Concentrates of buttermilk and krill oil improve cognition in aged rats.

Cognitive decline is one of the hallmarks of aging and can vary from mild cognitive impairment to dementia to Alzheimer's disease. In addition to some lifestyle interventions, there is room for the use of nutraceuticals/functional foods as pharma-nutritional tools to lessen the burden of cognitive decline before it worsens. We previously reported the promising molecular actions of milk fat globule membranes and krill oil concentrates in a rat model of aging. In this study, we concentrated on the activities on cognition, using an array of validated tests. We also performed lipidomic analyses of plasma, erythrocytes, and different brain areas. We report lower emotional memory (contextual fear conditioning) in aged rats supplemented with concentrates of polar lipids from buttermilk or krill oil at doses that approximate human consumption. No other behavioral parameter was significantly influenced by the supplements, calling for further research to confirm or not the purported salubrious activities of polar lipids, namely those rich in ω3 long-chain polyunsaturated fatty acids, on cognitive decline.

Phytogenic actives supplemented in hyperprolific sows: effects on maternal transfer of phytogenic compounds, colostrum and milk features, performance and antioxidant status of sows and their offspring, and piglet intestinal gene expression.

Phytogenic actives (PA) are plant-derived natural bioactive compounds that may promote livestock health and well-being, as well as improve growth performance and production efficiency. The current study aims to evaluate their effects on sows and their offspring. Eighty-one hyperprolific sows (up to parity 7) were assigned to 3 experimental treatments. Control sows were offered a nonsupplemented diet during gestation and lactation, and treated sows were fed the control diet supplemented with 1 g/kg of a blend of PA (BPA) in lactation (L) or during gestation and lactation (GL). An evaluation was made of placental and milk maternal transfer of these BPA and colostrum-milk features, sows and piglets antioxidant status, reproductive performance (litter size), body weight (BW) changes, weaning-estrus interval, and litter performance. Finally, piglet´s jejunum gene expression was measured. The BPA supplementation during gestation (GL) increased the number of piglets born alive (P = 0.020) and reduced (P < 0.05) the newborn piglets BW, while there were no differences among treatments on the suckling (day 20) and weaned (day 7) piglets BW (P > 0.05). Dietary phytogenic volatile compounds reached GL placental fluid, and milk of L and GL sows (P < 0.05). Moreover, colostrum protein in GL and milk fat content in L and GL were increased (P < 0.05). Milk of GL showed inhibitory activity against Bacillus subtilis and Staphylococcus aureus (P < 0.05). Antioxidant status of GL sows showed an enhanced (P < 0.05) of catalase (CAT) and total antioxidant capacity levels at early gestation (day 35), whereas higher levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzymes at late gestation (day 110). Likewise, GL newborn piglets showed higher CAT levels, whereas both CAT and SOD levels in suckling piglets, as well as CAT, SOD, and GSH-Px in weaned piglets, were increased in L and GL (P < 0.05). Jejunum messenger ribonucleic acid abundance of suckling piglets in L and GL groups showed overexpression of barrier function MUC2, digestive enzyme IDO, and immune response PPARGC-α, TNF-α, TGF-ß1, and IL-10 genes (P < 0.05). In conclusion, dietary BPA supplementation in hyperprolific sows increased the litter size (born alive) and improved the composition and bioactivity of colostrum and milk, besides, modified the antioxidant status of sows and their offspring, as well as the suckling piglets gut health gene expression. Several BPA volatile compounds were prenatal and postnatal maternally transferred (placental fluid and milk).

Delirium tremens in an AUD patient after an intrathecal baclofen pump induced total alcohol abstinence.

OBJECTIVE: Delirium Tremens (DT) is the most severe complication of alcohol withdrawal syndrome (AWS), and has a mortality rate of 1-5%. Baclofen is recommended for spasticity treatment, but it has recently been used for alcohol withdrawal symptoms reduction and alcohol abstinence. CASE REPORT: A cervical spinal cord injury patient was treated for two years with oral baclofen 80 mg/day for spasticity. He is alcohol-dependent and a cannabis user and required an intrathecal baclofen (ITB) pump implant. A week after the implant, he stopped drinking, as "he didn't felt the urge anymore". The AWS appeared five days after the last alcohol intake and DT at 7 days. Diazepam 20 mg was used up to three times per day, but didn't seem to improve or reduce the anxiety, agitation, visual or auditory hallucinations. Two years later the patient remains alcohol abstinent and still on intrathecal baclofen. CONCLUSIONS: Alcohol-dependent patients can abruptly stop their alcohol intake, while in continuous infusion of intrathecal baclofen. Baclofen can be useful in the acute treatment of AWS as it seems to reduce diazepam requirements and in long-term alcohol abstinence. In the presence of AWS, while on chronic baclofen, no dose reduction should be attempted, as it can worsen the AWS or trigger baclofen withdrawal.

Activities, bioavailability, and metabolism of lipids from structural membranes and oils: Promising research on mild cognitive impairment.

Concomitant with increased lifespan, large segments of the population are experiencing cognitive decline, which might progress to Alzheimer's disease (AD). Currently, there is no cure for AD and, once the neurodegenerative disorders are established, patients use pharmacologic therapy to slow the progression of the symptoms and require appropriate care to manage their condition. The preclinical stage of neural degeneration that progress through mild cognitive impairment (MCI) before the onset of AD is when it might be possible to introduce behavioral changes and pharma-nutritional interventions that modify the risk factors of MCI conversion to AD. Some food components accumulate in brain tissues, where they play essential roles. Among them, polar lipids, omega 3 fatty acids, and carotenoids appear to work additively or synergistically. Therefore, there is an opportunity to formulate nutraceuticals/functional foods to slow the progression of MCI. In this paper, we review the biochemical bases and recent interventions with bioactive lipids-rich formulations. Based on accumulated evidence, we propose that appropriate large-scale trials are warranted.

Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano / Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients

Objetivos. Analizar las características de los pacientes ingresados por fractura de cadera y su evolución 6 meses tras la cirugía para determinar los factores potencialmente relacionados con estancia hospitalaria, complicaciones médicas, mortalidad y recuperación funcional tras esta enfermedad tan prevalente y con graves consecuencias. Material y métodos. Estudio prospectivo de un grupo de 130 pacientes mayores de 75 años hospitalizados por fractura de cadera de perfil osteoporótico. Se evaluaron sus antecedentes médicos, situación mental y física previas a la caída, tipos de fractura y tratamiento quirúrgico, complicaciones hospitalarias, así como evolución funcional y social tras la hospitalización. Resultados. Los pacientes que tenían mayor grado de deterioro físico y mental previamente a la fractura y los institucionalizados tuvieron peor capacidad de recuperación tras la cirugía. El empleo de terapias alternativas a la transfusión para el tratamiento de la anemia se relacionó con disminución de estancia hospitalaria y mejor capacidad de deambulación a medio plazo. Las principales complicaciones médicas en el ingreso fueron infección e insuficiencia cardiaca, e implicaron prolongación de la hospitalización. La prescripción de suplementos nutricionales en pacientes adecuadamente seleccionados se relacionó con mejor evolución funcional. Conclusiones. La valoración de la situación mental, física y social previas a la fractura debe ser la base de un plan de tratamiento individualizado por ser claramente determinante de pronóstico. Los equipos multidisciplinares con seguimiento médico continuado simultáneo al quirúrgico son importantes para prevenir y tratar precozmente las frecuentes complicaciones perioperatorias. La administración de ferroterapia intravenosa y la prescripción de suplementos de nutrición pueden mejorar la recuperación física a medio plazo del paciente intervenido fractura de cadera (AU)

Objectives. Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. Material and methods. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Results. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture. Conclusions. Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture (AU)

Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. / Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano.

OBJECTIVES: Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. MATERIAL AND METHODS: A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. RESULTS: Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture.

Anosognosia en la enfermedad de Alzheimer: prevalencia, factores asociados e influencia en la evolución de la enfermedad / Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression

Introducción: La anosognosia es frecuente en la enfermedad de Alzheimer (EA). El objetivo fue describir su prevalencia en el momento del diagnóstico y analizar los factores predisponentes y su influencia en la evolución posterior de la EA. Métodos: Estudio observacional, multicéntrico, prospectivo, analítico, realizado en consultas de neurología general. Se incluyó a pacientes recién diagnosticados de EA (criterios NINCDS-ADRDA). Se realizaron 2 evaluaciones -cognitivas, funcionales y neuropsiquiátricas-, con un intervalo de 18 meses. Se empleó la Clinical Insight Rating scale como medida de anosognosia (CIR, rango 0-8). El criterio de progresión fue un incremento en la Clinical Dementia Rating-sum of boxes mayor a 2,5 puntos. Las variables predictoras se analizaron mediante regresión logística. Resultados: Se incluyó a 127 pacientes, 94 completaron las 2 evaluaciones. El 31,5% mostraba anosognosia grave (CIR 7-8), el 39,4% conciencia alterada (CIR 3-6) y el 29,1% conciencia normal (CIR 0-2). La mediana del CIR basal en la cohorte fue 4 (Q1-Q3: 1-7) y a los 18 meses 6 (Q1-Q3: 3-8); p < 0,001. La edad avanzada (odds ratio [OR] 2,43; IC del 95%, 1,14-5,19), menor escolaridad (OR 2,15; IC del 95%, 1,01-4,58) y mayor afectación neuropsiquiátrica (OR 2,66; IC del 95%, 1,23-5,74) fueron variables predictoras de anosognosia. El CIR basal fue similar en los grupos con y sin progresión clínica significativa. Conclusiones: La gran mayoría de los pacientes con EA en el momento del diagnóstico muestran un grado significativo de anosognosia que se asocia a mayor edad, menor escolaridad y mayor afectación conductual. No se demostró influencia de la anosognosia sobre la evolución inicial de la EA tras el diagnóstico

Introduction: Anosognosia is a frequent symptom in Alzheimer disease (AD). The objective of this article is to describe prevalence of this condition at time of diagnosis and analyse any predisposing factors and their influence on disease progression. Methods: Observational, prospective, and analytical multi-centre study in an outpatient setting. Patients recently diagnosed with AD (NINCDS-ADRDA criteria) were included. Each patient underwent two cognitive, functional, and neuropsychiatric assessments separated by an interval of 18 months. The Clinical Insight Rating Scale was employed as a measure of anosognosia (CIR, scored 0-8). Progression was defined as an increase in the Clinical Dementia Rating Scale-sum of boxes of more than 2.5 points. The predictor variables were analysed using binary logistic regression. Results: The study included 127 patients, and 94 completed both assessments. Of the total, 31.5% displayed severe anosognosia (CIR 7-8); 39.4%, altered level of consciousness (CIR 3-6); and 29.1%, normal awareness (CIR 0-2). The median baseline CIR in this cohort was 4 (Q1-Q3: 1-7), and at 18 months, 6 (Q1-Q3: 3-8), P<.001. Advanced age (odds ratio (OR) 2.43; CI 95%:1.14-5.19), lower educational level (OR 2.15; CI 95%:1.01-4.58), and more marked neuropsychiatric symptoms (OR 2.66; CI 95%:1.23-5.74) were predictor variables of anosognosia. Baseline CIR was similar in the groups with and without significant clinical progression. Conclusions: The large majority of patients with AD at the time of diagnosis showed significant anosognosia, and this condition was associated with advanced age, lower educational level, and more marked behavioural symptoms. Our results did not show that anosognosia had an effect on the initial clinical progression of AD after diagnosis

Medicinal plants used for ophthalmological problems in Navarra (Spain).

ETHNOPHARMACOLOGICAL RELEVANCE: Several plants have been found to have effective against number of ophthalmological problems in Navarra. MATERIAL AND METHODS: Information was collected using semi-structured ethnobotanical interviews with 686 informants in 267 locations. In order to confirm the pharmacological application of the uses more cited by the informants, a literature review was conducted. RESULTS: A total of 57 pharmaceutical uses were reported, for 19 plants and 13 families, mainly represented by Asteraceae. The most frequently used parts were inflorescences, flowers, aerial parts, leaves and flowered aerial parts. The related affections fell into eleven categories: bloodshot eyes, watery eyes and wounds, improve vision, irrited eyelids, rheums and styes, tired eyes, conjunctivitis, eyewash, ocular problems in general. The most cited plants were: Chamaemelum nobile (L.) All., Santolina chamaecyparissus L. ssp. squarrosa (DC.) Nyman, Sambucus nigra L. ssp. nigra, Rosa agrestis Savi and Calendula officinalis L. None of them have been pharmacologically validated by Official International Organisms. From the therapeutic point of view, Allium sativum L., Foeniculum vulgare Mill., C. officinalis, and S. chamaecyparissus ssp. squarrosa deserve special attention, because ethnobotanical and pharmacological studies suggest that these medicinal plants are effective for ophthalmological problems. CONCLUSIONS: The present study constitutes a good basis for further phytochemical and pharmacological research of these four plants, which could be of interest in the design of new inexpensive, effective and safe drugs. The remaining plants are needed to be screened through standard pharmacological and clinical procedures for their activities.

Medicinal plants used for musculoskeletal disorders in Navarra and their pharmacological validation.

ETHNOPHARMACOLOGICAL RELEVANCE: This paper provides important ethnopharmacological information on plants used in musculoskeletal disorders in Navarra. MATERIAL AND METHODS: Information was collected using semi-structured ethnobotanical interviews. In order to confirm the pharmacological validation of the uses, monographs from Official International Agencies (ESCOP, Commission E, WHO and EMA) were reviewed. A literature review was conducted focusing on the plants that were widely used but had no published monograph. RESULTS: A total of 199 pharmaceutical uses were reported, for 38 plants and 24 families, mainly represented by Asteraceae and Lamiaceae (11%, each), Rosaceae (8%) and Boraginaceae, Cucurbitaceae, Equisetaceae, Malvaceae, Oleaceae and Urticaceae (5%, each). The most frequently used parts were the aerial parts, roots, followed by inflorescences and leaves. Nine out of 38 plants (24%) and 123 uses (62%), had already been pharmacologically validated. CONCLUSIONS: The authors propose to validate four species for their use in musculoskeletal disorders: Verbena officinalis, Symphytum tuberosum, Hypericum perforatum and Equisetum ssp.

Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial.

BACKGROUND AND AIM: Hypertension is one of the main cardiovascular risk factors in the elderly. The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production. METHODS AND RESULTS: An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples. Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta = 4.84; 95% CI: 0.57-9.10). CONCLUSIONS: TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.

Medicinal plants used for respiratory affections in Navarra and their pharmacological validation.

ETHNOPHARMACOLOGICAL RELEVANCE: This paper provides important ethnopharmacological information on plants used in respiratory affections in Navarra. MATERIAL AND METHODS: Information was collected using semi-structured ethnobotanical interviews with 667 informants in 265 locations. In order to confirm the pharmacological validation of the uses claimed by the informants, monographs from Official International Agencies (ESCOP, Commission E, WHO and EMA) were reviewed. A literature review was conducted focusing on the plants that were widely used but had no published monograph. RESULTS: A total of 456 pharmaceutical uses was reported, for 79 plants and 34 families, mainly represented by Lamiaceae, Asteraceae, Rosaceae, Crassulaceae and Malvaceae. The most frequently used parts were the aerial parts followed by inflorescences and leaves. Twenty-two out of 79 plants (28%) and 270 of 456 uses (42%), had already been pharmacologically validated. CONCLUSIONS: The authors propose Verbena officinalis for validation.

Medicinal plants used for cardiovascular diseases in Navarra and their validation from official sources.

ETHNOPHARMACOLOGICAL RELEVANCE: This paper provides significant ethnopharmacological information on plants used to treat cardiovascular diseases in Navarra, Spain. MATERIAL AND METHODS: Information was collected using semi-structured ethnobotanical interviews with 667 informants (mean age 72; 55.47% women, 44.53% men) in 265 locations. Official sources such as the European Scientific Cooperative on Phytotherapy (ESCOP), German Commission E, World Health Organization (WHO), European Medicines Agency (EMA), European Pharmacopoeia (Ph. Eur.) and Real Farmacopea Española (RFE) monographs were consulted in order to establish the therapeutic efficacy of the reported uses and to obtain further details about quality and safety aspects. A literature review was carried out on the plants that were most frequently cited and were not the subject of a monograph, using a new tool developed by the University of Navarra, UNIKA. RESULTS: A total of 460 pharmaceutical uses were reported by the informants, belonging to 90 plant species and 39 families, mainly represented by Urticaceae, Rosaceae, Asteraceae, and Equisetaceae. The most frequently used parts of the plants were the aerial parts followed by leaves and flowers. Seventeen out of 90 plants (19%) and 208 out of 460 popular uses (45%) had already been pharmacologically validated in relation to their therapeutic efficacy and safety aspects. CONCLUSIONS: The authors propose to validate five species for their use in cardiovascular diseases: Rhamnus alaternus L., Potentilla reptans L., Equisetum telmateia Ehrh., Centaurium erythraea Rafn and Parietaria judaica L.

Bioavailability of vitamin D2 from enriched mushrooms in prediabetic adults: a randomized controlled trial.

BACKGROUND/OBJECTIVES: Based on the growing evidence of risk reduction from fresh fruit and vegetable consumption and an inverse relationship between serum 25-hydroxyvitamin D (25OHD) and the risk of type 2 diabetes (T2D), we determined the benefits of regularly consuming vitamin D-enriched mushrooms in a prediabetic cohort. Exposing edible mushrooms to ultraviolet B (UVB) light increases vitamin D2 (D2) and raises serum 25OHD2 in healthy young adults; however, their benefit to deficient prediabetics and glucose metabolism remains untested. SUBJECTS/METHODS: Forty-three prediabetic, D-deficient adults (25OHD≤20 ng/ml), BMI>25 were randomized to four groups consuming daily entrées containing 100 g fresh sliced cooked mushrooms prepared by a chef for 16 weeks. Two groups were fed UVB-treated mushrooms initially containing: 600 IU D2 or 4000 IU D2; each one also received one capsule of placebo daily. Two control groups were fed untreated mushrooms and D3 dietary supplements at two label doses: 600 IU D3 and 4000 IU D3. D2 and D3 content were analyzed in mushrooms, before and after cooking and in over-the-counter supplements. RESULTS: After 16 weeks, both D2-UVB-mushroom entrée doses, which were significantly lower after cooking, produced modest or no increases in 25OHD2 or total 25OHD relative to the positive control subjects who actually consumed about 1242 and 7320 IU per day of D3 (higher than stated on the label). CONCLUSIONS: Unanticipated D2 cooking loss from fresh UVB mushrooms and probable low absorption and/or hydroxylation may explain the smaller increase in 25OHD2 in our prediabetic overweight/obese cohort compared with past findings in younger, healthy subjects. Moreover, no dose or vitamin D source was associated with modifying T2D risk factors.

Medicinal plants used for dermatological affections in Navarra and their pharmacological validation.

AIM OF THE STUDY: This paper provides significant ethnopharmacological information on plant used in dermatological affections in Navarra. MATERIAL AND METHODS: Information was collected using semi-structured ethnobotanical interviews with 667 informants (mean age 72; 55.47% women, 44.53% men) in 265 locations. In order to confirm the pharmacological validation of the uses reports, the European Scientific Cooperative on Phytotherapy (ESCOP), German Commission E, World Health Organization (WHO), European Medicines Agency (EMA), European Pharmacopoeia (Ph. Eur.) and Real Farmacopea Española (RFE) monographs have been revised. A literature review has been carried out with the plants without monograph and high frequency citations, using a new tool of the University of Navarra, UNIKA. RESULTS: A total of 982 pharmaceutical uses are reported from the informants, belonging to 91 plants and 42 families, mainly represented by Asteraceae, Lamiaceae, Euphorbiaceae and Crassulaceae. The most frequently used parts of the plants are aerial parts followed by leaves and inflorescences. Seventeen out of 91 plants (19%) and 148 of 982 popular uses (15%), have already been pharmacologically validated. CONCLUSIONS: The authors propose seven species for their validation (Allium cepa, Sambucus nigra, Hylotelephium maximum, Chelidonium majus, Ficus carica, Allium sativum and Anagallis arvensis).

Indicadores de monitorización del proceso de soporte nutricional especializado / Indicators monitoring the process of specialized nutritional support

Objetivo: Identificar y desarrollar indicadores de monitorización del proceso de soporte nutricional especializado, que permitan medir el grado de cumplimiento de los estándares de práctica establecidos. Método: Se seleccionaron los estándares de práctica considerados aspectos clave del proceso sobre los que desarrollar indicadores de rendimiento. La construcción de indicadores combinó la evidencia científica con la opinión de expertos. Se identificaron los objetivos clave dentro de cada estándar cuya consecución permitiera incrementar el alcance del mismo. Se generaron iniciativas de mejora concretas vinculadas a cada objetivo clave. Por último, se definieron indicadores de monitorización que permitieran realizar un seguimiento de la implantación de las iniciativas de mejora, o bien valorar el grado de consecución de los objetivos clave identificados. Resultados: Se han seleccionado 19 estándares de práctica representativos de los aspectos críticos del proceso. Se ha definido el mapa estratégico de cada estándar, identificándose un total de 43 objetivos clave. A fin de alcanzar estos objetivos clave se ha generado una cartera de mejoras integrada por 56 acciones. Por último, se han definido 44 indicadores de monitorización agrupados en tres categorías: 1. Numéricos: valoran el grado de cumplimiento del objetivo; 2. Dicotómicos (si/no): Informan de la ejecución de las acciones de mejora; 3. Resultados de las auditorías de la práctica. Conclusiones: Se dispone de indicadores de monitorización que permiten evaluar el cumplimiento de los estándares de práctica del proceso de soporte nutricional especializado y el impacto de la implantación de acciones de mejora en el mismo (AU)

Objective: To identify and develop monitoring indicators of the process of specialized nutritional support that will allow measuring the level of adherence to the established practice standards. Methods: Those practice standards considered to be key elements of the process were selected to develop performance indicators. The construction of these indicators combined the scientific evidence with expert opinion. Key goals were identified within each standard provided that its consecution would allow increasing the achievement of the standard. Particular improvement initiatives associated to each key goal were generated. Lastly, monitoring indicators were defined allowing undertaking a follow-up of the implementation of the improvement initiatives or either to assess the level of achievement of the key goals identified. Results: Nineteen practice standards were selected representative of the critical points of the process. The strategic map for each standard has been defined, with the identification of 43 key goals. In order to achieve these key goals, a portfolio of improvements has been generated comprising 56 actions. Finally, 44 monitoring indicators have been defined grouped into three categories: 1. Numeric: they assess the level of goal achievement; 2. Dichotomic (yes/no): they inform on the execution of the improvement actions; 3. Results of the practice audits. Conclusions: We have made available monitoring indicators that allow assessing the level of adherence to the practice standards of the process of specialized nutritional support and the impact of the Implementation of improvement actions within this process (AU)

High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates.

BACKGROUND: Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates. AIMS: To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance. METHODS: Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT. RESULTS: A hundred and thirty-six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intention-to-treat analysis and 88.2% (95% CI: 81.2-92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects. CONCLUSIONS: Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.

Pharmaceutical ethnobotany in the Middle Navarra (Iberian Peninsula).

ETHNOPHARMACOLOGICAL RELEVANCE: This paper provides significant ethnobotanical information on pharmaceutical plant uses in the Middle Navarra (Iberian Peninsula). Collect, analyze and evaluate the ethnobotanical knowledge about medicinal plants in this area with 3622.2 km(2) and 404,634 inhabitants. MATERIALS AND METHODS: We performed semi-structured interviews with 276 informants (mean age 72; 46% women, 54% men) in 111 locations, identified the plant reported and analyzed the results, comparing them with those from other territories. RESULTS: The informants reported data on 198 medicinal plants belonging to 60 botanical families. This work is focused on human medicinal plant uses, which represent 98% of the pharmaceutical uses (1401 use reports). The species with the highest number of cites are Santolina chamaecyparissus ssp. squarrosa, Jasonia glutinosa and Chamaemelum nobile with a long tradition of use in Navarra. All different plant parts are used; aerial part is exploited more frequently than other plant parts. Most of the listed remedies use a single ingredient, typically soaked in water. The most common mode of administration is oral, while the second most common is topical. CONCLUSIONS: The main ailments treated are digestive troubles, wounds and dermatological problems, and respiratory affections. Informants reported 80 new or scarcely cited uses for 14 medicinal plants. For 36% of the species (5) we have not found bibliographical references in the scientific literature and 64% (9) have only one to three references.

Pharmaceutical ethnobotany in the Riverside of Navarra (Iberian Peninsula).

AIM OF THE STUDY: This paper provides significant ethnobotanical information on pharmaceutical plant uses in the Riverside of Navarra. Thereby, it will extend and complement a recent previous study carried out in the Northern Navarra. This paper aim to collect, analyse and evaluate the ethnobotanical knowledge about medicinal plants in the Riverside of Navarra (Iberian Peninsula) with 2554.4km(2) and 144,674 inhabitants. MATERIAL AND METHODS: We performed semi-structured interviews with 147 informants (mean age 76 years; the percentage of men and women was almost 50%) in 34 locations, identified the plants reported and analyzed the results, comparing them with those from other territories. RESULTS: The informants reported data on 90 medicinal plants belonging to 39 botanical families. This work is focused on human medicinal plant uses, which represent 99% of the pharmaceutical uses (541). The species with the highest number of cites are Santolina chamaecyparissus ssp. squarrosa, Thymus vulgaris, Rosmarinus officinalis and Urtica dioica. All different plant parts are used; aerial part is exploited more frequently than other plant parts. Most of the listed remedies use a single ingredient, typically soaked in water. The percentage of internal uses is three times higher than external uses. CONCLUSIONS: The main ailments treated are digestive troubles, dermatological problems, and respiratory affections. Informants reported 11 new or scarcely cited uses for 8 medicinal plants. For 50% of the species (4) we have not found bibliographical references in the scientific literature and 50% have only one or two references.

Pharmaceutical ethnobotany in Northern Navarra (Iberian Peninsula).

AIM OF THE STUDY: This paper provides significant ethnobotanical information on pharmaceutical plant uses in Northern Navarra from an area known both for its high biological diversity and its cultural significance, suggesting the survival of uses lost elsewhere. Collect, analyze and evaluate the ethnobotanical knowledge about medicinal plants in Northern Navarra (Iberian Peninsula) with 4243 km(2) and 71,069 inhabitants. MATERIAL AND METHODS: We performed semi-structured interviews with 253 informants (mean age 69; 61% women, 39% men) in 120 locations, identified the plant reported and analyzed the results, comparing them with those from other territories. RESULTS: The informants reported data on 174 medicinal plants belonging to 63 botanical families. This work is focused on human medicinal plant uses, which represent 98% of the pharmaceutical uses (1725 use reports). The species with the highest number of cites are Chamaemelum nobile, Sambucus nigra and Verbena officinalis, with a long tradition of use in The Mountain (Navarra). All different plant parts are used; aerial part is exploited more frequently than other plant parts. Most of the listed remedies use a single ingredient, typically soaked in water. Usually, the administration is primarily oral followed by topical applications. CONCLUSIONS: The main ailments treated are digestive troubles, wounds and dermatological problems, and respiratory affections. Informants reported 24 new or scarcely cited uses for 23 medicinal plants. For 35% of the species (8) we have not found bibliographical references in the scientific literature and 48% (11) have only one to three references.