Emerging Evidence on the Use of Probiotics and Prebiotics to Improve the Gut Microbiota of Older Adults with Frailty Syndrome: A Narrative Review.

BACKGROUND: The gut microbiota can impact older adults' health, especially in patients with frailty syndrome. Understanding the association between the gut microbiota and frailty syndrome will help to explain the etiology of age-related diseases. Low-grade systemic inflammation is a factor leading to geriatric disorders, which is known as "inflammaging". Intestinal dysbiosis has a direct relationship with low-grade systemic inflammation because when the natural gut barrier is altered by age or other factors, some microorganisms or their metabolites can cross this barrier and reach the systemic circulation. OBJECTIVES: This review had two general goals: first, to describe the characteristics of the gut microbiota associated with age-related diseases, specifically frailty syndrome. The second aim was to identify potential interventions to improve the composition and function of intestinal microbiota, consequently lessening the burden of patients with frailty syndrome. METHODS: A search of scientific evidence was performed in PubMed, Science Direct, and Redalyc using keywords such as "frailty", "elderly", "nutrient interventions", "probiotics", and "prebiotics". We included studies reporting the effects of nutrient supplementation on frailty syndrome and older adults. These studies were analyzed to identify novel therapeutic alternatives to improve gut microbiota characteristics as well as subclinical signs related to this condition. RESULTS: The gut microbiota participates in many metabolic processes that have an impact on the brain, muscles, and other organs. These processes integrate feedback mechanisms, comprising their respective axis with the intestine and the gut microbiota. Alterations in these associations can lead to frailty. We report a few interventions that demonstrate that prebiotics and probiotics could modulate the gut microbiota in humans. Furthermore, other nutritional interventions could be used in patients with frailty syndrome. CONCLUSION: Probiotics and prebiotics may potentially prevent frailty syndrome or improve the quality of life of patients with this disorder. However, there is not enough information about their appropriate doses and periods of administration. Therefore, further investigations are required to determine these factors and improve their efficacy as therapeutic approaches for frailty syndrome.

Complete Genome Sequence of Halomonas venusta Type Strain DSM 4743, a Moderately Halophilic Marine Bacterium.

Here, we report the genome sequence of Halomonas venusta strain DSM 4743T, a moderately halophilic marine bacterium. This type species genome consists of a 4.3-Mb chromosome, with 3,777 protein-coding genes, 60 tRNA loci, and 6 complete rRNA operons, plus a 6.1-kb plasmid termed p4743-A.

Simultaneous nitrification/denitrification and desulfurization of wastewater polluted with ammonium, COD and sulfide: effectiveness of a new up-flow vertical hybrid reactor.

Industrial wastewater discharges pose an environmental risk. Here, the effectiveness of an up-flow vertical hybrid system, operating with synthetic and industrial wastewater was investigated, as a new approach to perform nitrification/denitrification and desulfurization within a single reactor. The hybrid reactor is divided in two reaction zones, the oxic and anoxic. The removal of chemical oxygen demand (COD), ammonium, and sulfide was investigated, highlighting changes in microbial diversity. The reactor was evaluated at hydraulic residence time (HRT) of 1.6 days, and its performance throughout 180 days is presented in four stages. In stages I-II, high COD and ammonium removal was obtained with synthetic wastewater. In stage-III, sulfide-rich synthetic wastewater did not alter the system, attaining COD, ammonium, and sulfide removal efficiencies of 81, 99.5, and 99.7%, respectively. In the last stage, a mixture of effluents was fed into the reactor at loading rates of 277 mg COD/L-d, 46.5 mg NH4 +-N /L-d, and 15 mg HS--S /L-d. Sulfide and ammonium removals were 100% and 99.9%, respectively. However, low COD removal was observed, being of 51%, and the system removed 97% in terms of BOD5. The structure and microbial diversity also changed. Sulfide feeding, induced the proliferation of sulfur oxidizers like Thiomiscropira and Thiobacillus. Industrial wastewater enhanced the abundance of Pseudomonas (15.53%) and favored the proliferation of new bacteria of the genus Truepera (2.98%) and Alicyclipilus (7.56%). This is the first study reporting simultaneous nitrification/denitrification and desulfurization to remove ammonium, COD and sulfide from complex industrial wastewater using an up-flow vertical hybrid reactor.

[Anticoagulant induced intramural duodenal hematoma presenting as duodenal obstruction]. / Syndrome occlusif et hémorragique révélant un hématome duodénal intramural iatrogène.

An intramural hematoma of the duodenum was first reported in an article in the Lancet in 1838. At least, 90% of cases are caused by blunt abdominal trauma, typically accidents involving bicycles or motor vehicles. Intramural duodenal hematoma is a rare complication of anticoagulant therapy. It occurs in patients who receive excessive anticoagulation with warfarin or who have some other risk factor for bleeding. CT characteristics include circumferential wall thickening, intramural hyperdensity, luminal narrowing, and intestinal obstruction. Early diagnosis is crucial because most patients are treated nonoperatively with a good outcome.

[Opsoclonus-myoclonus syndrome: a case report]. / Syndrome opsoclonus-myoclonies : à propos d'un cas.

Opsoclonus-myoclonus syndrome is a rare disorder. We report a 44-year-old patient with opsoclonus associated with a cerebellar syndrome revealing a small cell lung carcinoma. The treatment with chemotherapy initially improved the clinical symptoms but these eventually recurred. Opsoclonus is a complex disorder of the ocular motility, characterized by irregular, continuous and chaotic eye saccades. When it is associated with other manifestations of the central nervous system (head myoclonus and ataxia), it constitutes a clinical picture known as opsoclonus-myoclonus syndrome. In adults, the most frequent causes are post-infectious, paraneoplastic and idiopathic. The symptomatic treatment is not defined, but the treatment of the underlying cause may improve the clinical features of this syndrome.

Control de calidad en cirugía mayor y menor ambulatoria / No disponible

Introducción: Entre los medios para conseguir una mejor asistencia progresiva en la unidad de cirugía ambulatoria (UCMA )están la medición y evaluación de los resultados, comparándolos con otras unidades y la posterior aplicación de correcciones. Las publicaciones citan unos indicadores constantes y otros variables no figurando siempre la complejidad de los procedimientos. La cirugía menor ambulatoria (cma) es una alternativa a la UCMA cada vez mayor para determinados procedimientos y sus indicadores de calidad no están establecidos. Material y métodos: Exponemos nuestra casuística de 13 años en la UCMA y de 7,5 en cma. Utilizamos como indicadores de calidad en la UCMA: índice de sustitución, ingresos (inmediatos y diferidos), anulaciones, visitas a urgencias y llamadas telefónicas; los comparamos con otras series. En cma hemos valorado los casos fallidos. Entregamos una encuesta de satisfacción y dos escala spsiquiátricas para evaluar el estado de ansiedad a 117 pacientes. Resultados: Asistimos en la UCMA 1.467 pacientes. Ingresos 3%, reingresos 0,34%, anulaciones 0,75%, llamadas 10,4%,índice de sustitución general 25%. En las 1.346 pacientes asistidas en cma los fracasos oscilaron, según los procedimientos, entre 2,5 y 22%. Promedio de satisfacción en CMA 9,4/10 y en cma8,9/10. Conclusiones: La evolución de nuestra calidad es favorable aunque podemos mejorar algunos aspectos. Convendría unificarlos índices utilizados para hacer más fácil el estudio comparativo entre unidades. El índice de sustitución debería referirse a los procedimientos susceptibles de realizarse en la UCMA. Sería conveniente notificar las intervenciones que han pasado de efectuarse en la UCMA a cma (AU)

Introduction: One of the means used to achieve a better progressive assistance in the Ambulatory Surgical Unit (ASU) is, first of all, to measure and to evaluate the results, comparing them with those of other units, and, then, to apply improvements. Publications mention some changing and some unchanging indicators, and the complexity of the procedures is not always mentioned. Outpatient Surgery (OS) is an increasing alternative to Ambulatory Surgery for certain procedures, and its quality indicators have not yet been established. Material and methods: We present our case history of the last 13 years in the ASU and of 7.5 years in the OS. The ASU quality indicators being used were: the replacement index, admissions(immediate and deferred), cancellations, visits to the emergency room and phone calls, and we compared them with other case histories. In OS, we have valued the unsuccessful cases. We handed out a satisfaction questionnaire and two psychiatric scalesto evaluate the anxiety state of 117 patients. Results: We attended 1,467 patients in the ASU. The admissions represented a 3%; readmissions, 0.34%; cancellations,0.75%; phone calls, 10.4%, and general substitution index, 25%. Amongst the 1,346 patients attended in OS, the unsuccessful cases varied from 2.5% to 22%, depending on the procedures. The average of satisfaction in the ASU was 9.4/10, and in OS was 8.9/10.Conclusions: The development of our quality control index is favorable, although some aspects may be improved. Some of the indexes being used should be unified in order to make the comparative study amongst Units easier. The replacement index should refer to procedures susceptible to being carried out in the ASU. It would be advisable to notify which surgical procedures were performed in the ASU and are now performed in OS (AU)

UCMA ginecológica: experiencia de 10 años / Gynaecological ambulatory surgery: 10 years experience

INTRODUCCIÓN: Nuestro hospital dispone de una Unidad de Cirugía Mayor Ambulatoria (UCMA) autónoma, integrada al mismo, con la que comparte el área quirúrgica. Ginecología se incorporó a la UCMA en julio de 1994 y tras 10 años de actividad, habiendo sobrepasado las 1.000 intervenciones, hemos creido oportuno revisar y presentar nuestra casuística, con las nuevas indicaciones y las que hemos abandonado. Comentamos las posibilidades futuras de nuestra especialidad en Cirugía Mayor Ambulatoria (cma). MATERIAL y Métodos. Efectuamos un estudio retrospectivo de nuestra experiencia durante 10 años (julio 1994 – junio 2004). Exponemos las indicaciones y su evolución. Efectuamos el control de calidad mediante los ingresos inmediatos y diferidos, anulaciones y llamadas telefónicas. Analizamos las repercusiones de la UCMA sobre nuestra actividad quirúrgica general y sobre la productividad. RSULTADOS: Durante este período efectuamos 4.369 intervenciones, 1.141 (26%) en la UCMA. El Servicio de Ginecología participó con el 7% en la actividad total de la UCMA, que recibió durante este período 16.513 pacientes. Las intervenciones más frecuentes fueron histerosocpia de flujo (47,5%), laparoscopia (19,5%) y cirugía mamaria (14%). Hemos dejado de efectuar el legrado uterino. Iniciamos la minilaparosocpia para la (..) (AU)

INTRODUCTION: Our hospital has an autonomous Ambulatory Surgical (ASU) which is into the main building and shares the Surgical Area with the rest of the hospital. The Department of Gynaecology was incorporated into this ASU in July 1994. After ten years of activity and having done over 1,000 operations, we have thought fit to review and present our case history, with the new procedures that have been included and those that were abandoned. We will comment onthe future possibilities of our speciality in Ambulatory Surgery (AS). MATERIAL AND METHODS: we carried out a retrospective study of our experience over 10 years (July 1994 – Jun 2004). We described the surgical indications and their evolution. The control of quality was evaluated by means of the most significant indicators: immediate hospital admission, delayed re-admissions, cancellations and phone calls to the ASU. We analyzed the influence of its activity on our general surgical activity and productivity. RESULTS: Over these 10 years we have carried out 4,369 gynaecological procedures, 1,141 (26%) of them were performed in the ASU. The Gynaecological Department took part with 7% of the total activity of the ASU, where 16,513 patients from all the surgical specialities were received. The most frequent procedures were: hysteroscopy (47.5%), laparosocpy (19.5%) and breast surgery (14%). We stopped doing uterine curettage. We recently started mini-laparosocpy for tubal occlusion, under local anesthesia and sedation, in 26 patients; we have increased the surgical indications for laparoscopy for treatment of adnexal pathology. In breast surgery, 3 cases of sentinel node biopsy were included, we decreased the number of biopsies of non-palpable lesions, previously marked with a needle. We started to perform vaginal hysterectomy at the end of this series. We had 37 (3.2%) immediate admissions, 5 (0.4%) delayed re-admissions, 10 (0.9%) cancellations and 138 (12%) telephone calls. During this time, we have improved our Ambulatory Surgery and Office Surgery activites, with the consequent increase inproductivity. DISCUSSION: Our speciality has great possibilities in AS. We have updated some resources procedures (Le Font operation and Manchester Operation), included some new techniques (continous flow histeroscopy, mini-laparoscopy, sentinel node biopsy), and we have abandoned some others (uterine curettage, breast biopsy with needle localization). Our Quality controls are appropriated, and we have increases our surgical productivity,. In the future. We want to add hysterosocpic tubal occlusion and the treatment of urinary stress incontinence with tension-free vaginal tape (TVT) to our surgical indications (AU)