Chemical Composition, Functional and Antioxidant Properties of Dietary Fibre Extracted from Lemon Peel after Enzymatic Treatment.

Lemon peel represents an interesting by-product owing to its content of dietary fibre (DF) and (poly)phenols, which is of great importance for its valorisation. Hence, the objective of this study was to characterise the DF, total phenolic content (TPC), and antioxidant capacity of two lemon-peel-derived ingredients using two different methods (drying with warm air and enzymatic hydrolysis with pectinesterase). The analysis included a DF assessment, followed by neutral sugars characterisation through GC-FID and uronic acids determination via colorimetry. Subsequently, TPC and antioxidant capacity using the FRAP method were quantified through spectrophotometry. The swelling capacity (SWC), water retention capacity (WRC), and fat absorption capacity (FAC) were also determined as functional properties. It was observed that pectinesterase treatment led to a reduction in soluble DF and an increase in insoluble DF. This treatment also affected the pectin structure, thereby diminishing its ability to absorb water and fat within its matrix. The TPC was also reduced, resulting in a decrease in antioxidant capacity. Conversely, employing warm air exhibited a noteworthy increase in antioxidant capacity. This underscores its crucial contribution to the valorisation of lemon peel, not only by diminishing the environmental impact but also by enabling the acquisition of fibre ingredients with a noteworthy antioxidant capacity.

Dietary fibre fractions rich in (poly)phenols from orange by-products and their metabolisation by in vitro digestion and colonic fermentation.

Orange peel is an interesting by-product because of its composition, particularly its dietary fibre and flavanones. The aim of this work was to extract different fibre fractions from orange peel to obtain potential added-value ingredients and evaluate how the presence of fibre may interfere with (poly)phenol metabolism. Using an aqueous extraction, as a green extraction method, an insoluble fibre fraction (IFF) and a water-soluble extract (WSE) were obtained. Those fractions were analysed to determine the proximate and dietary fibre composition, hydration properties, (poly)phenol composition and antioxidant capacity, comparing the results with the orange peel (OP). The IFF presented the highest content of insoluble dietary fibre and the WSE showed the highest content of (poly)phenols, these being mainly flavanones. An in vitro faecal fermentation was carried out to evaluate the production of short-chain fatty acids (SCFAs) and lactate as prebiotic indicators; the IFF gave the highest production, derived from the greater presence of dietary fibre. Moreover, catabolites from (poly)phenol metabolism were also analysed, phenylpropanoic acids being the major ones, followed by phenylacetic acids and benzoic acids. These catabolites were found in higher quantities in WSE, because of the greater presence of (poly)phenols in its composition. IFF also showed a significant production of these catabolites, which was delayed by the greater presence of fibre. These results reveal that the new ingredients, obtained by an environmentally friendly water extraction procedure, could be used for the development of new foods with enhanced nutritional and healthy properties.

Successful implementation of prophylactic veno-venoarterial extracorporeal membrane oxygenation in high-risk trauma surgery: A case report.

INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) is increasingly utilized in trauma care, yet its elective use during high-risk surgeries remains unreported. CASE REPORT: We report a successful instance of prophylactic ECMO support via a Veno-Venoarterial (V-VA) configuration during high-risk surgery in a patient with extensive trauma, including severe thoracic damage and a highly unstable thoracic spine fracture. V-VA ECMO prevented complications such as hemodynamic and respiratory collapse associated with chest compression during the surgical procedure, as the patient should be in a prone position. DISCUSSION: The potential of ECMO as prophylactic support in high-risk surgery amongst trauma patients underscores a novel application of this technology. Complex configurations must be evaluated to avoid associated ECMO complications. CONCLUSION: Our case highlights the potential of prophylactic ECMO hybrid modes, indicating their safe application during high-risk procedures in select trauma patients.

Interaction between Dietary Fibre and Bioactive Compounds in Plant By-Products: Impact on Bioaccessibility and Bioavailability.

In Europe, around 31 million tonnes of food by-products are generated during primary production and trade. The management of these by-products may cause a negative impact, both at the economic and environmental levels, for both industry and society. In this regard, taking into consideration that these by-products retain the dietary fibre compositions and the bioactive compounds of the starting materials, plant food agro-industries have an interest in taking advantage of them, from a nutritional point of view. Therefore, this review evaluates the role of dietary fibre and bioactive compounds in these by-products as well as the potential interactions of both components and their implications for health, since the bioactive compounds associated with fibre may reach the colon, where they can be metabolised into postbiotic compounds, providing important health benefits (prebiotic, antioxidant, anti-inflammatory, etc.). Consequently, this aspect, on which there are few studies, is very relevant and must be considered in the revaluation of by-products to obtain new ingredients for food processing with improved nutritional and technological properties.

Systematic Review on the Metabolic Interest of Glucosinolates and Their Bioactive Derivatives for Human Health.

In the last decade, most of the evidence on the clinical benefits of including cruciferous foods in the diet has been focused on the content of glucosinolates (GSL) and their corresponding isothiocyanates (ITC), and mercapturic acid pathway metabolites, based on their capacity to modulate clinical, biochemical, and molecular parameters. The present systematic review summarizes findings of human studies regarding the metabolism and bioavailability of GSL and ITC, providing a comprehensive analysis that will help guide future research studies and facilitate the consultation of the latest advances in this booming and less profusely researched area of GSL for food and health. The literature search was carried out in Scopus, PubMed and the Web of Science, under the criteria of including publications centered on human subjects and the use of Brassicaceae foods in different formulations (including extracts, beverages, and tablets), as significant sources of bioactive compounds, in different types of subjects, and against certain diseases. Twenty-eight human intervention studies met inclusion criteria, which were classified into three groups depending on the dietary source. This review summarizes recent studies that provided interesting contributions, but also uncovered the many potential venues for future research on the benefits of consuming cruciferous foods in our health and well-being. The research will continue to support the inclusion of GSL-rich foods and products for multiple preventive and active programs in nutrition and well-being.

Dietary-Fibre-Rich Fractions Isolated from Broccoli Stalks as a Potential Functional Ingredient with Phenolic Compounds and Glucosinolates.

The Brassica oleracea industry generates large amounts of by-products to which value could be added because of the characteristics of their composition. The aim was to extract different fibre fractions from broccoli stalks to obtain potential new added-value ingredients. Using an ethanol and water extraction procedure, two fibre-rich fractions (total fibre fraction, TFB, and insoluble fibre fraction, IFB) were obtained. These fractions were analysed to determine the nutritional, (poly)phenols and glucosinolates composition and physicochemical properties, comparing the results with those of freeze-dried broccoli stalks (DBS). Although TFB showed a higher content of total dietary fibre, IFB had the same content of insoluble dietary fibre as TFB (54%), better hydration properties, higher content of glucosinolates (100 mg/100 g d.w.) and (poly)phenols (74.7 mg/100 g d.w.). The prebiotic effect was evaluated in IFB and compared with DBS by in vitro fermentation with human faecal slurries. After 48 h, the short-chain fatty acid (SCFA) production was higher with IFB than with DBS because of the greater presence of both uronic acids, the main component of pectin, and (poly)phenols. These results reveal that novel fibre-rich ingredients-with antioxidant, technological and physiological effects-could be obtained from broccoli stalks by using green extraction methods.

Using Explainable Machine Learning to Improve Intensive Care Unit Alarm Systems.

Due to the continuous monitoring process of critical patients, Intensive Care Units (ICU) generate large amounts of data, which are difficult for healthcare personnel to analyze manually, especially in overloaded situations such as those present during the COVID-19 pandemic. Therefore, the automatic analysis of these data has many practical applications in patient monitoring, including the optimization of alarm systems for alerting healthcare personnel. In this paper, explainable machine learning techniques are used for this purpose, with a methodology based on age-stratification, boosting classifiers, and Shapley Additive Explanations (SHAP) proposed. The methodology is evaluated using MIMIC-III, an ICU patient research database. The results show that the proposed model can predict mortality within the ICU with AUROC values of 0.961, 0.936, 0.898, and 0.883 for age groups 18-45, 45-65, 65-85 and 85+, respectively. By using SHAP, the features with the highest impact in predicting mortality for different age groups and the threshold from which the value of a clinical feature has a negative impact on the patient's health can be identified. This allows ICU alarms to be improved by identifying the most important variables to be sensed and the threshold values at which the health personnel must be warned.

Influence of Raspberry and Its Dietary Fractions on the In vitro Activity of the Colonic Microbiota from Normal and Overweight Subjects.

Raspberry is a source of dietary fibre and phenolic compounds, which are metabolised by the gut microbiota, resulting in the production of short chain fatty acids (SCFAs) and phenolic catabolites; but the formation of these compounds depends on the microbiota composition. The aim of this study was to investigate whether the raspberry and its fractions (phenolic extract, total and insoluble dietary fibre) affect the microbial activity depending on the body weight condition. For this, in vitro fermentations of raspberry fractions were carried out using faeces from normal-weight (NW) and overweight volunteers (OW) during 48 h, and phenolic catabolites and SCFAs were analysed at 0, 6, 24 and 48 h. The whole raspberry and the phenolic extract produced greater quantities of urolithins and total SCFAs when compared with fibre fractions, reaching the highest amount between 24 and 48 h. The body weight condition was an important factor, since faeces from NW led to greater production of urolithins from non-extractable phenolic compounds bound to fibre fractions, whereas in OW the urolithins production was higher from the fractions with more extractable polyphenols. In summary, the whole raspberry has been shown to have a prebiotic effect, mainly due to its phenolic compounds content rather than its fibre content.

Post-Harvest Use of Ultraviolet Light (UV) and Light Emitting Diode (LED) to Enhance Bioactive Compounds in Refrigerated Tomatoes.

Different strategies have been developed to increase the concentration of bioactive compounds in tomatoes during post-harvest, with ultraviolet light (UV) and light emitting diodes (LEDs) being interesting tools. The aim of this study was to evaluate the effect of ultraviolet (UVA at 366 nm and UVC at 254 nm) pre-treatment (1 kJ/m2) and red-blue LED light (25.4 µmol/m2/s) on the concentration of carotenoids, (poly)phenols and hydrophilic/lipophilic antioxidant capacity during 7 days of refrigeration storage of green tomatoes (Solanum lycopersicum L.) cultivar "Raf". In addition, special attention was paid to quality parameters (weight loss, colour, acidity, soluble solids and ripening index). Tomatoes exposed to LED light at 6 °C for 7 days increased up to three times the total carotenoids content (mainly ß-carotene and E-lycopene) compared to tomatoes refrigerated in the dark, while UV treatments alone did not significantly affect the carotenoid content. Besides, exposure to LEDs increased the hydrophilic and lipophilic antioxidant capacity of tomatoes by 30%, without affecting phenolic contents. Thus, LED treatments alone during refrigerated storage fostered ripening and improved the nutritional value of tomatoes, without compromising quality parameters. Further studies must be carried out to evaluate the impact on sensory attributes and consumer acceptance.

Six novel variants in the PKLR gene associated with pyruvate kinase deficiency in Argentinian patients.

BACKGROUND: Pyruvate kinase deficiency (PKD) is a rare recessive congenital hemolytic anemia caused by mutations in the PKLR gene. The disease shows a marked variability in clinical expression. We studied the molecular features of nine unrelated Argentinian patients with congenital hemolytic anemia associated with erythrocyte pyruvate kinase deficiency. DESIGN AND METHODS: Routine hematologic investigations were performed to rule out other causes of chronic hemolytic anemia. Sanger sequencing and in-sílico analysis were carried out to identify and characterize the genetics variants. RESULTS: Six different novel missense variants were detected among the 18 studied alleles: c.661 G > C (Asp221His), c.956 G > T (Gly319Val), c.1595 G > C (Arg532Pro), c.347 G > A (Arg116Gln), c.1232 G > T (Gly411Val), c.1021G > A (Gly341Ser). Structural implications of amino-acid substitutions were correlated with the clinical phenotypes seen in the probands. CONCLUSIONS: This is the first comprehensive report on molecular characterization of pyruvate kinase deficiency in Argentina and the second from South America that would contribute to our knowledge on the distribution and frequency of PKLR variants in our population but also offer new insights into the interpretation of the effect of PKLR variants and phenotype.

Seasonal Variation of Health-Promoting Bioactives in Broccoli and Methyl-Jasmonate Pre-Harvest Treatments to Enhance Their Contents.

Broccoli is a source of bioactive compounds that provide an important nutritional value. The content of these compounds can vary depending on agronomic and environmental conditions, as well as on elicitation. In this study, three crop trials were carried out to evaluate the effects of the cultivation season, the application of different dosages of methyl-jasmonate (MeJA) on the overall quality and on the total content of bioactive compounds of 'Parthenon' broccoli cultivated under the field conditions of southeastern Spain. Color parameters, chlorophyll content, total phenolic compounds, total flavonoids and antioxidant activity were measured to evaluate the overall quality. Moreover, individual carotenoids, phenolic compounds and glucosinolates were evaluated by high performance liquid chromatography with diode array detection (HPLC-DAD) and high performance liquid chromatography equipped with diode array detector coupled to mass spectrometer using electro spray ionization (HPLC-DAD-ESI/MSn). The content of total carotenoids, phenolic compounds and glucosinolates were higher in autumn compared with spring, showing increases of 2.8-fold, 2-fold and 1.2-fold, respectively. Moreover, a double application of MeJA increased the contents of total carotenoids, phenolic compounds and glucosinolates by 22%, 32% and 39%, respectively, relative to the untreated samples. Considering our results, the controlled and timely application of 250 µM MeJA to the aerial parts of the plants four days before harvest, on two consecutive days, seems to be a valid agronomic strategy to improve the health-promoting capacity of Parthenon broccoli, without compromising its overall quality.

Improvement of the Flavanol Profile and the Antioxidant Capacity of Chocolate Using a Phenolic Rich Cocoa Powder.

Chocolate is made from cocoa, which is rich in (poly)phenols that have a high antioxidant capacity and are associated with the prevention of chronic diseases. In this study, a new production process was evaluated in order to obtain a dark chocolate enriched in (poly)phenols using a cocoa powder with an improved flavanol profile. The antioxidant capacity (Oxygen Radical Absorbance Capacity (ORAC) assay) and the flavanol profile (HPLC-DAD and HPLC-FL) was determined. The analysis of the enriched chocolate showed that the total flavan-3-ols (monomers) content was 4 mg/g representing a 3-fold higher than that quantified in the conventional one. Total levels of dimers (procyanidin B1 and B2) were 2.4-fold higher in the enriched chocolate than in the conventional, with a total content of 6 mg/g. The total flavanol content (flavan-3-ols and procyanidins) in the enriched chocolate was increased by 39% compared to the conventional one which led to a 56% increase in the antioxidant capacity. The new flavanol-enriched dark chocolate is expected to provide greater beneficial effect to consumers. Moreover, the amount of flavonols provided by a single dose (ca. 200 mg per 10 g) would allow the use of a health claim on cardiovascular function, a fact of interest for the cocoa industry.

Xerocitosis hereditaria. Presentación de dos casos clínicos pediátricos / Hereditary xerocytosis. Presentation of two pediatric cases

La xerocitosis hereditaria es un desorden poco frecuente causado por defectos en la permeabilidad eritrocitaria, que se caracteriza por anemia hemolítica de gravedad variable y sobrecarga de hierro. El diagnóstico suele ser tardío y confundirse con otras anemias hemolíticas, lo que puede llevar a indicaciones de procedimientos, como la esplenectomía, contraindicados en estos pacientes. Se reportan las características clínicas, hematológicas y moleculares de dos pacientes pediátricos no relacionados con diagnóstico de xerocitosis hereditaria. Ambos presentaban eritrocitos deshidratados con alta concentración de hemoglobina corpuscular media, frotis no patognomónico, marcadores de hemólisis y una curva de fragilidad osmótica resistente. El diagnóstico se confirmó por la secuenciación del gen PIEZO.Se resalta la importancia de reconocer la causa de la anemia hemolítica para dar un enfoque terapéutico preciso y dar adecuado consejo genético

Hereditary xerocytosis is a rare disorder caused by defects of red blood cell permeability that are characterized by hemolytic anemia of variable degree and iron overload. Diagnosis is usually late and confused with other hemolytic anemias, which can lead to procedural indications, such as splenectomy, contraindicated in these patients. We report the clinical, haematological, and molecular characteristics of two patients from two unrelated families affected by hereditary xerocytosis. Both patients had dehydrated erythrocytes with a high concentration of mean corpuscular hemoglobin, non-pathognomonic smears, markers of hemolysis and a resistant osmotic fragility curve. The diagnosis was confirmed by the sequencing of the PIEZO gene. We emphasize the importance of recognizing the cause of hemolytic anemia to give an accurate therapeutic approach and give adequate genetic counseling.

[Hereditary xerocytosis. Presentation of two pediatric cases]. / Xerocitosis hereditaria. Presentación de dos casos clínicos pediátricos.

Hereditary xerocytosis is a rare disorder caused by defects of red blood cell permeability that are characterized by hemolytic anemia of variable degree and iron overload. Diagnosis is usually late and confused with other hemolytic anemias, which can lead to procedural indications, such as splenectomy, contraindicated in these patients. We report the clinical, haematological, and molecular characteristics of two patients from two unrelated families affected by hereditary xerocytosis. Both patients had dehydrated erythrocytes with a high concentration of mean corpuscular hemoglobin, non-pathognomonic smears, markers of hemolysis and a resistant osmotic fragility curve. The diagnosis was confirmed by the sequencing of the PIEZO gene. We emphasize the importance of recognizing the cause of hemolytic anemia to give an accurate therapeutic approach and give adequate genetic counseling.

La xerocitosis hereditaria es un desorden poco frecuente causado por defectos en la permeabilidad eritrocitaria, que se caracteriza por anemia hemolítica de gravedad variable y sobrecarga de hierro. El diagnóstico suele ser tardío y confundirse con otras anemias hemolíticas, lo que puede llevar a indicaciones de procedimientos, como la esplenectomía, contraindicados en estos pacientes. Se reportan las características clínicas, hematológicas y moleculares de dos pacientes pediátricos no relacionados con diagnóstico de xerocitosis hereditaria. Ambos presentaban eritrocitos deshidratados con alta concentración de hemoglobina corpuscular media, frotis no patognomónico, marcadores de hemólisis y una curva de fragilidad osmótica resistente. El diagnóstico se confirmó por la secuenciación del gen PIEZO. Se resalta la importancia de reconocer la causa de la anemia hemolítica para dar un enfoque terapéutico preciso y dar adecuado consejo genético.

Caracterización fenotípica y genotipica de la deficiencia de glucosa-6-fosfato deshidrogenasa en Argentina: Estudio retrospectivo y descriptivo / Phenotypic and genotypic characterization of glucose-6-phosphate dehydrogenase deficiency in Argentina: Retrospective and descriptive study

La deficiencia de glucosa-6-fosfato deshidrogenasa es la enzimopatía eritrocitaria causada por mutaciones en el gen G6PD, cuya herencia está ligada al cromosoma X. Se analizan las características clínicas y de laboratorio de 24 individuos con deficiencia de G6PD durante 25 años. La edad mediana al momento del diagnóstico fue 10,2 años (rango: 0,6-56,4). El 54,2 % de los pacientes fueron asintomáticos, mientras que el 25 % presentó anemia hemolítica crónica no esferocítica; el 12,5 %, ictericia neonatal y anemia hemolítica posinfecciones, y el 8,3 %, anemia hemolítica aguda pos ingesta de habas. Los 24 pacientes estudiados presentaron variantes descritas previamente en la literatura. Las características clínicas observadas estuvieron acordes con las variantes encontradas. Veintiuna mujeres, pertenecientes a la rama materna de los individuos afectados, pudieron ser identificadas por biología molecular como portadoras de la deficiencia, por lo que recibieron el consejo genético correspondiente.

Glucose-6-phosphate dehydrogenase deficiency is an erythrocyte enzyme disorder caused by mutations in the G6PD gene, which has an X-linked inheritance. Here we analyze the clinical and laboratory characteristics of 24 subjects with G6PD deficiency over 25 years. Their median age at diagnosis was 10.2 years (range: 0.6-56.4). No symptoms were observed in 54.2 % of patients, whereas 25 % had chronic non-spherocytic hemolytic anemia; 12.5 %, neonatal jaundice and postinfectious hemolytic anemia; and 8.3 %, acute hemolytic anemia after ingestion of fava beans. The 24 studied patients had variants that had been previously described in the bibliography. The clinical characteristics observed here were consistent with the variants found. A total of 21 women from the maternal line of affected subjects were identified as deficiency carriers using molecular biology techniques, so they received the corresponding genetic counseling.

Phenotypic and genotypic characterization of glucose-6-phosphate dehydrogenase deficiency in Argentina. Retrospective and descriptive study. / Caracterización fenotípica y genotipica de la deficiencia de glucosa-6-fosfato deshidrogenasa en Argentina. Estudio retrospectivo y descriptivo.

Glucose-6-phosphate dehydrogenase deficiency is an erythrocyte enzyme disorder caused by mutations in the G6PD gene, which has an X-linked inheritance. Here we analyze the clinical and laboratory characteristics of 24 subjects with G6PD deficiency over 25 years. Their median age at diagnosis was 10.2 years (range: 0.6-56.4). No symptoms were observed in 54.2 % of patients, whereas 25 % had chronic non-spherocytic hemolytic anemia; 12.5 %, neonatal jaundice and postinfectious hemolytic anemia; and 8.3 %, acute hemolytic anemia after ingestion of fava beans. The 24 studied patients had variants that had been previously described in the bibliography. The clinical characteristics observed here were consistent with the variants found. A total of 21 women from the maternal line of affected subjects were identified as deficiency carriers using molecular biology techniques, so they received the corresponding genetic counseling.

La deficiencia de glucosa-6-fosfato deshidrogenasa es la enzimopatía eritrocitaria causada por mutaciones en el gen G6PD, cuya herencia está ligada al cromosoma X. Se analizan las características clínicas y de laboratorio de 24 individuos con deficiencia de G6PD durante 25 años. La edad mediana al momento del diagnóstico fue 10,2 años (rango: 0,6-56,4). El 54,2 % de los pacientes fueron asintomáticos, mientras que el 25 % presentó anemia hemolítica crónica no esferocítica; el 12,5 %, ictericia neonatal y anemia hemolítica posinfecciones, y el 8,3 %, anemia hemolítica aguda pos ingesta de habas. Los 24 pacientes estudiados presentaron variantes descritas previamente en la literatura. Las características clínicas observadas estuvieron acordes con las variantes encontradas. Veintiuna mujeres, pertenecientes a la rama materna de los individuos afectados, pudieron ser identificadas por biología molecular como portadoras de la deficiencia, por lo que recibieron el consejo genético correspondiente.

Factores que influyen en el inicio y mantenimiento de la lactancia materna exclusiva / Factors with impact on the initiation and maintenance of exclusive breastfeeding

OBJETIVO: conocer la prevalencia de lactancia materna (LM) al nacimiento, tiempo de duración y factores asociados con el inicio y mantenimiento de la lactancia materna exclusiva (LME), además de identificar las causas de abandono. MÉTODO: estudio observacional retrospectivo (2016-2017). La población de estudio pertenecía al Centro de Salud Zaidín Sur de Granada. Se seleccionó una muestra aleatoria de 60 bebés de un total de 326 que habían nacido en 2015. Se contactó por teléfono con las madres para entrevista sobre la LM. Análisis descriptivo y bivariante. Significación estadística si p< 0,05. RESULTADOS: prevalencia LME al nacimiento del 71,7%, a los tres meses del 58% y a los seis meses del 43,3%. Las causas identificadas de no inicio de LM fueron, principalmente, hipogalactia, el bebé no agarraba bien el pezón y enfermedad de la madre. Las causas más habituales de abandono de la LM fueron la hipogalactia (57,1%) y la falta de tiempo de la madre al volver al trabajo (23,8%). La LME se mantuvo más tiempo en las madres con estudios universitarios (media 4,13 meses) y en las no fumadoras (media 3,74), presentando diferencias estadísticamente significativas (p< 0,05). CONCLUSIONES: la prevalencia de LM al nacimiento y a lo largo del tiempo aporta unos datos favorables en la muestra de estudio. Se han identificado dos factores que influyen en la LM: el nivel de estudios de la madre y la condición de fumadora. La hipogalactia ha sido la causa principal de no inicio y abandono de la LM

OBJECTIVE: to understand the prevalence of maternal breastfeeding (BF) at birth, its time of duration, and factors associated with the initiation and maintenance of exclusive BF, as well as to identify the causes for discontinuation. METHOD: a retrospective observational study (2016-2017). The study population attended the Public Health Centre Zaidín Sur de Granada. A random sample of 60 babies was selected from 326 babies in total born in 2015. Their mothers were contacted by telephone for an interview about BF. Descriptive and bivariate analysis; statistical significance if p< 0.05. RESULTS: the prevalence of exclusive BF at birth was 71.7%, at three months: 58%, and at six months: 43.3%. The causes identified for non-initiation of BF were, mainly, hypogalactia, the baby did not hold the nipple well, and disease in the mother. The most usual causes for BF discontinuation were hypogalactia (57.1%) and lack of time by the mother when returning to work (23.8%). Exclusive BF was maintained for a longer time by mothers with university studies (mean 4.13 months) and those non-smoking (mean 3.74), presenting statistically significant differences (p< 0.05). CONCLUSIONS: the prevalence of BF at birth and over time provides favorable data in the sample studied. Two factors with impact on BF have been identified: the level of studies of the mother and her non-smoking status. Hypogalactia was the main cause for not initiating and discontinuing BF

Laparoscopic Nephrectomy for the Management of Xanthogranulomatous Pyelonephritis: Still a Challenging Procedure.

OBJECTIVE: The aim of the study was to assess the feasibility of laparoscopic nephrectomy (LN) in the treatment of patients with xanthogranulomatous pyelonephritis (XGP). METHODS: Retrospective review of medical records of 17 patients (mean age 60.0 ± 13.3 years) who underwent LN by a single surgeon from 2010 to 2018. Sociodemographic and clinical data including diagnosis, presenting clinical features, surgical management, and postoperative course were analyzed. RESULTS: LN was successfully performed in 15 (88.2%) patients. Two (12.5%) patients with disseminated disease were electively converted to open nephrectomy (ON) due to failure to progress. Two (11.8%) patients experienced intraoperative complications (grades 3b and 4b). Among patients in whom LN was successfully performed (n = 15), the mean operative time was 198.0 ± 107.1 min and was shorter when no intraoperative complications occurred (169.0 ± 48.1 min). Three (20%) of these patients required transfusions and nine (60.0%) required postoperative pelvic drainage (PD). Six (40%) patients experienced postoperative complications: one grade 1, four grade 2, and one grade 5. Mean hospital stay was 4.4 ± 4.3 days, and 3.4 ± 2.2 for those experiencing manageable or no complications. Among patients without postoperative complications (n = 6), mean hospital stay was shorter when no PD was placed (1.6 vs 2.6 days). CONCLUSION: LN is a feasible surgical option in patients with XGP although given the nature of XGP, it is associated with complications-nearly all manageable-which makes it a challenging surgical procedure. Advanced laparoscopic skills and experiences are needed. Dissemination of the disease is associated with the occurrence of more severe complications and conversion to ON. PD placement seems associated with shorter hospital stay.