Optimization and shelf life of a low-lactose yogurt with Lactobacillus rhamnosus HN001.

Lactose intolerance results in gastrointestinal discomfort and the malabsorption of certain nutrients, such as calcium. The replacement of milk with low-lactose and probiotic-enriched dairy products is an effective strategy of mitigating the symptoms of lactose intolerance. Lactobacillus rhamnosus HN001 (HN001) is a safe, immunity-stimulating probiotic. We have developed a process to increase the hydrolysis of lactose and HN001 growth in yogurt versus ß-galactosidase (ßG) concentration and enzymatic hydrolysis time (EHT) before bacterial fermentation. The objective of this study was to optimize the conditions by which yogurt is processed as a function of ßG and EHT using a multifactorial design, with lactose content, HN001 growth, process time, and sensory quality as dependent variables. Further, the shelf life of the optimized yogurt was evaluated. In the optimization study, polynomials explained the dependent variables. Based on Pearson correlation coefficients, HN001 growth correlated positively with the hydrolysis of lactose. However, low lactose content and high HN001 count increased the fermentation time and lowered the sensory quality. The optimized conditions-using polynomials to obtain yogurt with >1 × 10(7) cfu of HN001/mL, <10 g of lactose/L, and a minimum overall sensory quality of 7 on the Karlsruhe scale-yielded a theoretical value of 910 neutral lactose units/kg for ßG and 2.3h for EHT, which were validated in an industrial-scale assay. Based on a shelf-life study at 3 temperatures, the hydrolysis of lactose and the growth of HN001 continue during storage. Arrhenius equations were developed for the variables in the shelf-life study. Our results demonstrate that it is feasible to develop a low-lactose yogurt to which HN001 has been added for lactose-intolerant persons who wish to strengthen their immune system.

La determinación de PTH intraquirúrgica o posquirúrgica por quimioluminiscencia predice la hipocalcemia en el posoperatorio de la tiroidectomía en niños / Determination of PTH during or post surgery for quimioluminiscency can predict hypocalcemy in the post surgery children´s thyroidectomy

Objetivo: Evaluar la eficacia diagnóstica de la determinación de PTH en muestras de plasma tomadas durante la cirugía (intra) y posquirúrgica inmediata para predecir el riesgo de desarrollar hipocalcemia en el postoperatorio de la tiroidectomía total en pacientes pediátricos. Métodos: Se llevó a cabo un estudio de cohortes,prospectivo, longitudinal con 20 pacientes pediátricos en los que se practicó tiroidectomía total. Se determinaron los niveles de PTH preoperatorios, intraoperatorios y en el período posquirúrgico inmediato (basal, 5 y 60 minutos de la remoción de la glándula tiroides) utilizando un ensayo automatizado quimioluminiscente (IMMULITE, Siemens), límite de cuantificación 8 pg/mL, CV intra e interensayos < 5,4%. Para este estudio, la concentración de PTH de cada paciente no fue conocida por el equipo tratante hasta el final del mismo. Además se determinó la concentración en suero de Calcio total (Ca T) y/o Calcio iónico (Cai) regularmente durante las 48 hs posquirúrgicas y se controló la presencia de síntomas o signos de hipocalcemia. Se consideró hipocalcemia Ca T < 8 mg/dl y/o Cai < 0,8 nmol/L. Se realizó un análisis por curva ROC para determinar el nivel de PTH que fuera más eficaz en predecir la aparición de hipocalcemia según su sensibilidad (S), especificidad (E), eficiencia diagnóstica (ED) y Valor Predictivo Positivo (VPP). Resultados: Diez de los 20 pacientes (50%) desarrollaron hipocalcemia y 3 de ellos presentaron síntomas. La presentación de hipocalcemia sucedió: 40% en las primeras 6 hs y 40% a las 24 hs.vel de PTH en la muestra intraoperatoria < 14 pg/ml mostró S: 80%, E: 100%, ED: 90% (IC95%: 73-100) y VPP: 100% para predecir hipocalcemia posquirúrgica. En la muestra posquirúrgica inmediata, la concentración de PTH < 14 pg/ml presentó S: 80%, E: 90%, ED 82% (IC95% 63-100) y VPP 90% para predecir hipocalcemia posquirúrgica. Cuando la PTH intraquirúrgica o posquirúrgica es <14 pg/ml el riesgo relativo de presentar hipocalcemia postiroidectomía es de 9. Conclusiones: La medición de PTH intraquirúrgica y posquirúrgica es una herramienta eficiente para predecir hipocalcemia posquirúrgica por tiroidectomía total en la población pediátrica. Esta detección permite la inmediata decisión sobre el tratamiento suplementario con calcio en los pacientes de riesgo mejorando su evolución y evitando la presentación de tetania y otros síntomas de hipocalcemia. Además, permitiría disminuir los controles en los pacientes que evolucionarán con normocalcemia, reduciendo en ambos grupos de pacientes los costos de internación.

Types of arrhythmia among cases of American trypanosomiasis, compared with those in other cardiology patients.

The frequencies of each type of arrythmia were investigated, by age and sex, among 3056 Brazilian patients with cardiac arrhythmia. Each patient investigated had been tested serologically for American trypanosomiasis and 1013 had been found seropositive for the disease. In general, the seropositive 'chagasic' patients were each likely to be suffering from more types of arrhythmia than the seronegative 'non-chagasic', with means of 1.81 and 1.03 types/patient, respectively. Right-branch bundle blocks (RBBB), ventricular extrasystoles (VE) and left anterior hemiblocks (LAHB) were the commonest cardiac arrhythmias among the chagasic patients, and each of these types of arrhythmia (alone or with other types of arrythmia) was more frequent in the chagasic patients than the non-chagasic. The incidence of RBBB among the arrhythmic varied significantly with age in the non-chagasic patients (increasing with age among both the males and females) but not among the chagasic subjects. When the frequencies of each type of arrythmia and each combination of types were compared, the co-occurrence of RBBB and another type of arrhythmia was almost indicative of American trypanosomiasis (occurring in 30.6% of the chagasic subjects but only 2.6% of the non-chagasic). Similarly, only 0.4% of the non-chagasic patients but 7.4% of the chagasic had RBBB, VE and LAHB concurrently. However, the frequencies of RBBB in isolation (i.e. with no other, concurrent, electrocardiographic abnormality), VE in isolation, or LAHB in isolation were not significantly different in the chagasic and non-chagasic patients.

Pathways to psychiatric care in Ibadan, Nigeria.

Pathways patients take to psychiatric care will reflect the nature of the services available and the popular beliefs about mental illness. Studying the pathways may help in the identification of sources of delay in the receipt of care and suggest possible improvements. By studying the pathways of 159 patients to a tertiary psychiatric service in Nigeria, we show that traditional and religious healers are consulted at some stage by many patients with mental illness. Such healers are the first carers to a large proportion of the patients. These patients are not different from those who consult orthodox medical practitioners either in demographic features, presenting complaints, or nearness to service. Patients who consult traditional healers first tended to arrive at a tertiary psychiatric service much later than those who consult other carers. Our observations suggest that attempts to incorporate traditional medical care into the health care system must seek to improve their referral skill.

Psychiatric disorders in a paediatric primary care clinic.

BACKGROUND: The proportion of children with psychiatric disorders treated in primary care is not known in most developing countries. METHOD: In a two-stage epidemiological study, 990 children aged between 7 and 14 years were screened with the parents' version of the Rutter scale. Of these, a stratified sample of 227 was interviewed jointly with their mothers, using the children's version of the Schedule for Affective Disorders and Schizophrenia (K-SADS). RESULTS: We obtained a weighted prevalence of 19.6 +/- 2.5% for the presence of one or more DSM-III-R disorders. Depressive disorders were present in 6.0%, anxiety-related disorders in 4.7%, and conduct disorders in 6.1%. CONCLUSION: Psychiatric disorders in children are common in primary care. Doctors working at this level of care need the skills to detect and treat them.

The utility of ethnographic methods in medical research: experience with substance use disorders.

Ethnographic research methodology provides investigators with the opportunity to explore various ways in which culture affects and modulates human behaviour and beliefs. These methods, even though commonly used in medical anthropology, are often neglected in the main-stream of medical research, possibly as a result of relative unfamiliarity with their principles and techniques. Drawing on experience gained in Ibadan during a WHO collaborative study in nine different countries, we demonstrate the use of key informants interview and focus group techniques. We conclude that the methods are easy to learn and apply, and have potentials for helping researchers in many areas of medicine to address important questions.

Do young schizophrenics with recent onset of illness show evidence of hypofrontality?

Young schizophrenic patients (n=43), manic controls (n=32), both groups diagnosed according to the Research Diagnostic Criteria and on remission from acute illness, and 53 normal subjects were given a battery of neuropsychologic tests selected to assess different functional areas in the brain. Compared with normal controls, patient groups showed evidence of impaired functioning of many cortical areas but with the schizophrenics having the worst performance. In addition, schizophrenic patients performed poorly in tests designed to assess frontotemporal cortical functioning. This pattern of deficits differentiated schizophrenics from both manic and normal subjects. The results suggest that widespread cognitive deficits are a feature of both schizophrenia and mania but that frontal lobe dysfunction may be more specific to the former. It would also appear that these impairments are not artefacts of age, chronicity or of institutionalization, and are present even in schizophrenic patients who may have an illness with putative better outcome than those studied in previous reports.