[Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic]. / Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Influence of technological conditions of sausage fermentation on the aminogenic activity of L. curvatus CTC273.

The influence of technological factors (temperature and relative humidity of the manufacturing process and the diameter of the sausage) on the aminogenic activity of the strain Lactobacillus curvatus CTC273 was evaluated. Inoculation of sausages with L. curvatus CTC273 resulted in the accumulation of large amounts of biogenic amines (higher than 1000 mg/kg dry matter in some samples) during the manufacture of fuet and llonganissa sausages. Sausages produced via process 'A' (3 days at 20-23 °C and 90-95% RH followed by 20 days at 12-14 °C and 70% RH) contained significantly higher amounts (p < 0.05) of biogenic amines than those manufactured via process 'B' (23 days at 12-13 °C and 70-90% RH), specifically tyramine, cadaverine and phenylethylamine in llonganissa and phenylethylamine in fuet. The higher fermentation temperature and relative humidity during the fermentation stage in process 'A' promoted decarboxylase activity in L. curvatus CTC273 and thus favoured amine accumulation. The diameter of the sausages also influenced biogenic amine production. Higher amine levels were found (p < 0.05) in llonganissa than in fuet, regardless of the manufacturing conditions. The effect of the factors considered on the modulation of aminogenic activity is not necessarily linked to the effect of strain growth, but chiefly favouring proteolytic and decarboxylase reactions.

Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

Biologically active amines in fermented and non-fermented commercial soybean products from the Spanish market.

Biologically active amines were determined in commercial soybean products. The antioxidant polyamines were found in both non-fermented and fermented soybean products. Natto and tempeh showed the highest content of polyamines (75-124 and 11-24 mg/kg of spermidine and spermine, respectively). On the other hand, the bacterial-related biogenic amines, tyramine, histamine, tryptamine and ß-phenylethylamine, were detected in practically all fermented products with a high variability. The highest contents were found in sufu, tamari and soybean paste. Extremely high tyramine and histamine contents, 1700 and 700 mg/kg, respectively, found in some sufu samples could be unhealthy. However, biogenic amines observed in the other soybean products should not be a risk for healthy consumers. However, individuals who take monoamine and diamine oxidase inhibitors drugs should be strongly recommended to avoid this kind of products in order to suffer no adverse health effects. These biogenic amines were not detected in non-fermented soybean products.

Isoflavone profile and protein quality during storage of sterilised soymilk treated by ultra high pressure homogenisation.

The application of ultra high pressure homogenisation (UHPH) treatments is useful to obtain fine and stable soymilk emulsions. Changes of isoflavones, protein digestibility and lysine availability during 4 months of storage at 20 ± 2°C in soymilk treated by UHPH (300 MPa and 75°C of inlet temperature) were studied in comparison to UHT-sterilised soymilk (142°C, 6s). Results indicated that although there was a significantly higher extractability of isoflavones in UHT (about 38%) than in UHPH-treated samples (about 15%), similar total contents were found at the end of storage. The interconversion of isoflavones into ß-glucosides was faster in UHT than in UHPH-treated soymilk. Similar evolution of protein digestibility in both UHPH and UHT-treated soymilks was found, being slightly higher in the initial UHT (88.4%) than in UHPH-treated samples (83.3%). No great differences were observed in the % of blocked lysine among samples after treatments, neither in their evolution throughout storage.

[Variability in preventive activities among primary care teams in Catalonia. Application of a multilevel analysis]. / Variabilidad en las actividades preventivas en los equipos de atención primaria de Cataluña. Aplicación del análisis de niveles múltiples.

OBJECTIVES: To determine whether variability exists among primary care teams (PCTs) in Catalonia in opportunistic screening activities (screening for smoking, drinking, hypertension and tetanus vaccination) and to analyze the explanatory factors in the individual characteristics of the population treated and the characteristics of the PCT. METHODS: A multilevel analysis with individual and PCT explanatory variables was performed. The data were draw from a sample of 3,000 clinical histories from the adult population treated in 1995 in 30 PCTs from the restructured primary care network in Catalonia and from PCT characteristics. RESULTS: The recording of preventive activities in the clinical histories increased with the number of risk factors and/or diseases diagnosed, the number of other preventive activities recorded, and age. Recording of arterial pressure was more frequent in women while the remaining preventive activities were more frequent in men. Workload impeded opportunistic detection. Greater recording of antitetanus vaccination was associated with the number of years that the PCT had been functioning and with wider geographical area. Recording of smoking was higher in urban areas. CONCLUSIONS: Variability in opportunistic detection exists among PCTs in Catalonia. The characteristics of the PCT and the population treated that explain part of this variability are identified. Lower workload favors preventive activities in primary care.

[Health professionals' opinion of the Catalan Health Plan. Basis for a reflexion on the future]. / La opinión de los profesionales sanitarios sobre el Plan de Salud de Cataluña. Punto de partida para una reflexión orientada al futuro.

OBJECTIVES: To know health professional's opinion of the Health Plan for Catalonia (Spain) in order to get news elements for the formulation and management of new plans. DESIGN: Combination of quantitative and qualitative methodologies. Postal survey to doctors and nurses (multistage randomised sample). 3.223 questionnaires were obtained (response rate: 34,1%). Interview to a selected sample of 41 health care professionals and managers. MEASUREMENTS AND MAIN RESULTS: 78,8% (IC95%: 1,4) of health professionals are familiar with the Health Plan, and for most of them it is valued as important. 28,9% (IC95%: 1,7) of the professionals who know the Plan consider that it has repercussions in their daily work and 51,8% (IC95%: 1,9) declare that it doesn't have any repercussions. Different issues such as the planning process, the contents, the dissemination strategy, as well as a the poor impact on the health budget are critised. Differences by age group and sex, care setting and type of health professional are observed. CONCLUSIONS: The implication of health professionals in the discussion, formulation and implementation of the Health Plan proposals needs to be improved. It will be necessary to make progress in identifying health problems and needs, in setting priorities and in the allocation of resources. To increase the multisectorial involvement and to develop marketing strategies directed to politicians, managers and health professionals will also be needed in order to increase the impact of the Health Plan on both the Health System and the other sectors involved in health. The role to be played by the Health Plan in the health system must be redefined and this will lead to redesigning the planning process and the implementation of health strategies.

[Health self-perception in men and women among the elderly]. / Percepción del estado de salud en varones y mujeres en las últimas etapas de la vida.

OBJECTIVES: To analyze the differences in health self-perception between men and women in the later stages of life and to assess their association with sociodemographic and health variables. METHODS: Data on 1,459 men and 1,993 women aged 60 or older from the 1994 Catalan Health Survey, were collected and an analysis of health self-perception according to age, gender, social class, reporting of chronic disease and handicaps was performed. Multivariate logistic regression analysis was used, taking into account the survey design. RESULTS: Of the women aged 60 and older, 57.3% reported poor health compared with 43.6% of men of the same age. The proportion of women with one or more handicaps was also greater (41.2%) than that of the men (28.7%), as was the case with chronic disease (92.2% in women and 85.6% in men). The multivariate model also revealed that health self-perception was poorer among women than among men. Other explanatory factors were the number of chronic diseases, having handicaps, and being a member of a lower social class. Age interacted with the number of chronic diseases to mitigate the effect of chronic diseases on perceived health status. CONCLUSIONS: In the elderly population, poor health self-perception was greater among women, even when other significant explanatory variable (social class, age, handicaps and chronic disease) were adjusted for. The most important explanatory factors in health self-perception were having chronic disease and/or handicaps. The impact of chronic disease on poor health self-perception decreased in older age groups.

[Equilibrium and auditory disorders in patients affected by HIV-1]. / Trastornos del equilibrio y de la audición en pacientes infectados por el VIH-1.

It is thought that about 10% of the patients with advanced human immunodeficiency virus (HIV) infection have otoneurological symptoms, although up to 41% of these patients have general otorhinolaryngological symptoms. The otological changes may be divided into those of balance and those of hearing, to improve classification, although these symptoms are often to be found together in the same patient. We studied 30 seropositive patients with stage II and stage III disease, carrying out studies of oculomotricity, electronystagmography and audiometry (both conventional and high frequency). Oculomotricity changes were seen in 27% of the patients, whilst the caloric test were mainly normal. Conventional audiometry was normal, but high frequency audiometry showed neurosensorial deafness in 23% of the patients. These findings indicate probable changes in the vestibular and oculomotor pathways, with little change in the peripheral sensor for balance.

[Evaluation of the possible ototoxicity of josamycin by high frequency audiometry]. / Evaluacíon de la posible ototoxicidad de la josamicina mediante audiometría de alta frecuencia.

Josamycin is an antibiotic macrolide similar to erythromycin, with some differences in its biologic behaviour. There have been no reports of ototoxic effects caused by this drug, but its similitudes with erythromycin have prompted us to undertake a study about its possible cochleo-toxicity. Most trials of this kind have been carried out using conventional audiometry (up to 8,000 Hz), thus not being able to detect threshold shifts above this frequency. Ototoxic lesions usually begin in the upper frequency limit. Twenty-eight patients without previous auditory impairment were studied with conventional (up to 8,000 Hz) and high-frequency audiometry (up to 20,000 Hz) before and after oral treatment with josamycin during eight days. No significant differences were found in auditory thresholds registered before and after treatment in any of the patients. These results suggest that josamycin is devoid of any cochleo-toxic effect in all the frequencies that a normal subject can hear.

Ciprofloxacin plus fluocinolone acetonide versus ciprofloxacin alone in the treatment of diffuse otitis externa.

OBJECTIVE: We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide (antibiotic plus corticosteroid) ear drops compared to ciprofloxacin (antibiotic) ear drops in diffuse otitis externa. METHODS: This was a multicentre, randomised, parallel-group, double-blind study involving 590 patients of both sexes aged 7 years or older. RESULTS: The rate of clinical cure was higher (p = 0.01) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone. The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide (p = 0.005). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin. Resolution of oedema and otorrhoea (p = 0.003 and p = 0.002, respectively) was higher with ciprofloxacin plus fluocinolone acetonide, as was eradication or presumed eradication (p = 0.003). There were eight mild adverse events, three with the ciprofloxacin plus fluocinolone acetonide combination (not related to the treatment) and five when ciprofloxacin was administered alone (directly related to the treatment). CONCLUSIONS: Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone. The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile.

Effect of ultra high pressure homogenization treatment on the bioactive compounds of soya milk.

Ultra high pressure homogenization (UHPH) is a useful novel technology to obtain safe and high-quality liquid foods. The effect of UHPH at 200 and 300 MPa in combination with different inlet temperatures (Tin) (55, 65 and 75 °C) on the bioactive compounds of soya milk was studied. Total phytosterols increased with the higher combination of pressure and temperature. The main phytosterol was ß-sitosterol, followed by stigmasterol and campesterol. Total tocopherols in UHPH-treated soya milks decreased as the temperature and pressure increased. UHPH treatment also affected the different chemical forms of tocopherols. No biogenic amines were detected in any of the analyzed soya milks. Meanwhile, the polyamines SPD and SPM were found in all soya milks, being stable to the UHPH treatment. Total isoflavones increased with the higher combination of pressure and temperature. No differences in the isoflavone profile were found, with ß-glucoside conjugates being the predominant form.

Changes of isoflavones and protein quality in soymilk pasteurised by ultra-high-pressure homogenisation throughout storage.

Ultra high pressure homogenisation (UHPH) is an emerging technology to obtain fine and stable soymilk emulsions. Very little information is available about the stability of this kind of product during storage. Changes of isoflavone profile, protein digestibility and lysine availability in pasteurised-UHPH soymilks were studied for 21 days at 4 °C in comparison to heat-pasteurised soymilks. Neither heat nor UHPH treatments affected the isoflavone profile, as the percentage of each chemical form, in comparison with unprocessed-soymilk. During storage, there was a conversion of isoflavone forms to aglycones, being higher in heat-processed samples. In addition, UHPH samples showed a lesser percentage of blocked lysine during storage. No differences were observed in the evolution of protein digestibility among samples. Therefore, UHPH treatment seems to produce a better product, due to lower amounts of aglycones, and higher protein nutritional quality than heat treatment.

Identification of 5-hydroxymethyl-2-furfural (5-HMF) in Cava sparkling wines by LC-DAD-MS/MS and NMR spectrometry.

The aim of this study was to elucidate the structure of a potential ageing marker for Cava sparkling wine. In order to clarify the structure of this compound, NMR spectroscopy and hyphenated UHPLC-DAD-MS/MS techniques were used. We identified the hitherto unknown compound as 5-hydroxymethyl-2-furfuraldehyde (5-HMF). This is the first time that this compound has been reported in sparkling wines. A survey, based on the analysis of 80 commercial sparkling wines, showed that 5-HMF is present between 0.25 and 12.81 mg/L, and is compared with those reported for other types of wine. Hypothetical origin of 5-HMF in Cava sparkling wine is discussed.

Fast simultaneous determination of free and conjugated isoflavones in soy milk by UHPLC-UV.

Ultra high pressure liquid chromatography (UHPLC) has become a widely used technique in separation science as it can shorten analysis time while maintaining resolution and increasing sensitivity. Here we developed a UHPLC method with UV detection for the simultaneous determination of isoflavone aglycones (daidzein, glycitein and genistein), their corresponding glycoside forms (daidzin, glycitin and genistin), and acetyl and malonyl conjugate forms of glycosides (malonyldaidzin, malonylglycitin, malonylgenistin, acetyldaidzin, acetylglycitin, acetylgenistin) in soy milk. The method allowed reliable determinations of 12 isoflavones in less than 8 min of chromatographic elution. It provided a satisfactory linearity ranging from 0.1 to 5mg/L, except for daidzin and genistin, for which it ranged from 0.1 to 10mg/L. In addition, it showed acceptable chromatographic sensitivity, with a detection limit lower than 0.05 mg/L and a determination limit below 0.2mg/L. The precision, in terms of relative standard deviation, was lower than 5% and the accuracy, as mean recovery, was greater than 95%. Total isoflavone content in commercial soy milk samples (n=8) ranged from 1805.22 to 3195.59 mg/kg dw. Genistin and Daidzin were the major isoflavones in all samples. The proportion of aglycones, ß-glucosides, and acetyl and malonyl glucosides differed among the samples. ß-Glucosides were identified as the predominant forms.

Validation of an ultra high pressure liquid chromatographic method for the determination of biologically active amines in food.

Biologically active amines include the so called biogenic amines, such as histamine, tyramine and cadaverine, and polyamines such as spermidine and spermine. Ultra high pressure liquid chromatography (UHPLC) is a new generation of separation techniques that takes full advantage of chromatographic principles to increase speed flow which drastically reduce analysis time. The aim of the present work was to validate a rapid method of UHPLC to detect the presence of biogenic amines and polyamines in food. Different food matrixes (wine, fish, cheese, and dry fermented sausage) were used in order to test the versatility of the method. The UHPLC method described in this article has been demonstrated as a reliable procedure to determine 12 biogenic amines and polyamines in less than 7min of chromatographic elution. The method provides a satisfactory linearity and chromatographic sensitivity with a detection limit lower than 0.2mg/L and a determination limit falling below 0.3mg/L for all amines. The precision, in terms of relative standard deviation, was lower than 5% and the accuracy, as mean recovery, was between 93% and 98%, depending on the food matrix.

[Health status and gender in Catalonia. An approach using the information sources available]. / Estado de salud y género en Cataluña. Una aproximación a través de las fuentes de información disponibles.

OBJECTIVE: To present health status differences between men and women in Catalonia across the main available data sources. METHODS: The main institutional health data sources of the Catalan population are presented. Mortality and morbidity differences by gender are studied. RESULTS: Men die before than women and present more frequently pathologies that require hospitalary care. Unhealthy behaviours are more frequent in men than in women. Women in general, in all social classes, present more frequently chronic disorders and disabilities and declare worse perception of health status than men of the same social class. CONCLUSIONS: Institutional sources of data available in Catalonia allow the description of gender differences in health, nevertheless new variables should be included to improve gender perspective analyse.

Migraine: an alternative in the diagnosis of unclassified vertigo.

Vertigo and unsteadiness are frequent reasons for medical consultation. In some cases, these symptoms remain unclassified. The association of equilibrium disorders with migraine is often mentioned in literature. Seventy-two cases of unclassified vertigo were studied in order to ascertain the prevalence of migraine in patients affected by recurring episodes of vertigo from undetermined causes, and attempting to establish a possible relationship with migraine. Characteristics of the vertigo and the headache, were evaluated by clinical history and examination, electronystagmogram (ENG), electroencephalogram (EEG), computerized tomography scanning (CT) and/or magnetic resonance imaging (MRI). In the group of patients studied 50% suffered from headache, and 32.8% fulfilled the diagnostic criteria of migraine. Results suggest that only a thorough clinical history would be able to give enough information to establish the diagnosis of migraine in these patients. These observations imply an alternative diagnosis to be taken into account when a case of unclassified vertigo is evaluated.

[Hemorrhagic complications and thrombotic phenomena in oral anticoagulation of elderly patients]. / Complicaciones hemorrágicas y fenómenos trombóticos en la anticoagulación oral de pacientes ancianos.

OBJECTIVE: To retrospectively analyze the hemorrhagic complications and thrombotic events associated with aging and the degree of anticoagulation in a series of ambulatory patients treated with acenocumarol and controlled in a specialized anticoagulant therapy unit. PATIENTS AND METHODS: A total of 1,613 ambulatory patients were studied. Patients were divided into two groups (group 1, 645 patients > 65 years old, mean age 71.7 +/- 4.5 years; INR, 2.1-2.8; group 2, 968 patients < or = 65 years, mean age 53.7 +/- 10 years; INR, 2.8-4.2) for a time period of twelve months. The prevalence of hemorrhagic complications and severity according to a validated international index (Bleeding Severity Index), as well as the thrombotic events occurred despite anticoagulation therapy. RESULTS: Fifty-two hemorrhagic events (8/100 patients-year) were recorded in the older group (group 1). Twenty-six cases were considered banal episodes, 24 minor hemorrhages and two major hemorrhages. Ten patients (1.5/100 patients-year) had thrombotic complications. In the younger group (group 2) 150 bleeding episodes were recorded (15 patients-year), of which 11 were banal, 39 minor hemorrhages and no major hemorrhages. Only eight patients 0.8/100 patients-year) had thrombosis. The presence of local factors predisposing to bleeding was more common in group 1 (p < 0.001). Older patients had in general more complications than younger patients (p < 0.001), but no significant differences were observed between the occurrence of hemorrhages or thrombosis independently analyzed between both groups. The rate in the therapeutic range was greater among the youngest individuals (p < 0.05). CONCLUSIONS: Our results support the idea that patients with advanced age can benefit from a less aggressive anticoagulation. A statistical trend was observed, although not significant, towards the presence of major hemorrhages and thrombosis in this group of patients. The presence of local or predisposing factors to hemorrhage (underlying disease and NSAIDs use) is more relevant in patients with advanced age.