Fortificacion y evaluacion de tortillas de nixtamal

Se evaluó el efecto de la adición de vitaminas y pasta de soya desgrasada sobre la calidad de la tortilla de nixtamal (TN), así como las pérdidas de algunos nutrientes durante el proceso de nixtamalización. La adición de vitaminas y pasta de soya desgrasada se fijaron en 0.15% y 4% respectivamente, puesto que valores superiores afectaron negativamente el color y sabor en el producto. Se observó que el maíz pierde aproximadamente 1.5% de proteínas durante su transformación a tortilla, mientras que la tortilla de nixtamal fortificada con 4% de soya desgrasada (TNS) presentó 3% mas proteína que la TN. Los contenidos de calcio en las tortillas fueron de 7.7, 114 y 212.5 mg/100 g para el maíz, TN y para TNS respectivamente. Respecto a la pérdida de vitaminas durante la transformación de maíz a tortilla se cuantificó 29.0% de pérdida para niacina, 46.3% para ácido fólico, 36.4% para tiamina y 80% para riboflavina. Durante el lavado del nixtamal se pierden gran cantidad de vitaminas, se cuantificó una pérdida de 18.2% de tiamina, 16.6% de riboflavina y 20.7% de ácido fólico. Por el contrario la harina nixtamalizada integral, en cuyo proceso de elaboración no se contempla el lavado, presentó un balance de niacina positivo del 7.9%. Las pérdidas durante el cocimiento de la tortilla fueron muy elevadas especialmente para la riboflavina, ya que del 80% de pérdidas de esta vitamina durante el proceso total, el 63.8 % se presentó durante su cocimiento y el 16.6% durante el lavado del nixtamal.Fortification and evaluation of the nixtamal tortillas. The effect of the addition of vitamins and soy protein on the quality characteristics of nixtamal tortillas (TN) and the losses of nutrients during the nixtamalization process were evaluated. Vitamins (0.15% as is) and defatted soy (4% as is) were added to the tortillas without affecting their sensory characteristics. Higher values of those nutrients had a negative effect on the color and flavor of the product. During the production of the tortilla the corn lost approximately 1.5% of proteins. The nixtamal tortilla fortified with 4% of defatted soy (TNS) showed 3% higher protein content than the TN. The calcium content in the samples was 7.7,114 and 212.5 mg/100 g for the corn, the TN and the TNS respectively. In the process of produccing the nixtamal tortillas from corn 28.9% of the niacin, 46.3% of the folic acid, 36.3% of the thiamin and 80% of the riboflavin were lost. During the washing and rinsing of the nixtamal there were losses of 18.2% of the thiamin, 16.6% of the riboflavin and 20.7% of the folic acid. Although the niacin showed a 28.9% loss, the alkaline process caused an important release of that vitamin. The losses during the cooking of the tortillas were high especially for riboflavin which showed a total loss of 80% in comparison with the original corn. Of the total, 63% was lost during cooking and 16.6% was lost during washing of the nixtamal

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research