Micronutrient Deficiencies in Medical and Surgical Inpatients

Inpatients are threatened by global malnutrition, but also by specific micronutrient (i.e., trace element and vitamins) deficiencies that frequently are overseen in the differential diagnosis of major organ dysfunctions. Some of them are related to specific geographic risks (iodine, iron, selenium, zinc, vitamin A), while others are pathology related, and finally many are associated with specific feeding patterns, including low dose enteral feeding. Among the pathologies in which laboratory blood investigations should include a micronutrient outwork, anemia is in the front line, followed by obesity with bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies and heart failure. The micronutrients at the highest risk are iron, zinc, thiamine, vitamin B12 and vitamin C. Admission to hospital has been linked with an additional risk of malnutrition-feeding below 1500 kcal/day was frequent and has been associated with a structural additional risk of insufficient micronutrient intake to cover basal needs. Although not evidence based, systematic administration of liberal thiamine doses upon admission, and daily complementation of inpatients' food and enteral feeding solutions with multi-micronutrient tablets might be considered

La inoculación con bacterias del ácido acético mejora la calidad de las aceitunas de mesa verdes naturales

This study aims to develop a method for the preparation of natural table olives using locally selected microorganisms and without resorting to the usual techniques which employ lye treatment and acids. The effects of parameters, such as lye treatment, inoculation with yeasts, substitution of organic acids with vinegar and/or acetic acid bacteria, and finally alternating aeration have been assessed. Four different combinations were applied to the “Picholine marocaine” olive variety using indigenous strains, namely Lactobacillus plantarum S1, Saccharomyces cerevisiae LD01 and Acetobacter pasteurianus KU710511 (CV01) isolated respectively from olive brine, Bouslikhen dates and Cactus. Two control tests, referring to traditional and industrial processes, were used as references. Microbial and physicochemical tests showed that the L3V combination (inoculated with A. pasteurianus KU710511 and L. plantarum S1 under the optimal growth conditions of the Acetic Acid Bacteria (AAB) strain with 6% NaCl) was found to be favorable for the growth of the Lactic Acid Bacteria (LAB) strain which plays the key role in olive fermentation. This result was confirmed by sensory evaluation, placing L3V at the top of the evaluated samples, surpassing the industrial one where a chemical debittering treatment with lye was used. In addition, alternating aeration served to increase the microbial biomass of both AAB and LAB strains along with Saccharomyces cerevisiae LD01 strain, but also to use lower concentration of NaCl and to reduce the deterioration of olives compared to the anaerobic fermentation process. Finally, a mixed starter containing the three strains was prepared in a 10-L Lab-fermenter from the L3V sample in order to improve it in subsequent studies. The prepared starter mixture could be suitable for use as a parental strain to prepare table olives for artisan and industrial application in Morocco.Este estudio tiene como objetivo desarrollar un método para la preparación de aceitunas de mesa naturales utilizando microorganismos seleccionados localmente y sin recurrir a las técnicas habituales que utilizan el tratamiento con lejía y ácidos. Se han evaluado los efectos de parámetros como el tratamiento con lejía, la inoculación con levaduras, la sustitución de ácidos orgánicos por bacterias de vinagre y/o ácido acético, y finalmente la aireación alterna. Se ensayaron cuatro combinaciones diferentes en la variedad de aceituna «Picholine marocaine» utilizando cepas autóctonas, como Lactobacillus plantarum S1, Saccharomyces cerevisiae LD01 y Acetobacter pasteurianus KU710511 (CV01) aisladas respectivamente de salmuera de aceitunas, Bouslikhen y Cactus. Se utilizaron como referencia dos pruebas de control, referidas a procesos tradicionales e industriales. Las pruebas microbianas y fisicoquímicas mostraron que la combinación L3V (inoculada con A. pasteurianus KU710511 y L. plantarum S1 en las condiciones óptimas de crecimiento de la bacteria del ácido acético (AAB) con NaCl al 6%) resultó ser favorable para el crecimiento del Láctico. Las cepas de bacterias ácidas (LAB) juegan un papel clave en la fermentación de las aceitunas. Este resultado fue confirmado por la evaluación sensorial colocando L3V en la parte superior de las muestras evaluadas, superando a la industrial, donde se usó un tratamiento de eliminación química con lejía. Además, la aireación alterna permitió aumentar la biomasa microbiana de las cepas AAB y LAB junto con la cepa Saccharomyces cerevisiae LD01, también usar una concentración más baja de NaCl y reducir el deterioro de las aceitunas, en comparación con la operación de fermentación anaerobia. Finalmente, se preparó un iniciador mixto que contenía las tres cepas en un fermentador de laboratorio de 10-L a partir de la muestra L3V con el objeto de mejorarlo en los estudios posteriores. El iniciador de mezcla preparado podría ser adecuado para usarse como una cepa parental para preparar aceitunas de mesa para aplicaciones artesanales e industriales en Marruecos

SINGULAR PERTURBATIONS AND BOUNDARY LAYER THEORY FOR CONVECTION-DIFFUSION EQUATIONS IN A CIRCLE: THE GENERIC NONCOMPATIBLE CASE

We study the boundary layers and singularities generated by a convection-diffusion equation in a circle with noncompatible data. More precisely, the boundary of the circle has two characteristic points where the boundary conditions and the external data $f$ are not compatible. Very complex singular behaviors are observed, and we analyze them systematically for highly noncompatible data. The problem studied here is a simplified model for problems of major importance in fluid mechanics and thermohydraulics and in physics.open4

Country-wide HIV incidence study complementing HIV surveillance in Germany

Serological methods exist that allow differentiating between recent and long-standing infections in persons infected with HIV. During a pilot study in Berlin between 2005 and 2007 methodologies have been evaluated. In a cross-sectional study blood samples, demographic, laboratory, clinical and behavioural data based on a KABP survey were collected from patients with newly diagnosed HIV infections. The BED-CEIA was used to determine recency of infection. Recent HIV infections contributed 54% (CI [95%]: 45; 64) in MSM and 16% (CI [95%]: 0; 39) in patients with other transmission risks (p=0.041). Proportions of recent infections were significantly higher in MSM ≤30 years (p=0.019). The mean age was 33.9 (median 34 years) in recent compared with 38.6 years (median: 38 years) in long-standing infections (p=0.011). High-risk behaviour indicated through very low condom use in recently HIV infected MSM could be identified. The results of the pilot study support expectations that the modified application of the method may contribute to improving HIV prevention efforts in Germany. On this basis the Robert Koch Institute implemented a countrywide HIV incidence study to complement HIV surveillance in early 2008. The study is funded by the German Ministry of Health. Data on recent HIV infections and current HIV transmission risks are collected. Design, methods and impact are described in detail

Estimating the regional distribution of men who have sex with men (MSM) based on Internet surveys

<p>Abstract</p> <p>Background</p> <p>Measurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution. Population-based surveys have recently been used to estimate the total number of MSM, but these surveys are usually not large enough to measure regional differences in the proportion of MSM in the population. We explored the use of the proportional regional distribution of participants of large internet-based surveys among MSM from Germany to estimate the regional distribution of MSM in Germany.</p> <p>Methods</p> <p>We compared participants from two separate MSM behavioural surveys with each other and with the distribution of user profiles of the largest contact and dating website for gay and other MSM in Germany in terms of the representativeness of the regional distribution. In addition, we compared the regional distribution of reportedly HIV positive survey participants with the regional distribution of HIV notifications within the national surveillance system that can be attributed to transmission through homosexual contacts.</p> <p>Results</p> <p>Regional distribution of survey participants was almost identical in both surveys, despite little overlap between survey participants. Slight discrepancies between surveys and user profiles could be observed. Proportional regional distribution of survey participants with HIV diagnosis resembled national surveillance data.</p> <p>Conclusion</p> <p>Considering the difficulties to obtain representative data by other sampling methods for "hidden" populations like MSM, internet-based surveys may provide an easy and low cost tool to estimate the regional population distribution – at least in Western post-industrialized countries. Some uncertainties remain about the exact place of residence of MSM in larger cities or catchment areas of these cities. Slightly different results from different datasets may be due to unequal popularity of MSM websites in different regions. The total population size of the MSM population can be estimated based on e.g. data from representative national population surveys. Both estimates can then be combined to calculate the absolute size of regional MSM populations.</p