Producción de jarabe de fructosa con enzimas inmovilizadas en un proceso continuo a partir de tiquisque (<i>Xanthosoma sagittifolium</i>)

High fructose corn syrups (HFCS) are mainly used by the food industry and are produced by enzymatic hydrolysis from cornstarch. The main objective of this project was to produce fructose syrups using tiquisque starch (Xanthosoma sagittifolium) as new source. Conditions to produce tiquisque glucose syrup were obtained in a previous study. Fructose was produced using a column packed isomerase (Sweetzyme IT). The effect of flow rate (0.5 and 1.0 mL/min), glucose syrup concentration (40 and 45 °Brix) and hydrolysis temperature (55 and 60 °C) were studied using a 23 factorial design. Response variables were fructose and glucose concentrations, fructose yield and conversion degree. All variables were statistically significant (p < 0.05), and flow rate presented the main effect on response variables. Higher conversion degree (99.16 %) was achieved using 40 °Brix glucose syrup and a flow rate of 0.5 mL/min at 60 °C. Fructose syrups obtained experimentally presented higher fructose content than commercial syrup (HFCS-42).Los jarabes de fructosa (HFCS) son utilizados principalmente por la industria de alimentos y se producen por vía enzimática a partir de almidón de maíz. El objetivo principal de esta investigación fue producir jarabe de fructosa partiendo de una fuente no tradicional de almidón: el tiquisque (Xanthosoma sagittifolium). El jarabe de fructosa se produjo por tratamiento enzimático con una isomerasa (Sweetzyme IT) inmovilizada usando como sustrato jarabe de glucosa producido previamente. Se evaluó el efecto del flujo del jarabe a través de la enzima inomovilizada (0.5 y 1.0 mL/min), la concentración del jarabe de glucosa (40 y 45 °Brix) y la temperatura (55 y 60 °C), utilizando un diseño factorial 23 . Las variables respuesta fueron la concentración de glucosa y fructosa, el rendimiento de fructosa y el grado de conversión. El mayor grado de conversión (99.16 %) se logró usando una concentración de glucosa de 40 °Brix y un flujo de 0.5 mL/min a 60 °C. Los jarabes obtenidos experimentalmente presentaron un mayor contenido de fructosa que el jarabe comercial (HFCS-42).

Human Papiloma Virus in lung cancer tissue. Experience at the Calderon Guardia Hopsital

Background: The epidemiology of lung cancer, a major cause of morbidity throughout the world and the leading cause of mortality among adult men and women, has changed substantially in the past few years. Some of these changes can be explained by tobacco consumption, but there is also the possibility of other carcinogenic agents involved in lung cancer etiology, such as Human Papilloma Virus (HPV) and they have described a mechanism by which some of the viral structural proteins interfere with tumor suppressor genes, leading to uncontrolled and fast cellular proliferation. Methods: The objective of this study was to establish the prevalence of HPV in lung cancer (LC) tissue. The study population was a group of 110 patients with histologically confirmed LC. The biopsies of lung tissue where fixed in paraffin and formalin at the Calderon Guardia Hospital, Department of Pathology, from January 2002 to July 2009. The viral DNA was extracted using a system for fixed tissue -QIAmp DNA FFPE-, and the virus detection was done by multiple PCR differentiation on the molecular weight of the E6 gen that differs within genotypes. Results: The prevalence of HPV in LC was 4,5%. Most of the HPV types found were non-oncogenic Conclusions: The prevalence found is very low in comparison with other regions of the world. There was no association found between HPV and LC histology, gender, and tobacco use."This study was carried out at the Hospital Rafael Angel Calderón " " José Costa Rica and it was sponsored by the Fundación Académica " "Guardia, San" "Stvdivm, the Consejo Nacional de Investigaciones Científicas (CONICIT) and the " "Costarrican Science and Technology Ministry. "UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Un acercamiento filosófico a la Educación en valores y derechos humanos para la formación docente con ejemplos de Alemania y Costa Rica. Investigación: Las experiencias de la Universidad de Costa Rica, la Universidad Nacional y la Universidad de Osnabrück. Buenas prácticas

Este libro, como producto del proyecto inter-universitario “Educación en valores y derechos humanos en la formación docente”, con la participación de la Universidad de Costa Rica, Universidad Nacional y Universidad de Osnabrück y apoyado por el Servicio Académico de Intercambio Alemán (DAAD), se organiza en tres capítulos, el primero denominado: Un acercamiento filosófico para la formación docente con ejemplos de Alemania y Costa Rica, invita a reflexionar sobre la formación en derechos humanos y en valores en la educación superior y permite realizar un recorrido histórico sobre la concepción de los derechos humanos, su relación con la desigualdad y la exclusión, y cómo la educación intercultural surge como una alternativa para el garantizar el bien común. El segundo capítulo, Investigación, presenta los resultados en primer lugar sobre el análisis a los planes de estudios de las carreras de formación docente de las universidades de Costa Rica, Nacional y de Osnabrück, en cuanto a la inclusión de contenidos en educación en derechos humanos y valores; a la vez que se incluyen los resultados de las consultas sobre las perspectivas del estudiantado y profesorado sobre cómo es la formación en esos aspectos. El tercer y último capítulo, Buenas prácticas, explica qué es una buena práctica en educación en derechos humanos, brinda criterios para su reconocimiento y brinda ejemplos de las mismas.Servicio Alemán de Intercambio Académico (DAAD)Centro de Estudios Generale

Clinical validation of cutoff target ranges in newborn screening of metabolic disorders by tandem mass spectrometry: A worldwide collaborative project

PURPOSE:: To achieve clinical validation of cutoff values for newborn screening by tandem mass spectrometry through a worldwide collaborative effort. METHODS:: Cumulative percentiles of amino acids and acylcarnitines in dried blood spots of approximately 25-30 million normal newborns and 10,742 deidentified true positive cases are compared to assign clinical significance, which is achieved when the median of a disorder range is, and usually markedly outside, either the 99th or the 1st percentile of the normal population. The cutoff target ranges of analytes and ratios are then defined as the interval between selected percentiles of the two populations. When overlaps occur, adjustments are made to maximize sensitivity and specificity taking all available factors into consideration. RESULTS:: As of December 1, 2010, 130 sites in 45 countries have uploaded a total of 25,114 percentile data points, 565,232 analyte results of true positive cases with 64 conditions, and 5,341 cutoff values. The average rate of submission of true positive cases between December 1, 2008, and December 1, 2010, was 5.1 cases/day. This cumulative evidence generated 91 high and 23 low cutoff target ranges. The overall proportion of cutoff values within the respective target range was 42% (2,269/5,341). CONCLUSION:: An unprecedented level of cooperation and collaboration has allowed the objective definition of cutoff target ranges for 114 markers to be applied to newborn screening of rare metabolic disorders. © 2011 Lippincott Williams &amp; Wilkins

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

International audienceBackground: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60&nbsp;years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death.&nbsp;The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death