A mobile application to monitor mode, content and duration of health navigation services for people living with HIV in Guatemala.

Health navigation is increasingly being used to support people living with HIV, but timely monitoring of navigation is challenging due to the burden of reporting a high volume of diverse activities. We designed a mobile application (app) for navigators to report their interactions with men who have sex with men living with HIV (n = 374), including: (1) mode of support; (2) content; and (3) duration. We assessed sociodemographic and behavioral characteristics of the study sample and calculated monitoring system indicators. We also conducted qualitative interviews with navigators (n = 7) and used thematic analysis to assess app acceptability and usability. From January 2017 to June 2018, 95.3% of participants interacted with their navigator at least one time and 4281 reports were recorded by nine navigators. The median number of interactions per participant was 10 (range: 1-46). The majority of interactions (71.6%) occurred remotely. Most frequently covered topics included: appointment reminders (36.9%), employment (19.9%), and family (15.5%). Navigators indicated that the system was easy to use, but some did not use it in real time as intended. Timely access to navigator data enabled feedback and continuous training. These data can also facilitate analysis of intensity and content of interactions to improve tailoring and sustainability.

Reaction strategies for the enzymatic synthesis of neopentyl glycol diheptanoate.

This work describes for the first time the green synthesis of neopentyl glycol diheptanoate in a solvent-free medium via an enzymatic pathway. The process has been carried out in an open-air reactor in order to ease water removal through evaporation and shift the chemical equilibrium towards product formation. The inhibiting effect of high concentrations of heptanoic acid has been put into evidence by a reduction of initial reaction rate when esterification was performed with stoichiometric amounts of substrates. Therefore, in this work different strategies for the stepwise addition of heptanoic acid are proposed, and best results were obtained when stoichiometric quantities of acid were divided in four equal amounts and added when previous batch was consumed. Biocatalyst Novozym® 435 concentration and temperature were optimised, giving yields of 90% in neopentyl glycol diheptanoate when 7.5% (w/w) and 70 °C were used. With a remaining 7% of heptanoic acid (probably caused by the alcohol evaporation) the addition of neopentyl glycol led to a conversion of 95%. Thus, product can be used in cosmetics without further purification and can be labelled as environmentally-friendly synthesized because of its enzymatic origin.

Effects of locally applied Insulin-like Growth Factor-I on osseointegration.

BACKGROUND: The aim of this study was to assess the effect of local application of IGF-I on osseointegration of dental implants placed in osteoporotic bones. MATERIAL AND METHODS: 16 rabbits were randomly distributed into two groups: eight animals were ovariectomized and fed a low-calcium diet for six weeks, in order to induce experimental osteoporosis, and the others were sham-operated and fed a standard diet. A titanium implant was inserted into the tibiae in both groups. In half of the rabbits, 4 µg of IGF-I was applied into the ostectomy, prior to the implant insertion. A total of 32 implants were placed. Animals were sacrificed two weeks after surgery and decalcified samples were processed for Bone-To-Implant Contact (BIC) and Bone Area Density (BAD) measurements. Analysis of variance (ANOVA) was used for statistical evaluation. P<0.05 was considered to be significant. RESULTS: Ovariectomy induced statistically significant lower BAD values (p=0.008) and a tendency towards lower BIC values when compared osteoporotic and healthy groups. The administration of 4 µg of IGF-I did not produce statistically significant differences neither on BIC nor on BAD values, neither in the osteoporotic animals nor in healthy. CONCLUSIONS: Within the limitations of this experimental study, local administration of 4 µg of IGF-I was not able to induce any changes in the osseointegration process two weeks after surgery, neither in healthy rabbits nor in the osteoporotic group.

Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study.

BACKGROUND AND AIMS: The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. METHODS: This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. RESULTS: A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn's disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37-45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6-3.7], depression [OR = 2.4, 95% CI = 1.4-3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1-2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4-5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3-14.2], anxiety [RC = 25.8, 95% CI = 20.0-31.5], depression [RC = 30.6, 95% CI = 24.3-37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3-20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. CONCLUSIONS: The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.

Making the Link: A Pilot Health Navigation Intervention to Improve Timely Linkage to Care for Men Who have Sex with Men and Transgender Women Recently Diagnosed with HIV in Guatemala City.

We piloted a health navigation strategy to promote timely linkage to care among men who have sex with men (MSM) and transgender women (TW) recently diagnosed with HIV in Guatemala City. We used a mixed-methods approach, integrating quantitative data collected during clinic visits and qualitative data from in-depth interviews, to characterize acceptability of navigation and time to linkage, defined as having the first clinical care visit. Out of 54 participants who enrolled in the pilot (n = 52 MSM; n = 2 TW), 50 (92.6%) accepted navigation and all were linked to care. Median time to linkage was 3 days (Interquartile Range 2-5 days). In qualitative interviews, participants expressed feeling scared and alone following their diagnosis and appreciated the support of a navigator, especially when they did not feel they could access their existing support networks. Future research and evaluation should continue to assess how to best use health navigation to support key populations recently diagnosed with HIV.

"Oh, I'm Not Alone": Experiences of HIV-Positive Men Who Have Sex With Men in a Health Navigation Program to Promote Timely Linkage to Care in Guatemala City.

Men who have sex with men (MSM) are disproportionately affected by HIV in Guatemala and may benefit from health navigation programs designed to support timely linkage to HIV care. We conducted qualitative in-depth interviews with MSM (n = 19) linked to care within days of their diagnosis with the support of a health navigator. We used narrative analysis and systematic coding to identify themes related to HIV diagnosis and experiences with navigators. Participants experienced strong feelings of fear upon receiving a positive HIV test result. This fear led to social isolation and limited reliance on family and friend networks for support. Health navigators developed strong relationships with participants by providing the emotional support they were lacking and supporting them to overcome their fear and other structural barriers to HIV care, including stigma. Findings support the important role of navigation for MSM in Guatemala and could be transferable to other settings in Latin America.

Efecto de inoculantes bacterianos edáficos mixtos en el desarrollo temprano de cultivares mejorados de cacao (Theobroma cacao L.) en un sistema agroforestal tradicional del norte de Oaxaca, México / Effect of mixed edaphic bacterial inoculants in the early development of improved cocoa cultivars (Theobroma cacao L.) in a traditional agroforestry system of Oaxaca, Mexico

El cacao (Theobroma cacao L.) es nativo de América del Sur y representa uno de los recursos «bioculturales¼ más significativos de Mesoamérica, ya que es una región donde se domesticó y tuvo relevancia como bebida ritual y como moneda en muchas culturas prehispánicas hasta la llegada de los españoles, quienes difundieron su uso en el mundo y lo convirtieron en una de las mercancías «commodity¼ más consumidas. Mediante este trabajo se propone una alternativa para atender la problemática de las plantaciones a través de la introducción de una diversidad amplia de cultivares de cacao en sistemas agroforestales tradicionales, en sinergia con la inoculación de bacterias edáficas fijadoras de nitrógeno y solubilizadoras de fósforo insoluble. En una parcela agroforestal tradicional se introdujeron plantas de cacao injertadas de cuatro cultivares y se dispusieron 3 tratamientos: aplicación de biofertilizante, aplicación de fertilizante químico y testigo. Se registraron la altura, el diámetro basal, el número de hojas y el número de ramas a los 2 y 12 meses, y se caracterizó la población de microorganismos asociada alrededor del tallo bajo la copa de las plantas. Los resultados de crecimiento muestran un buen potencial para los 4 cultivares estudiados y se observó que la biofertilización generó efectos significativos en algunos de los indicadores de crecimiento de las plantas de cacao. Así, las asociaciones vegetales en un sistema agroforestal podrían ser favorables para potenciar el desarrollo de frutos y resistencia a plagas y enfermedades.

Cocoa plant (Theobroma cacao L.) is native from South America and it represents one of the most significant "bio-cultural" resources of Mesoamerica, since it is a region where it was domesticated and had a relevance as ritual drink and as currency in many pre-hispanic cultures until the arrival of the Spaniards who spread its use worldwide, and became it one of the most consumed commodity goods. Through this research, an alternative is proposed to address the problem of cultivars through the introduction of a wide variety of cocoa plants in traditional agroforestry systems, in synergy with the inoculation of nitrogen-fixing and insoluble phosphor solubilizing edaphic bacterial consortia. Four cultivars of improved grafted cocoa plants were introduced in a traditional agroforestry plot and three fertilization treatments were applied: application of biofertilizer, application of chemical fertilizer and control. Measurements of height, stem diameter, number of leaves and branches were recorded at 2 and 12 months after planting and rhizosphere microbial populations were characterized. Growth results showed good potential for all studied cultivars and it was observed that biofertilization foresees significant effects in some of the growth indicators of cocoa plant. Thereby, plant associations in an agroforestry system could be favorable to promote fruit development and resistance to pests and diseases.

Intervención con terapia ocupacional en una situación aguda de acoso escolar / Intervention with occupational therapy in a acute situation of school harassment

En los últimos estudios se muestra que el riesgo de convertirse en víctimas del Bullying puede ser determinado a partir de características y factores individuales del entorno inmediato de los niños. Ser acosado se asocia con síntomas graves de problemas de salud mental, que pueden ser de larga duración. Los estudios han encontrado que las víctimas de acoso escolar muestran no sólo niveles elevados de aislamiento social, depresión, y ansiedad sino también, sobre todo en las chicas, aumento de los comportamientos de autolesión e ideaciones suicidas. El caso clínico que presentamos es de un chico de 13 años, que acude a urgencias con problemas de conducta en su entorno más cercano, con dificultades en las habilidades sociales, se siente triste, incapaz, ya no es el chico que era antes, con dificultades para realizar las tareas de clase, y gestos auto lesivos. Tras la valoración de sus capacidades, (cuestionario de auto concepto, escala de autoestima). La intervención consistió en la aplicación de una técnica de creación literaria, durante 10 días, a través de una serie de palabras, el chico fue capaz de contar su historia de maltrato y acoso por parte de los compañeros, y las dificultades que existen en su entorno familiar. Como resultados, mejoró la autoestima y podemos observar que es capaz de afrontarse a todas las actividades que se le propone, su ánimo ha mejorado notablemente, y verbaliza proyectos para realizar después del ingreso. Según los estudios, el impacto de la intimidación no se limita sólo a las conductas que son perjudiciales para uno mismo, sino que también se extiende a los comportamientos nocivos hacia los demás. Además, hay que tomar conciencia de la importancia de implementar estrategias de prevención e intervención en las familias, escuelas y en la comunidad, con el fin de reducir los comportamientos intimidatorios

In recent studies it is shown that the risk of becoming victims of Bullying can be determined based on characteristics and individual factors of the children's immediate environment. Being bullied is associated with severe symptoms of mental health problems,which can be long-lasting. Studies have found that victims of bullying show not only high levels of social isolation, depression, and anxiety but also, especially in girls, increased self-harm and suicidal ideation behaviors. We describe a clinical case of a 13-year-old boy, who comes to the emergency room with behavioral problems in his closest context, with difficulties in social skills, sadness, unable, is no longer the boy he was before, with difficulties to perform class tasks, and self-injurious behaviors. After assessing his abilities (self-concept questionnaire, self-esteem scale), the intervention consisted of the application of a technique of literary creation, during 10 days, through a series of words. The boy was able to tell his story of mistreatment and harassment in the school, and the difficulties that exist in his familiar context. As a result, he improved his self-esteem and we can see that he is able to face all the activities that are proposed, his mood has improved significantly, and verbalizes projects in the future. According to the studies, the impact of bullying is not limited only to behaviors that are harmful to oneself, but also extends to harmful behaviors towards others. In addition, we must be aware of the importance of implementing prevention and intervention strategies in families, schools and in the community, in order to reduce intimidating behavior

Development of a Mechatronic System for Rehabilitation of Injuries in the Radial Nerve / Desarrollo de un Sistema Mecatrónico para Rehabilitación de Lesiones del Nervio Radial

ABSTRACT This work presents the design, analysis and implementation of a mechatronic System focused on helping to improve Rehabilitation therapies to patients affected by some Radial Nerve Injuries (SYRR-NERI). The device was developed with the aim of finding simple solutions for the different subsystems that form the SYRR-NERI. The mechatronic system basically consists of two coupled four-bar mechanisms with a Proportional-Integral-Derivative (PID) controller in their respective drive motors to regulate the rotational velocity. In addition, each mechanism has touch sensors in order to limit its movement. The implementation of the control algorithm and the logic to perform the synchronized movements is performed by a microcontroller. The result is an affordable and functional prototype which needs to be tested in real situations with the help of physiotherapists and patients to obtain the necessary information to improve its performance.

RESUMEN Este trabajo presenta el diseño, análisis e implementación de un sistema mecatrónico enfocado en ayudar a mejorar las terapias de rehabilitación para pacientes afectados por algunas lesiones del nervio radial. El dispositivo fue desarrollado tratando de proponer soluciones sencillas para los diferentes subsistemas que integran el dispositivo. El sistema mecatrónico consiste básicamente en dos mecanismos acoplados de cuatro barras con un controlador Proporcional-Integral-Derivativo (PID) en sus respectivos motores impulsores para regular la velocidad angular. Además, cada mecanismo tiene sensores táctiles para limitar el movimiento. La implementación del algoritmo de control y de la lógica para realizar los movimientos sincronizados se lleva a cabo mediante un microcontrolador. El resultado es un dispositivo económicamente accesible y funcional que tiene por objetivo ser probado en situaciones reales y, con la ayuda de fisioterapeutas y pacientes, obtener la información necesaria para mejorar su desempeño.

[Effect of mixed edaphic bacterial inoculants in the early development of improved cocoa cultivars (Theobroma cacao L.) in a traditional agroforestry system of Oaxaca, Mexico]. / Efecto de inoculantes bacterianos edáficos mixtos en el desarrollo temprano de cultivares mejorados de cacao (Theobroma cacao L.) en un sistema agroforestal tradicional del norte de Oaxaca, México.

Cocoa plant (Theobroma cacao L.) is native from South America and it represents one of the most significant "bio-cultural" resources of Mesoamerica, since it is a region where it was domesticated and had a relevance as ritual drink and as currency in many pre-hispanic cultures until the arrival of the Spaniards who spread its use worldwide, and became it one of the most consumed commodity goods. Through this research, an alternative is proposed to address the problem of cultivars through the introduction of a wide variety of cocoa plants in traditional agroforestry systems, in synergy with the inoculation of nitrogen-fixing and insoluble phosphor solubilizing edaphic bacterial consortia. Four cultivars of improved grafted cocoa plants were introduced in a traditional agroforestry plot and three fertilization treatments were applied: application of biofertilizer, application of chemical fertilizer and control. Measurements of height, stem diameter, number of leaves and branches were recorded at 2 and 12 months after planting and rhizosphere microbial populations were characterized. Growth results showed good potential for all studied cultivars and it was observed that biofertilization foresees significant effects in some of the growth indicators of cocoa plant. Thereby, plant associations in an agroforestry system could be favorable to promote fruit development and resistance to pests and diseases.

Diseño de un Prototipo de Exoesqueleto para Rehabilitación del Hombro / Design of an Exoskeleton Prototype for Shoulder Rehabilitation

Resumen: La discapacidad motora es un problema a nivel mundial y según el censo 2010 del INEGI, en México, las personas con problemas de movilidad representan el 58.3 % de la población con discapacidad. Para afrontar esta problemática, han surgido dispositivos robóticos para rehabilitación que permiten realizar terapias con precisión, eficiencia, reducción de esfuerzos físicos y la oportunidad de realizarlas en grupo. Sin embargo, estos dispositivos no pueden igualar la movilidad de los miembros a rehabilitar y su adaptación a la antropometría mexicana es limitada. En este artículo se presenta el diseño de un exoesqueleto enfocado a la población adulta mexicana con pérdida parcial de movilidad en el hombro. El objetivo es desarrollar un exoesqueleto capaz de generar los 3 movimientos básicos del hombro (flexión-extensión, abducción-aducción y rotación interna-externa), considerando las medidas antropométricas de la población objetivo. Para el diseño del prototipo se utiliza una adaptación de la metodología de diseño mecatrónico de robots. El diseño propuesto es validado cinemáticamente mediante simulaciones numéricas en Matlab® y en ADAMS™, comprobando el rango de movilidad de cada articulación. Además, se realiza el análisis de elemento finito para cuantificar los esfuerzos y las deformaciones en el exoesqueleto, verificando la selección de materiales para su manufactura.

Abstract: The motor disability is a problem at the global level and according to the census 2010 from INEGI, in Mexico, people with mobility problems represent 58.3 % of the population with disabilities. To face this problem, robotic devices for rehabilitation have emerged which allow to perform therapies with accuracy, efficiency, reduction of physical efforts and the opportunity to perform them in group. However, these devices may not match the mobility of the members to rehabilitate and their adaptation to the mexican anthropometry is limited. In this article, the design of an exoskeleton focused on the Mexican adult population with partial loss of mobility in the shoulder is presented. The objective is to develop an exoskeleton capable of generating the 3 basic movements of the shoulder (flexion-extension, abduction-adduction and internal-external rotation) considering the anthropometric measurements of the target population. For the design of the prototype, an adaptation of the mechatronic design methodology for robots is used. The proposed design is validated kinematically through numerical simulations in Matlab® and ADAMS™, the numerical results prove the range of mobility of each exoskeleton joint. Moreover, a finite element analysis is carried out to quantify the stress and strain levels in the exoskeleton, verifying the selection of materials for its manufacture.

Satellitosis and CD117 immunohistochemical expression correlates with poor outcome in thick vulvar melanoma.

BACKGROUND: Melanoma of the vulva is the second most common vulvar cancer after epidermoid carcinoma. Patients suffering from this disease usually present with a late-stage disease with a poor prognosis. The prognostic factors reported in previous studies are not homogeneous and the clinical/pathogenic role of c-KIT expression is not clear. Breslow staging currently is the most accurate predictor factor. METHODS: A clinicopathological study with literature review was performed to identify predictors of prognosis and survival in melanoma of the vulva and investigated the expression of c-KIT (by immunohistochemistry) in 10 patients from the National Institute for Cancer Research (Mexico City). RESULTS: The 10 patients enrolled were all older women with delayed presentation, high-stage disease and limited response to treatment. Five patients (50%) were found to have c-KIT expression; 4 of them recurred (P=0.01), and ultimately 3 died (P=0.038). We identified satellitosis and c-KIT expression as prognostic predictors for death. CONCLUSIONS: We conclude that c-KIT expression is a valuable predictor of prognosis and survival, especially in thick (>4 mm) melanomas.

Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study.

OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed. METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included. RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe. CONCLUSIONS: The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe.

Pharmacologic therapy for inflammatory bowel disease refractory to steroids.

Although corticosteroids are an effective treatment for induction of remission in inflammatory bowel disease (IBD), many patients are dependent on or refractory to corticosteroids. This review is based on scrutinizing current literature with emphasis on randomized controlled trials, meta-analyses, and Cochrane reviews on the management of IBD refractory to corticosteroids. Based on this evidence, we propose algorithms and optimization strategies for use of immunomodulator and biologic therapy in IBD refractory to corticosteroids.

Stem cell therapy in inflammatory bowel disease: A promising therapeutic strategy?

Inflammatory bowel diseases are inflammatory, chronic and progressive diseases of the intestinal tract for which no curative treatment is available. Research in other fields with stem cells of different sources and with immunoregulatory cells (regulatory T-lymphocytes and dendritic T-cells) opens up new expectations for their use in these diseases. The goal for stem cell-based therapy is to provide a permanent cure. To achieve this, it will be necessary to obtain a cellular product, original or genetically modified, that has a high migration capacity and homes into the intestine, has high survival after transplantation, regulates the immune reaction while not being visible to the patient's immune system, and repairs the injured tissue.

Application of a diffusion-reaction kinetic model for the removal of 4-chlorophenol in continuous tank reactors.

A continuous tank reactor was used to remove 4-chlorophenol from aqueous solutions, using immobilized soybean peroxidase and hydrogen peroxide. The influence of operational variables (enzyme and substrate concentrations and spatial time) on the removal efficiency was studied. By using the kinetic law and the intrinsic kinetic parameters obtained in a previous work with a discontinuous tank reactor, the mass-balance differential equations of the transient state reactor model were solved and the theoretical conversion values were calculated. Several experimental series were used to obtain the values of the remaining model parameters by numerical calculation and using an error minimization algorithm. The model was checked by comparing the results obtained in some experiments (not used for the determination of the parameters) and the theoretical ones. The good concordance between the experimental and calculated conversion values confirmed that the design model can be used to predict the transient behaviour of the reactor.

Results of a survey on albumin use in clinical practice in intensive care units.

BACKGROUND: Human albumin solutions are used in a number of disorders, though their indications are not clear in all circumstances. These solutions are costly, and their benefit has not been established in all settings. It is therefore interesting to assess the presence of albumin solutions in the daily clinical practice of critical care professionals. OBJECTIVES: To report the standard clinical practices and to describe the variability of albumin solutions use in critically ill patients. DESIGN: A survey sent by e-mail to Spanish and South American Intensive Care Units (ICUs) PERIOD: Planning and execution during the year 2012. METHODS: A questionnaire comprising 35 questions. RESULTS: Fifty-seven surveys were analyzed. The use of albumin solutions was sporadic or negligible in critically ill patients (96.5%). The exceptions were patients with liver disease (87.7% of the responders administered albumin to these patients). A high percentage of professionals claimed to know the available scientific evidence on the use of albumin in patients with liver disease (82.5%) and in patients without liver disease (77.2%). Only 5.3% of the responders preferred to rely on their own experience to establish the indications of albumin use. CONCLUSIONS: The use of albumin solutions is infrequent in ICUs, except in patients with liver disease. Evidence-based knowledge on albumin use is declared to be extensive in ICUs. As a rule, opinions on the use of albumin solutions are based on the scientific recommendations, especially in patients with liver disease. Professional experience rarely prevails over the published clinical guidelines.

Esterification of polyglycerol with polycondensed ricinoleic acid catalysed by immobilised Rhizopus oryzae lipase.

The enzymatic method for synthesising polyglycerol polyricinoleate (PGPR), a food additive named E-476, was successfully carried out in the presence of immobilised Rhizopus oryzae lipase in a solvent-free medium. The great advantage of using the commercial preparation of R. oryzae lipase is that it is ten times cheaper than the commercial preparation of R. arrhizus lipase, the biocatalyst used in previous studies. The reaction, which is really a reversal of hydrolysis, takes place in the presence of a very limited amount of aqueous phase. Immobilisation of the lipase by physical adsorption onto an anion exchange resin provided good results in terms of activity, enzyme stability and reuse of the immobilised derivative. It has been established that the adsorption of R. oryzae lipase on Lewatit MonoPlus MP 64 follows a pseudo-second order kinetics, which means that immobilisation is a process of chemisorption, while the equilibrium adsorption follows a Langmuir isotherm. The use of this immobilised derivative as catalyst for obtaining PGPR under a controlled atmosphere in a vacuum reactor, with a dry nitrogen flow intake, allowed the synthesis of a product with an acid value lower than 6 mg KOH/g, which complies with the value established by the European Commission Directive. This product also fulfils the European specifications regarding the hydroxyl value and refractive index given for this food additive, one of whose benefits, as proved in our experiments, is that it causes a drastic decrease in the viscosity (by 50 %) and yield stress (by 82 %) of chocolate, comparable to the impact of customary synthesised PGPR.

Continuous tank reactors in series: an improved alternative in the removal of phenolic compounds with immobilized peroxidase.

Immobilized derivatives of soybean peroxidase, covalently bound to a glass support, were used in a continuous stirred tank reactor in series, in order to study the removal of two phenolic compounds: phenol and 4-chlorophenol. The use of two reactors in series, rather than one continuous tank, improved the removal efficiencies of phenol and 4-chlorophenol. The distribution of different amounts of enzyme between the two tanks showed that the relative distributions influenced the removal efficiency reached and the degree of the enzyme deactivation. The highest removal percentages were reached at the outlet of the second tank for a distribution of 50% of the enzyme in each tank. However, with a distribution of 75% in the first tank and 25% in the second, the elimination percentage in the second tank was slightly lower than in the previous case, and the effects of deactivation of the enzyme in the first tank were less pronounced. In all the distributions assayed it was observed that the first tank acts as a filter for the second one, which receives a feed with a smaller load of phenolic compounds, thus diminishing enzyme deactivation in the second tank.