Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups.

BACKGROUND: People with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services. METHODS: Cross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed. RESULTS: A total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression. CONCLUSIONS: People with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient's risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.

Elaboration and characterization of nanoemulsion with orange essential oil and pectin.

BACKGROUND: Nanoemulsions formulated with citric essential oils are currently of interest because of their physical and chemical properties and multiple applications in areas such as the food industry or agrochemicals. These are thermodynamically unstable and have almost Newtonian flow behaviour, but a suitable formulation allows systems to be obtained with good physical stability and rheological properties. The addition of pectin makes this possible. In this work, food nanoemulsions formulated with pectin, orange essential oil (5 wt%), and Tween 80 were obtained by microfluidization. First, the effect of Tween 80 concentration from 1 to 5 wt% on emulsions without pectin was evaluated. Then, pectin was added to the most stable nanoemulsion obtained and two variables were studied: the pectin solution concentration (from 2 to 6 wt%) and the pectin/emulsion ratio (1:1 or 2:1) at a fixed pectin concentration. RESULTS: Rheological, laser diffraction, and multiple light scattering techniques were employed to determine the content of Tween 80 that results in the most stable nanoemulsion without pectin, which was 3 wt%. In addition, these techniques were used to determine the structure and physical stability of the nanoemulsions containing orange essential oil and pectin. The results obtained showed that the emulsions containing 2 wt% pectin were destabilized before 24 h. Furthermore, the emulsion with 6 wt% pectin and a 2:1 pectin/emulsion ratio showed the highest viscosity and the lowest mean diameters, and therefore the greatest stability. CONCLUSION: This work extends the knowledge of formulation of nanoemulsions and using essential oils. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Influence of nanoemulsion/gum ratio on droplet size distribution, rheology and physical stability of nanoemulgels containing inulin and omega-3 fatty acids.

BACKGROUND: New consumer habits are forcing the food industry to develop new and healthy products. In response to this tendency, in this investigation, we obtained nanoemulgels by microfluidization containing inulin fibre and omega-3 fatty acids. First, the influence of the number of microfluidization cycles on the physical properties of the nanoemulsions was studied. Subsequently, an advanced-performance xanthan gum was added to the nanoemulsion in different nanoemulsion/xanthan ratios (1:1, 2:1, 3:1, 4:1, 1:2, and 1:3). RESULTS: Laser diffraction, multiple light scattering, and rheology techniques were used to characterize nanoemulsions and the corresponding nanoemulgels. The nanoemulsion with the lowest Sauter mean diameter (138 nm) and the longest physical stability was obtained after three passes through a microfluidization device at a fixed pressure of 103 421 kPa. Thus, these processing conditions were always used to obtain the nanoemulsion; these were subsequently mixed with a xanthan gum solution to produce nanoemulgels that showed weak gel-like viscoelastic and shear-thinning flow behaviours. A decrease in the nanoemulsion/xanthan ratio (i.e. by an increase in the content of xanthan gum in the nanoemulgel) increased the viscoelastic moduli and the zero shear viscosity values. A rise in the droplet size was observed with aging time, probably due to flocculation. The nanoemulsion/xanthan gum mass ratio of 1:3 yielded the most stable nanoemulgel. CONCLUSIONS: This work is a contribution to the development of functional foods. It has been demonstrated that it is possible to obtain a stable nanoemulgel-based food matrix containing fibre and omega-3 fatty acids. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups.

BACKGROUND: Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors. METHODS: Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed. RESULTS: The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017-0.052 and 0.008-0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198-1.726 and 2.722-4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457-14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022-6241 and 1.949-3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068-1.51 and 0.103-0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659-4.319 and 3.629-4.989). CONCLUSIONS: The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.

Role of the Cholinergic Anti-Inflammatory Reflex in Central Nervous System Diseases.

In several central nervous system diseases, it has been reported that inflammation may be related to the etiologic process, therefore, therapeutic strategies are being implemented to control inflammation. As the nervous system and the immune system maintain close bidirectional communication in physiological and pathological conditions, the modulation of inflammation through the cholinergic anti-inflammatory reflex has been proposed. In this review, we summarized the evidence supporting chemical stimulation with cholinergic agonists and vagus nerve stimulation as therapeutic strategies in the treatment of various central nervous system pathologies, and their effect on inflammation.

Characterization of novel nanoemulsions, with improved properties, based on rosemary essential oil and biopolymers.

BACKGROUND: Nowadays, it is of great interest to develop stable and sustainable formulations that act as nanocarriers of active ingredients. In this work, the droplet size distribution, rheology and physical stability of nanoemulsions with improved properties containing rosemary essential oil and biopolymers as a function of the concentration of these polysaccharides were investigated. RESULTS: Mean diameters below 150 nm were achieved, indicating nanostructures were obtained. Regardless of gum type, a gel-like structure and a shear thinning behaviour was achieved. In addition, an increase of G', G″ and viscosity and a decrease of J0 , J1 , J2 , λ1 and λ2 with increasing gum concentration were observed, due to the formation of a three-dimensional network in the aqueous phase. Slight differences between nanoemulsions containing welan or xanthan were found. Creaming, depletion flocculation and gel aggregation were the main destabilization processes at low, intermediate and high gum concentration, respectively. A 0.4 wt% gum nanoemulsion exhibited the best physical stability. CONCLUSION: These stable and sustainable nanoemulsions with improved rheological properties contribute to the development of biodegradable and non-toxic food or agrochemical products. © 2020 Society of Chemical Industry.

Strategies for reducing Ostwald ripening phenomenon in nanoemulsions based on thyme essential oil.

BACKGROUND: White thyme essential oil, which can be incorporated in clean-label and food emulsion-based products, is a natural antimicrobial agent. However, emulsions containing essential oils commonly undergo Ostwald ripening as the main destabilization process. The main objective of this work was to evaluate various strategies for the inhibition of Ostwald ripening so as to develop stable nanoemulsions containing white thyme essential oil as food preservative and Kolliphor EL as surfactant. RESULTS: In a first approach, the influence of the surfactant/dispersed phase ratio and the number of cycles through a microfluidizer on droplet size distribution was evaluated. Unfortunately, these emulsions underwent Ostwald ripening, which was demonstrated by the application of the Lifshitz-Slyozov-Wagner theory. In order to reduce this destabilization mechanism, two different techniques based on the modification of the formulation (addition of rosin gum or Aerosil COK84) were analysed using laser diffraction and multiple light scattering techniques. The addition of rosin gum inhibited the Ostwald ripening mechanism, but only partially. Conversely, the incorporation of Aerosil COK84 to the continuous phase led to a gel-like rheological behaviour which seemed to practically avoid Ostwald ripening. CONCLUSIONS: Aerosil particles cover the droplets and form a three-dimensional network suggesting a Pickering stabilization, which was confirmed using transmission electronic microscopy. The results confirmed the role of Aerosil COK84, not only as a thickener or gelling agent, but also as an Ostwald ripening inhibitor. © 2019 Society of Chemical Industry.

Pathogen-insect interaction candidate molecules for transmission-blocking control strategies of vector borne diseases.

OBJECTIVE: To analyze the current knowledge of pathogen-insect interactions amenable for the design of molecular-based control strategies of vector-borne diseases. MATERIALS AND METHODS: We examined malaria, dengue, and Chagas disease pathogens and insect molecules that participate in interactions during their vectors infection. RESULTS: Pathogen molecules that participate in the insect intestine invasion and induced vector immune molecules are presented, and their inclusion in transmission blocking vaccines (TBV) and in genetically modify insect (GMI) vectors or symbiotic bacteria are discussed. CONCLUSIONS: Disruption of processes by blocking vector-pathogen interactions provides several candidates for molecular control strategies, but TBV and GMI efficacies are still limited and other secondary effects of GMI (improving transmission of other pathogens, affectation of other organisms) should be discarded.

Cellular stress associated with the differentiation of Plasmodium berghei ookinetes.

For malaria transmission, Plasmodium parasites must develop in the mosquito vector. Oxidative stress in the insect midgut, triggered by environmental changes (e.g., pH and temperature), influences the cellular signaling involved in differentiation from gametocytes to mobile ookinetes for the purpose of parasite survival. Oxidative stress activates the homeostatic response to stress characterized by the phosphorylation eIF2α, the attenuation of protein synthesis, and the transcription of genes participating in the unfolded protein response and antioxidant processes, forming a part of an integrated stress response (ISR). We hypothesized that ISR operates during the differentiation of gametocytes to ookinetes to assure Plasmodium survival. Using in-vitro conditions resembling the mosquito midgut conditions, we cultured Plasmodium berghei gametocytes to ookinetes and evaluated the redox balance by detecting reactive oxygen species and superoxide dismutase activity. Additionally, we evaluated the phosphorylation of eIF2α, the attenuation of the global protein synthesis, and the gene expression of cellular stress markers (e.g., endoplasmic reticulum chaperones and antioxidant molecules, measured by reverse-transcription quantitative polymerase chain reaction), finding that these processes were all taking place, probably to improve survival during the differentiation of Plasmodium berghei ookinetes.

Sepsis, mitochondrial failure and multiple organ dysfunction.

PURPOSE: The purpose of this review is to consider the state of oxidative stress, failure of the antioxidant systems and mitochondrial failure as the main physiopathological mechanisms leading to multiple organ dysfunction during sepsis. PRINCIPAL FINDINGS: Sepsis is a clinical syndrome caused by a severe infection that triggers an exaggerated inflammatory response. Involved in the pathogenesis of sepsis are the activation of inflammatory, immune, hormonal, metabolic and bioenergetic responses. One of the pivotal factors in these processes is the increase of reactive species accompanied by the failure of the antioxidant systems, leading to a state of irreversible oxidative stress and mitochondrial failure. In a physiological state, reactive species and antioxidant systems are in redox balance. The loss of this balance during both chronic and infectious diseases leads to a state of oxidative stress, which is considered to be the greatest promoter of a systemic inflammatory response. The loss of the redox balance, together with a systemic inflammatory response during sepsis, can lead to progressive and irreversible mitochondrial failure, energy depletion, hypoxia, septic shock, severe sepsis, multiple organ dysfunction and death of the patient. CONCLUSION: Knowledge of the molecular processes associated with the development of oxidative stress should facilitate the development of effective therapies and better prognosis for patients with sepsis and organ dysfunction.

Development of an Enzyme-Linked Immunosorbent Assay (ELISA) as a tool to detect NS1 of dengue virus serotype 2 in female Aedes aegypti eggs for the surveillance of dengue fever transmission.

Dengue is a significant disease transmitted by Aedes mosquitoes in the tropics and subtropics worldwide. The disease is caused by four virus (DENV) serotypes and is transmitted to humans by female Aedes aegypti mosquito bites infected with the virus and vertically to their progeny. Current strategies to control dengue transmission focus on the vector. In this study, we describe an indirect Enzyme-Linked Immunosorbent Assay (ELISA), using a monoclonal antibody against the non-structural dengue virus protein 1 (NS1), to detect DENV2 in Ae. aegypti eggs. The assay detects NS1 in eggs homogenates with 87.5% sensitivity and 75.0% specificity and it is proposed as a tool for the routine entomovirological surveillance of DENV 2 in field mosquito populations.

The Perceived Quality of Life of Older People in Spain Who Care for Grandchildren and Related Variables: A Mixed Methods Study.

Grandparental care of grandchildren is a prevalent social phenomenon. This study explores the perceptions of health-related quality of life of grandparents caring for their grandchildren. A mixed methods design was developed. In the first phase, participants were interviewed using a baseline questionnaire. The second phase consisted of focus groups with 19 of the 100 participants in the quantitative phase. The scores obtained from the quantitative analysis are in line with the qualitative data; they reflect that grandparent carers who are more involved in the care of their grandchildren have more symptoms of depression and stress and have poorer perceptions of physical health-related quality of life. What may at first appear to be a positive aspect, keeping grandparent carers active, can become negative when it comes to shared care and when the grandparents' willingness to provide care is abused.

SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases.

OBJECTIVE: This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases. METHODS: Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0. RESULTS: A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed. CONCLUSIONS: This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.

Technological Benefits Associated with the Use of Spray-Dried Animal Plasma in Fish-Based Chunks for Canned Pet Food.

Spray-dried animal plasma (SDAP) and wheat gluten (WG) are common binders in wet pet food that provide amino acids and energy, as well as texture and cohesiveness due to their gelling strength, water retention and fat emulsion properties. Binder use is a valuable tool especially in recipes based on ingredients with low technological properties such as fish by-products containing spines and scales and soft texture after cooking. Two basal recipes for chunks in gravy were produced to evaluate experimental treatments. One basal recipe used a mixture of salmon and tuna by-products as the only animal protein sources without binders or with a 20 g/kg inclusion of SDAP or WG. The other basal recipe mimicked a more typical commercial recipe containing meat animal ingredients and a 40 g/kg salmon by-product to develop experimental treatments with and 0, 10, 20, 30 or 40 g/kg inclusions of SDAP. Dry matter, protein, and viscosity were evaluated in raw emulsions. After a 1 h retorting at 121 °C, hardness was measured in emulsions and in cooked chunks, juiciness, and Texture Profile Analysis (TPA) were assessed. Results demonstrated the viability of producing quality chunks in gravy containing only fish by-products including 20 g/kg of SDAP, which significantly increased hardness, elasticity, cohesiveness, and juiciness. There was a positive linear correlation of increased SDAP inclusion rate in the commercial recipe for most of the quality parameters evaluated. Based on these results, the inclusion of SDAP in fish recipes can help manufacturers achieve technological quality control targets for commercial wet pet food and may help producers to successfully formulate new recipes for wet pet food products using fish by-products as the sole animal protein source.

Effect of a Change in the CaCl2/Pectin Mass Ratio on the Particle Size, Rheology and Physical Stability of Lemon Essential Oil/W Emulgels.

A three-step (rotor-stator-microfluidization-rotor stator) protocol was used to prepare 15% lemon essential oil in water emulgels using a mixture of Tween 80 and Span 20 surfactants as low molecular mass emulsifiers and 0.4% low-methoxyl citrus peel pectin as a gelling agent. Ca2+ was used as a gel-promoting agent. Different CaCl2/pectin mass ratio values from 0.3 to 0.7 were used. Emulgels showed a microstructure consisting of oil droplets embedded in a sheared gel matrix, as demonstrated by bright field optical microscopy. Laser diffraction tests showed multimodal particle size distributions due to the coexistence of oil droplets and gel-like particles. Multiple light scattering tests revealed that the physical stability of emulgels was longer as the CaCl2/pectin mass ratio decreased and that different destabilization mechanisms took place. Thus, incipient syneresis became more important with increasing CaCl2 concentration, but a parallel creaming mechanism was detected for CaCl2/pectin mass ratio values above 0.5. Dynamic viscoelastic and steady shear flow properties of the emulgels with the lowest and highest CaCl2/pectin mass ratio values were compared as a function of aging time. The lowest ratio yielded an emulgel with enhanced connectivity among fluid units as indicated by its wider linear viscoelastic region, higher storage modulus, loss modulus and viscosity values, and more shear thinning properties than those of the emulgel formulated with the highest CaCl2/pectin mass ratio. The evolution of the dynamic viscoelastic properties with aging time was consistent with the information provided by monitoring scans of backscattering as a function of sample height.

Detection of NS1 protein from dengue virus in excreta and homogenates of wild-caught Aedes aegypti mosquitoes using monoclonal antibodies.

Dengue fever is one of the most devastating infectious diseases worldwide. Development of methods for dengue virus (DENV) detection in mosquitoes to assess prevalence as a preliminary screen for entomological surveillance in endemic regions of DENV will certainly contribute to the control of the disease. A monoclonal antibody against the NS1 (nonstructural protein 1) viral protein was generated using recombinant NS1 protein and used to detect and analyze DENV in both excreta and total homogenates from Aedes aegypti mosquitoes. Results demonstrated expression of NS1 in excreta of DENV laboratory-infected mosquitoes and homogenates from field mosquitoes infected with DENV. The immunodetection method reported here represents a first-line strategy for assessing the prevalence of DENV in mosquitoes, for entomological surveillance in endemic regions of dengue. Detection of DENV prevalence in field mosquitoes could have an impact on vector surveillance measures to interrupt dengue transmission.

Relation between Droplet Size Distributions and Physical Stability for Zein Microfluidized Emulsions.

Zein, a subproduct of the food industry and a protein, possesses limited applications due to its high hydrophobic character. The objective of this research was to investigate the influence of homogenization pressure and cycles on the volumetric mean diameter (D4,3), span values, and Turbiscan Stability Index (TSI) using the response surface methodology for microfluidized emulsions containing zein as a unique stabilizer. Results showed that homogenization pressure seems to be the most influential parameter to obtain enhanced physical stability and droplet size distributions, with the optimum being 20,000 psi. Interestingly, the optimum number of cycles for volumetric diameter, span value, and TSI is not the same. Although a decrease of D4,3 with number of cycles is observed (optimum three cycles), this provokes an increase of span values (optimum one cycle) due to the recoalescence effect. Since physical stability is influenced by D4,3 and span, the minimum for TSI is observed at the middle level of the cycles (2 cycles). This work highlights that not only volumetric diameter, but also span value must be taken into consideration in order to obtain stable zein emulsions. In addition, this study wants to extend the limited knowledge about zein-based emulsions processed with a Microfluidizer device.

Histiocytoid Sweet Syndrome associated with anorectal lymphogranuloma venereum in a patient with HIV infection.

Sweet Syndrome belongs to a group of diseases known as neutrophilic dermatoses. An uncommon variant named Histiocytoid Sweet Syndrome (HSS) can be associated with a variety of conditions, including cancer, infections, drug toxicity and others. Here we present an instance of HSS in an HIV-positive patient in an infectious disease setting.

Transcriptome analysis uncover differential regulation in cell cycle, immunity, and metabolism in Anopheles albimanus during immune priming with Plasmodium berghei.

In invertebrates, "immunological priming" is considered as the ability to acquire a protective (adaptive) immune response against a pathogen due to previous exposure to the same organism. To date, the mechanism by which this type of adaptive immune response originates in insects is not well understood. In the Anopheles albimanus - Plasmodium berghei model, a DNA synthesis that probably indicates an endoreplication process during priming induction has been evidenced. This work aimed to know the transcriptomic profile in the midguts of An. albimanus after priming induction. Our analysis indicates the participation of regulatory elements of the cell cycle in the immunological priming and points out the importance of the cell cycle regulation in the mosquito midgut.