scielo publicada en los últimos 5 años, considerando aportes significativos en áreas de pediatría y neonatología, como planteamientos teóricos, con el propósito de reflejar las controversias que surgen en torno a las patologías evitables en la lactancia materna exclusiva.Resultados: La lactancia materna proporciona nutrientes y componentes inmunológicos esenciales que fortalecen la salud del lactante y lo protegen contra enfermedades ofreciendo beneficios como la protección contra enfermedades infecciosas y alergias, y promueve un desarrollo cognitivo óptimo. Aunque los sustitutos de la leche materna han mejorado, no pueden igualar sus beneficios únicos. Conclusión: La lactancia materna exclusiva durante los primeros seis meses es fundamental para la salud del neonato, proporcionando nutrientes esenciales y fortaleciendo su sistema inmunológico. Aunque los sucedáneos han avanzado, no pueden igualar los beneficios de la lactancia materna. Se destaca la importancia de promoverla para mejorar la salud infantil y prevenir enfermedades

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN