The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system.

OBJECTIVE: To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS: We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS: In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS: Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.

Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network.

BACKGROUND: The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES: To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS: This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS: In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION: Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System.

BACKGROUND: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Relationship between the Prenatal Diagnosis of Placenta Acreta Spectrum and Lower Use of Blood Components.

OBJECTIVE: To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. MATERIALS AND METHODS: A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). RESULTS: During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0-4 versus median: 3; [IQR]: 2-4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750-2,000 mL versus 1,500 mL [IQR]: 1,200-1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). CONCLUSION: Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.

Incidencia de parálisis braquial obstétrica tras programa de entrenamiento en distocia de hombros / Incidence of obstetric brachial plexus palsy after a training program in shoulder dystocia

Introducción: La distocia de hombros es una emergencia obstétrica no prevenible que causa graves complicaciones, como la parálisis braquial obstétrica. El objetivo del estudio fue determinar la incidencia de parálisis braquial obstétrica y de otras complicaciones neonatales asociadas a la distocia de hombros en los partos atendidos en un Hospital Universitario tras la implantación de un curso basado en simulación, de carácter voluntario y destinado a todos los profesionales en paritorio. Material y métodos: Estudio observacional retrospectivo; registro de los casos de distocia de hombros y de las complicaciones asociadas (principalmente parálisis braquial obstétrica) que tuvieron lugar entre enero del 2017 y diciembre del 2020, tras la implantación del curso. De forma paralela, se rescataron los casos de parálisis braquial obstétrica que tuvieron lugar en el hospital antes del entrenamiento (2008-2016). Resultados: En el período 2017-2020, de entre 125 distocias de hombros (lo que representa el 1,38% de los partos vaginales), hubo 14 casos de parálisis braquial obstétrica (el 11,2% de las distocias de hombros), siete fracturas de clavícula y una fractura de húmero; ninguna de las parálisis braquiales obstétricas fue permanente ni requirió tratamiento o rehabilitación más allá de los seis meses. En los años anteriores al entrenamiento, hubo siete casos de parálisis braquial obstétrica, dos permanentes y cinco transitorias (tres de las cuales necesitaron rehabilitación). Conclusión: Estos resultados reflejan la importancia de conocer la morbilidad presente en el paritorio y el posible beneficio de la formación basada en simulación para la resolución de estas complicaciones obstétricas. (AU)

Introduction: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. Material and methods: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008–2016). Results: In 2017–2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). Conclusion: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications. (AU)

Relationship between the Prenatal Diagnosis of Placenta Acreta Spectrum and Lower Use of Blood Components / Relação entre o diagnóstico prenatal de espectro da placenta acreta e menor uso de hemoderivados

Abstract Objective To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. Materials and Methods A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). Results During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0-4 versus median: 3; [IQR]: 2-4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750-2,000 mL versus 1,500 mL [IQR]: 1,200-1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). Conclusion Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.

Incidence of obstetric brachial plexus palsy after a training program in shoulder dystocia.

INTRODUCTION: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. MATERIAL AND METHODS: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008-2016). RESULTS: In the 2017-2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). CONCLUSION: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.

[Knowledge assessment of shoulder dystocia management by Spanish professionals.] / Evaluación del conocimiento en la resolución de la distocia de hombros en profesionales españoles.

OBJECTIVE: Shoulder dystocia (SD) training is recommended by diverse international healthcare organizations; however, it is not so in Spain, and there is no specific programmes. The objective of the study was to evaluate the level of knowledge and attitudes towards resolving a SD among a large sample of spanish obstetricians and midwives. METHODS: A multi-professional team carried out simulation-based training courses. Descriptive observational study where mean, standard deviation, minimum and maximum or median and interquartile intervals according to the distribution will be used for continuous variables. For the discrete variables, the number and the corresponding percentages will be reported. RESULTS: Between December 2015 and 2019, the team carried out 17 editions of SD workshop and 904 active professionals were trained in labour wards in different parts of Spain. The results showed that 64.8% of the professionals had learned to solve shoulder dystocia through books and/or 58.4% theoretical classes. 60.4% (380) of the respondents had not received any type of training in simulation in obstetrics. 87.1% (415/476) of the students had not felt prepared to face a SD when they finished the residency At the time of answering this survey, 61.8% (358) did not feel prepared to solve a SD. CONCLUSIONS: Training in Shoulder Dystocia in Spain is mainly theoretical and a high number of professionals recognize that they are not sufficiently prepared to face it with guarantees.

OBJETIVO: El entrenamiento en distocia de hombros (DH) está recomendado por numerosas sociedades médicas internacionales y, sin embargo, en España, no existen programas específicos de entrenamiento. El objetivo de este estudio fue evaluar el nivel de conocimiento y habilidades prácticas para resolver una distocia de hombros de un amplio número de matronas y ginecólogos españoles que habían realizado un curso basado en simulación. METODOS: El equipo multiprofesional de simulación obstétrica realizo talleres basados en simulación para la resolución de la DH. Estudio descriptivo observacional donde para las variables continuas se utilizará media, desviación estándar, mínimo y máximo o mediana e intervalos intercuartiles de acuerdo con la distribución. Para las variables discretas se reportarán el número y los porcentajes correspondientes. RESULTADOS: Entre diciembre de 2015 y 2019, el equipo llevo a cabo 17 ediciones del taller de DH y formo a 904 profesionales de diferentes partes de España. Los resultados mostraron que Un 64,8% de los profesionales había aprendido a solucionar la distocia de hombros a través de libros y/o un 58,4% clases teóricas. El 60,4% (380) de los encuestados, no había recibido ningún tipo de formación en simulación en obstetricia. Un 87,1% (415/476) de los alumnos no se había sentido preparado para enfrentarse a una DH cuando terminó la residencia En el momento de contestar esta encuesta, un 61,8% (358) no se sentía preparado para resolver una DH. CONCLUSIONES: La formación en distocia de hombros en España es principalmente teórica y un alto numero de profesionales reconoce que no están suficientemente preparados para afrontarla con garantías.

Main changes on the polyphenols profile and antioxidant capacity in Manila mango (Mangifera indica L)

Mango is the second most commercialized tropical fruit in the world, and Mexico is the major exporter. In terms of mango production, Manila´s variety represents a quarter of the total mangoes production in Mexico. However, the changes that occur on the phenolic compounds during the Manila mango ripening process are unknown. Quantitative analysis of the major phenolic compounds was conducted at different maturity stages, using several spectrophotometric measurements and by high-performance liquid chromatography (HPLC). At the late ripening stage was observed the biggest content in pulp and peel of total phenols (577 and 10547 mg EAG /100 g), flavonoids (95.33 and 537 mg EQ/100 g), and antioxidant capacity by DPPH (25 and 347 mmol TE/100 g). Some bioactive compounds achieve their highest values at optimal consumption ripening. Although they diminish when the fruit reaches a senescence appearance. This is the first study to prove that mangiferin by itself shows a higher correlation in antioxidant capacity compared to other phenolic compounds in mango peel, and this suggest that phenolic compounds may have an important role in the postharvest antioxidant metabolism in Manila mango fruit. On the other hand, the results show that the peel compared to the pulp contains higher amounts of total phenols, flavonoids, gallic acid, mangiferin and antioxidant capacity, so its use as an ingredient in the preparation of functional food products is recommended. More studies are needed to go in-depth in the changes of the content of phytochemicals during the ripening process in the peel and pulp mango, which ones could be caused by the hormones responsible for ripening in the fruit, such as ethylene, and bioavailability of these compounds at different stages of maturation(AU)

El mango es la segunda fruta tropical más comercializada del mundo y México es el principal exportador. En términos de producción de mango, la variedad Manila representa una cuarta parte de la producción total de mangos en México. Sin embargo, se desconocen los cambios que ocurren en los compuestos fenólicos durante el proceso de maduración del mango Manila. El análisis cuantitativo de los principales compuestos fenólicos se realizó en diferentes etapas de madurez, utilizando varias medidas espectrofotométricas y mediante cromatografía líquida de alta resolución (HPLC). En la etapa de madurez tardía se observó el mayor contenido en pulpa y cáscara de fenoles totales (577 y 10547 mg EAG / 100 g), flavonoides (95.33 y 537 mg EQ / 100 g) y capacidad antioxidante por DPPH (25 y 347 mmol TE / 100 g). Algunos compuestos bioactivos alcanzan sus valores más altos en el punto de madurez óptima. Aunque disminuyen cuando el fruto adquiere una apariencia de senescencia. Este es el primer estudio que demuestra que la mangiferina por sí misma presenta una alta correlación con la capacidad antioxidante en comparación con otros compuestos fenólicos de la cáscara de mango, y esto sugiere que los compuestos fenólicos pueden tener un papel importante en el metabolismo antioxidante postcosecha en el mango Manila. Por otro lado, los resultados muestran que la cáscara comparada con la pulpa contiene mayores cantidades de fenoles totales, flavonoides, ácido gálico, mangiferin y capacidad antioxidante por DPPH, por lo que se recomienda su uso como ingrediente en la elaboración de productos alimenticios fucionales. Se necesitan más estudios para profundizar en los cambios del contenido de fitoquímicos durante el proceso de maduración en la cáscara y pulpa del mango, los cuáles podrían ser provocados por las hormonas responsables de la maduración en el fruto, como el etileno, y la biodisponibilidad de estos compuestos en diferentes etapas de maduración(AU)

El Sistema de Endocannabinoides como regulador de la lipogénesis y su posible modulación por la Mangiferina

RESUMEN Actualmente es innegable la participación del sistema endocannabinoides (SEC) en la regulación metabólica; ya que su sobre estimulación ha sido relacionada con varias patologías entre las que se encuentran obesidad, diabetes mellitus, retinopatía e hígado graso no alcohólico. Éstas se relacionan mutuamente a través de alteraciones del metabolismo de los lípidos, como lo es una sobre estimulación de la síntesis de ácidos grasos, una disminución en la beta-oxidación, hiperglicemia causada por un aumento de la gluconeogénesis, así como en la glucólisis; procesos en los cuales se ha descrito al SEC como un participante crucial. Por otro lado, algunos compuestos fitoquímicos, tales como la mangiferina (MGF), han probado sus efectos farmacológicos en el metabolismo de lípidos a nivel hepático y en el control glicémico. Hasta el momento se desconoce el efecto de la mangiferina sobre los receptores de endocannabinoides, por lo que esta revisión aborda la regulación a nivel sistémico (órganos y tejidos) y central (sistema nervioso) de la lipogénesis por el SEC y la regulación negativa que tiene la mangiferina sobre éste. Finalmente se sugiere, con base en la información publicada hasta el momento, una relación entre el posible efecto que pueden tener la MGF sobre el SEC.

ABSTRACT Currently, the participation of the endocannabinoid system in metabolic regulation is undeniable; because its hyperactivation has been related to several pathologies such as obesity, diabetes mellitus, retinopathy and non-alcoholic fatty liver, and others. These pathologies are related through alterations in lipid metabolism, e.g. over stimulation of fatty acid synthesis, beta-oxidation decrease, hyperglycemia increase, all these changes are caused by increase in gluconeogenesis, as well as glycolysis, processes in which the SEC has been described as a main character. On the other hand, some phytochemicals such as mangiferin (MGF) have shown their pharmacological effects on lipid metabolism, as well as glycemic control. So far, the effect of mangiferin on cannabinoid receptors is unknown. In this review, we try to demonstrate how mangiferin and these receptors participate in the opposite manner in the adaptation of lipid metabolism in many organs like as liver, tissue adipose and SN (nervous system). In addition, we suggest, based on the published information to until now, a relationship between the MGF´s effect on the SEC.

Evaluación de la capacidad antioxidante, características fisicoquímicas y perfil sensorial de Opuntia robusta y O. ficus-indica / Evaluation of antioxidant capacity, physicochemical characteristics and sensory profile of Opuntia robusta and O. ficus-indica

Las Opuntia spp. son un recurso fitogenético Mexicano de gran valor nutritivo y alto contenido de betalaínas, compuestos conocidos por sus propiedades antioxidantes. Este estudio evaluó las características fisicoquímicas, el contenido de betalaínas y su capacidad antioxidante (CA), así como el perfil sensorial de frutos de O. robusta y O. ficusindica. Esta última presentó mayor acidez y contenido de sólidos solubles (F= 769,2; P= 0,0001), (F= 360,4; P ≤0,0001), que O. robusta. En humedad y contenido de cenizas no hubo diferencias significativas entre ambas especies. La concentración de betalaínas fue superior en Opuntia robusta (F=529,1; P= ≤0,0001) betacianinas (0,114 mg/mL pulpa) y betaxantinas (0,073 mg/ mL de pulpa), en O. ficus-indica (0,023 mg/ mL de pulpa y 0,0198 mg/ mL de pulpa). Se encontraron diferencias significativas en la CA (F=545,9; P ≤0,0001), en O. ficus-indica hasta 195,38 µmol equivalente Trolox/ mL por el método Ácido2, 2´-azino-bis-(3-etilbenzotiazolina)6-sulfónico (ABTS) y 22% de inhibición de radicales libres por el método 2,2 difenil-1-pricrilhidrazilo (DPPH), para O. robusta 165,6 µmol equivalente Trolox/ mL y más del 36% de inhibición de radicales libres. Los resultados mostraron que la CA está directamente relacionada con la concentración de betacianinas y betaxantinas. Ambas variedades de Opuntia exhiben una tendencia a lo dulce y ácido, con aromas, sabores y resabios con notas frutales y vegetales. Estos resultados sugieren que estas especies pueden ser empleadas para la extracción de betalaínas debido a su gran potencial para utilizarse en la industria como fuente de pigmentos naturales con propiedades antioxidantes y agradables características sensoriales(AU)

Opuntia spp. are a Mexican phytogenetic resource with great nutritive value and high betalains (compounds known for their antioxidant properties) content. Our main goal was to evaluate the physicochemical characteristics, betalains concentration and antioxidant capacity (AC), as well as sensory profiles of Opuntia robusta and O. ficus-indica, where the later one showed higher acidity and soluble solids content (F= 769.2; P= 0.0001 and F= 360.4; P ≤0.0001 respectively) than O. robusta. There was no significant difference between the species in terms of humidity and ash content. Betalains concentrations were higher in Opuntia robusta (F=529.1; P= ≤0.0001), while betacyanins (0.114 mg/ mL pulp) and betaxantins (0.073 mg/ mL de pulp) were higher in O. ficus-indica (0.023 mg/ mL pulp and 0.0198 mg/ mL de pulp). Significant differences for AC were found (F=545.9, P ≤0.0001), with O. ficus-indica showing up to 195.38 µmol Trolox equivalent / mL by the method 2,2'-Azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) and 22% of free radicals inhibition by the method 2, 2 diphenyl-1-pricrylhydrazyl (DPPH), while 165.6 µmol Trolox equivalent / mL and more than 36% free radicals inhibition were found for O. robusta. Results showed that the antioxidant capacity is directly related with betacyanins and betaxantines concentration. Both Opuntia varieties exhibit a tendency to sweetness and acidity, with aromas, flavors and scents within fruity and vegetable notes. These results suggest that both species could be used in the extraction of betalains due to their great industrial potential as a source of natural pigments with antioxidant properties and pleasant sensorial characteristics(AU)

Extractable and Non-Extractable Phenolics and Antioxidant Capacity of Mandarin Waste Dried at Different Temperatures.

The mandarin industry is generating more waste due to the increasing demand for juice. In this study, extractable and non-extractable phenolics as well as 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS), ferric reducing ability of plasma (FRAP), and oxygen radical absorbance capacity (ORAC) antioxidant activities in Satsuma mandarin waste dried at different temperatures were determined. The amounts of non-extractable total phenols, total flavonoids, and condensed tannins measured in mandarin waste dried at 120 °C were 39.4, 44.3, and 45.6 %, respectively, which were higher than those of fresh-mandarin waste. Dried mandarin waste is rich in extractable and non-extractable hesperidin (259.86 and 182.52 mg/g, respectively) and eriocitrin (85.12 and 197.24 mg/g, respectively), as well as non-extractable gallic acid (36.08 µg/g). The antioxidant capacities of extractable and non-extractable phenolics, from the highest to the lowest, were ABTS > ORAC > DPPH > FRAP and ORAC > ABTS > DPPH > FRAP, respectively. The information reported here may encourage mandarin industry operators to re-evaluate their by-products, extending the application of mandarin fruits and reducing waste.

Elderly victims of gender violence in Portugal: Invisible and not heard?

In this article, we explore professionals' representations of elderly female victims of gender violence. Semi-structured interviews were used to explore seven professionals' work philosophies and intervention methodologies in their work with elderly female victims of violence, their main problems and difficulties, and their perspectives regarding shelters for elderly women. Results show that there are no specific philosophies and methodologies to intervene with these victims. There is a tendency to homogenize all the victims of gender violence, regardless of their age and specific needs. The professionals also tended to trivialize gender violence against elderly female victims, considering that these women tolerate violence.

Linker histone partial phosphorylation: effects on secondary structure and chromatin condensation.

Linker histones are involved in chromatin higher-order structure and gene regulation. We have successfully achieved partial phosphorylation of linker histones in chicken erythrocyte soluble chromatin with CDK2, as indicated by HPCE, MALDI-TOF and Tandem MS. We have studied the effects of linker histone partial phosphorylation on secondary structure and chromatin condensation. Infrared spectroscopy analysis showed a gradual increase of ß-structure in the phosphorylated samples, concomitant to a decrease in α-helix/turns, with increasing linker histone phosphorylation. This conformational change could act as the first step in the phosphorylation-induced effects on chromatin condensation. A decrease of the sedimentation rate through sucrose gradients of the phosphorylated samples was observed, indicating a global relaxation of the 30-nm fiber following linker histone phosphorylation. Analysis of specific genes, combining nuclease digestion and qPCR, showed that phosphorylated samples were more accessible than unphosphorylated samples, suggesting local chromatin relaxation. Chromatin aggregation was induced by MgCl2 and analyzed by dynamic light scattering (DLS). Phosphorylated chromatin had lower percentages in volume of aggregated molecules and the aggregates had smaller hydrodynamic diameter than unphosphorylated chromatin, indicating that linker histone phosphorylation impaired chromatin aggregation. These findings provide new insights into the effects of linker histone phosphorylation in chromatin condensation.

Identification of novel post-translational modifications in linker histones from chicken erythrocytes.

Chicken erythrocyte nuclei were digested with micrococcal nuclease and fractionated by centrifugation in low-salt buffer into soluble and insoluble fractions. Post-translational modifications of the purified linker histones of both fractions were analyzed by LC-ESI-MS/MS. All six histone H1 subtypes (H1.01, H1.02, H1.03, H1.10, H1.1L and H1.1R) and histone H5 were identified. Mass spectrometry analysis enabled the identification of a wide range of PTMs, including N(α)-terminal acetylation, acetylation, formylation, phosphorylation and oxidation. A total of nine new modifications in chicken linker histones were mapped, most of them located in the N-terminal and globular domains. Relative quantification of the modified peptides showed that linker histone PTMs were differentially distributed among both chromatin fractions, suggesting their relevance in the regulation of chromatin structure. The analysis of our results combined with previously reported data for chicken and some mammalian species showed that most of the modified positions were conserved throughout evolution, highlighting their importance in specific linker histone functions and epigenetics. BIOLOGICAL SIGNIFICANCE: Post-translational modifications of linker histones could have a role in the regulation of gene expression through the modulation of chromatin higher-order structure and chromatin remodeling. Finding new PTMs in linker histones is the first step to elucidate their role in the histone code. In this manuscript we report nine new post-translational modifications of the linker histones from chicken erythrocytes, one in H5 and eight in the H1 subtypes. Chromatin fractionated by centrifugation in low-salt buffer resulted in two fractions with different contents and compositions of linker histones and enriched in specific core histone PTMs. Of particular interest is the fact that linker histone PTMs were differentially distributed in both chromatin fractions, suggesting specific functions. Future studies are needed to establish the interplay between PTMs of linker and core histones in order to fully understand chromatin regulation. A protein sequence alignment summarizing the PTMs found to date in chicken, mouse, rat and humans showed that, while many of the modified positions were conserved between these species, the type of modification often varied depending on the species or the cellular type. This finding suggests an important role for the PTMs in the regulation of linker histone functions.

Evaluation and management of the acutely injured worker.

Approximately 3 million work-related injuries were reported by private industries in 2011, and primary care physicians provided care for approximately one out of four injured workers. To appropriately individualize the treatment of an injured worker and expedite the return to work process, primary care physicians need to be familiar with the workers' compensation system and treatment guidelines. Caring for an injured worker begins with a medical history documenting preexisting medical conditions, use of potentially impairing medications and substances, baseline functional status, and psychosocial factors. An understanding of past and current work tasks is critical and can be obtained through patient-completed forms, job analyses, and the patient's employer. Return to work in some capacity is an important part of the recovery process. It should not be unnecessarily delayed and should be an expected outcome communicated to the patient during the initial visit. Certain medications, such as opioids, may delay the return to work process, and their use should be carefully considered. Accurate and legible documentation is critical and should always include the location, date, time, and mechanism of injury.

Sequence conservation of linker histones between chicken and mammalian species.

The percent identity matrices of two sequence multiple alignments between linker histones from chicken and mammalian species are described. Linker histone protein sequences for chicken, mouse, rat and humans, available on public databases were used. This information is related to the research article entitled "Identification of novel post-translational modifications in linker histones from chicken erythrocytes"published in the Journal of Proteomics [1].

Contribution of hydrophobic interactions to the folding and fibrillation of histone H1 and its carboxy-terminal domain.

Histone H1 is involved in chromatin structure and gene regulation. H1 also performs functions outside cell nuclei, which may depend on its properties as a lipid-binding protein. The H1 CTD behaves as an intrinsically disordered protein (IDP) with coupled binding and folding. Here, we used neutral detergents and anionic SDS to study the contribution of hydrophobic interactions to the folding of the CTD. In the presence of neutral detergents, the CTD folded with proportions of secondary structure motifs similar to those observed in the DNA complexes. These results identify a folding pathway for the CTD based on hydrophobic interactions, and independent of charge compensation. The CTD is phosphorylated to different extents by cyclin-dependent kinases. The general effect of phosphorylation in the presence of detergents was a decrease in the α-helix content and an increase in that of the ß-structure. The greatest effect was observed in the fully phosphorylated CTD (three phosphate groups) in the presence of anionic SDS (7:1, detergent/CTD molar ratio); in these conditions, the CTD became an all-ß protein, with 83% ß-structure and no α-helix. The CTD in all-ß conformation readily formed ribbon-like fibers. The entire H1 also formed fibers when fully phosphorylated in the CTD. Fibers were of the amyloid type, as judged by strong birefringence in the presence of Congo red and thioflavin fluorescence enhancement. Amyloid fiber formation was only observed in SDS, suggesting that it requires the joint effects of partial charge neutralization and hydrophobic interactions, together with the all-ß potential provided by full phosphorylation.

Effect of maturity stage and storage on flavor compounds and sensory description of berrycactus (Myrtillocactus geometrizans).

UNLABELLED: Descriptive sensory analysis combined with a chemical analysis, provided insight regarding sensory significance for a better understanding of berrycactus' flavor. This study was based on the volatile components derived from the gas chromatography-olfactometry (GC-O) analysis. Four different ripening stages were used for the experiments: unripe, red, transition, and over-ripe. Besides red and transition stages were stored in sealed plastic bags for 7 d at 5 °C as an additional treatment in order to establish comparisons with fresh samples. GC-O analysis was performed following OSME (time-intensity) method. Moreover, chemical characterization was achieved through GC-MS analysis, each compound was tentatively identified by comparing its mass spectra with the spectra from the library NIST02, by its aroma notes and Kovats Index. The aroma descriptors found were: caramel, fruity, acetic acid, fresh, citrus, floral, and phenolics. Nine volatile compounds are among the most important in flavor of berrycactus: furfural, 5-methyl-2-furancarboxaldehyde, 2(5H)-furanone, 5-acetoxymethyl-2-furaldehyde, 2-cyclohexen-1-ol, octanoic acid ethyl ester, decanoic acid ethyl ester, octanoic acid, and phenylethyl alcohol. To better reflect the real responses of these compounds, the regression analysis of concentrations to ripening stages were performed. The 2,3-dihydro-3,5-dihydroxy-6-methyl-(4H)-pyran-4-one was found in berrycactus, it has been reported in chemical profile of other berries as a product of heat-induced reactions, however, this compound has no aroma activity. The data suggest that both furanones and esters contribute to the aroma of berrycactus. On the other hand, solid phase microextraction was found to be more useful in detecting esters and acids whereas solvent extraction was more effective in detecting furanones and ketones. PRACTICAL APPLICATION: This information could contribute to setting up favorable processing conditions; in order to retain the best sensory characteristics of berrycactus along with functional properties that would enhance commercialization and exploitation of this fruit and to promote berrycactus cultivation programs.