Multiple sclerosis in Central America and Caribbean countries: frequency and clinical characterization of an emergent disease.

Background: Multiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population. Methods and results: Data from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3-3.5 × 100,000 inhabitants, and the lowest, 0.07-0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies. Conclusion: This is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged.

Differentiated Effect of Smoking on Disease Activity and Quality of Life among Different Spondyloarthritis Phenotypes.

BACKGROUND AND AIMS: The effect of smoking on disease activity and quality of life (QoL) in spondyloarthritis (SpA) is far from clear. We aimed to evaluate the relationship between smoking and these outcomes in patients with axial SpA (axSpA) and psoriatic arthritis (PsA). PATIENTS AND METHODS: This cross-sectional observational multicenter study included 242 patients with axSpA and 90 with PsA. The association between conventional cardiovascular risk factors and disease activity as well as QoL, in both SpA phenotypes was evaluated. For this, univariate and multivariate regression analyses were performed, as well as confirmatory meta-analyses. RESULTS: Regardless of age, sex, or disease duration, patients with axSpA showed significantly less association with obesity (OR 0.50 (0.26-0.96), p = 0.03) and hypertension (OR 0.33 (0.18-0.62), p = 0.0005). However, axSpA was significantly associated with smoking (OR 2.62 (1.36-5.04), p = 0.004). Patients with axSpA were more likely to be in a category of high disease activity compared with PsA (OR 2.86, p = 0.0006). Regardless of sex, age, disease duration, and education level, smoking was significantly associated with higher disease activity in axSpA (OR 1.88, p = 0.027). A fixed-effects model meta-analysis (OR 1.70, p = 0.038) confirmed the association between tobacco and disease activity. No relationship was found between smoking (or other cardiometabolic risk factors) and structural damage or worse QoL in either disease. CONCLUSIONS: Although the cardiometabolic risk profile is clearly different between both SpA phenotypes, the only clear link between these factors and increased disease activity was observed between smoking and axSpA. Our findings need further confirmation.

Short-Term Effect of Epley Maneuver as Treatment for Subjective Benign Paroxysmal Positional Vertigo.

Subjective Benign Paroxysmal Positional Vertigo (S-BPPV) is an atypical form of BPPV, its treatment is not well characterized and is not well known among otolaryngologists. The main aim of this study was to estimate the short-term efficacy of Epley maneuver as treatment for S-BPPV. This was a prospective study in a secondary care center. We included patients with unilateral S-BPPV demonstrated by negative nystagmus on Dix-Hallpike Maneuver (DHM) but with unilateral vestibular symptoms (dizziness or vertigo). Epley maneuver to the affected side was performed. Patients underwent Dizziness Handicap Inventory (DHI) and at 1-week follow-up, DHI and DHM were repeated. Outcome measures were resolution of symptoms during DHM and improvement of DHI scores. Patients were divided into resolved and unresolved groups according to the absence or presence of symptoms during the 1 week DHM. Wilcoxon-Mann-Whitney and Kruskal-Wallis tests were used, quantitative values were reported as mean and standard deviation. The results included thirteen participants, 12 females and 1 male, mean age 53.31 years (SD ± 15.71). Right ear was involved in 46.15% and left in 53.84%. A total of 46.15% patients (n = 6) had resolution of symptoms. DHI initial score for the resolved group was 34.66 ± 22 and for the unresolved group was 39.71 ± 19.61 (p = 0.568). At 1-week evaluation scores were 19.66 ± 25.05 for the resolved group and 30.28 ± 21.42 for the unresolved group (p = 0.252). DHI improvement was 15.00 ± 23.21 and 9.42 ± 10.17 for each group, respectively (p = 0.943). We concluded the Epley maneuver is an effective short-term treatment for S-BPPV. Half of the patients would need further diagnostic tests.

MITOGEN-ACTIVATED PROTEIN KINASE PHOSPHATASE 1 mediates root sensing of serotonin through jasmonic acid signaling and modulating reactive oxygen species.

Serotonin (5-hydroxytryptamine) acts as a neurotransmitter in mammals and is widely distributed in the plant kingdom, where it influences root growth and defense. Mitogen-Activated Protein Kinases (MAPKs) and MAPK phosphatases (MKPs) play critical functions in decoding hormonal signalling, but their possible roles in mediating serotonin responses await investigation. In this report, we unveiled positive roles for the MITOGEN-ACTIVATED PROTEIN KINASE PHOSPHATASE1 (MKP1) in the inhibition of the primary root growth, cell division, meristem structure, and differentiation events in Arabidopsis seedlings. mkp1 mutants were less sensitive to jasmonic acid applications that halted primary root growth in wild-type (WT) plants, and consistently, the neurotransmitter activated the expression of the JASMONATE ZIM-domain (JAZ) proteins JAZ1 and JAZ10, two critical proteins orchestrating jasmonic acid signalling. This effect correlated with exacerbated production of endogenous reactive oxygen species (ROS) in the WT, a process constitutively manifested in mkp1 mutants. These data help to clarify the relationship between serotonin and growth/defense trade-offs, and reveal the importance of the MAPK pathway in root development through ROS production.

Construct Validity of the Routine Assessment of Patient Index Data 3 (RAPID3) in the Evaluation of Axial Spondyloarthritis.

OBJECTIVE: Although there are different tools to evaluate axial spondyloarthritis (axSpA), they are hardly used in routine clinical practice due to time constraints. The Routine Assessment of Patient Index Data 3 (RAPID3) is a composite measure feasible for use as a sole metric in busy clinics. We aimed to test its measurement properties in patients with axial SpA in a real-world clinical setting. METHODS: This cross-sectional study included 131 consecutive patients with axial SpA. The convergent (Spearman ρ) and discriminant (receiver-operating characteristic [ROC] curve analysis) validity of RAPID3 were tested against several axSpA-specific measures (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS], Bath Ankylosing Spondylitis Functional Index [BASFI], and modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]). A multivariate model was built to detect disease factors associated with RAPID3 remission (values ≤ 3). RESULTS: The study included 82 men and 49 women, with a median age of 55 (IQR 46-61) years, and a median disease duration of 11 (IQR 6-24) years. Mean RAPID3 was 9.45 ± 6.7. The BASDAI showed moderate correlation with ASDAS (ρ 0.66, P < 0.0001), but higher correlations with BASFI (ρ 0.78, P < 0.0001) and RAPID3 (ρ 0.75, P < 0.0001). The ASDAS had moderate correlations with BASFI, BASDAI, and RAPID3 (ranges 0.66-0.68, P < 0.0001). Higher correlations were found between BASFI and BASDAI (ρ 0.78, P < 0.0001), and BASFI and RAPID3 (ρ 0.73, P < 0.0001). The mSASSS did not show any correlation with any of the above composite measures. κ agreement between RAPID3 remission and other SpA remission criteria was moderate (κ 0.46-0.56). The RAPID3 thresholds to define remission ranged from values ≤ 2 to ≤ 6 with areas under the ROC curve between 0.86-0.91. Female sex (OR 0.34, 95% CI 0.12-0.90, P = 0.03) and nonsteroidal antiinflammatory drug intake (OR 0.26, 95% CI 0.10-0.66, P = 0.005) were independently associated with lower odds of achieving RAPID3 remission. CONCLUSION: RAPID3 demonstrated construct validity in this cross-sectional study. This index can be useful for a more comprehensive assessment of axSpA in busy clinical settings.

Long-term follow-up of certolizumab pegol in uveitis due to immune-mediated inflammatory diseases: multicentre study of 80 patients.

OBJECTIVES: To evaluate effectiveness and safety of certolizumab pegol (CZP) in uveitis due to immune-mediated inflammatory diseases (IMID). METHODS: Multicentre study of CZP-treated patients with IMID uveitis refractory to conventional immunosuppressant. Effectiveness was assessed through the following ocular parameters: best-corrected visual acuity, anterior chamber cells, vitritis, macular thickness and retinal vasculitis. These variables were compared between the baseline, and first week, first, third, sixth months, first and second year. RESULTS: We studied 80 (33 men/47 women) patients (111 affected eyes) with a mean age of 41.6±11.7 years. The IMID included were: spondyloarthritis (n=43), Behçet's disease (n=10), psoriatic arthritis (n=8), Crohn's disease (n=4), sarcoidosis (n=2), juvenile idiopathic arthritis (n=1), reactive arthritis (n=1), rheumatoid arthritis (n=1), relapsing polychondritis (n=1), CONCLUSIONS: CZP seems to be effective and safe in uveitis related to different IMID, even in patients refractory to previous biological drugs.

Acúfeno como síntoma inicial de plasmocitoma de hueso temporal

Resumen Los tumores de base de cráneo son inusuales, entre ellos el plasmocitoma surge de las células plasmáticas y puede ser el precursor del mieloma múltiple. Existen 2 tipos de plasmocitoma: el óseo solitario y el extramedular. Además, el plasmocitoma temporal es aún menos frecuente. El acúfeno puede ser la presentación inicial de estos tumores inusuales. Se presenta caso de una paciente femenina de 74 años, que inicia con acúfeno derecho, así como hipoa-cusia derecha. Acompañado de dolor cervical y limitación de la flexión cervical e inestabilidad. Como único dato a la otoscopia derecha presenta hipervascularidad del promontorio. Se realizan estudios de imagen reportando tumor con erosión ósea de ambas porciones petrosas de hueso temporal, esfenoides y columna cervical. Se realizó una biopsia transesfenoidal reportando plasmocitoma CD 138 positivo. Se inició quimioterapia y radioterapia. El acúfeno unilateral debe estudiarse ampliamente ya que puede ser síntoma de diagnósticos inusuales como neoplasias de base de cráneo.

Abstract Skull-base tumors are unusual, Plasmacytoma arises from plasma cells and could be the precursor of multiple myeloma. There are 2 types of plasmacytoma: solitary bone and extramedullary. Temporal bone plasmacytoma is even more infrequent. Tinnitus could be the initial symptom of this unusual tumors. We present the case of a 74-year-old female patient, who started with right tinnitus as well as right hearing loss. Accompanied by cervical pain and limitation of cervical flexion and instability. As the only data on right otoscopy, there was an hypervascular promontory. Imaging studies were performed reporting tumor with bone erosion of both petrous portions of temporal bone, sphenoid, and cervical spine. A transsphenoidal biopsy was performed, reporting positive CD 138 plasmacytoma. Chemotherapy and radiotherapy were indicated. Unilateral tinnitus should be fully studied because it might be a symptom of unusual diagnoses such as skull base neoplasms.

Effects of mixing, sheeting, and cooking on the starch, protein, and water structures of durum wheat semolina and chickpea flour pasta.

The influence of the pasta preparation stages on starch, proteins, and water structures of semolina and chickpea pasta was studied. The hydrated starch structures (995/1022 FTIR ratio) increased in semolina and reduced in chickpea pasta. The processing stages in semolina pasta led to a significant increase of ß-sheet structures (~50% to ~68%). The ß-sheet structures content in chickpea pasta was lower (~52%), and was most affected by sheeting and cooking. The water structure was assessed by the analysis of the OH fingerprint FTIR region (3700-2800 cm-1) and showing that water molecules (~90%) are strongly and moderately bound. The chickpea pasta displayed the highest content of strongly bonded water (about 55%) in contrast to the semolina pasta (~48%). A principal component analysis showed that the molecular organization of semolina pasta was mostly affected by dough formation and cooking; the molecular organization of chickpea pasta was determined by the cooking stage.

Efficacy and safety of switching Jak inhibitors in rheumatoid arthritis: an observational study.

OBJECTIVES: Different Jak inhibitors (jakinibs) have shown efficacy in rheumatoid arthritis (RA), but in a significant proportion of patients, an insufficient response leads to therapy withdrawal. We describe the efficacy and safety of a second jakinib in patients stopping the first due to insufficient response or side effects. METHODS: This is an observational retrospective multicentric study of 31 patients with RA sequentially treated with baricitinib or tofacitinib in any order in clinical practice in ten medical centres in Spain. RESULTS: We identified 31 patients, sequentially treated with both jakinibs. An equal proportion had received tofacitinib or baricitinib first. Most patients (87%) had previously received one or several bDMARD, median 4 (2-5). Median survival for the first jakinib was 5 (3-8) months, and the reasons for withdrawal were inefficacy in 61% and adverse effects in 39%. Most patients (23/31, 74%) maintained the response to the second jakinib after a mean follow-up of 19.5 (12-24) months. In all 8 patients who discontinued the second jakinib, the reason was inefficacy. The treatment suspension rate was similar among patients that had discontinued the first jakinib for inefficacy (26%) or for adverse effects (25%). CONCLUSIONS: Therapy of RA with a second jakinib seems a safe and efficacious option after discontinuation of the first, either for inefficacy or for side effects.

Estimation of Torso Vibrotactile Thresholds Using Eccentric Rotating Mass Motors.

The characterization of vibrotactile perception is crucial to accurately configure haptic devices and create appropriate stimuli for improving user performance in human-machine interaction systems. This article presents a study aiming to determine the absolute and differential vibrotactile thresholds in different areas of the torso to develop reliable haptic patterns to be displayed using a haptic vest. In the 'absolute threshold' experiment, we measure the minimum detectable vibration using a forced-choice task. Furthermore, in the 'differential threshold' experiment, we measure the minimum frequency change needed for users to discriminate two successive vibrotactile stimuli using a vibration matching task. The first experiment does not show differences between absolute thresholds, opening up the possibility of setting a unique minimal vibration for creating haptic patterns. Similarly, the second experiment does not show differences between differential thresholds. Moreover, as these thresholds follow Weber's law, it is viable to estimate any upper or lower differential threshold for any reference stimulus using a K-value. These results are a first step for creating vibrotactile patterns over the torso with the employed eccentric rotating mass motors. Moreover, the whole study provides a method to obtain these psychophysical values since the usage of different motors can change these results.

Do NSAIDs Take Us Away From Treatment Goals in Axial Spondyloarthritis: A Story About Dysbiosis or Just a Matter of Bias?

Non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment for spondyloarthritides (SpA), a group of entities with common clinical and pathophysiological aspects, but also with differential features. Although NSAIDs provide significant symptomatic relief, especially for joint pain and morning stiffness, their role in achieving and maintaining the treatment goals advocated by the treat to target strategy in SpA is not entirely clear. These agents can induce changes in the composition of the intestinal microbiota, also favoring an alteration of the barrier function in the gut epithelium. All of this, favored by a pre-disposing genetic background, could activate a specific type of aberrant immune response in the gut lamina propria, also known as type-3 immunity. This article offers a perspective on how NSAIDs, despite their undeniable value in the short-term SpA treatment, could hinder the achievement of medium and long-term treatment goals by compromising the barrier function of the gut mucosa and potentially altering the composition of the gut microbiota.

Addition of chickpea markedly increases the indigestible carbohydrate content in semolina pasta as eaten.

BACKGROUND: There is a growing interest in increasing dietary fiber (DF) consumption because of the health benefits associated with this nutrient. Pulses are considered a good source of non-digestible carbohydrates. The aim of this study was to investigate the possibility of substituting semolina with chickpea flour to increase indigestible carbohydrate content without altering the texture of the pasta. RESULTS: Pasta was prepared by extruding semolina-chickpea blends. The protein and DF content in the cooked pasta increased with the chickpea level, with an important contribution of resistant starch (RS) to the DF values. The optimum cooking time decreased as the chickpea content increased, which was related to the degree of starch gelatinization of the raw pasta. The in vitro digestible starch content decreased with the chickpea substitution level, concomitant with the increase in RS content. In general, the texture of the chickpea-containing pasta was similar to that of semolina pasta. CONCLUSIONS: Pending acceptability studies on these pastas may grant their promotion as good fiber sources, probably helpful in the fight against obesity and diet-related non-communicable diseases. © 2020 Society of Chemical Industry.

Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy.

OBJECTIVES: Clinicians often face the challenge of providing effective and safe therapy for pregnant women with uveitis. Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer. In this study we assessed the efficacy of CZP in pregnant women with uveitis. We also provided information on outcomes of pregnant women and neonates exposed to CZP. METHODS: We carried out a multicentre study of women with uveitis who received CZP during pregnancy and their neonates. The main visual outcomes were visual acuity (VA), intraocular inflammation and corticosteroid-sparing effect. Pregnancy outcomes, maternal and neonatal infections and congenital malformations were also assessed. RESULTS: We studied 14 women (23 affected eyes); mean age of 34.3±5.5 years. The underlying diseases were spondyloarthritis (n=7), idiopathic (n=2), and Vogt-Koyanagi-Harada, rheumatoid arthritis, juvenile idiopathic arthritis, punctate inner choroidopathy and Behçet's disease (1 each). The patterns of ocular involvement were anterior (n=10), posterior (n=2), intermediate (n=1), panuveitis (n=1). Cystoid macular oedema was present in one patient (1 eye). Uveitis was bilateral in nine cases and chronic in seven patients. CZP was started before getting pregnant in ten patients and after conceiving in four. All patients achieved or maintained ocular remission throughout pregnancy. Fifteen healthy infants were born. Only one woman presented a mild infection during pregnancy. Neither infections nor malformations were observed in neonates after a follow-up of 6 months. Six infants were breastfed and all of them received scheduled vaccinations without complications. CONCLUSIONS: Certolizumab pegol is effective and safe in women with uveitis during pregnancy.

Adaptation and validation of the chronic otitis media questionnaire 12 (COMQ-12) in the Mexican Spanish language (COMQ-12-Mx).

Background: Chronic otitis media (COM) questionnaire 12 (COMQ-12) is a specific-disease tool that evaluates COM patients.Objective: To validate COMQ-12 in the Mexican Spanish language (COMQ-12-Mx).Materials and methods: Mexican Spanish-speaking healthy volunteers and COM patients who attended a Secondary Care Center from May 2019 to October 2019. The COMQ-12 in Mexican Spanish was obtained by translation and back translation from an English-Spanish translator. All participants completed the COMQ-12-Mx questionnaire. COM patients were included regardless of their COM status. Control group completed the questionnaire twice. Participants were categorized into three groups: group 1 (COM), group 2 (volunteers first test) and group 3 (volunteers retest). Cronbach's alpha was used for internal consistency, Spearman's rank correlation coefficient was used for test-retest reliability and Mann-Whitney U test compared groups.Results: We included 78 Mexican Spanish-speaking participants (COM n = 37, healthy volunteers n = 41), 51 females and 27 males, mean age was 39.67 years (SD ± 18.32). Group 1 COMQ-12-Mx score was 22.108 ± 11.79, group 2 score was 3.561 ± 4.399 (p ≤ .001) and group 3 score was 3.683 ± 4.435. Cronbach's alpha was 0.828 and test-retest reliability achieved a 0.928 outcome.Conclusions: COMQ-12-Mx is a valid and reliable tool to evaluate quality life in Mexican Spanish-speaking patients with COM.

Factores de riesgo de no adherencia al tratamiento en pacientes mayores de un núcleo rural / Risk factors of non-adherence to treatment in major patients of a rural nucleus

OBJETIVO: Conocer los factores de riesgo que favorecen la interrupción de los tratamientos en adultos mayores con enfermedades crónicas de un núcleo rural. METODOLOGÍA: Se han incluido en este estudio 115 hombres y 128 mujeres, que viven en un medio rural, que son portadores de procesos crónicos y que se encuentran en tratamiento con varios fármacos, los parámetros valorados se recogieron mediante encuesta, valorando las características personales, procesos médicos que presentan, tratamientos a los que están sometidos y respuesta a los distintos fármacos, causas de interrupción de los mismos y los datos referentes a los fármacos que pudieran comentar. Se analizaron los datos obtenidos mediante el análisis multivariante de riesgo de COX. RESULTADOS: Existe un riesgo significativo de abandono de los tratamientos en los hombres, en los grupos de edad comprendidos entre los 76-80 años y entre los 81 y 85 años y en las mujeres entre 81-85 años. Existe riesgo de no adherencia cuanto mayor es el número de fármacos prescriptos, en los tratamientos cada 8 horas y no significativo en las tomas únicas, así como los fármacos formulados en cápsulas por dificultades de deglución. Existe riesgo de no adherencia en las personas que viven solas y sobre las causas de interrupción son significativos el olvido, la desconfianza, la mala tolerancia o cansancio del tratamiento. CONCLUSIÓN: Ninguna estrategia para mejorar la adherencia puede considerarse mejor, las actuaciones serán más efectivas si se actúa de forma personalizada

OBJECTIVE: To know the risk factors that favor the interruption of treatments in older adults with chronic diseases of a rural nucleus. METHODOLOGY: 115 men and 128 women, living in a rural environment, who are carriers of chronic processes and who are in treatment with several drugs, have been included in this study, the assessed parameters were collected through a survey, assessing personal characteristics, medical processes that present, treatments to which they are subjected and response to the different drugs, causes of interruption of the same and the data referring to the drugs that could comment. We analyzed the data obtained through the multivariate analysis of COX risk. RESULTS: There is a significant risk of abandonment of treatments in men, in the age groups between 76-80 years and between 81 and 85 years and in women between 81-85 years. There is a risk of non-adherence the greater the number of prescribed drugs, in the treatments every 8 hours and not significant in the single shots, as well as the drugs formulated in capsules due to swallowing difficulties. There is a risk of non-adherence in people who live alone and forgetting, distrust, poor tolerance or fatigue of treatment are significant factors in the interruption. CONCLUSION: No strategy to improve adherence can be considered better, the actions will be more effective if you act in a personalized way

Extruded Unripe Plantain Flour as an Indigestible Carbohydrate-Rich Ingredient.

There is a growing interest in the development of functional ingredients, including those with high indigestible carbohydrate content. Unripe plantain flour (UPF) is a source of indigestible carbohydrates, type II resistant starch (RS) in particular. A major drawback of UPF, however, is that its RS content decreases sharply after wet heat treatment. Here, we explore the possibility of preparing an extruded UPF-based functional ingredient that retains limited starch digestibility features and high dietary fiber content. Both an unripe plantain pulp flour (UPFP) and a whole (pulp and peel) unripe plantain flour (UPFW) were prepared, extruded under identical conditions and evaluated for their gelatinization degree, total starch (TS), resistant starch (RS), and total dietary fiber (TDF) content; functional properties, such as pasting profile, water retention capacity, and solubility, and oil absorption index were also analyzed. The extruded functional ingredient was added to a yogurt and the rheological characteristics and in vitro starch digestibility of the product were evaluated. The extruded UPFW showed a lower gelatinization degree than the extruded UPFP, which may be due to the higher non-starch polysaccharide content of the former. A high TDF content was recorded in both extrudates (12.4% in UPFP and 18.5% in UPFW), including a significant RS fraction. The water retention capacity and solubility indices were higher in the extruded flours, particularly in UPFW, while only marginal differences in oil retention capacity were observed among the products. The addition of UPFP or UPFW (1.5 g TDF, w/v) to a yogurt did not alter the viscosity of the product, an important characteristic for the consumer's approval. Moreover, the composite yogurt showed a relatively low starch digestion rate. Extrusion of UPFs may be an alternative for the production of functional ingredients with important DF contents.

A multiscale kinetics model for the analysis of starch amylolysis.

Simple exponential decaying functions are commonly used for fitting the kinetics of starch digested by amylolytic enzymes. A common assumption is that a sole exponential function can account for the kinetics of the whole digestible starch. Recent studies using logarithm-of-slope (LOS) plots showed that digestion kinetics can exhibit multi-scale behavior, an effect reflecting starch fractions with different digestion characteristics. This work proposed an extension of the widely used Goñi et al.'s model to account for two starch fractions; one fraction linked with fast digestion rate and other with slow digestion rates. The fitting of experimental data was carried out by solving numerically a nonlinear least-squares problem. The estimated parameters have a straightforward interpretation in terms of reaction rates and digestible/resistant starch fractions. Two experimental examples were used for illustrating the performance of the multi-exponential function.

Aluminates with Fluorinated Schiff Bases: Influence of the Alkali Metal⁻Fluorine Interactions in Structure Stabilization.

New heterometallic aluminium-alkali metal compounds have been prepared using Schiff bases with electron withdrawing substituents as ligands. The synthesis of these new species was achieved via the reaction of AlMe3 with the freshly prepared alkali-metallated ligand. The derivatives formed were characterized by NMR in solution and by single crystal X-ray diffraction in the solid state. Aluminate derivatives with lithium and sodium were prepared and a clear influence of the alkali metal in the final outcome is observed. The presence of a Na···F interaction in the solid state has a stabilization effect and the species [NaAlMe3L]2 can de isolated for the first time, which was not possible when using Schiff bases without electron withdrawing substituents as ligands.

Schiff-base -ate derivatives with main group metals: generation of a tripodal aluminate metalloligand.

New heterobimetallic aluminates with well-defined structures bearing bidentate Schiff bases as ligands have been prepared. The ligands studied are PhO-CH[double bond, length as m-dash]N-Ar (Ar = C6H5 (La) and 2,6-iPr-C6H3 (Lb)), with and without donor substituents in the ortho position of the arene ring bonded to the iminic nitrogen. To prepare the heterometallic species, the HL proligands were treated with the appropriate alkali metal precursor and then AlMe3 was added. In these reactions the alkali metal size has a substantial influence on the outcome. For lithium, the formation of [LiAlMe3(L)]21(a-b) compounds was straightforward and their nuclearity in the solid state was confirmed by X-ray studies. When moving to sodium, the analogous species [NaAlMe3(L)]n initially formed, quickly evolved to [NaAlMe2(L)2]n3(a-b) in solution. As well, for potassium, the initial derivatives formed [KAlMe3L] progressed very rapidly to the generation of [KAlMe2L2] as evidenced from the isolation of [KAlMe2(Lb)2] 4b as a crystalline product. Furthermore, for potassium the unique species [KAlMe(Lb)3] 5b was isolated which shows, as a striking feature, the presence of an unusual tripodal metalloligand.

Evolution of the incidence of inflammatory bowel disease in Southern Spain

Background: The incidence of inflammatory bowel disease is increasing in Europe and in Spain. However, there is no recent data from Southern Spain. Objectives: To determine the evolution of the hospital incidence of inflammatory bowel disease in Southern Spain. Material and methods: A retrospective study was performed in two hospitals in Southern Spain. Data was collected from inflammatory bowel disease patients, divided into two periods (1995-2000 and 2001-2014) and compared. The reference population from both areas was 1,011,555 inhabitants. Results: A total of 430 patients were registered during the first period (1995-2000); 50% (215) had Crohn's disease that resulted in a cumulative incidence rate of 7.08 cases/100,000 inhabitants per year. The overall inflammatory bowel disease incidence was 3.54 cases/100,000 inhabitants per year. During the second period (2001-2014), 2,089 patients were collected; 51.7% had ulcerative colitis (1,081). The rate of cumulative incidence of inflammatory bowel disease was 14.7 cases/100,000 inhabitants per year (7.6 cases of ulcerative colitis/100,000 inhabitants/year and 7.1 cases of Crohn's disease/100,000 inhabitants/year). Conclusions: The incidence of inflammatory bowel disease in Southern Spain has doubled in the last decade and is similar to that of the rest of the country and Europe (AU)

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