Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain.

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05).  Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.

Evaluation of Individualized Homeopathic Treatment in Patients With Irritable Bowel Syndrome: A Pilot Study.

BACKGROUND: Some studies have suggested the efficacy of homeopathic treatment for irritable bowel syndrome (IBS). OBJECTIVE: The aim of this pilot study was to evaluate the efficacy of individualized homeopathic treatment in patients with IBS. METHODS: The study was carried out at the National Homeopathic Hospital of the Secretary of Health, Mexico City, Mexico and included 41 patients: 3 men and 38 women, mean age 54 ± 14.89 years, diagnosed with IBS as defined by the Rome IV Diagnostic criteria. Single individualized medicine was prescribed for each patient, taking into account all presenting symptoms, clinical history, and personality via repertorization using RADAR Homeopathic Software (archibel, Isnes, Belgium). The homeopathic drugs were used at fifty-millesimal (LM) potency per the Mexican Homeopathic Pharmacopoeia starting with 0/1 and increasing every month (0/2, 0/3, 0/6). Severity scales were applied at the beginning of treatment and every month for 4 months of treatment. The evaluation was based on comparing symptom severity scales during treatment. RESULTS: The results demonstrated that 100% of patients showed some improvement and 63% showed major improvement or were cured. The study showed a significant decrease in severity of symptom scores 3 months after treatment, with the pain score showing a decrease 1 month after treatment. The results highlight the importance of individualized medicine regimens using LM potency, although the early decrease in pain observed could also be due to the fact that Lycopodium clavatum and Nux vomica were the main homeopathic medicine prescribed, and these medicines contain many types of alkaloids, which have shown significant analgesic effects on pain caused by physical and chemical stimulation. CONCLUSION: This pilot study suggests that individualized homeopathic treatment using LM potencies benefits patients with IBS.

Omics in traditional vegetable fermented foods and beverages.

For a long time, food microbiota has been studied using traditional microbiological techniques. With the arrival of molecular or culture-independent techniques, a strong understanding of microbiota dynamics has been achieved. However, analyzing the functional role of microbial communities is not an easy task. The application of omics sciences to the study of fermented foods would provide the metabolic and functional understanding of the microbial communities and their impact on the fermented product, including the molecules that define its aroma and flavor, as well as its nutritional properties. Until now, most omics studies have focused on commercial fermented products, such as cheese, wine, bread and beer, but traditional fermented foods have been neglected. Therefore, the information that allows to relate the present microbiota in the food and its properties remains limited. In this review, reports on the applications of omics in the study of traditional fermented foods and beverages are reviewed to propose new ways to analyze the fermentation phenomena.

Concentrates of triterpenic acids obtained from crude olive pomace oils: characterization and evaluation of their potential antioxidant activity.

BACKGROUND: Pentacyclic triterpenic acids (TA) are phytochemicals of increasing nutritional interest owing to their bioactive properties, such as anti-inflammatory, antitumoral, antihyperglycemic and hepatoprotective. Crude olive pomace oils constitute a non-exploited significant source of these compounds. In the present study, concentrates of TA were extracted and characterized from crude olive pomace oils that were obtained by centrifugation and subsequent solvent extraction, respectively. Specifically, the concentrates were obtained from the byproduct generated in the filtration of the oils. The solids were subjected to Soxhlet extractions with hexane to remove the residual oil and then with ethanol for the TA extraction. RESULTS: Concentrates containing 850-980 g kg-1 TA were isolated from the oils obtained by centrifugation, whereas those isolated from oils obtained by hexane extraction presented levels of TA that ranged from 510 to 900 g kg-1 . Oleanolic (OA) and maslinic (MA) acids were the TA found in the concentrates. The relative contents of OA and MA were, respectively, 30:70 (w/w) and 77:23 (w/w). All concentrates also presented phenolic compounds at levels of g kg-1 and displayed slight antioxidant properties. CONCLUSION: Concentrates of TA, containing MA and OA, can be readily obtained from a byproduct generated by filtration of crude olive pomace oils. Concentrates isolated from oils obtained by centrifugation were rich in MA, whereas those from oils extracted with hexane were rich in OA. The concentrates showed slight antioxidant properties that can be mainly attributed to the presence of phenolic compounds and not to TA. © 2018 Society of Chemical Industry.

Quantitative analyses of the bacterial microbiota of rearing environment, tilapia and common carp cultured in earthen ponds and inhibitory activity of its lactic acid bacteria on fish spoilage and pathogenic bacteria.

The present study aimed to evaluate the bacterial load of water, Nile Tilapia and common Carp intestines from earthen ponds, isolate lactic acid bacteria (LAB) and assess their antimicrobial activity against fish spoilage and pathogenic bacteria. Following enumeration and isolation of microorganisms the antimicrobial activity of the LAB isolates was evaluated. Taxonomic identification of selected antagonistic LAB strains was assessed, followed by partial characterisation of their antimicrobial metabolites. Results showed that high counts (>4 log c.f.u ml-1 or 8 log c.f.u g-1) of total aerobic bacteria were recorded in pond waters and fish intestines. The microbiota were also found to be dominated by Salmonella spp., Vibrio spp., Staphylococcus spp. and Escherichia coli. LAB isolates (5.60%) exhibited potent direct and extracellular antimicrobial activity against the host-derived and non host-derived spoilage and pathogenic bacteria. These antagonistic isolates were identified and Lactococcus lactis subsp. lactis was found as the predominant (42.85%) specie. The strains displayed the ability to produce lactic, acetic, butyric, propionic and valeric acids. Bacteriocin-like inhibitory substances with activity against Gram-positive and Gram-negative (Vibrio spp. and Pseudomonas aeruginosa) bacteria were produced by three L. lactis subsp. lactis strains. In this study, the LAB from the microbiota of fish and pond water showed potent antimicrobial activity against fish spoilage or pathogenic bacteria from the same host or ecological niche. The studied Cameroonian aquatic niche is an ideal source of antagonistic LAB that could be appropriate as new fish biopreservatives or disease control agents in aquaculture under tropical conditions in particular or worldwide in general.

Possible adverse effects of frying with vegetable oils.

The question of whether heated fats in the diet may be detrimental to health is nowadays of the upmost concern, but finding an answer is not easy and requires careful consideration of different aspects of lipid oxidation. This review is divided into two sections. The first part deals with the nature of the new compounds formed at high temperature in the frying process as well as their occurrence in the diet while the second part focuses on their possible nutritional and physiological effects. Oxidation products present in abused frying fats and oils are the compounds most suspected of impairing the nutritional properties of the oils or involving adverse physiological effects. The recent studies on their health implications include those related to their fate and those focused on their effects in metabolic pathways and the most prevalent diseases.

Systematic review and meta-analysis of randomized controlled trials comparing single incision versus conventional laparoscopic appendectomy.

BACKGROUND: Single incision laparoscopic appendectomy (SILA) has been proposed as an alternative to conventional laparoscopic appendectomy (CLA). OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of SILA when compared with CLA through a systematic review. METHODS: We performed an electronic search of EMBASE, PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that compared SILA with CLA were included. RESULTS: Six RCTs met eligibility criteria, which included a total of 800 patients, 401 in the SILA group and 399 in the CLA group. There were no significant differences in terms of overall complications (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.59-1.47; p = 0.77). SILA had a higher technical failure rate (OR 3.30; 95% CI 1.26-8.65; p = 0.01) and required a longer operative time (mean difference [MD] 4.67; 95% CI 1.76-7.57; p = 0.002). SILA was associated with better cosmetic results (standardized MD -0.4; 95% CI -0.64 to -0.16; p = 0.001) and earlier return to normal activity (MD -0.64; 95% CI -1.09 to -0.20; p = 0.005), although these advantages should be taken with caution due to the small number of studies reporting these two items and the short follow-up in the evaluation of cosmetic results. There were no significant differences in terms of postoperative pain or length of hospital stay between groups. CONCLUSIONS: SILA is comparable to CLA in selected patients, although it is associated with a higher technical failure rate and longer operative time. Further randomized trials are needed to determine if SILA really offers benefits over CLA.

A reference consensus genetic map for molecular markers and economically important traits in faba bean (Vicia faba L.).

BACKGROUND: Faba bean (Vicia faba L.) is among the earliest domesticated crops from the Near East. Today this legume is a key protein feed and food worldwide and continues to serve an important role in culinary traditions throughout Middle East, Mediterranean region, China and Ethiopia. Adapted to a wide range of soil types, the main faba bean breeding objectives are to improve yield, resistance to biotic and abiotic stresses, seed quality and other agronomic traits. Genomic approaches aimed at enhancing faba bean breeding programs require high-quality genetic linkage maps to facilitate quantitative trait locus analysis and gene tagging for use in a marker-assisted selection. The objective of this study was to construct a reference consensus map in faba bean by joining the information from the most relevant maps reported so far in this crop. RESULTS: A combination of two approaches, increasing the number of anchor loci in diverse mapping populations and joining the corresponding genetic maps, was used to develop a reference consensus map in faba bean. The map was constructed from three main recombinant inbreed populations derived from four parental lines, incorporates 729 markers and is based on 69 common loci. It spans 4,602 cM with a range from 323 to 1041 loci in six main linkage groups or chromosomes, and an average marker density of one locus every 6 cM. Locus order is generally well maintained between the consensus map and the individual maps. CONCLUSION: We have constructed a reliable and fairly dense consensus genetic linkage map that will serve as a basis for genomic approaches in faba bean research and breeding. The core map contains a larger number of markers than any previous individual map, covers existing gaps and achieves a wider coverage of the large faba bean genome as a whole. This tool can be used as a reference resource for studies in different genetic backgrounds, and provides a framework for transferring genetic information when using different marker technologies. Combined with syntenic approaches, the consensus map will increase marker density in selected genomic regions and will be useful for future faba bean molecular breeding applications.

Major dietary lipids in nutrition and health.

In this chapter, an overview of the major lipids in the diet with emphasis in nutritional aspects is provided. Triacylglycerols, i.e., glycerol esterified with three fatty acids, are the predominant constituents in dietary lipids. Therefore, this chapter focuses on the nature and nutritional significance of the main fatty acids in the diet and their possible modifications during food processing and commercialization. The main fatty acids in dietary lipids are grouped into saturated, monounsaturated and polyunsaturated fatty acids. Nutritional implications, the latest intervention trials and health recommendations will be discussed. A brief description of the major sources of lipids in the diet is included, oils and fats standing out. Other food sources shortly commented are milk and dairy products, meat, poultry and eggs, fish, and structured lipids designed to improve functional and nutritional properties. Modifications of fatty acids as a result of processing and commercialization are discussed because of their great relevance for their health implications, especially oxidation compounds and trans fatty acids.

Growth inhibition of Streptococcus from the oral cavity by α-amyrin esters.

Five terpenoids were tested by the macrodilution broth method to determine their inhibition activity on cariogenic bacterial growth. In general, α-, β-amyrin and α-amyrin phenylacetate proved to be active, reducing the bacterial viability to less than 20%.

Incorporation of hydroxytyrosol alkyl esters of different chain length as antioxidant strategy in walnut oil spray-dried microparticles with a sodium alginate outer layer.

Omega-3 rich vegetable oils, such as walnut oil, are gaining interest because of their health benefits. Synthetized homologous series of hydroxytyrosol alkyl esters (HTEs) with different alkyl chain lengths (C4-C18) were incorporated in purified walnut oil (PWO) spray-dried microparticles, designed with Capsul® (C) as encapsulating agent and sodium alginate (SA) as outer layer (PWO-C/SA). The encapsulation efficiency (>87%) and Tg of PWO-C/SA microparticles were not affected by the HTEs. The incorporation of HTE-C10 increased the melting point (185.0 ± 1.3 °C), decreasing the formation of Dimers + Polymers (1.12 ± 0.05% at day 35 of storage) and the crystallinity of the microparticles (>170 °C). The highest stability of PWO-C(HTE-C10)/SA suggests a specific location of HTE-C10 at the oil:water interface. The SA layer delayed the release of fatty acids during in vitro digestion. The incorporation of HTEs of medium chain length can be a suitable strategy to protect unsaturated oils encapsulated by spray-drying.

Performance of Olive-Pomace Oils in Discontinuous and Continuous Frying. Comparative Behavior with Sunflower Oils and High-Oleic Sunflower Oils.

Frying performance of olive-pomace oils (OPOs) as compared to sunflower oils (SOs) and high-oleic sunflower oils (HOSOs) was studied in discontinuous frying (DF) and continuous frying (CF) for the first time. DF is used in household, restaurants and frying outlets, while CF is used in the food industry. Oil alteration during frying was determined by measurements of polar compounds (PC) and polymers. Fried potatoes were analyzed for oil absorption and alteration, color, and evaluated in an acceptability test. Results for DF showed that all SOs reached 25% PC at the 9th frying operation (FO), whereas HOSOs did between the 17-18th FO and variable results were found for OPOs since initial levels of diacylglycerols were different. Rates of formation of PC or polymers were the lowest for OPOs, thus showing the best performance in DF. Specifically for PC, relative rates of formation were 1.00-1.11, 2.46-2.71 and 1.37-1.41 for OPOs, SOs and HOSOs respectively. In CF, OPOs and HOSOs behaved similarly and better than SOs, although none reached 25% PC after 40 FO. The good performance of OPOs can be attributed to the high monounsaturated-to-polyunsaturated ratio, in common with HOSOs, and the additional positive effect of minor compounds, especially ß-sitosterol and squalene.

Chemical Changes of Hydroperoxy-, Epoxy-, Keto- and Hydroxy-Model Lipids under Simulated Gastric Conditions.

Chemical changes occurring in dietary lipid oxidation compounds throughout the gastrointestinal tract are practically unknown. The first site for potential chemical modifications is the stomach due to the strong acidic conditions. In this study, model lipids representative of the most abundant groups of dietary oxidation compounds were subjected to in vitro gastric conditions. Thus, methyl linoleate hydroperoxides were used as representative of the major oxidation compounds formed in food storage at low and moderate temperatures. Methyl 9,10-epoxystearate, 12-oxostearate and 12-hydroxystearate were selected as model compounds bearing the oxygenated functional groups predominantly found in oxidation compounds formed at the high temperatures of frying. Analyses were performed using gas-liquid chromatography/flame ionization detection/mass spectrometry and high performance-liquid chromatography/ultraviolet detection. Losses of methyl 9,10-epoxystearate and linoleate hydroperoxides in the ranges 17.8-58.8% and 42.3-61.7% were found, respectively, whereas methyl 12-oxostearate and methyl 12-hydroxystearate remained unaltered. Although quantitative data of the compounds formed after digestion were not obtained, methyl 9,10-dihydroxystearate was detected after digestion of methyl 9,10-epoxystearate, and some major volatiles were detected after digestion of linoleate hydroperoxides. Overall, the results showed that significant modifications of dietary oxidized lipids occurred during gastric digestion and supported that the low pH of the gastric fluid played an important role.

Stability of Bioactive Compounds in Olive-Pomace Oil at Frying Temperature and Incorporation into Fried Foods.

The stability of minor bioactive compounds in olive-pomace oils (OPOs) was evaluated at frying temperature under the conditions of a thermoxidation test. Bioactive compounds analyzed included squalene, tocopherols, sterols, triterpenic acids and alcohols, and aliphatic alcohols. In order to determine the amount of OPO bioactive compounds incorporated into foods after frying, three different kinds of frozen products were selected, i.e., pre-fried potatoes (French fries), pre-fried battered chicken nuggets, and chicken croquettes (breaded patties), and were used in discontinuous frying experiments. Results obtained in both the thermoxidation and frying studies showed high stability of triterpenic alcohols (erythrodiol and uvaol), oleanolic acid, and aliphatic alcohols, naturally present in OPOs. In all fried foods, the content of lipids increased after frying, as expected, although the extent of absorption of OPOs into fried foods and the exchange with food lipids depended on the food characteristics. Overall, frying with OPOs improved the nutritional properties of all products tested by increasing the level of oleic acid and by the incorporation of squalene, triterpenic acids and alcohols, and aliphatic alcohols, in significant quantities.

Evaluation of endosulfan degradation capacity by six pure strains isolated from a horticulture soil.

Endosulfan is an organochlorine pesticide included in the Stockholm Convention for Persistent Organic Compounds. The utilization of endosulfan as the sole source of carbon and its mineralization was evaluated using pure strains of Bacillus subtilis, Bacillus pseudomycoides, Peribacillus simplex, Enterobacter cloacae, Achromobacter spanius, and Pseudomonas putida, isolated from soil with historical pesticide use. The consumption of the α isomer of endosulfan by five of the six strains studied was higher than 95%, while B. subtilis degraded only 76% of the initial concentration (14 mg/L). On the other hand, the degradation of the ß isomer was approximately 86% of the initial concentration (6 mg/L) by B. subtilis, P. simplex, and B. pseudomycoides and 95% by P. putida, E. cloacae, and A. spanius. The ability of A. spanius, P. simplex, and B. pseudomycoides to degrade endosulfan has not been previously reported. The production of endosulfan lactone by the Bacillus strains, as well as A. spanius and P. putida, indicated that endosulfan was degraded by the hydrolytic pathway.

Microbial Interactions between Amylolytic and Non-Amylolytic Lactic Acid Bacteria Strains Isolated during the Fermentation of Pozol.

Pozol is a Mexican beverage prepared from fermented nixtamalized maize dough. To contribute to understanding its complex microbial ecology, the effect of inoculating on MRS-starch pure and mixed cultures of amylolytic Sii-25124 and non-amylolytic W. confusa 17, isolated from pozol, were studied on their interactions and fermentation parameters. These were compared with L. plantarum A6, an amylolytic strain isolated from cassava. Microbial growth, kinetic parameters, amylolytic activity, lactic acid production, and hydrolysis products from starch fermentation were measured. The population dynamics were followed by qPCR. L. plantarum A6 showed higher enzymatic activity, lactic acid, biomass production, and kinetic parameters than pozol LAB in pure cultures. Mixed culture of each pozol LAB with L. plantarum A6 showed a significant decrease in amylolytic activity, lactic acid yield, specific growth rate, and specific rate of amylase production. The interaction between Sii-25124 and W. confusa 17 increased the global maximum specific growth rate (µ), the lactic acid yield from starch (Ylac/s), lactic acid yield from biomass (Ylac/x), and specific rate of lactic acid production (qlac) by 15, 30, 30, and 40%, respectively, compared with the pure culture of Sii-25124. Interactions between the two strains are essential for this fermentation.

Validation of a questionnaire on the use of Interactive Response System in Higher Education.

OBJETIVO: this study aims to design and validate a questionnaire to measure the students' perception of the use of IRS as a technopedagogical resource in the classroom. METHOD: a 24 items questionnaire (Interactive Response System for the Improvement of the Teaching-Learning Process) was designed ad hoc for this research and applied to 142 university students. RESULTS: both the exploratory and confirmatory factorial analysis yielded 3 dimensions: classroom environment, teaching-learning processes and learning assessment. The results obtained both in reliability (Cronbach's alpha= 0.955) and in the Confirmatory Factor Analysis (χ2/df=1.944, CFI=0.97; GFI=0.78; RMR=0.077; RMSEA=0.08) reveal highly satisfactory indices. CONCLUSION: statistical analyses confirm that this instrument is a valid, reliable, and easy-to-apply tool for professors to evaluate the student perception of student-centred learning.

Metaproteomic Insights Into the Microbial Community in Pozol.

Pozol is an acidic, refreshing, and non-alcoholic traditional Mayan beverage made with nixtamalized corn dough that is fermented spontaneously. The extensive analysis of the microbiology, biochemistry and metaproteomics of pozol allowed the construction of a comprehensive image of the fermentation system. The main changes in both the substrate and the microbiota occurred in the first 9 h of fermentation. The increase in microorganisms correlated with the drop in pH and with the decrease in the contents of carbohydrates, lipids, and nitrogen, which shows that this stage has the highest metabolic activity. Bacterial proteins were mainly represented by those of lactic acid bacteria, and among them, the proteins from genus Streptococcus was overwhelmingly the most abundant. Yeast proteins were present in all the analyzed samples, while proteins from filamentous fungi increased up to 48 h. The metaproteomic approach allowed us to identify several previously unknown enzyme complexes in the system. Additionally, enzymes for hydrolysis of starch, hemicellulose and cellulose were found, indicating that all these substrates can be used as a carbon source by the microbiota. Finally, enzymes related to the production of essential intermediates involved in the synthesis of organic acids, acetoin, butanediol, fatty acids and amino acids important for the generation of compounds that contribute to the sensorial quality of pozol, were found.

Antioxidant and antimicrobial material by grafting of L-arginine onto enzymatic poly(gallic acid).

Microwave-mediated grafting of L-Arg onto naturally derived and stable multiradical poly(gallic acid) (PGAL) in aqueous media has been successfully achieved. This polymeric material has no adverse effect in human cells as there is no hemolytic activity upon MTT and Neutral Red assays. The analytical and computational characterization studies carried out in this study describe a helical molecular structure with random incorporation of L-Arginine pendant groups from PGAL's backbone. The antioxidant properties of the precursor polymer are preserved as proved by the elimination of stable DPPH and hydroxyl radical scavenging, as well as the FRAP and ORAC assays. Regarding the latter, the oxygen radical inhibition is enhanced compared to PGAL, which is attributed to the guanidyl moieties. PGAL-g-L-Arg displays antimicrobial activity against Gram (+) Listeria monocytogenes and Staphylococcus aureus strains with a MIC of 0.8 g/L and a bacteriostatic effect against Gram (-) Escherichia coli. Additionally, scanning electron and confocal fluorescence microscopies as well as crystal violet colorimetric assay demonstrate that the mechanism involved in the bacterial inhibition is related to the formation of porous channels on the membrane, which is discussed according to the helical secondary structure of the polymer and the amino acid guanidyl moieties interacting to bacterial membranes.

[Parastomal hernias: background, current status and future prospects]. / Eventración paraestomal: antecedentes, estado actual y expectativas de futuro.

Parastomal hernia (PH) is the most common delayed complication in stoma surgery. Only a third of these are operated on, something which is partly explained by the high recurrence rate observed after repair. The use of prosthetic materials has improved the results, although they continue to be below the ideal. For this reason, it has been proposed that the best solution may be in preventing the PH. Several studies show promising results, with very marked reductions in the percentage of IH, on placing a prophylactic peristomal prosthesis. In this article we present a review of the risk factors associated with PH, a classification of the existing diversity of repair techniques, and an algorithm is proposed for the management of PH, including its prevention.