Nanocellulose from Cocoa Shell in Pickering Emulsions of Cocoa Butter in Water: Effect of Isolation and Concentration on Its Stability and Rheological Properties.

There is a growing interest in developing new strategies to completely or partially replace cocoa butter in food and cosmetic products due to its cost and health effects. One of these alternatives is to develop stable emulsions of cocoa butter in water. However, incorporating cocoa butter is challenging as it solidifies and forms crystals, destabilizing the emulsion through arrested coalescence. Prevention against this destabilization mechanism is significantly lower than against coalescence. In this research, the rheological properties of nanocellulose from cocoa shell, a by-product of the chocolate industry, were controlled through isolation treatments to produce nanocellulose with a higher degree of polymerization (DP) and a stronger three-dimensional network. This nanocellulose was used at concentrations of 0.7 and 1.0 wt %, to develop cocoa butter in-water Pickering emulsion using a high shear mixing technique. The emulsions remained stable for more than 15 days. Nanocellulose was characterized using attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR), hot water and organic extractives, atomic force microscopy (AFM), degree of polymerization (DP), and rheological analysis. Subsequently, the emulsions were characterized on days 1 and 15 after their preparation through photographs to assess their physical stability. Fluorescent and electronic microscopy, as well as rheological analysis, were used to understand the physical properties of emulsions.

Factores de riesgo para enfermedad cerebrovascular en el adulto mayor / Risk Factors for Cerebrovascular Disease in the Older Adult

Introducción: La vejez está subvalorada, poco se piensa en el bienestar físico y psicosocial del anciano. La enfermedad cerebrovascular tiene como factores de riesgo comorbilidades como la hipertensión arterial, la diabetes mellitus, la dislipidemia, cardiopatías o malos estilos de vida como el consumo de cigarrillo, la obesidad y la poca actividad física, todos estos comunes en esta etapa de la vida. Objetivo: Identificar los factores de riesgo que presentan los adultos mayores para sufrir enfermedad cerebrovascular de un centro gerontológico de la ciudad de Medellín. Métodos: Fue una investigación descriptiva, de tipo transversal; se indagaron 37 adultos mayores con historias clínicas y exámenes de laboratorio. Se midieron los niveles de hemoglobina glicosilada, colesterol total, colesterol de baja densidad, colesterol de alta densidad y triglicéridos. Resultados: Se evidenció que la población era en su mayoría de sexo masculino con 51,4 por ciento y el sexo femenino con 48,6 por ciento; con rango de edad entre 60 y 70 años el 51,4 por ciento. Los factores de riesgo más relevantes fueron el índice de masa corporal mayor o igual a 25 con (75,7 por ciento), hipertensión arterial y no realizar actividad física. Conclusiones: Se logró determinar los principales factores de riesgo que tienen estos adultos mayores para sufrir enfermedad cerebrovascular; con resultados algunos similares y otros diferentes a estudios a nivel mundial. Con actividades de promoción y prevención se pueden intervenir estilos de vida de la población(AU)

Introduction: Old age is undervalued; little is thought about the physical and psychosocial well-being of the elderly. Among the risk factors of cerebrovascular disease, there are comorbidities, such as high blood pressure, diabetes mellitus, dyslipidemia and cardiopathies, or poor lifestyles like cigarette smoking, obesity and little physical activity, all of which are common at this stage of life. Objective: To identify, in a gerontological center in Medellín City, the risk factors that older adults present for being affected by cerebrovascular disease. Methods: This was a descriptive and cross-sectional research carried out with 37 older adults with medical antecedents and laboratory tests. The levels of glycated hemoglobin, total cholesterol, low-density and high-density cholesterol, as well as triglycerides were measured. Results: It was evidenced that the population was mostly male (51.4 por ciento), while females accounted for 48.6 por ciento. Their age range was mostly between 60 and 70 years (51.4 por ciento). The most relevant risk factors were body mass index greater than or equal to 25 (75.7 por ciento), arterial hypertension and not doing any physical activity. Conclusions: It was possible to determine the main risk factors for these older adults being affected by cerebrovascular disease; in this respect, some results were similar to and others were different from studies worldwide. With promotion and prevention activities, lifestyles of the population can be intervened(AU)

Propuesta metodllógica preliminar para la estimción del caudal ambiental en prroyectos licenciados por el ministerio de ambiente y desarrollo sostenible (mads), Colombia / Preliminary Methodological Proposal for Estimating Environmental Flows in Projects Approved by the Ministry of Environment and Sustainable Development (MADS), Colombia

Se presenta una propuesta metodológica para estimar los caudales ambientales en grandes proyectos licenciados por la Agencia Nacional de Licencias Ambientales (ANLA) de Colombia, resultado de un convenio interadministrativo suscrito entre el ahora Ministerio de Ambiente y Desarrollo Sostenible (MADS) de Colombia y la Universidad Nacional de Colombia, Bogotá(UNC). El método propuesto parte de garantizar criterios hidrológicos, continúa con una validación hidráulica y de calidad del agua, sigue con la determinación de la integridad del hábitat, en un proceso iterativo que requiere evaluación para las condiciones antes y después de la construcción del proyecto y que permite establecer un caudal que, además de conservar las funciones ecológicas del río, garantiza los usos del recurso aguas abajo. Específicamente dentro del componente biótico, la propuesta incluye la determinación y monitoreo de índices de integridad biótica para cuatro comunidades acuáticas (perifiton, macroinvertebrados, vegetación ribereña y peces), a fin de hacer un seguimiento a los efectos que puede producir la reducción del caudal a mediano y largo plazo. Se presentan los resultados de la aplicación de la metodología en varios proyectos licenciados por el MADS.

A methodological proposal for estimating environmental flows in large projects approved by Agencia Nacional de Licencias Ambientales (ANLA) in Colombian rivers was developed. The project is the result of an agreement between the MADS and the Universidad Nacional de Colombia, Bogotá(UNC). The proposed method begins with an evaluation of hydrological criteria, continues with a hydraulic and water quality validation, and follows with the determination of habitat integrity. This is an iterative process that compares conditions before and after the project construction and allows to obtain the magnitude of a monthly flow that, besides preserving the ecological functions of the river, guarantees the water uses downstream. Regarding to the biotic component, the proposal includes the establishment and monitoring of biotic integrity indices for four aquatic communities (periphyton, macroinvertebrates, riparian vegetation, and fish). The effects that flow reduction may produce in the medium and long term can be assessed by these indices. We present the results of applying the methodology to several projects licensed by the MADS.

Pediatric cardiac transplantation in children with high panel reactive antibody.

BACKGROUND: Elevated panel reactive antibody (PRA) may be considered a risk factor precluding pediatric orthotopic heart transplantation. We retrospectively reviewed our management strategy and outcome data for children undergoing heart transplantation with high PRA (> 10%). METHODS: Sixty consecutive children (median age = 130.5 days) underwent heart transplantation. Diagnoses included hypoplastic left heart syndrome (HLHS) (30 patients), cardiomyopathy (18 patients), and postoperative complex congenital heart disease (CCHD) (12 patients). Standard induction immunosuppressive therapy included pulse steroids, gamma globulin, and polyclonal rabbit antithymocyte globulin. Initial immunosuppression is a calcinurin inhibitor and an antiproliferative agent. Eight children exhibited elevated PRA (group P). Fifty-two exhibited nonelevated PRA (group N). Immunosuppression was modified in group P as follows: preoperative intravenous immunoglobulin G (IVIG) and/or cyclophosphamide or mycophenolate mofetil and preoperative and postoperative exchange transfusions or plasmapheresis. In group P, cyclophosphamide was the initial antiproliferative agent. RESULTS: Group P = 4 HLHS patients (all status post [s/p] prior cardiac surgery) and 4 postoperative CCHD patients. Group N = 26 HLHS patients (4 patients s/p prior cardiac surgery), 18 cardiomyopathy patients, and 8 postoperative CCHD patients. Group P patients were older and weighed more than group N patients. Waiting time for donor heart, cardiac ischemic time, and length of hospital stay were similar in both groups. Thirty-day mortality for group P was 25% and for group N it was 7.9% (p = 0.178). Overall mortality for group P was 50% and for group N it was 15.4% (p = 0.043). CONCLUSIONS: Although heart transplantation can offer children with end-stage heart failure and elevated PRA their only chance of survival, these patients remain high risk despite aggressive immunosuppression.

Extubación temprana (fast-track) en neuroanestesia: ¿Una alternativa segura? / Extubación early (fast-track) in neuroanestesia: A sure alternative?

Las técnicas de transito rápido (fast y track) han impactado la práctica de la disciplina, desde áreas tan diversas como cardioanestesia a anestesia ambulatoria sin quedar fuera de este movimiento la neuroanestesia. Teniendo en este contexto una repercusión aun mayor, fundamentada en que la evaluación de la condición neurológica en un paciente despierto, es el método mejor y menos costoso de neuromonitoreo disponible; pero a pesar de la premisa anterior la aplicación de este tipo de protocolos en neurocirugía debe ser vista como un trabajo en equipo, para que la ejecución de la técnica no sea detrimente para el resultado final. Por eso durante esta revisión pretendemos evaluar el papel del fast y track en neuroanestesia, teniendo en cuenta las repercusiones fisopatològicas y por ende los pros y contras del despertar temprano vs. tardío; generando las bases para la elaboración de un posible plan anestésico para tránsito rápido, por que finalmente la emergencia anestésica y extubación temprana en neuroanestesia es deseable y posible en la mayoría de los casos, lo cual es esencial para detectar complicaciones postoperatorias a la llegada a recuperación...

The modern approach to patent ductus arteriosus treatment: complementary roles of video-assisted thoracoscopic surgery and interventional cardiology coil occlusion.

BACKGROUND: In an effort to analyze our experience and develop treatment guidelines, we reviewed all our patients with patent ductus arteriosus (PDA) treated with video-assisted thoracoscopic surgery (VATS) or interventional cardiology coil occlusion. METHODS: One hundred patients underwent 102 cardiac catheterizations. Forty-five children underwent VATS. The entire cohort of patients is 141 because 4 patients underwent both catheterization and VATS. RESULTS: Successful PDA coil occlusion occurred in 91 patients (91 of 100; 91%); 8 had unsuccessful attempts at coil occlusion and 1 was referred for surgical ligation after catheterization without any attempt at coil placement. Thirty-nine children had successful VATS PDA closure. Six children required conversion to thoracotomy because of inadequate exposure during VATS. Hospital stay for children more than 45 days of age was as follows: VATS median stay, 1 day, mean, 1.4 days; thoracotomy median stay, 4 days, mean, 4.6 days. One patient treated with PDA coil occlusion developed a recurrent PDA and required reembolization. Three children underwent initial catheterization without successful coil placement with subsequent successful VATS. All VATS patients left the operating theater with echocardiography documenting no residual PDA. Two children who underwent successful VATS with no residual PDA at hospital discharge were found on outpatient follow-up to have developed tiny recurrent PDAs and both were successfully coil occluded; 1 of these 2 children is 1 of the 3 children initially evaluated by catheterization and then referred for VATS. CONCLUSIONS: Video-assisted thoracoscopic surgery and coil occlusion represent complementary techniques for PDA treatment. A rationale for selection of the appropriate treatment modality can be based upon the size and age of the patient and the size and morphology of the PDA.

Minimally invasive endoscopic repair of pectus excavatum.

OBJECTIVE: We report our initial 3 years 4 months' single institution experience in 31 consecutive patients with pectus excavatum treated with minimally invasive endoscopic pectus excavatum repair utilizing a modification of the 'Nuss' technique. METHODS: Under general anesthesia, a curved steel bar is individually shaped for each patient to match the ideal chest wall shape and is placed through an endoscopically created retrosternal tunnel between two bilateral midaxillary line 2-cm incisions. The tunnels initially go along the outside of the rib cage, under the pectoral muscles. At the level of the sternum, these tunnels go retrosternal and communicate with each other. The steel bar is passed with the convexity facing posteriorly, within a protective flat silastic drain. Under endoscopic guidance, the curved steel bar is passed through one tunnel, under the sternum, and out the other tunnel. Once positioned, the bar is turned over, thereby correcting the deformity. An epidural catheter provides perioperative pain relief. RESULTS: Minimally invasive endoscopic pectus excavatum repair has been performed on 31 patients (age: range 4.4-31.0 years, median 15.0 years, mean 14.5 years). Median hospital length of stay is 4 days (range 3-10 days, mean 4.6 days). Pneumothorax occurred in five patients requiring tube thoracostomy in three. One patient developed delayed bilateral pleural effusions requiring drainage. Two patients developed evidence of sterile seroma formation at the skin incision several months after minimally invasive repair of pectus excavatum. These seromas resolved with non-interventional conservative medical treatment. No other complications occurred. CONCLUSION: The minimally invasive endoscopic pectus repair is safe and effective and currently our procedure of choice for primary pectus excavatum in all ages. Endoscopic visualization facilitates the safe creation of the retrosternal tunnel. Short-term results have been excellent. Further follow-up will be necessary to determine long-term results.

Tratamiento médico del embarazo ectópico no roto / Nonoperative treatment of ectopic pregnancy

Veinte mujeres con embarazo tubárico fueron tratadas con una inyección de Metotrexate por vía intramuscular, dosis única. Se obtiene una respuesta satisfactoria en 16 de las pacientes (80/100) dada por una negativización de la Beta-HCG en un promedio de 10 días. Las cuatro pacientes restantes (20/100) debieron ser reintervenidas entre el primero y el vigésimo segundo día después de iniciado el tratamiento médico. Se encuentran entre los efectos secundarios, leves molestias de pirosis que ceden espontáneamente. El seguimiento posterior de las pacientes, además de la cuatificación seriada de la Beta-HCG, se realiza mediante una hiterosalpingografía que busca comprobar la permeabilidad tubárica aproximadamente 3 meses después de la negativización de la subunidad beta de la gonadotropina coriónica. Este seguimiento ha podido efectuarse en seis de las pacientes correspondiendo a un 30/100 de la población estudio, encontrando permeabilidad tubárica en el 100/100 de los casos. Además, se tiene un embarazo intrauterino en una paciente que no fue sometida a la histerosalpingografía y que tenía un antecedente de salpingectomía por embarazo ectópico anterior.

Manejo de la hiperplasia endometrial con acetato de medroxiprogesterona de depósito

Un total de 41 pacientes con diagnóstico histológico de Hiperplasia Endometrial, fueron sometidos a tratamiento médico con Acetato de Medroxiprogesterona de Depósito(AMPD). Un grupo de 26 pacientes (Grupo I), recibió una dosis de 2.5 mg/Kg peso/semana de AMPD durante 8 semanas, y otro grupo de 15 pacientes (Grupo II), recibió una dosis de 5 mgr/Kg peso/semana de AMPD durante el mismo tiempo. Se hizo un seguimeinto clínico-histológico, que varió de 6 a 54 meses, con un promedio de 18 meses. Se observó mejoría histológica al mes de iniciada la terapia en el 63 por ciento de los pacientes, y un mes después de terminada la misma, en 100 por ciento de los pacientes de ambos grupos no existía indicios del diagnóstico inicial. A través del seguimiento se observó mejoría clínica en el 61 por ciento de los pacientes del Grupo I(16/26), y en el 87 por ciento del Grupo II (13/15). Hubo 10 casos (38 por ciento) de recurrencia clínica en el Grupo I y 3 casos (20 por ciento) en el Grupo II. Solo hubo 1 caso de recurrencia histológica en el Grupo I y ninguna en el grupo II. Aquellos pacientes que presentaron recurrencia, recibieron un segundo ciclo de tratamiento con el doble de la dosis inicial, y de estos 3 casos se consideraron fracasos por evolución clínica desfavorable; sin embargo, al ser intervenidos quirúrgicamente se encontró una causa orgánica(adenomiosis miomatosis), posiblemente responsable de la evolución clínica de estos casos. Finalmente en forma paralela severificó la confiabilidad de la Biopsia de Endometrio para el seguimiento de estos casos, encontrándosae una excelente correlación entre los resultados histopatológicos encontrados en el Legrado Uterino y la Biopsia de Endometrio practicados a una misma paciente (Coeficiente de Correlación, r=0.870 p menor 0.001). El manejo médico de la Hiperplasia ofrece ventajas para aquellas pacientes de riesgo quirúrgico alto, o para quienes no acepten esta via