Impact of 1-Year Supplementation with High-Rich Docosahexaenoic Acid (DHA) on Clinical Variables and Inflammatory Biomarkers in Pediatric Cystic Fibrosis: A Randomized Double-Blind Controlled Trial.

A randomized, double-blind, and placebo-controlled study was conducted to assess the effect of dietary supplementation with high-rich docosahexaenoic acid (DHA) (Tridocosahexanoin-AOX® 70%) at 50 mg/kg/day in pediatric patients with cystic fibrosis (CF) as compared with placebo. The duration of supplementation was 12 months. A total of 22 patients were included, with 11 in the DHA group and 11 in the placebo group. The mean age was 11.7 years. The outcome variables were pulmonary function, exacerbations, sputum cellularity, inflammatory biomarkers in sputum and peripheral blood, and anthropometric variables. In the DHA group, there was a significant increase in FVC (p = 0.004) and FVE1 expressed in liters (p = 0.044) as compared with placebo, and a lower median number of exacerbations (1 vs. 2). Differences in sputum cellularity (predominantly neutrophilic), neutrophilic elastase, and sputum and serum concentrations of resolvin D1 (RvD1), interleukin (IL)-8 (IL-8), and tumor necrosis factor alpha (TNF-α) between the study groups were not found. Significant increases in weight and height were also observed among DHA-supplemented patients. The administration of the study product was safe and well tolerated. In summary, the use of a highly concentrated DHA supplement for 1 year as compared with placebo improved pulmonary function and reduced exacerbations in pediatric CF.

Potentially toxic elements fluxes in 210Pb-dated sediment cores from a large coastal lagoon (southern Gulf of Mexico) under environmental stress.

Terminos Lagoon (TL), in the southern Gulf of Mexico, has been under intensive anthropogenic pressure (e.g., oil-industry development) since the 1970s. Historical changes in flux ratios of potentially toxic elements (PTEs; As, Cd, Cr, Cu, Ni, Pb, V, Zn) were, for the first time, assessed inside TL by using 210Pb-dated sediment cores. Sediments showed minor enrichments for Cd, Ni, Pb, and V. However, according to international benchmarks, the As, Cr, Cu, and Ni concentrations could pose a risk for benthic biota. Sedimentary processes involved in the accumulation of PTEs were identified through a chemometric approach. Increments in PTEs flux ratios concur with the recent (⁓50 years) and extensive land-use changes, particularly the transport and deposit of materials delivered by rivers. These findings are expected to be used in managing this crucial natural resource, the larger Mexican coastal lagoon ecosystem, to mitigate the effects of global change.

Laryngeal Dystonia, Dystonic Tremor and Vocal Tremor: Three Different Entities.

OBJECTIVE: The main objective of this study was to compare the demographic and clinical characteristics of patients with laryngeal dystonia (LD), dystonic tremor (DT), and vocal tremor (VT). STUDY DESIGN: This was a retrospective longitudinal study. METHODS: Data analysis from every patient diagnosed with LD, DT, or VT from January 1, 2010, to September 30, 2022, at a tertiary hospital center. Differential diagnosis between these entities was clinical (clinical history, voice assessment, and endoscopy) and confirmed by laryngeal electromyography. RESULTS: A total of 87 patients were included in this study: 50 patients with LD, 23 with DT, and 14 with VT. Age at diagnosis was significantly lower in patients with LD, with a mean age of 56.2 years when compared to DT (67.6 years; P = 0.002) and VT (70.5 years; P = 0.009). Furthermore, VT had a higher female prevalence (92.9%) when compared with LD (52%; P = 0.011). LD was mainly adductor, with only two patients diagnosed with abductor LD, and DT was adductor in every case. Tremor direction in patients with VT was horizontal in 50% and mixed (horizontal + vertical) in 50%, while in DT was mixed in 65.2% and horizontal in 34.8%. LD was more commonly an isolated laryngeal movement disorder (78%) when compared to DT (47.8%; P = 0.015) or VT (28.5%; P < 0.001), which were more often secondary to generalized neurological disorders. There were no differences between groups on Voice Handicap Index-10, self-reported grade of dysphonia on a visual analogic scale (0-10), maximum phonation time, and G, R, B, A, and I in the GRBAS-I scale at diagnosis (P > 0.05). S was significantly higher in LD when compared to VT (P < 0.001) and nonsignificantly higher than in DT (P = 0.075). CONCLUSIONS: LD, DT, and VT seem to be different entities with different demographics and clinical characteristics.

Surveillance of Shiga toxin-producing Escherichia coli associated bloody diarrhea in Argentina / Vigilancia de diarrea sanguinolenta asociada a Escherichia coli productor de toxina Shiga en Argentina

Abstract In Argentina, hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC-HUS) infection is endemic, and reliable data about prevalence and risk factors have been available since 2000. However, information about STEC-associated bloody diarrhea (BD) is limited. A prospective study was performed during the period October Surveillance; 2018-June 2019 in seven tertiary-hospitals and 18 referral units from different regions, aiming of STEC-HUS cases in the same hospitals and during the same period were also assessed. Twenty-nine (4.1%) of the BD patients were STEC-positive, as determined by the Shiga Toxin Quik Chek (STQC) test and/or the multiplex polymerase chain reaction (mPCR) assay. The highest fre-quencies were found in the Southern region (Neuquén, 8.7%; Bahía Blanca, 7.9%), in children between 12 and 23 month of age (8.8%), during summertime. Four (13.8%) cases progressed to HUS, three to nine days after diarrhea onset. Twenty-seven STEC-HUS in children under 5 years of age (77.8%) were enrolled, 51.9% were female; 44% were Stx-positive by STQC and all by mPCR. The most common serotypes were O157:H7 and O145:H28 and the prevalent geno-types, both among BD and HUS cases, were sfx2a-only or -associated. Considering the endemic behavior of HUS and its high incidence, these data show that the rate of STEC-positive cases is low among BD patients. However, the early recognition of STEC-positive cases is important for patient monitoring and initiation of supportive treatment.

Resumen En Argentina, el síndrome urémico hemolítico asociado a Escherichia coli productor de toxina Shiga (STEC-SUH) es endémico y, desde 2000, de notificación obligatoria. Sin embargo, la información sobre diarrea sanguinolenta (DS) asociada a STEC (DS-STEC) es limitada. Se realizó un estudio prospectivo desde octubre de 2018 hasta junio de 2019 en siete hospitales de tercer nivel y 18 unidades de referencia de diferentes provincias argentinas, con el objetivo de determinar la frecuencia de casos de DS-STEC en 714 niños de 1 a 9 años que tuvieron DS (I) y la tasa de progresión de DS a SUH en dicha cohorte (II). También se evaluó el número y distribución regional de casos de STEC-SUH en los mismos hospitales en dicho período. Veintinueve casos de DS (4,1%) fueron STEC-positivos, determinados por Shiga Toxin Quik Chek (STQC) o PCR múltiple (mPCR). Las frecuencias más altas se encontraron en el sur del área relevada (Neuquén, 8,7%; Bahía Blanca, 7,9%), en niños de 12 a 23 meses (8,8%), en verano. Cuatro casos de DS-STEC (13,8%) progresaron a SUH, de tres a nueve días después del inicio de la diarrea. Se registraron 27 niños con STEC-SUH, estos fueron mayoritariamente <5 anos (77,8%) del sexo femenino (51,9%). El 44% de estos casos fueron Stx-positivos por STQC y todos por mPCR. Los serotipos más comunes fueron O157:H7y O145:H28, y el genotipo predominante fue stx2a, solo o asociado, en DS y SUH. Considerando el comportamiento endémico del SUH y su alta incidencia, estos datos muestran que la tasa de casos de DS-STEC es baja. Sin embargo, su reconocimiento temprano es importante para el seguimiento e inicio del tratamiento de sostén.

Isavuconazole use and TDM in real-world pediatric practice.

Isavuconazole (ISA) is approved for treating invasive aspergillosis and mucormycosis in adults, but its use in children remains off-label. We report on the use of ISA in real-world pediatric practice with 15 patients receiving ISA for treatment of invasive fungal infections. Therapeutic drug monitoring (TDM) was performed in all patients, with 52/111 (46.8%) Ctrough determinations out of range, thus supporting the need for TDM in children, especially those receiving extracorporeal membrane oxygenation (ECMO).

Surveillance of Shiga toxin-producing Escherichia coli associated bloody diarrhea in Argentina.

In Argentina, hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC-HUS) infection is endemic, and reliable data about prevalence and risk factors have been available since 2000. However, information about STEC-associated bloody diarrhea (BD) is limited. A prospective study was performed during the period October 2018-June 2019 in seven tertiary-hospitals and 18 referral units from different regions, aiming to determine (i) the frequency of STEC-positive BD cases in 714 children aged 1-9 years of age and (ii) the rate of progression of bloody diarrhea to HUS. The number and regional distribution of STEC-HUS cases in the same hospitals and during the same period were also assessed. Twenty-nine (4.1%) of the BD patients were STEC-positive, as determined by the Shiga Toxin Quik Chek (STQC) test and/or the multiplex polymerase chain reaction (mPCR) assay. The highest frequencies were found in the Southern region (Neuquén, 8.7%; Bahía Blanca, 7.9%), in children between 12 and 23 month of age (8.8%), during summertime. Four (13.8%) cases progressed to HUS, three to nine days after diarrhea onset. Twenty-seven STEC-HUS in children under 5 years of age (77.8%) were enrolled, 51.9% were female; 44% were Stx-positive by STQC and all by mPCR. The most common serotypes were O157:H7 and O145:H28 and the prevalent genotypes, both among BD and HUS cases, were stx2a-only or -associated. Considering the endemic behavior of HUS and its high incidence, these data show that the rate of STEC-positive cases is low among BD patients. However, the early recognition of STEC-positive cases is important for patient monitoring and initiation of supportive treatment.

Web Geographic Information System: A Support Tool for the Study, Evaluation, and Monitoring of Foci of Malaria Transmission in Mexico.

Malaria is currently an endemic disease in Mexico. The country joined the WHO's E-25 initiative for the elimination of Plasmodium vivax to achieve elimination and certification within the established period. Having a Web-based information system was, therefore, deemed necessary to assist in the detection, investigation, and elimination of transmission in the foci, as well as for the timely treatment of malaria-positive cases. The "Information System for the Elimination of Malaria in Mexico" was designed, developed, and implemented with a geographic vision, which includes a Web tool to georeference homes and aquatic systems, a dashboard and an indicator evaluation card for monitoring activities, notification of probable cases, and vector control among other indicators. The implementation of the system was gradual in the seven states that are currently in the malaria elimination phase; subsequently, the system was implemented in non-transmission states. In 2020, the system implementation stage began; first, the basic data of more than 96,000 homes throughout the country were georeferenced, and then the primary data capture tools of 17 formats, 32 reports, and 2 geographic viewers were enabled for information queries. A total of 56 active foci have been identified in 406 localities as well as 71 residual foci in 320 localities. Recently, the Foci Manager was developed, which is a specific tool for the study, evaluation, and monitoring of active foci through a GIS, a dashboard, and a systematized evaluation certificate. Georeferencing tools decreased the cost of spatial data collection.

Antifungal Potential of Marine Organisms of the Yucatan Peninsula (Mexico) against Medically Important Candida spp.

Invasive fungal infections represent a global health threat. They are associated with high mortality and morbidity rates, partly due to the ineffectiveness of the available antifungal agents. The rampant increase in infections recalcitrant to the current antifungals has worsened this scenario and made the discovery of new and more effective antifungals a pressing health issue. In this study, 65 extracts from marine organisms of the Yucatan Peninsula, Mexico, were screened for antifungal activity against Candida albicans and Candida glabrata, two of the most prevalent fungal species that cause nosocomial invasive fungal infections worldwide. A total of 51 sponges, 13 ascidians and 1 gorgonian were collected from the coral reef and mangrove forest in the Yucatan Peninsula (Mexico) and extracted with organic solvents. Nine crude extracts showed potent antifungal activity, of which four extracts from the sponge species Aiolochroia crassa, Amphimedon compressa, Monanchora arbuscula and Agelas citrina had promising activity against Candida spp. Bioassay-guided fractionation of the M. arbuscula extract revealed the remarkable fungicidal activity of some fractions. Analysis of the chemical composition of one of the most active fractions by UHPLC-HRMS and NMR indicated the presence of mirabilin B and penaresidin B, and their contribution to the observed antifungal activity is discussed. Overall, this work highlights marine organisms of the Yucatan Peninsula as important reservoirs of natural products with promising fungicidal activity, which may greatly advance the treatment of invasive fungal infections, especially those afflicting immunosuppressed patients.

Is Immobile vocal fold Related to the Spinal Accessory Nerve Agenesis?: A Case Report.

The spinal accessory nerve innervates the sternocleidomastoid and trapezius muscles, but the internal branch from the spinal accessory nerve is also contributing to the motor innervation of the larynx. For the first time, we report a case of an impairment of sternocleidomastoid, trapezius, and thyroarytenoid muscles from the same side. In our case, the anatomical variant that can explain this situation implies the cranial roots and some fibers from the spinal roots of the spinal accessory nerve to form the internal branch. In the case of agenesis of these spinal roots, the muscles reliant on it would be missing. For this reason, it is advisable to rule out laryngeal problems in patients with sternocleidomastoid and/or trapezius muscles impairment.

Neurophysiological Findings in Critical COVID-19 Patients With Peripheral Nervous System Manifestations.

INTRODUCTION: Coronavirus disease 2019 patients hospitalized in intensive care units develop neuromuscular manifestations. However, to our knowledge, a study describing the neurophysiological findings in these patients has not been reported. The objective of this study was to diagnose the cause of neuromuscular deficit in severe coronavirus disease 2019 patients, through neurophysiological examination. METHODS: This is a retrospective, observational case series. Data were collected from April 13, 2020, to May 31, 2020. Twenty-two coronavirus disease 2019 patients with generalized neuromuscular deficit during intensive care unit hospitalization were studied. Neurophysiological examinations included motor and sensory peripheral nerve conductions, needle electromyography, F waves, and repetitive nerve stimulation. RESULTS: The subjects were 14 men (63.6%) and eight women, ranged from 35 to 74 years old (58.0, interquartile ranges 50.7-66.2). Intensive care unit hospitalization time ranged from 14 to 82 days (median 37.5, interquartile ranges 22.7-55.0). Through neurophysiological examination, myopathy was diagnosed in 17 patients (77.3%) and polyneuropathy in four (18.2%). Focal neuropathies were diagnosed in 12 patients (54.6%), with a total of 19 affected nerves. Common peroneal nerve lesions at the fibular head (68.4%) and ulnar nerve lesions at the elbow level (21.1%) were the most frequent locations. No significant differences were established between neurophysiological findings and clinical or analytical data. CONCLUSIONS: In critical coronavirus disease 2019 patients with neuromuscular complaints, neurophysiological examination provides an accurate diagnosis-useful to select treatment measures and establish the prognosis of recovery. Neurophysiological findings are similar to those described for critical illness neuromuscular disease, with myopathy being the most frequent diagnosis.

Biogeochemical behaviour of cadmium in sediments and potential biological impact on mangroves under anthropogenic influence: A baseline survey from a protected nature reserve.

Cadmium is a toxic element and its effects are well understood for human health, but its biogeochemical behaviour is still poorly studied and understood in natural ecosystems. This work addresses knowledge gaps concerning its presence, biogeochemical behaviour and impacts in mangrove ecosystems. Through geochemical data and multivariate analysis (i.e., factor and cluster analysis) of data from mangroves of Isla del Carmen, one of the largest extents in Mexico we explored the biogeochemical behaviour of Cd, a potentially toxic element, to identify its anthropogenic sources and interactions with sediments. Pollution indices, including enrichment factor (EF), geo-accumulation index (Igeo), sediment quality guidelines (SQG) and toxicological studies were used to assess the biological impacts of Cd and infer the natural levels tolerated by mangrove trees that form the basis of this natural ecosystem. Our results highlighted that Cd accumulation is driven by interactions between organic matter (OM), sulphur and fine particles; whereas enrichment factor showed values of 6.9 (EF) and 3.5 (EF) associated with point sources and ranged between 2 and 2.9 (EF) in relation to non-point sources. Finally, our geochemical approach revealed that Cd enrichment originates from urban activities and from the poor management of urban residuals.

Posicionamiento de la Sociedad Española de Infectología Pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos en pediatría hospitalaria / Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in hospital paediatrics

Durante los últimos años ha habido un aumento en la aparición de resistencias antimicrobianas, lo cual supone un grave problema de salud pública. El mal uso de antimicrobianos es un factor determinante en su desarrollo. La población pediátrica no queda exenta de dicha problemática ya que la prescripción de antibióticos en pediatría es elevada, y en muchas ocasiones inadecuada.La incorporación de los programas de optimización de uso de antimicrobianos (PROA) ha resultado ser una medida crucial para disminuir el riesgo en la aparición de resistencias antibióticas. A nivel internacional se reconoce la necesidad de crear PROA específicos en pediatría (PROA-P) debido a las diferencias existentes entre pacientes adultos y pediátricos en referencia a las infecciones, así como al abordaje tanto diagnóstico como terapéutico de las mismas. Por esta misma razón, los PROA-P deben ser programas multidisciplinares liderados por especialistas en infecciones pediátricas y trabajar con indicadores específicos pediátricos (DOT, patrones de sensibilidad antibiótica de población pediátrica, indicadores clínicos…), que permitan detectar puntos de mejora y establecer estrategias dirigidas eficaces. Por otro lado, es imprescindible el apoyo y liderazgo por parte de las distintas sociedades científicas implicadas.El objetivo de este documento es dar a conocer el posicionamiento de la Sociedad Española de Infectología Pediátrica (SEIP) sobre la implementación de los PROA pediátricos hospitalarios en nuestro territorio, así como aportar herramientas que ayuden en la aplicación de dichos programas en los diferentes hospitales de las distintas regiones sanitarias del país. (AU)

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country. (AU)

Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals.

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.

I am done with this! Women dropping out of engineering majors.

Women are still underrepresented in STEM careers (Science, Technology, Engineering, and Mathematics). One of the possible drivers behind this gender gap in the labour market is the female dropout from STEM education. The causes of the gender differences in the persistence of pursuing STEM studies have been explained by multiple factors related to interest and resolution in this type of career. The goal of the present research is to study the Engineering persistence gender gap in higher education by exploring the main factors underlying the leakage in the pipeline of Engineering fields. Our study reports the results of 34 qualitative in-depth interviews where internal barriers, stereotypes and external obstacles are assessed by women who have left their university degrees, compared with men who have withdrawn and women who have persisted. Results from the content analysis suggest that the undermining of persistence in Engineering fields is related to factors such as the chilly and hostile environment in classes or the workload from an excessively demanding curriculum. Other factors affecting women's withdrawal are the lack of role models and the perceived incongruity between the female gender role and STEM roles in society, leading to a weakening of female students' self-efficacy and eroding their sense of belongingness, even making them consider dropping out of their Engineering degree. These findings provide information for the design of future STEM interventions aimed to enhance women's persistence in STEM university studies.

Accumulation and fluxes of potentially toxic elements in a large coastal lagoon (southern Gulf of Mexico) from 210Pb sediment chronologies.

Three 210Pb-dated sediment cores were used to evaluate the contamination degree and flux ratios of potentially toxic elements (PTEs; As, Cd, Cr, Cu, Ni, Pb, V, and Zn) in seagrass meadows from the northern margin of Términos Lagoon (TL), southern Gulf of Mexico. The sediments displayed minor Cd, Ni, V, and Zn enrichments but moderate to strong enrichment by As. Results from a chemometric analysis revealed that: 1) salinization and grain size, along with 2) the terrigenous inputs are the major factors influencing the PTEs accumulation. The historical trends of PTEs flux ratios nearly follow the large-scale land-use changes around TL, linked to the growth of the Mexican oil industry in the area since the 1970s. Our findings showed the critical role of seagrass meadows as PTEs sinks. This information is useful for decision-makers to develop restoration projects for a vulnerable site within the largest coastal lagoon ecosystem in Mexico.

Epstein-Barr virus-associated risk factors for post-transplant lymphoproliferative disease in pediatric liver transplant recipients.

BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) are the most common de novo malignancies after liver transplantation (LT) in children. The aim of our study was to assess the role of pre-LT EBV status and post-LT EBV viral load as risk factors for developing PTLD in a cohort of pediatric LT recipients. METHODS: Data of all children who underwent LT between January 2002 and December 2019 were collected. Two cohorts were built EBV pre-LT primary infected cohort and EBV post-LT primary infected cohort. Moreover, using the maximal EBV viral load, a ROC curve was constructed to find a cutoff point for the diagnosis of PTLD. RESULTS: Among the 251 patients included in the study, fifteen PTLD episodes in 14 LT recipients were detected (2 plasmacytic hyperplasia, 10 polymorphic PTLD, 2 monomorphic PTLD, and 1 Classical-Hodgkin's lymphoma). Patients of the EBV post-LT primary infected cohort were 17.1 times more likely to develop a PTLD than patients of the EBV pre-LT primary infected cohort (2.2-133.5). The EBV viral load value to predict PTLD was set at 211 000 UI/mL (93.3% sensitivity and 77.1% specificity; AUC 93.8%; IC 0.89-0.98). In EBV post-LT primary infected cohort, patients with a viral load above 211 000 were 30 times more likely to develop PTLD than patients with a viral load below this value (OR 29.8; 3.7-241.1; p < 0.001). CONCLUSIONS: The combination of pretransplant EBV serological status with EBV post-transplant viral load could be a powerful tool to stratify the risk of PTLD in pediatric LT patients.

Beneficial Effects of Fructooligosaccharides Esterified with Lauric Acid in a Metabolic Syndrome Model Induced by a High-Fat and High-Carbohydrate Diet in Wistar Rats.

Metabolic syndrome (MS) is a group of abnormalities in which obesity, insulin resistance (IR), oxidative stress, and dyslipidemia stand out. This pathology predisposes to the development of cardiovascular diseases and diabetes. The ingestion of linear fructooligosaccharides (FOS) such as inulin reduces conditions such as hyperinsulinemia, increased body fat, and triglyceridemia. When FOS are esterified with fatty acids, they present emulsifying and surfactant properties; however, there are no reports of their function at the biological level. The purpose of this investigation was to evaluate the effect of Agave tequilana Weber's FOS (AtW-FOS) and FOS esterified with lauric acid (FOS-LA) in MS markers in a rat model induced by a HFHC diet. Supplementation with AtW-FOS and FOS-LA decreased IR, improved glucose tolerance, reduced liver weight (19%), plasma triglycerides (24%), and blood pressure (16%) when compared with the untreated MS group. In conclusion, the ingestion of AtW-FOS and FOS-LA has beneficial effects in the prevention of MS alterations, showing a high potential for their application in functional foods.

Vocal fold immobility with normal LEMG: A range of possibilities.

OBJECTIVE: The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG. METHODS: A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied. RESULTS: Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression. CONCLUSIONS: Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.