[Classic and new-generation commercial thickeners. Organoleptic qualities and usefulness in the diagnostic tests of dysphagia]. / Espesantes comerciales clásicos y de nueva generación. Cualidades organolépticas y utilidad en las pruebas diagnósticas de la disfagia.

INTRODUCTION: Introduction: thickeners are widely used in swallowing disorders, both for diagnosis and to achieve a safe and effective diet. Recently, products composed of gums have been commercialized in the Spanish market in order to improve the organoleptic and physical qualities of thickened foods. Objective: to compare thickening agents of clinical scope marketed in Spain, and to verify their organoleptic and physical characteristics, to be used in the diagnostic procedures and the feeding of patients with dysphagia. Method: the organoleptic (appearance, colour, smell, taste, aftertaste) and physical (solubility, stability) properties of eight thickeners (4 classic starch-based and 4 new gum-based) were assessed in a sample of 44 healthy subjects. In addition, their usefulness in diagnostic tests was studied by mixing them with dyes and water-soluble contrasts. Results and conclusions: new-generation thickeners, based on gums, generally obtain better scores for their physical and organoleptic qualities than conventional thickeners. Starch thickeners are more suitable for diagnostic tests, as gum thickeners present some peculiarities in their mixtures with dyes and contrasts that must be taken into account in diagnostic tests.

INTRODUCCIÓN: Introducción: los espesantes son muy utilizados en los trastornos de la deglución, tanto para su diagnóstico como para conseguir una alimentación segura y eficaz. Recientemente se han comercializado en el mercado español productos compuestos por gomas con el fin de mejorar las cualidades organolépticas y físicas de los alimentos espesados. Objetivo: comparar agentes espesantes de ámbito clínico comercializados en España y verificar sus características organolépticas y físicas para ser utilizados en los procedimientos diagnósticos y en la alimentación del paciente con disfagia. Método: se valoraron las propiedades organolépticas (apariencia, color, olor, sabor y regusto) y físicas (solubilidad y estabilidad) de ocho espesantes (4 clásicos con almidón y 4 nuevos a base de gomas) en una muestra de 44 sujetos sanos. Además, se estudió su utilidad en las pruebas diagnósticas al mezclarlos con colorantes y contrastes hidrosolubles. Resultados y conclusiones: los espesantes de nueva generación, a base de gomas, obtienen en general mejores puntuaciones en sus cualidades físicas y organolépticas con respecto a los espesantes convencionales. Los espesantes con almidón son más adecuados en las pruebas diagnósticas, ya que los espesantes con gomas presentan algunas peculiaridades en las mezclas con colorantes y contrastes que deben ser tenidas en cuenta en dichas pruebas.

Synthesis and characterization of silica-chitosan hybrid materials as antibacterial coatings for titanium implants.

To avoid dental implant-related infections and to promote the osseointegration of titanium implants, the application of silicon and chitosan containing coatings is proposed. Silicon is a well-known osteogenic element and chitosan was selected to confer the antibacterial properties. The synthesis of hybrid silica-chitosan coatings using the sol-gel process is presented and the characterization using 29Si-NMR to verify the correct formation of the network is discussed. The 13C NMR spectroscopy was used to confirm the covalent union between chitosan and the silicon network. Hydrolytic degradation and silicon release studies showed the effective silicon release from the hybrids and, hence, the possibility to promote bone formation. The introduction of different amounts of chitosan and tetraethyl orthosilicate (TEOS) modulated the Si release. The analysis of cell cultures in vitro demonstrated that the hybrid coatings were not cytotoxic and promoted cell proliferation on their surfaces. The coatings containing 5%-10% chitosan had substantial antibacterial properties.

Health literacy interventions for immigrant populations: a systematic review.

BACKGROUND: Health literacy is considered a social health determinant that influences improvement in health, patient empowerment and reduction in inequalities. There is a lack of health literacy interventions for vulnerable social groups (i.e. immigrants), and nurses have shown little familiarity with the concept. AIM: This study aimed to identify and analyse whether interventions directed at immigrant populations improve the functional (basic reading, writing and arithmetic skills), interactive (social and cognitive skills) and critical (advanced cognitive and social skills in critically analyzing information and making informed decisions) dimensions of health literacy, taking into account the role played by nursing in these interventions. METHODS: A systematic review of four databases including PubMed, PsycINFO, the Cochrane Library and ERIC was conducted to identify relevant articles published between 2000 and 2015. Thirty-four articles met the inclusion criteria, and nine articles used a validated instrument. RESULTS: Few specific health literacy interventions for immigrant populations were found. The main findings of the studies showed positive changes in functional health literacy. However, the interventions were less effective in improving interactive and critical health literacy. LIMITATIONS: Several of the findings of this review were based on studies that had their own limitations. The assessment of the articles was not blinded, and the review was restricted to articles written in Spanish and English. CONCLUSIONS: The interventions studied were reported as being effective in improving health literacy in immigrants, particularly the functional aspects. Regarding the role played by nursing, this review observed little involvement. IMPLICATIONS FOR NURSING AND HEALTH POLICY: It is important for educational strategies to include health literacy dimensions. The concept of health literacy should be included as a Nursing Outcomes Classification and in its subsequent validation taxonomy. To promote community health, health literacy must be a prioritized objective of health management and policies.

Development of advanced biantibiotic loaded bone cement spacers for arthroplasty associated infections.

The incidence increase of infections in patients with hip or knee implants with resistant pathogens (mainly some S. coagulase-negative and gram positive bacteria) demands advanced antibiotic loaded formulations. In this paper, we report the design of new biantibiotic acrylic bone cements for in situ delivery. They include a last generation antibiotic (daptomycin or linezolid) in combination with vancomycin and are performed based on a novel modification of the Palacos R® acrylic bone cement, which is based on two components, a liquid (methyl methacrylate) and a solid (polymeric phase). Hence, the solid component of the experimental formulations include 45wt% of microparticles of poly(D,L-lactic-co-glycolic) acid, 55wt% of poly(methyl methacrylate) beads and supplements (10wt-% each) of antibiotics. These formulations provide a selective and excellent control of the local release of antibiotics during a long time period (up to 2 months), avoiding systemic dissemination. The antimicrobial activity of the advanced spacers tested against S. aureus shows that single doses would be enough for the control of the infection. In vitro biocompatibility of cements on human osteoblasts is ensured. This paper is mainly focused on the preparation and characterization of cements and the studies of elution kinetics and bactericidal effects. Developed formulations are proposed as spacers for the treatment of infected arthroplasties, but also, they could be applied in other antibiotic devices to treat relevant bone-related infection diseases.

In vitro assessment of an antibacterial quaternary ammonium-based polymer loaded with chlorhexidine for the coating of polypropylene prosthetic meshes.

PURPOSE: This study assesses the use of an absorbable polymer loaded with chlorhexidine (CHX) as an antibacterial coating for polypropylene (PP) meshes employed in hernia repair. METHODS: The polymer N,N-dimethyl-N-benzyl-N-(2-methacryloyloxyethyl) ammonium bromide was loaded with CHX (1 % w/w). Fragments (1 cm2) of Optilene® Mesh Elastic were coated either with the unloaded (POL) or CHX-loaded polymer (POL-CHX). Uncoated fragments (PP) served as controls. The release kinetics of the POL-CHX coating was monitored by HPLC. Sterile fragments were placed on agar plates previously contaminated with 106 CFU of Staphylococcus aureus (Sa) ATCC25923, Staphylococcus epidermidis (Se) ATCC12228, or Escherichia coli (Ec) ATCC25922 and incubated at 37 °C for 1/2/7 days. At each time point, inhibition halos were measured and bacterial adhesion to the meshes quantified by sonication and scanning electron microscopy. Coating cytotoxic effects were examined on cultured fibroblasts. RESULTS: The polymer coating gradually released CHX over 3 days. Inhibition halos were produced only around the POL-CHX-coated meshes and these were significantly smaller for Ec than Sa or Se (p < 0.01). While POL-CHX prevented bacterial adhesion to the mesh, the reduced bacterial yields over time were observed for the POL-coated versus control PP meshes (p < 0.001). By day 7, only Ec remained attached to the surface of control meshes. The POL coating was not cytotoxic, yet POL-CHX reduced the viability of cultured fibroblasts. CONCLUSIONS: When loaded with the antiseptic CHX, this quaternary ammonium-based polymer coating released its contents in a controlled manner indicating its potential prophylactic use to reduce the risk of infection following PP mesh implantation.

The synthesis and characterisation of strontium and calcium folates with potential osteogenic activity.

Compounds having the general formula MFO·4H2O where M = Ca or Sr and FO = a folate anion were prepared and their structure and physico-chemical properties were determined by elemental and thermal TGA, DSC analysis, FTIR, and EDAX spectroscopies and DRX. The results indicate that the two compounds form stable structures where folic acid acts as a self-bridging ligand via two bidentate carboxylate groups. Moreover the two compounds showed a low toxicity in vitro response as h-osteoblast cell viability was not negatively affected by the presence of folate derivatives within the range of 0.063-0.5 mg ml-1. The results also indicate that the folate derivatives that are formed overcome the toxic effects related to free Sr2+ ions. The range of maximum cell viability corresponding with a concentration of SrFO falls within the in vitro physiologically active range for strontium while within the same range the strontium derivative showed a potential osteogenic activity as indicated by the overexpression of ALP activity.

Deterioro cognitivo: a propósito de un caso / Cognitive impairment: a case presentation

El deterioro cognitivo es una afección cada vez más frecuente en las consultas de atención primaria y no en todos se debe a enfermedad de Alzheimer o demencia vascular. Entre otras posibilidades diagnósticas, la hidrocefalia normotensiva o hidrocefalia crónica del adulto puede manifestarse de esta forma. Se presenta a continuación un caso clínico de hidrocefalia normotensiva, entidad que se caracteriza por una tríada típica: trastornos de la marcha, demencia e incontinencia urinaria. Con este caso queremos llamar la atención sobre un tipo de deterioro cognitivo que puede ser mejorable si la derivación ventricular es efectiva (AU)

Cognitive impairment is becoming increasingly more common in primary care, and not all is due to Alzheimer's disease or Vascular Dementia. Other diagnostic possibilities, such as normotensive hydrocephalus or chronic adult hydrocephalus also have very similar signs. A clinical case of normotensive hydrocephalus is presented, a condition that is characterised by a typical triad: Gait disturbance, dementia and urinary incontinence (AU)

Sangre y Cirugía. EStrategia de Ahorro en cirugía cardiaca / Blood and Surgery. Strategic saving in cardiac surgery

El incremento de intervenciones quirúrgicas y su mayor complejidad y agresividad, especialmente en cirugía cardiovascular y trasplantes, junto con el envejecimiento de la población ha supuesto un considerable aumento de la demanda de transfusión sanguínea y derivados hemáticos. Los riesgos médicos inherentes al uso de sangre homóloga, el rechazo por motivaciones personales, éticas o creencias religiosas y una insuficiente disponibilidad de hemoderivados consecuencia de la escasezde donaciones, ha condicionado la necesidad del desarrollo de procesos de ahorro de sangre en cirugía y la búsqueda de técnicas alternativas a la transfusión. Problemática que alcanza su máxima expresión en cirugía cardiaca bajo circulación extracorpórea, como consecuencia del alto consumo de sangre de los enfermos cardiológicos intervenidos. Con la experiencia que aporta un promedio de quinientas cirugías anuales de corazón se realiza una revisión sobre las diferentes medidas y procedimientos asociados al ahorro de sangre en cirugía, especialmente en cirugía cardiovascular (AU)

The increase in the number of operations and their greater complexity and aggressiveness, especially in cardiovascular surgery and transplants, together with the aging of the population, has entailed an increase in the demand for transfusion and haematological derivates. The inherent medical risks of homolog blood usage, rejection for personal motivations, ethical and religious beliefs and insufficient availability of haematological derivates as a consequence of the shortage of donations, have conditioned the necessity for the development of processes for saving blood during surgery and the search for alternative techniques to transfusion. This is a problem which has its highest repercussions in cardiac surgery with cardio-pulmonary by-pass because of the high consumption of blood of patients undergoing cardiac surgery. With the experience of approximately 500 operations per year a review of the different measures and procedures associated with saving blood in surgery has been carried out, especially with regard to cardiovascular surgery (AU)

Biocompatibility of alendronate-loaded acrylic cement for vertebroplasty.

This paper reports a biological evaluation of a non-resorbable acrylic cement loaded with alendronate for the treatment of osteoporotic vertebral compression fractures. The cement formulation was based on polymethyl methacrylate and acrylic monomers; one of these had covalently linked vitamin E residues. The same cement in the absence of alendronate was used as a control. The setting of the charged cement presented a maximum polymerization temperature of 44°C, a setting time of 24 min, a residual monomer content lower than 3 wt.%, a compressive strength of 99±10 MPa and an elastic modulus of 1.2±0.2 GPa. Cytotoxicity studies using human osteoblast cultures revealed that the leachable substances of the alendronate loaded cement collected between 1 and 7 days decreased cell viability to values lower than 80%. However, morphological changes and cellular damage in cells produced by the extracts decreased with the leak time. Cell adhesion and growth on charged cement was significantly lower than on the control. Implantation of the cement paste in the intra-femoral cavity of rabbits showed that initially the osteogenic activity was evident for the cement charged with alendronate, and the osteosynthesis process took place mainly in the trabeculae and was manifested by the presence of a non-mineralised osseous spicule. The interface between material and adjacent bone tissue was initially characterized by a variable fibrous response that in many cases it appeared reduced to thin connective tissue after a 24-week-period.

Bioactive polymeric systems with platelet antiaggregating activity for the coating of vascular devices.

The preparation, characterization, and analysis of physicochemical and biological properties of a new bioactive polymer system, based on a copolymer of an acrylic derivative of triflusal (a molecule with chemical structure related to aspirin with antiaggregating activity for platelets) is described and evaluated as thin bioactive coating for vascular grafts and coronary stents. The acrylic monomer derived from triflusal (THEMA) provides random copolymers when it is polymerized with butyl acrylate (BA), according to their reactivity ratios, r(THEMA) = 1.05 and r(BA) = 0.33. The copolymer THBA70, containing a molar composition f(THEMA) = 0.45 and f(BA) = 0.55 presents the optimal properties of stability, flexibility, and adhesion, with a T(g) = 21 ± 2 °C, to be applied as bioactive and biostable coatings for vascular grafts and coronary stents. Thin films of this copolymer system present an excellent biocompatibility and a good inherent antiaggregant activity for platelets.

Polymeric drugs based on random copolymers with antimitotic activity.

Polymeric drugs based on random copolymers with antimitotic activity were obtained by free radical copolymerization of oleyl 2-acetamido-2-deoxy-α-d-glucopyranoside methacrylate (OAGMA) and 2-ethyl-(2-pyrrolidone) methacrylate (EPM) at low and high conversion and analyzed in terms of microstructure, physicochemical, and biological properties. Reactivity ratios of monomers were found to be r(OAGMA) = 1.34 and r(EPM) = 0.98, indicating the obtaining of statistical copolymers with random sequence distribution of the comonomeric units in the macromolecular chains. The glass transition temperature of the copolymers presents a negative deviation from the predicted values according to the Fox equation, suggesting a higher flexibility of the alternating diad. Copolymeric systems with OAGMA contents between 10-50 mol % presented thermosensitive behavior in a heating process showing cloud point temperatures (CPT) in the range 45-28 °C with increasing OAGMA content and hysteresis in one heating-and-cooling cycle. In vitro glycolipid release studies revealed the stability of the ester group in culture medium. The polymeric drugs with 30 and 50 mol % OAGMA presented antimitotic activity on a human glioblastoma line, but they were less toxic on normal human fibroblast cultures.

A study on partially biodegradable microparticles as carriers of active glycolipids.

This paper describes a study on the preparation and characterisation of partially biodegradable microparticles of poly(epsilon-caprolactone)/poly(ethyl methacrylate) (PCL/PEMA) as carriers of synthetic glycolipids with antimitotic activity against brain tumour cells. Microparticles prepared by suspension polymerisation of methacrylate in the presence of already polymerised PCL showed a predominantly spherical but complex morphology, with segregation of PCL micro/nano-domains towards the surface. Small diameter discs were prepared by compression moulding of blends of microparticles and the active principle under mild conditions. The in vitro behaviour of the discs and release of the glycolipid were studied in different simulated fluid models. Ingress of fluids increased with increasing hydrophobicity of the medium. Release of the glycolipid was sustained in all fluids, the most prolonged profile being in human synovial fluid and phosphate-buffered saline modified with 20 vol.% dioxane. Slow disintegration of the discs and partial degradation of the microparticles was evident in accelerated studies. The antimitotic activity of glycolipid released from the discs was proved against a human glioblastoma line. This activity, along with selectivity against human fibroblasts, could be controlled by the amount of drug charged in the disc.

Epidemiología de gestión de la morbilidad psiquiátrica atendida en los hospitales españoles / No disponible

Introducción: Para una correcta planificación enSalud Mental es fundamental conocer la carga asistencialhospitalaria derivada de los ingresos psicopatológicos,por ello abordamos el estudio de la realidad psiquiátricahospitalaria española.Objetivo: Analizar los episodios hospitalarios psiquiátricosen España y las variables sociodemográficasy clínicas asociadas a estos.Material y métodos: Estudio epidemiológico descriptivode la morbilidad en psicopatología hospitalaria,bajo un diseño ecológico. Se analizan todos los ingresospsiquiátricos de los hospitales del Sistema Nacional deSalud (SNS) del año 2002 (69.413 altas), utilizandocomo fuentes de información el Conjunto Mínimo deDatos al Alta Hospitalaria (CMBDAH) y los GruposRelacionados por el Diagnóstico (GRD).Resultados y discusión: Se evidencian diferencias enfunción del sexo (principalmente psicopatológicas y deestancia hospitalaria) y se constata, mediante indicadoresmultivariantes, la diversidad en cuanto a carga asistencialy a la gestión que de los episodios de hospitalizaciónrealizan las diferentes comunidades(AU)

Introduction: According to a correct Mental Healthplanning, to know the hospital assistance load derivedfrom the psychiatric admissions is required. Thus, westudied the psychiatric hospitalization reality in Spain.Objective: To analyse the psychiatric hospitalizationepisodes in Spain, and its clinical and social-demographicvariables associated.Material and methods: Epidemiologic descriptivestudy of the morbidity in psychopathology hospitalization,within an ecological design. The analysis of all thepsychiatric admissions in the National Health SystemHospitals (SNS) for the year 2002 was effected (69,413admissions), using the Minimum Basic Data Set at HospitalDischarge (CMBDAH) and Diagnosis RelatedGroups (DRG’s), as sources of information.Results and discussion: Differences in terms of sexare showed (mainly, psycho-pathologic and hospitalstay), and the diversity as for assistance load and for themanagement of the hospitalization episodes conductedby the different autonomous regions is noted, by meansof multivariate indicators(AU)