Extraction of Antioxidant Compounds from Brazilian Green Propolis Using Ultrasound-Assisted Associated with Low- and High-Pressure Extraction Methods.

The demand for bee products has been growing, especially regarding their application in complementary medicine. Apis mellifera bees using Baccharis dracunculifolia D.C. (Asteraceae) as substrate produce green propolis. Among the examples of bioactivity of this matrix are antioxidant, antimicrobial, and antiviral actions. This work aimed to verify the impact of the experimental conditions applied in low- and high-pressure extractions of green propolis, using sonication (60 kHz) as pretreatment to determine the antioxidant profile in the extracts. Total flavonoid content (18.82 ± 1.15-50.47 ± 0.77 mgQE·g-1), total phenolic compounds (194.12 ± 3.40-439.05 ± 0.90 mgGAE·g-1) and antioxidant capacity by DPPH (33.86 ± 1.99-201.29 ± 0.31 µg·mL-1) of the twelve green propolis extracts were determined. By means of HPLC-DAD, it was possible to quantify nine of the fifteen compounds analyzed. The results highlighted formononetin (4.76 ± 0.16-14.80 ± 0.02 mg·g-1) and p-coumaric acid (

Tomato as a Natural Source of Dyes in the Food Industry: A Patent Data Analysis.

BACKGROUND: Foods that promote health benefits are being increasingly used. Innovative techniques, such as nanotechnology, have been used to improve functional properties, sensory characteristics, or the conservation of foods. OBJECTIVE: The objective of this study was to identify the technological domain of patents for tomato products with or without nanotechnology and elucidate the technological advances associated with the recent use of tomatoes as a natural food dye in the food industry by exploring patent documents. METHODS AND RESULTS: The search was conducted using the Espacenet and INPI databases. There was an increase in patent document applications employing nanotechnology in 2013, with a peak between 2017 and 2018. China is the lead country in the number of patent applications. In Brazil, the patent applications are variable, and the food industry is most involved in studies on tomatoes as a natural food dye. Most patent deposits using nanotechnology were from companies, and the main sources of the patent application were the food and pharmaceutical industries. CONCLUSION: There is an increasing trend for the use of tomatoes as natural food dyes, produced with or without nanotechnology, and number of patents filed yearly. New technologies are being developed in several application areas.

Adult immunization practices, challenges and opportunities in Central America and the Caribbean: Advisory board proceedings.

As individuals age, they become increasingly prone to infectious diseases, many of which are vaccine-preventable diseases (VPDs). Adult immunization has become a public health priority in the modern era, yet VPDs vaccination rates for adults are low worldwide. In Central America and Caribbean, national recommendations and vaccination practices in adults differ across countries, and adult vaccination coverage data are limited. An advisory board comprised infectious disease experts, pulmonologists, geriatricians, occupational health, and public health professionals for Central America and Dominican Republic was convened to: a) describe adult immunization practices in these countries; b) discuss challenges and barriers to adult vaccination; and c) find strategies to increase awareness about VPDs. The advisory board discussions reflect that national immunization guidelines typically do not include routine vaccine recommendations for all adults, but rather focus on those with risk factors. This is the case for influenza, pneumococcal, and hepatitis B immunizations. Overall, knowledge lacks about the VPD burden among health-care professionals and the general public. Even more, there is insufficient information on vaccinology for students in medical schools. Actions from the responsible authorities - medical schools and scientific societies which can advocate for vaccination and a better knowledge in vaccinology - can help address these issues. A preventive medicine culture in the workplace may contribute to the advancement of public opinion on vaccination. Promoting vaccine education and research could be facilitated via working groups formed by disease experts, public and private sectors, and supranational authorities, in an ethical and transparent manner.

The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis.

Globally, an estimated 23 million children missed vaccination in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed vaccination coverage trends and catch-up strategies/recommendations implemented in Latin America during the pandemic. We performed a national administrative database analysis and a systematic literature review to evaluate vaccination coverage data and identify catch-up strategies for missed vaccinations in selected countries in Latin America (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Data were extracted from national health ministry vaccination coverage and supranational databases to identify coverage of rotavirus (RV), pentavalent/hexavalent, measles, Bacillus Calmette-Guérin (BCG) and pneumococcal conjugate vaccines (PCV) at country level before and during the COVID-19 pandemic. A systematic literature review of published papers was conducted to identify vaccination catch-up strategies published in January 2020-June 2021. National administrative database-reported data showed that vaccination coverage trends were declining prior to 2020. The change in vaccination coverage before and during the COVID-19 pandemic ranged from 2.5% to -11.5% (RV), -3.0% to -11.0% (measles), 1.5% to -7.5% (PCV), 9.0% to -14.0% (pentavalent/hexavalent), and 3.0% to -18.5% (BCG). Among 696 identified studies, 14 studies were included in this review. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. Overall vaccination coverage declined by varying degrees among the countries investigated. This trend was observed prior to 2020, suggesting multifactorial reasons for declining vaccination rates in Latin America.

What is the context? The coronavirus disease 2019 (COVID-19) led to health immunization disruptions in at least 68 countries, affecting around 80 million children.Routine childhood vaccination coverage was already suffering a decline in Latin America in the past decade, this situation could deteriorate further due to COVID-19.Consensus is lacking on the use of current guidelines and recommendations for catch-up vaccinations, as these are difficult to implement.What is new? We analyzed national health ministry databases to evaluate vaccination coverage trends in Latin America before and during the COVID-19 pandemic.We also conducted a systematic literature review to describe catch-up strategies for missed vaccinations during the pandemic.Vaccination coverage declined for the rotavirus, measles and pneumococcal conjugate vaccines at country level from 2017-2020.Pentavalent/hexavalent and Bacillus Calmette-Guerin vaccine coverage varied among countries for the same period.Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule.What is the impact? Continued efforts from healthcare officials and providers could prevent unvaccinated children from severe disease through catch-up vaccinations.

Consensus for the use of flash glucose monitoring in the Colombian adult population with type 1 and 2 diabetes mellitus / Consenso para el uso de monitoreo de glucosa flash en la población adulta colombiana con diabetes mellitus tipo 1 y 2

Abstract Introduction: in Colombia, the Clinical Practice Guidelines for the treatment of patients with type 1 (DM1) and type 2 (DM2) diabetes do not mention the use of flash glucose monitoring, as this system was not available. The objective of this study was to establish a set of recommendations for the use of intermittent flash monitoring in Colombia. Methods: the group of experts consisted of eight Colombian physicians from different cities within Colombia, with expertise in the management of patients with DM1 and DM2; a certified diabetes nurse educator; a patient with DM1; and a methodological expert. Using the Zoom Enterprise video conferencing application (Zoom Video Communications, San Jose, California), the group generated questions through the Metaplan method, then carried out a systematic literature search and evidence review. The recommendations were made according to the degree of evidence and strength of the recommendation, following the GRADE method. Results: clinical recommendations were made for: a) patients with DM1 and hypoglycemia; b) patients with DM1 and poor metabolic control; c) patients with insulin-treated DM2; d) pregestational diabetes; e) quality of life; and f) inpatient use. Conclusions: this consensus's clinical recommendations guide clinical decision making with regard to the use of intermittent flash monitoring in patients with diabetes in various clinical settings. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2239).

Resumen Introducción: en Colombia las Guías de Práctica Clínica para el manejo del paciente con diabetes tipo 1 (DM1) y tipo 2 (DM2) no mencionan el uso del monitoreo de glucosa flash dado que dicho sistema no estaba disponible. El objetivo del presente trabajo fue establecer un grupo de recomendaciones sobre el uso del monitoreo intermitente flash en Colombia. Métodos: el grupo de expertos estuvo conformado por ocho médicos colombianos expertos en el manejo de pacientes con DM1 y DM2 de diversas ciudades de Colombia, una enfermera licenciada educadora en diabetes, una paciente con diagnóstico de DM1 y un experto metodológico. A través de Zoom Enterprise versión de la aplicación de videoconferencia Zoom (Zoom Video Communications, San Jose, California) el grupo generó las preguntas con metodología Metaplan. Posteriormente, se realizó una búsqueda sistemática de la literatura y análisis de la evidencia. Las recomendaciones se generaron mediante grupo nominal según el grado de evidencia y la formaleza de la recomendación siguiendo la metodología GRADE. Resultados: se generaron recomendaciones clínicas enfocadas a: a) paciente con diagnóstico de DM1 e hipoglucemia; b) paciente con diagnóstico de DM1 y mal control metabólico, c) paciente con diagnóstico de DM tipo 2 tratado con insulina, d) diabetes pregestacional, e) calidad de vida y f) uso intrahospitalario. Conclusiones: las recomendaciones clínicas del presente consenso orientan la toma de decisiones clínicas con respecto al uso de monitoreo intermitente flash en el paciente con diagnóstico de diabetes en diferentes escenarios clínicos. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2239).

Development and Characterization of Powdered Antioxidant Compounds Made from Shiraz (Vitis vinifera L.) Grape Peels and Arrowroot (Maranta arundinacea L.).

Grapevine (Vitis vinifera L.) is a plant containing many phenolic compounds, mostly distributed in the peel, pulp, and seeds. This study evaluates the centesimal composition and bioactive compounds in Shiraz grape (Vitis vinifera) peels using spectrophotometric and UHPLC techniques and develops different formulations of compound powders from the peels and arrowroot using conventional drying technology. The results demonstrate that Shiraz grape skin contains significant amounts of insoluble fiber (15.3%), phenolics (157.09 ± 6.96-149.11 ± 9.27 mg GAE g-1), and flavonoids (0.75 ± 0.50-2.00 ± 0.50 mg QE g-1), with excellent antioxidant capacity observed in the alcoholic extracts. The phenolic content in the developed powdered compounds ranged from 128.32 to 139.70 mg GAE g-1. In general, the compounds showed good antioxidant capacity (IC50 = 0.17 to 0.19 µg mL-1). According to the chromatographic evaluation, it was possible to quantify gallic acid, catechin, and epicatechin, the latter of which was found in the largest quantities in the six formulations. The EV5 formulation was the most efficient in terms of phenolic compounds and protein amounts. This formulation's composition and low cost could make it viable for use in the food industry.

Syrah Grape Skin Residues Has Potential as Source of Antioxidant and Anti-Microbial Bioactive Compounds.

In this study, we evaluated the effects of ultrasound-assisted extraction (UAE) under different time-temperature conditions on the content of bioactive compounds, antioxidant and antimicrobial activities of Syrah grape skin residue. The application of UAE showed a positive effect on the extraction of total flavonoids, and a negative effect on total polyphenols. The temperature of 40 °C and 60 °C without the UAE caused an increase of 260% and 287% of the total polyphenols, respectively. Nineteen individually bioactive compounds were quantified. The anthocyanin concentration (malvidin-3,5-di-O-glucoside 118.8-324.5 mg/100 g) showed high variation, to a lesser extent for phenolic acids, flavonoids, flavonols, procyanidins and stilbenes due to the UAE process. The Syrah grape skin residue has a high concentration of total phenolic compounds of 196-733.7 mg·GAE/100 g and a total flavonoid content of 9.8-40.0 mg·QE/100 g. The results of free radical scavenging activity (16.0-48.7 mg/100 mL, as EC50) and its inhibition of microbial growth (0.16 mg/mL, as EC50 for S. aureus, and 0.04 mg/mL, as EC50 for E. coli) by grape skin extract (UAE 40:20) indicate high antioxidant and antibacterial activity. It was concluded that the use of ultrasound needs further analysis for its application in this context, as it has shown deleterious effects on some compounds of interest. Syrah grape skin residue has potential as a source of bioactive antioxidants, antimicrobial activity and for use as a functional food ingredient.

Cambios en el uso de anticonceptivos, embarazos no planificados e hijos en adolescentes chilenas entre 1997 y 2018 / Changes in the use of contraceptives, unplanned pregnancies and children in Chilean adolescents between 1997 and 2018

INTRODUCCIÓN: El embarazo en las adolescentes ha persistido como un problema de salud pública y social en Chile, afectando a las adolescentes más vulnerables y reflejando las desigualdades. OBJETIVO: Describir los cambios en el uso de anticonceptivos, embarazos no planificados e hijos en adolescentes chilenas entre 1997 y 2018. MÉTODO: Estudio ecológico de series temporales entre los años 1997 y 2018. Se midió la asociación entre variables sociodemográficas y efectividad del método anticonceptivo para los años 2006 y 2018, mediante la prueba estadística de Rao-Scott. Se estimaron tendencias del porcentaje de uso de métodos anticonceptivos según su eficacia y presencia de embarazos no planificados e hijos con modelos de regresión lineal (método de Prais-Winsten). RESULTADOS: Se observó un aumento en la frecuencia de adolescentes sexualmente activas y en el uso de anticonceptivos, especialmente píldoras e inyectables. La serie temporal de uso de anticonceptivos fue no estacionaria, la tendencia fue creciente (coeficiente: 4,59; intervalo de confianza del 95% [IC95%]: 3,43-5,74; p = 0,001), aumentando 4,59% cada 3 años. Las series de embarazos no planificados y tener hijos fueron series temporales no estacionarias y ambas presentaron una tendencia decreciente (coeficiente: −4,78; IC95%: −6,32 a −3,24; p = 0,002; y coeficiente: −3,93; IC95%: −6,18 a −1,68; p = 0,008), disminuyendo un 4,78% y un 3,93%, respectivamente, cada 3 años. CONCLUSIONES: El aumento en el uso de anticonceptivos en adolescentes ha ido unido a una importante disminución en los embarazos no planificados y los hijos en esta población.

INTRODUCTION: Adolescent pregnancy has persisted as a public and social health problem in Chile, affecting the most vulnerable adolescents and reflecting inequalities. OBJECTIVE: To describe the changes in the use of contraceptives, unplanned pregnancies and children in Chilean adolescents between 1997 and 2018. METHOD: Ecological study of time series between the years 1997 and 2018. The association between sociodemographic variables and the effectiveness of the contraceptive method for the years 2006 and 2018 was measured using the Rao-Scott statistical test. Trends in the percentage of use of contraceptive methods were estimated according to their efficacy and presence of unplanned pregnancies and children with linear regression models (Prais-Winsten method). RESULTS: An increase in the frequency of sexually active adolescents and the use of contraceptives, especially pills and injectables, was observed. The time series of contraceptive use was non-stationary, the trend was increasing (coefficient: 4.59; 95% confidence interval [95% CI]: 3.43-5.74; p = 0.001), increasing 4.59% every three years. The time series, unplanned pregnancies and having children were non-stationary time series, both showed a decreasing trend (coefficient: −4.78; 95%CI: −6.32 to −3.24; p = 0.002; and coefficient: −3.93; 95% CI: −6.18 to −1.68; p = 0.008), decreasing 4.78% and 3.93%, respectively, every 3 years. CONCLUSIONS: The increase in the use of contraceptives in adolescents has been linked to a significant decrease in unplanned pregnancies and children in this population.

Pregnant again? Perspectives of adolescent and young mothers who and do not experience a repeat pregnancy in adolescence.

Introduction: Teen pregnancy remains a major social and public health issue in developing countries. Each additional child compromises the development of both the mother and children. Scarce studies have been performed in Latin America.Purpose: This study explores and analyzes individual and family factors associated with repeat pregnancies during adolescence to better elucidate the phenomenon.Methods: Qualitative-descriptive study. Thirty semi-structured interviews were conducted with mothers 20 years of age or younger from urban areas of Santiago, Chile. Participants were divided into Repeat Pregnancy (RP) and No Repeat Pregnancy (NRP) groups. Qualitative data analysis was based on elements of grounded theory.Results: The RP group generally related life stories reflecting greater psychosocial vulnerability. Most of the RP group dropped out of school after their first pregnancy to focus on parenting and had a passive attitude towards contraception. In contrast, members of the NRP group actively sought long-term contraceptive methods, motivated largely by the desire to continue their education to improve their living conditions and achieve greater personal fulfilment. They tended to have family support networks that facilitated school retention.Conclusion: Key differences between groups included use of contraception, focus on life projects, and motivation to finish school. Prevention strategies should promote long-term contraceptive methods, offer strategies to help young mothers continue their education, facilitate achievement of personal projects, and provide support for parenting.

Site vs. core laboratory variability in computed tomographic angiography-derived SYNTAX scores in the SYNTAX III trial.

AIMS: To investigate the variability between site and core laboratory (CL) calculation of the anatomical SYNTAX score (SS) based on coronary computed tomography angiography (CTA) alone and functional SS based on coronary CTA and fractional flow reserve derived from computed tomography (FFRCT) in the SYNTAX III trial. METHODS AND RESULTS: The SYNTAX III trial was a multicentre, international study that included 223 patients with three-vessel disease with or without left main involvement. Functional SS was computed by subtracting non-flow limiting stenoses (FFRCT > 0.80) from anatomical SS. SS was combined with clinical information to generate the SYNTAX score II (SS II) that provides treatment recommendations. The mean anatomical SS based on coronary CTA alone was 33.4 ± 12.7 by sites and 37.1 ± 13.4 by CL (P < 0.001). The mean functional SS based on coronary CTA and FFRCT was 30.5 ± 13.0 by sites and 33.3 ± 13.6 by CL (P < 0.001). The intraclass correlation coefficient was 0.49 [95% confidence interval (CI) 0.37-0.59) in anatomical SS and 0.62 (95% CI 0.52-0.70) in functional SS. The Cohen's κ comparing treatment recommendation between sites and CL was 0.68 (95% CI 0.58-0.78) based on anatomical SS and 0.71 (95% CI 0.60-0.82) based on functional SS. CONCLUSION: The mean anatomical SS derived from coronary CTA alone and functional SS based on coronary CTA and FFRCT were higher when assessed by the CL than by the sites themselves. However, substantial agreement in treatment recommendation by SS II between sites and CL was demonstrated. CLINICAL TRIALS.GOV IDENTIFIER: NCT02385279.

Application of Liposomes in Cancer Therapy: An Assessment of the Advancement of Technology Through Patent Documents.

BACKGROUND: Cancer is caused by mutations in oncogenes and loss of tumor suppressor activity. Despite the efforts of the pharmaceutical industry to fight cancer, it is necessary to investigate new methods to enhance the action against this disease. In this scenario, liposome technology has emerged as a drug delivery system for cancer treatment. The objective of this study was to evaluate the use of liposome technology in the treatment of cancer through analysis of patent documents. METHODS: We analyzed prospective documents in the Derwent Innovation Index database. RESULTS: A total of 203 patent documents were related to the area of interest, published between 2000 and 2020, and the USA and Japan were shown as countries with the largest number of publications. Moreover, most of these publications came from companies, however, also with the representation of important universities, mainly the University of California. According to the International Patent Classification, the codes most applicable to the documents were in the areas of human necessities and chemistry. CONCLUSION: The results of this study showed that the study and application of liposomes for the development of cancer treatment tended to grow, along with the number of related patents.

Evaluation of the Technological Potential of Grape Peels Through Patent Document Analysis: Agro-industrial Waste with Biotechnological Potential.

BACKGROUND: Grape (Vitis vinifera L.) is consumed by old-world populations in its natural form and is used to produce wine or juice. Currently, China is the largest grape producer in the world. The red grapes stand out because of their phytochemical composition, more specifically their high resveratrol levels. Resveratrol is a compound that has a number of different beneficial effects on health and is mainly used in the food and cosmetic industries. Grape peel is a waste product and new strategies based on nanotechnology can minimize its environmental impact and add value to this residue. OBJECTIVES: The first objective of this study was to evaluate the technological potential of utilizing grape peel by researching and analyzing information extracted from patent documents filed worldwide in order to identify the main countries that hold the research technology, the main depositors and inventors, and the main areas of application. The second aim was to research and investigate grape peel products that have been created using nanotechnology. METHODS: An analysis of all patented documents related to grape peel processes, products, or different industrial applications that may use nanotechnology was carried out. This was achieved by undertaking a Derwent Innovation Index (DII) database search. RESULTS: A total of 752 patent documents were identified in the surveyed area. These were assessed for depositor country of origin, type of depositor, inventors, the evolution of deposits over time, and areas of application. Only 6% of the total represented products and processes in the nanotechnology area. There was a growth in the number of patent filings from 2015, which showed that the researched area is a current and developing technology with new application possibilities. The main depositing countries were China, the United States, and Japan, which dominate the researched technology. The identified documents discussed using the grape peel to develop new food, medical and dental products. CONCLUSION: Over the last few years, different approaches have been suggested for the production of nanoproducts based on grape peel. The results from this study showed that although incipient, nanotechnology is a promising area of research that can be explored by universities and companies because the products could have significant positive characteristics and, even though they are made out of a byproduct, have great application potential.

Effect of Experimental Parameters on the Extraction of Grape Seed Oil Obtained by Low Pressure and Supercritical Fluid Extraction.

Grape seeds are an important byproduct from the grape process. The objective of this work was to evaluate the effect of experimental parameters (temperature and time of pretreatment with ultrasound) to obtain grape seed oil using low pressure (Soxhlet-Sox and Bligh Dyer-BD) and high pressure (supercritical carbon dioxide-SFE) methods. The best condition for pretreatment of samples was 30 min of sonication at 30 °C before extraction by Sox or BD. Ultrasound pretreatment was efficient to increase oil extraction yield by 32.10 (Sox), 20.31 (BD) and 12.54% (SFE), depending on the extraction method used as well as, and certainly influenced the total phenolic concentration in 311 (Sox), 234 (BD), and 184 (SFE)%. Ten fatty acids were identified in the oils, the major ones being 18:2ω-6cis (linoleic 52.39%-63.12%), 16:0 (palmitic 20.22%-26.80%) and 18:0 (stearic 8.52%-13.68%). The highest epicatechin concentration was identified in the BD sample: 30-30 (150.49 ± 5.98mg/kg), which presented a concentration of ≥3 times compared to the control (56.68 ± 1.81mg/kg). Ultrasound pretreatment also contributed positively (56% and 99% increase) in the α-tocopherol content of the SFE: 30-30 and BD: 30-30 samples, respectively. The results indicate that the ultrasound pretreatment is a suitable technology to improve the quality of the oil from the grape seed.

Physicochemical and sensory profile of Beauregard sweet potato beer.

Beer has been one of the most consumed alcoholic beverages worldwide. However, the incorporation of adjuncts in the beer can add new organoleptic and functional characteristics to the beverage. For this, Beauregard sweet potato shows high potential due to being a rich source of starch and many bioactive compounds. The aim of this study was to develop the best process condition to produce a Sweet potato beer with enhanced nutritional and antioxidant properties and good sensory characteristics. Beer samples showed increased antioxidant activity especially due to ß-carotene and their total phenolic content. The phytochemical profile of sweet potato biocompounds demonstrated a direct effect of this adjunct on sensory and functional characteristics of the finished beer. In conclusion, it was found that Beauregard sweet potato is a promising adjunct for beer brewing with nutraceutical properties due to its rich composition of bioactive compounds.

Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial.

BACKGROUND: Fractional flow reserve (FFR) is a reliable tool for the functional assessment of coronary stenoses. FFR computed tomography (CT) derived (FFRCT) has shown to be accurate, but its clinical usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the impact of FFRCT on heart team's treatment decision-making and selection of vessels for revascularization in patients with 3-vessel coronary artery disease. METHODS: The trial was an international, multicenter study randomizing 2 heart teams to make a treatment decision between percutaneous coronary interventions and coronary artery bypass grafting using either coronary computed tomography angiography or conventional angiography. The heart teams received the FFRCT and had to make a treatment decision and planning integrating the functional component of the stenoses. Each heart team calculated the anatomic SYNTAX score, the noninvasive functional SYNTAX score and subsequently integrated the clinical information to compute the SYNTAX score III providing a treatment recommendation, that is, coronary artery bypass grafting, percutaneous coronary intervention, or equipoise coronary artery bypass grafting-percutaneous coronary intervention. The primary objective was to determine the proportion of patients in whom FFRCT changed the treatment decision and planning. RESULTS: Overall, 223 patients were included. Coronary computed tomography angiography assessment was feasible in 99% of the patients and FFRCT analysis in 88%. FFRCT was available for 1030 lesions (mean FFRCT value 0.64±13). A treatment recommendation of coronary artery bypass grafting was made in 24% of the patients with coronary computed tomography angiography with FFRCT. The addition of FFRCT changed the treatment decision in 7% of the patients and modified selection of vessels for revascularization in 12%. With conventional angiography as reference, FFRCT assessment resulted in reclassification of 14% of patients from intermediate and high to low SYNTAX score tertile. CONCLUSIONS: In patients with 3-vessel coronary artery disease, a noninvasive physiology assessment using FFRCT changed heart team's treatment decision-making and procedural planning in one-fifth of the patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02813473.

Effect of Cellulose Nanocrystals from Different Lignocellulosic Residues to Chitosan/Glycerol Films.

Interest in nanocellulose obtained from natural resources has grown, mainly due to the characteristics that these materials provide when incorporated in biodegradable films as an alternative for the improvement of the properties of nanocomposites. The main purpose of this work was to investigate the effect of the incorporation of nanocellulose obtained from different fibers (corncob, corn husk, coconut shell, and wheat bran) into the chitosan/glycerol films. The nanocellulose were obtained through acid hydrolysis. The properties of the different nanobiocomposites were comparatively evaluated, including their barrier and mechanical properties. The nanocrystals obtained for coconut shell (CS), corn husk (CH), and corncob (CC) presented a length / diameter ratio of 40.18, 40.86, and 32.19, respectively. Wheat bran (WB) was not considered an interesting source of nanocrystals, which may be justified due to the low percentage of cellulose. Significant differences were observed in the properties of the films studied. The water activity varied from 0.601 (WB Film) to 0.658 (CH Film) and the moisture content from 15.13 (CS Film) to 20.86 (WB Film). The highest values for tensile strength were presented for CC (11.43 MPa) and CS (11.38 MPa) films, and this propriety was significantly increased by nanocellulose addition. The results showed that the source of the nanocrystal determined the properties of the chitosan/glycerol films.

Identifying Data Elements to Measure Frailty in a Dutch Nationwide Electronic Medical Record Database for Use in Postmarketing Safety Evaluation: An Exploratory Study.

INTRODUCTION: The role of frailty in postmarketing drug safety is increasingly acknowledged. Few European electronic medical records (EMRs) have been used to explore frailty in observational drug safety research. OBJECTIVE: The aim of this study was to identify data elements, beyond multimorbidity and polypharmacy, that could potentially contribute to measuring frailty among older adults in the Dutch nationwide Integrated Primary Care Information (IPCI) database. METHODS: Persons aged between 65 and 90 years in the IPCI database were identified from 2008 to 2013. Clinical non-disease, non-drug measurements that could potentially contribute to measuring frailty were identified and selected if they were recorded in > 0.005% of patients and could be included in at least one of three definitions of frailty: the frailty phenotype model, the cumulative deficit model, and direct evaluations of frailty through standardized frailty scores. The frequency of these measures was calculated. RESULTS: Overall, 314,191 (17% of the source population) elderly persons were identified. Of these, 7948 (2.53%) had one or more of 12 clinical measurements identified that could potentially contribute to measuring frailty, such as clinical evaluations of cognition, mobility, and cachexia, as well as direct measures of frailty, such as the Groningen Frailty Index. Three of five measurements required for the frailty phenotype were identified in < 0.5% of the population: cachexia, reduced walking speed, and reduced physical activity; weakness and fatigue were not identified. The measurements outlined above may be appropriate for the cumulative deficit definition of frailty, provided that at least 30 deficits, including comorbidities and drug utilization, are evaluated in total. The most commonly recorded item identified that could potentially be used in a cumulative frailty model was the Mini-Mental State Examination score (N= 2850; 0.91%); the only recorded direct measurement of frailty was the Groningen Frailty Index (N = 2382; 0.76%). CONCLUSION: Non-disease, non-drug clinical data that could potentially contribute to a frailty model was not commonly recorded in the IPCI; less than 3% of a cohort of elderly persons had these data recorded, suggesting that the use of these data in postmarketing drug safety evaluation may be limited.

Determinantes en la elección de anticonceptivos en adolescentes consultantes en un centro de atención de salud sexual y reproductiva / Determinants in the choice of contraceptives in adolescents consulting in a sexual and reproductive health care center

ANTECEDENTES: Preferencias personales y prioridades son factores importantes a considerar cuando se elige un método anticonceptivo, y son aspectos claves en la toma de decisiones de la población adolescente. OBJETIVO: Identificar los factores más relevantes al seleccionar un método anticonceptivo y sus razones para elegir o rechazar cada uno de los métodos anticonceptivos disponibles en adolescentes. MATERIAL Y MÉTODOS: Estudio transversal analítico. Un cuestionario anónimo y auto-administrado se aplicó a 116 adolescentes que consultaron durante un año a un centro de salud sexual y reproductiva. RESULTADOS: El inyectable fue el método que más conocen y que más usan, seguido de la píldora. La eficacia, protección contra ITS y regular los períodos menstruales son las tres más importantes razones para elegir un MAC. Mientras que las razones más importantes para no elegir la píldora fue tener que recordar su uso cada día. En el caso del implante, el miedo y dolor al colocarlo y removerlo fue la razón más importante. CONCLUSIÓN: A pesar que la confiabilidad y uso de larga duración pueden ser muy importantes ventajas para posponer embarazo en adolescentes, el miedo al dolor e inserción hacen que los métodos de larga duración como el implante y dispositivos intrauterinos sean menos atractivos para adolescentes.

BACKGROUND: Personal preferences and priorities are important factors to consider when choosing a contraceptive method, key aspects in the decision making of the adolescent population. OBJECTIVE: To identify the most relevant factors when selecting a contraceptive method and its reasons for choosing or rejecting each of the contraceptive methods available in adolescents. MATERIAL AND METHODS: Analytical cross-sectional study. An anonymous and self-administered questionnaire was administered to 116 adolescents who consulted for a year in a sexual and reproductive health center. RESULTS: The injectable method was the most known and most used followed by the pill. Efficacy, protection against STIs and regulation of menstrual bleeding are the three most important reasons for choosing a MAC. While the most important reasons for not choosing the pill was to have to remember its use every day, in the case of the implant, it was the fear and pain to place it and removed it. CONCLUSIONS: Although reliability and long-term use may be very important advantages in postponing pregnancy in adolescents, fear of pain and insertion make long-lasting methods such as implant and intrauterine devices less attractive for adolescents.

Identifying Cases of Type 2 Diabetes in Heterogeneous Data Sources: Strategy from the EMIF Project.

Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93-100%), while drug-based components were the main contributors in RLDs (81-100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies.

[The legal framework to prevent teenage pregnancies]. / Conocimientos y práctica clínica de los proveedores de salud para la prevención del embarazo adolescente según marco legal chileno.

BACKGROUND: There are legal regulations about sexual and reproductive rights of adolescents. However, this legal framework (LF) may have contradictory elements: there are laws assuring confidentiality and access to contraception at any age but there are other laws that consider any sexual contact with an adolescent younger than 14 a sexual assault, whose report to the legal authorities in mandatory. AIM: To explore the knowledge and clinical practice of primary health care (PHC) providers regarding prevention of teenage pregnancy. MATERIAL AND METHODS: Qualitative study collecting data using semi-structured interviews made to midwives and directors of PHC centers. Analysis of the data was based on Grounded Theory. RESULTS: There is a differentiated clinical care for pregnancy prevention among adolescents if they are over 14 years old. This is due to the LF, specifically to the sexual crime’s law (19,927) and the law about regulation of the fertility (20,418). The differences affect health care, access and counseling about contraception and confidentiality. Healthcare of teenagers under the age of 14 is perceived as problematic for providers, due to the possible legal implications. CONCLUSIONS: The LF causes insecurity on health care providers and derives in a differentiated clinical approach according to the patient´s age. This is a barrier to provide timely and confidential access to counseling and contraception.