Proceso INFORNUT: validación de la fase de filtro-FILNUT--y comparación con otros métodos de detección precoz de desnutrición hospitalaria.

INTRODUCTION According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. OBJECTIVES To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. MATERIAL AND METHODS In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull's method, CONUT and INFORNUT were done. The settings of the INFORNUT filter were: albumin < 3.5 g/dL, and/or total proteins <5 g/dL, and/or prealbumin <18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol <180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. RESULTS In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66.9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. CONCLUSIONS Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.

Incidence and transmission patterns of tuberculosis among indigenous populations in Brazil

Approximately 10% of the Brazilian indigenous population lives in the state of Mato Grosso do Sul (MS), where a large number of new cases of tuberculosis (TB) are reported. This study was conducted to assess TB occurrence, transmission and the utility of TB diagnosis based on the Ogawa-Kudoh (O-K) culture method in this remote population. The incidence of TB was estimated by a retrospective review of the surveillance data maintained by the Notifiable Diseases Surveillance System for the study region. The TB transmission pattern among indigenous people was assessed by genotyping Mycobacterium tuberculosis isolates using the IS 6110restriction fragment length polymorphism (RFLP) technique. Of the 3,093 cases identified from 1999-2001, 610 (~20%) were indigenous patients (average incidence: 377/100,000/year). The use of the O-K culture method increased the number of diagnosed cases by 34.1%. Of the genotyped isolates from 52 indigenous patients, 33 (63.5%) belonged to cluster RFLP patterns, indicating recently transmitted TB. These results demonstrate high, on-going TB transmission rates among the indigenous people of MS and indicate that new efforts are needed to disrupt these current transmissions.

Four main virotypes among extended-spectrum-β-lactamase-producing isolates of Escherichia coli O25b:H4-B2-ST131: bacterial, epidemiological, and clinical characteristics.

A total of 1,021 extended-spectrum-β-lactamase-producing Escherichia coli (ESBLEC) isolates obtained in 2006 during a Spanish national survey conducted in 44 hospitals were analyzed for the presence of the O25b:H4-B2-ST131 (sequence type 131) clonal group. Overall, 195 (19%) O25b-ST131 isolates were detected, with prevalence rates ranging from 0% to 52% per hospital. Molecular characterization of 130 representative O25b-ST131 isolates showed that 96 (74%) were positive for CTX-M-15, 15 (12%) for CTX-M-14, 9 (7%) for SHV-12, 6 (5%) for CTX-M-9, 5 (4%) for CTX-M-32, and 1 (0.7%) each for CTX-M-3 and the new ESBL enzyme CTX-M-103. The 130 O25b-ST131 isolates exhibited relatively high virulence scores (mean, 14.4 virulence genes). Although the virulence profiles of the O25b-ST131 isolates were fairly homogeneous, they could be classified into four main virotypes based on the presence or absence of four distinctive virulence genes: virotypes A (22%) (afa FM955459 positive, iroN negative, ibeA negative, sat positive or negative), B (31%) (afa FM955459 negative, iroN positive, ibeA negative, sat positive or negative), C (32%) (afa FM955459 negative, iroN negative, ibeA negative, sat positive), and D (13%) (afa FM955459 negative, iroN positive or negative, ibeA positive, sat positive or negative). The four virotypes were also identified in other countries, with virotype C being overrepresented internationally. Correspondingly, an analysis of XbaI macrorestriction profiles revealed four major clusters, which were largely virotype specific. Certain epidemiological and clinical features corresponded with the virotype. Statistically significant virotype-specific associations included, for virotype B, older age and a lower frequency of infection (versus colonization), for virotype C, a higher frequency of infection, and for virotype D, younger age and community-acquired infections. In isolates of the O25b:H4-B2-ST131 clonal group, these findings uniquely define four main virotypes, which are internationally distributed, correspond with pulsed-field gel electrophoresis (PFGE) profiles, and exhibit distinctive clinical-epidemiological associations.

Lactic acid bacteria from fresh fruit and vegetables as biocontrol agents of phytopathogenic bacteria and fungi

This study evaluated the efficacy of lactic acid bacteria (LAB) isolated from fresh fruits and vegetables as biocontrol agents against the phytopathogenic and spoilage bacteria and fungi, Xanthomonas campestris, Erwinia carotovora, Penicillium expansum, Monilinia laxa, and Botrytis cinerea. The antagonistic activity of 496 LAB strains was tested in vitro and all tested microorganisms except P. expansum were inhibited by at least one isolate. The 496 isolates were also analyzed for the inhibition of P. expansum infection in wounds of Golden Delicious apples. Four strains (TC97, AC318, TM319, and FF441) reduced the fungal rot diameter of the apples by 20%; only Weissella cibaria strain TM128 decreased infection levels by 50%. Cell-free supernatants of selected antagonistic bacteria were studied to determine the nature of the antimicrobial compounds produced. Organic acids were the preferred mediators of inhibition but hydrogen peroxide was also detected when strains BC48, TM128, PM141 and FF441 were tested against E. carotovora. While previous reports of antifungal activity by LAB are scarce, our results support the potential of LAB as biocontrol agents against postharvest rot. [Int Microbiol 2008; 11(4):231-236]

La LAU ante la crisis inmobiliaria

El present Treball de Fi de Carrera du a terme un anàlisi de l’evolució del mercat de la vivenda de lloguer a Espanya. Degut a la crisi immobiliària iniciada a l’any 2008, es posa en evidència la necessitat de potenciar l’arrendament al nostre país, opció que històricament es presentava en clar desavantatge enfront a la compra d’un immoble, però que en l’actualitat s’erigeix com una solució realista al problema d’accés a un habitatge digne. Per aquest motiu, s’analitza l’ampli ventall de normatives adoptades a través del temps, profunditzant en el problema de la vivenda i les dades rellevants a tenir en compte. Es fa menció especial al registre de morosos, un instrument que pretén pal·liar la manca de voluntat per part dels propietaris d’arrendar els seus immobles, de manera que es garanteixin els drets d’ambdues parts implicades, tenint en consideració el període de crisis en el que estem immersos en l’actualitat.

Qualitat microbiològica dels productes vegetals frescos mínimament processats i desenvolupament de tecnologies de bioconservació mitjançant bacteris de l'àcid làctic

Food safety today is conditiones by the implementation of new Tecnologies for food preservation based on mild treatments and mínimum process, Novel foods, severe restrictions in the toxicològic profile of chemical preservatives, And the drastic limitation /prohibition of antibiotics, and as a consequence, by the New emergint pathogens or by the increase of classical food-borne pathogens. Biopreservatives appear within this context with strong expectations, because thei are safe microorganisms of ten isolated from foods, chemical compounds of natural origin -antimicrobial peptides and proteins, botanical extracts, enzymes- and sintetic compounds based on natural structures, but less toxic and more eficients, like the amtimicrobial peptides. Among the microbial biopreservatives, lactic acid bacteria have shown great possibilities in the preservation of cured meat products, ready to eat fresh fruit and vegetables, as well as to decrease microbial spoilage in food by products before processing for valorization. Our laboratory has performed an extense survey of the microbiological quality of fresh fruit and vegetables, and of ready-to-eat products, and have detect low levels, but significant of Salmonella sp., E. coli and Listeria spp., including L.monocytogenes, in retail markets and Supermarkets of Catalonia. Due to this reason, we started a project consisting of Developing application of lactic acid bacteria (LAB) obtained from these products, as biopreservatives. LAB were abundant in ready-to-eat fresh fruits and vegetables, specially in germinated seeds. From these products we obtained strains of Leuconostoc, Lactobacillus and Weissella, producing bacteriocins and with a Significant activity of control of L.monocytogenes in fresh apple and cut salad. Ather strains were efective in the inhibition of fungal rot during postharvest caused by Penicillium expansum

Biologia de ninfas e adultos do percevejo-verde em estruturas reprodutivas de algodoeiro

O objetivo deste trabalho foi determinar a biologia de ninfas e adultos do percevejo-verde em estruturas reprodutivas do algodoeiro. Os alimentos testados foram: dieta padrão, contendo vagem de feijão, amendoim cru e frutos de ligustro; vagem verde de soja; semente de soja; botão floral de algodoeiro; e maçãs e sementes de algodoeiro. Foram avaliados os parâmetros biológicos: período de desenvolvimento e sobrevivência ninfal; longevidade de fêmeas e machos; percentagem de fêmeas em oviposição; períodos de pré-oviposição e oviposição; número total de ovos por fêmea; e viabilidade dos ovos. Ninfas alimentadas com estruturas reprodutivas do algodoeiro morreram no segundo ou no terceiro ínstar. Adultos alimentados com botão floral e semente de algodoeiro não se reproduzem; porém, há reprodução quando adultos os de percevejo-verde são alimentados com maçã de algodoeiro, o que indica a capacidade de adaptação da espécie na fase reprodutiva do algodoeiro.

E-portal de cartografía de las bibliotecas de la UPC: acceso a las colecciones mediante un mapa sensible

Peer Reviewed

Espessura do músculo adutor do polegar: um método rápido e confiável na avaliação nutricional de pacientes cirúrgicos

OBJETIVO: Determinar se a medida da espessura do músculo adutor do polegar é confiável para avaliação nutricional de pacientes cirúrgicos e se correlaciona bem com outros parâmetros antropométricos, bioquímicos e clínicos. MÉTODOS: Estudo de corte transversal, com avaliação de 87 pacientes candidatos à procedimento cirúrgico de grande porte no trato gastrointestinal. Eles foram submetidos à avaliação nutricional através da avaliação subjetiva global, antropometria (circunferência do braço, prega cutânea triciptal, e circunferência muscular do braço), albumina sérica, linfocitometria e pela medida da espessura do músculo adutor do polegar em ambas as mãos. RESULTADOS: A média da espessura da mão dominante (direita) foi de 12,64 ± 3,19 mm e da mão não dominante 12,23 ± 2,9 mm. Para desnutrição, a sensibilidade da espessura do músculo adutor do polegar direita foi de 72,37% e da esquerda de 77,33% para os pontos de cortes encontrados com a curva Receiver Operating Characteristic (13,4 e 13,1 mm respectivamente). Para ambas as mãos a especificidade foi de 100%. Encontrou-se correlação significativa (p<0,01) da espessura do músculo adutor do polegar com todas as outras técnicas antropométricas de avaliação nutricional. Os seus valores médios nos pacientes eutróficos segundo a avaliação subjetiva global foram significativamente maiores (P<0.001) que dos desnutridos leves, e estes também maiores (P<0,05) que os desnutridos graves (avaliação subjetiva global-C). CONCLUSÃO: a espessura do músculo adutor do polegar é um método de fácil execução, baixo custo, confiável e transmite segurança na avaliação do estado nutricional, podendo ser usado na prática clínica em pacientes cirúrgicos.

Concepto de los profesionales encargados sobre el programa de promoción y prevención para adolescentes

Con este estudio se pretende identificar el concepto de los profesionales encargados sobre los programas de Promoción y Prevención en los adolescentes en las instituciones de primer Nivel de Atención de la Secretaria Distrital de Salud.

Una proposta de treball cooperatiu a l'entorn de la comprensió i l'expressió basada en la lectura, l'escriptura i les eines telemàtiques. 'Una propuesta de trabajo cooperativo en el entorno de la comprensión y la expresión basada en la lectura, la escritura y las herramientas telemáticas'.

Resumen de la revista en catalán. Este artículo forma parte del monográfico 'Les TIC : una eina per aprendre llengua'

L'ús del català en la població escolaritzada de Can Parellada (Terrassa). 'El uso del catalán en la población escolarizada de Can Parellada (Terrassa)'.

Análisis del uso de catalán entre los escolares de Can Parellada, un barrio de Terrassa. A partir de un trabajo de investigación de bachillerato realizado por cuatro alumnas, se establecen una serie de hipótesis sobre este tema.

Enseñar y aprender en un espacio cibernético.

resumen basado en el de la publicación

Lactic acid bacteria as bioprotective agents against foodborne pathogens and spoilage microorganisms in fresh fruits and vegetables

La present tesi doctoral es centra en l'aplicació dels bacteris de l'àcid lactic (BAL) com a agents bioprotectors davant microorganismes patògens i deteriorants.Es van aïllar i seleccionar BAL de fruites i hortalisses fresques i es van assajar in vitro davant 5 microorganismes fitopatògens i 5 patògens humans.Es van realitzar assajos d'eficàcia en pomes Golden Delicious amb tots els aïllats enfront les infeccions causades pel fong Penicillium expansum. La soca més eficaç era Weissella cibaria TM128, que reduïa el diàmetre de les infeccions en un 50%.Les soques seleccionades es van assajar enfront els patògens Salmonella typhimurium, Escherichia coli i Listeria monocytogenes en enciams Iceberg i pomes Golden Delicious.Els BAL interferien eficientment amb el creixemet de S. typhimurium, and L. monocytogenes, però van mostrar poc efecte enfront E. coli.Finalment, es van realitzar assajos dosi-resposta amb les soques Leuconostoc mesenteroides CM135, CM160 and PM249 enfront L. monocytogenes. De totes les soques assajades, la soca CM160 va ser la més efectiva.