Resumen: Un paciente que se somete a una cirugía mayor se enfrenta a un factor estresante importante. Dependiendo de la mag nitud de la cirugía, la respuesta al estrés quirúrgico puede alterar los procesos metabólicos y la homeostasis. A pesar de cualquier complicación quirúrgica, se ha demostrado que las cirugías mayores reducen la capacidad fisiológica y funcional del individuo. Al mismo tiempo, la inactividad y el reposo en cama pueden inducir una rápida atrofia muscular. Estas consecuencias se asocian a perores resultados quirúrgicos. La pre-habilitación quirúrgica es un enfoque innovador en el campo de la medicina que busca mejorar los resultados de los pacientes sometidos a cirugía mediante la optimización de su estado físico y mental antes de la intervención quirúrgica. A diferencia de la rehabilitación, que se lleva a cabo después de la cirugía para ayudar en la recuperación, la pre-habilitación se realiza antes de la operación con el objetivo de preparar al paciente de manera integral. El objetivo principal de la pre-habilitación quirúrgica es minimizar los efectos negativos de la cirugía, acelerar la recuperación y mejorar la calidad de vida después de la intervención. Para lograr esto, se implementan diferentes intervenciones multidisciplinarias que abordan aspectos físicos, emocionales y nutricionales del paciente. En este artículo, exploramos el concepto de prehabilitación como una herramienta eficaz para mejorar los resultados de las intervenciones quirúrgicas. Discutimos diferentes estrategias y enfoques que pueden implementarse como parte de la prehabilitación quirúrgica, con el objetivo de minimizar complicaciones, acelerar la recuperación y mejorar la calidad de vida postoperatoria. Además, examinamos la evidencia actual disponible y resaltamos la necesidad de futuras investigaciones para validar y ampliar el conocimiento sobre esta prometedora área en la medicina perioperatoria.

Abstract: Patients undergoing major surgery face an important stress factor. Depending on the significance of the surgery, response to surgical stress may alter metabolic processes and surgical stress response. Despite any surgical complication, there is evidence that major surgeries reduce the physiological and functional capacity of individuals. Simultaneously, inactivity and bed rest may result in rapid muscle atrophy. These consequences are often associated to worsened surgical outcome. Prehabilitation in patients undergoing surgery constitutes an innovative approach in the field of medicine that seeks to improve surgical outcome of patients by optimizing their physical and mental conditions before surgery. Unlike rehabilitation that takes place after surgery to contribute to recovery, prehabilitation is done before surgery and aims to the comprehensive preparation of patients. The main objective of surgical prehabilitation is to minimize the negative effects of surgery, accelerate recovery and improve the quality of life after surgery. To that end, different multidisciplinary interventions are applied to address physical, emotional and nutritional aspects of patients. The study explores the concept of rehabilitation as an effective tool to improve patient’s outcome after surgery. Different strategies and approaches that may be implemented as part of surgical rehabilitation are discussed, with the purpose of minimizing complications, accelerating recovery and improving postoperative quality of life. Besides, the study analyzes current evidence available and emphasize on the need to conduct further research to validate and amplify knowledge on this promising area o perioperative medicine.

Resumo: Um paciente submetido a uma cirurgia de grande porte enfrenta um grande estressor. Dependendo da magnitude da cirurgia, a resposta ao estresse cirúrgico pode alterar os processos metabólicos e a homeostase. Independentemente das possíveis complicações cirúrgicas, as cirurgias de grande porte demonstraram reduzir a capacidade fisiológica e funcional do indivíduo. Ao mesmo tempo, a inatividade e o repouso no leito podem induzir uma rápida atrofia muscular. Essas consequências estão associadas a piores resultados cirúrgicos. A pré-habilitação cirúrgica é uma abordagem inovadora na área da medicina que busca melhorar os resultados dos pacientes submetidos à cirurgia, otimizando seu estado físico e mental antes da cirurgia. Ao contrário da reabilitação, que é realizada após a cirurgia para auxiliar na recuperação, a pré-habilitação é realizada antes da operação com o objetivo de preparar o paciente de forma integral. O principal objetivo da pré-habilitação cirúrgica é minimizar os efeitos negativos da cirurgia, acelerar a recuperação e melhorar a qualidade de vida após a cirurgia. Para conseguir isso, são implementadas diferentes intervenções multidisciplinares que abordam aspectos físicos, emocionais e nutricionais do paciente. Neste artigo, exploramos o conceito de pré-habilitação como uma ferramenta eficaz para melhorar os resultados das intervenções cirúrgicas. Discutimos diferentes estratégias e abordagens que podem ser implementadas como parte da pré-habilitação cirúrgica, com o objetivo de minimizar complicações, acelerar a recuperação e melhorar a qualidade de vida pós-operatória. Além disso, revisamos as evidências atualmente disponíveis e destacamos a necessidade de pesquisas futuras para validar e expandir o conhecimento sobre essa promissora área da medicina perioperatória.

ABSTRACT Some studies have found that severity of COVID-19 is associated with a high viral load determined by the number of cycles (Ct) of SARS-CoV-2 DNA amplification. The objective was to determine the relationship between the Ct value and the severity of the SARS-COV-2 virus infection in inpatients and outpatients at a reference hospital in Paraguay between March and June 2021. Cross-sectional retrospective study of adult patients with COVID-19, ambulatory and hospitalized admitted to the National Hospital. Patients whose infection was confirmed by RT-PCR for SARS-CoV-2 were included, a cut off point of Ct <25 was considered. Five hundred seventeen patients between 16 and 98 years of age were studied (mean ± SD: 51.5 ± 17.5), 268 men (51.8%), age> 60 years (36.6%), hospitalized (69.8%), admitted to ward (57.1%), and admitted to intensive care (12.8%), mean time of illness 8.48 ± 4.2 days and mortality was 22.2%. A higher risk of death was found for patients with Ct <25 for both gene E (OR: 1.61; 95% CI: 1.06-2.44) and gene N2 (OR: 1.83; 95% CI: 1.19- 2.80) and with age> 60 years (OR: 3.69; 95% CI: 2.39-5.68). These two factors remained associated with death in the multivariate analysis. There was a higher risk of hospitalization and death in patients with TC <25. Ct value could be useful for predicting clinical course and prognosis of COVID-19 patients.

RESUMEN Algunos estudios han encontrado que la severidad de la COVID-19 se asocia con una alta carga viral determinada por los números de ciclos (Ct) de amplificación de ADN de SARS-CoV-2. El objetivo fue determinar la relación entre el umbral de ciclos de PCR de SARS-CoV-2 y la severidad de la infección por el virus SARS-COV-2 en pacientes internados y ambulatorios en un hospital de referencia entre marzo a junio del 2021. Estudio retrospectivo observacional analítico de corte trasverso de pacientes adultos con COVID-19, ambulatorios e internados en el Hospital Nacional. Se incluyeron los pacientes cuya infección fue confirmada por RT-PCR para SARS-CoV-2, se consideró un punto de corte para Ct<25. Se estudiaron 517 pacientes entre 16 a 98 años de edad (media ± DE: 51,5±17,5), 268 varones (51,8%), edad >60 años (36,6%), estuvieron hospitalizados (69,8%), internados en sala (57,1%), y admitidos en cuidados intensivos (12,8%), tiempo medio de enfermedad 8,48 ± 4,2 días. La mortalidad fue de 22,2%. Se encontró mayor riesgo de fallecer para los pacientes con Ct <25 tanto para el gen E (OR: 1.61; IC95%: 1,06-2,44) como para el N2 (OR: 1.83; IC95%: 1,19-2,80) y con edad >60 años (OR: 3,69; IC95%: 2,39-5,68). Estos dos factores permanecieron asociados con el óbito en el análisis multivariado. Hubo mayor riesgo de hospitalizarse y fallecer en los pacientes con Ct<25. El valor Ct podría ser útil para la predicción del curso clínico y el pronóstico de los pacientes con COVID-19.

Resumen: La tuberculosis es una enfermedad infecciosa endémica en México, la cual es causada por Mycobacterium tuberculosis, un bacilo ácido-alcohol resistente. La principal afección orgánica es a nivel pulmonar; sin embargo, se ha reportado que hasta 25% de los casos pueden tener una afección extrapulmonar, ya sea por diseminación linfática o hematógena, y en casos aislados como primoinfección extrapulmonar. Presentamos el caso de un masculino de 62 años de edad con un cuadro de dolor abdominal de siete días de evolución asociado con melena, en la que se documentaron múltiples perforaciones ileales en el borde antimesentérico con diagnóstico histológico de tuberculosis intestinal. Esta entidad debe sospecharse en pacientes con tratamiento inmunosupresor crónico y deben realizarse medidas de escrutinio de manera preventiva.

Abstract: Tuberculosis is an endemic infectious disease in Mexico, caused by Mycobacterium tuberculosis, an acid-fast stain-positive bacillus. The most common clinical scenarios are pulmonary affections. However, it has been reported that up to 25% of the cases may present as an extrapulmonary disease, either due to lymphatic or hematogenous dissemination, and isolated cases have been reported as an extrapulmonary primary infection. We present the case of a 62-year-old male with a 7-day history of abdominal pain associated with melena, in which multiple ileal perforations were documented in the anti-mesenteric border with a histological diagnosis of intestinal tuberculosis. This entity should be suspected in patients with chronic immunosuppressive treatment and special screening should be performed to prevent these clinical scenarios.

Resumen: Existe evidencia epidemiológica en humanos, a partir de estudios de cohortes de grandes poblaciones, de que la dieta ejerce una fuerte influencia en el desarrollo y curso de la enfermedad inflamatoria intestinal (EII). Además, la mayoría de los tratamientos médicos basados en la evidencia para las EII están dirigidos a suprimir la respuesta inmunitaria y conllevan riesgos de efectos secundarios importantes. La evidencia actual ha demostrado varios factores dietéticos que probablemente protejan contra los brotes, como la fibra, el zinc y la vitamina D en ambas formas de EII y una alta proporción de Ácidos grasos poliinsaturados (AGPI) n -3 / n -6 en la dieta en la CU. Otros factores aumentan el riesgo de brotes, son los alimentos que contienen ácido mirístico, las carnes rojas y el azúcar. Esta revisión explorará las interacciones de la dieta y el sistema inmunológico en el contexto de la enfermedad de Crohn (EC) y la colitis ulcerosa (CU), centrándose en el papel de la dieta en la patogénesis, en particular la interacción con el sistema inmunológico del paciente. Al mismo tiempo se analizará el rol de la nutrición médica como intervención terapéutica.

Abstract: There is vast epidemiological evidence based on cohort studies of large populations of humans, that diet exerts a strong influence on the development and outcome of inflammatory bowel disease. Besides, most evidence-based medical therapies for this condition aim to suppress the immune response and entail significant side effects. Current evidence has proved that several diet factors probably protect against outbreaks, as in the case of fibre, zinc and vitamin D in both forms of inflammatory bowel disease and a high proportion of polyunsaturated fatty acids (PUFAs) n -3 / n -6 in the ICU diet. Other foods also impact the outbreak risk, such as those containing myristic acid, red meats and sugar. This review will explore diet interactions and the immune system within the context of Crohn's disease and ulcerative colitis, focusing on the role of diet in the pathogenesis, in particular in terms of its interaction with the patient's immune system. Simultaneously, the role of medical nutrition will be analysed as a therapeutic intervention.

Resumo: Há evidências epidemiológicas em seres humanos de estudos de coorte de grandes populações que a dieta tem uma forte influência no desenvolvimento e no curso da Doença Inflamatória Intestinal (DII). Além disso, a maioria dos tratamentos médicos baseados em evidências para DII têm como objetivo suprimir a resposta imunológica e acarretam riscos de efeitos colaterais significativos. A evidência atual mostrou vários fatores dietéticos que provavelmente protegem contra surtos, como fibra, zinco e vitamina D em ambas as formas de DII e uma alta proporção de ácidos graxos poliinsaturados (PUFAs) n -3 / n -6 na dieta na colite ulcerativa (UC). Outros fatores que aumentam o risco de surtos são os alimentos que contêm ácido mirístico, a carne vermelha e o açúcar. Esta revisão explora as interações da dieta e do sistema imunológico no contexto da Doença de Crohn (DC) e da Colite Ulcerativa (UC), com foco no papel da dieta na patogênese, em particular na interação com o sistema imunológico do paciente. Ao mesmo tempo, faz-se uma análise do papel da nutrição médica como intervenção terapêutica.

ABSTRACT Introduction: The reverse transcriptase polymerase chain reaction (RT-PCR) test has limitations in its diagnostic performance and requires complex equipment. Antibody detection tests can be used as epidemiological screening, but should be evaluated in a regional context. Knowing the profitability of the test, part of the spectrum of humoral immunity evoked by SARS-CoV-2 could be explored. Health personnel, as a population with high commitment and first impact in the pandemic, constitutes the ideal stage. Objective: To evaluate the diagnostic performance of the serological test, antibody response and its correlation with clinical characteristics in health workers with COVID-19 at the General Hospital of Luque. Methodology: To evaluate the diagnostic performance of the serological test, antibody response and its correlation with clinical characteristics in health workers with COVID-19 at the General Hospital of Luque between March and October 2020, a descriptive study was carried out in 107 health workers, selected by convenience between March and October 2020, after having completed ≥14 days from the diagnosis. The RT-PCR test was performed on nasal and pharyngeal swab samples. Antibody detection was performed in plasma sample, analyzed by Elecsys Anti-SARS-CoV-2 electrochemiluminescence immunoassay (<1, negative). Data were also collected: demographic, anthropometric, comorbidities, recent history of dengue, BCG vaccination, symptoms of the acute stage, and time between onset of symptoms and swabbing and onset of symptoms and interview. Descriptive and inferential analysis was used and the sensitivity, specificity, predictive values and accuracy of the test were calculated. Results: Globally, 56 health care workers had a positive diagnosis of COVID-19, of which seven women (asymptomatic) showed levels <1 to the immunoassay for antibodies. Of the 51 workers with a negative RT-PCR result, 3 showed elevated antibody titers. The sensitivity of the test was 89.3%, the specificity 94.1% and the accuracy 91.6%. No correlation was observed between the global level of antibodies and age (r 0.09; p 0.52) as well as with comorbidities. Finally, workers with persistent symptoms had more noticeable antibody levels than those who resolved the disease (p = 0.049). Conclusion: The anti-N antibody detection test for SARS-CoV-2 had a good diagnostic performance, showing some false negatives to RT-PCR, confirming its usefulness for seroprevalence studies. Antibody levels were higher in workers with persistent symptoms.

RESUMEN Introducción: La prueba de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) tiene limitaciones en su desempeño diagnóstico y requiere equipamiento complejo. Las pruebas de detección de anticuerpos pueden ser utilizadas como cribado epidemiológico, pero deberían ser evaluadas en un contexto regional. Conociendo la rentabilidad del test, se podría explorar parte del espectro de la inmunidad humoral que evoca el SARS-CoV-2. El personal de salud, como población de alto compromiso y de primer impacto en la pandemia constituye el proscenio ideal. Objetivo: Evaluar el desempeño diagnóstico de prueba serológica, respuesta de anticuerpos y su correlación con características clínicas en trabajadores de salud con COVID-19 del Hospital General de Luque. Metodología: Evaluar el desempeño diagnóstico de prueba serológica, respuesta de anticuerpos y su correlación con características clínicas en trabajadores de salud con COVID-19 del Hospital General de Luque entre marzo y octubre del año 2020 mediante un estudio observacional con componente analítico realizado en 107 trabajadores de salud, seleccionados por conveniencia entre marzo y octubre del 2020, luego de haber cumplido ≥14 días desde el diagnóstico. La prueba de RT-PCR fue realizada en muestras de hisopado nasal y faríngeo. La detección de anticuerpos fue realizada en muestra de plasma, analizada por inmunoensayo de electro quimioluminiscencia Elecsys Anti-SARS-CoV-2 (<1, negativo). Se recolectaron además datos: demográficos, antropométricos, comorbilidades, historia reciente de dengue, vacunación con BCG, síntomas del estadio agudo y tiempo entre inicio de síntomas y realización del hisopado e inicio de síntomas y entrevista. Se utilizó análisis descriptivo e inferencial y se calculó la sensibilidad, especificidad, valores predictivos y exactitud del test. Resultados: Del total, 56 trabajadores tuvieron diagnóstico de COVID-19 positivo, de los cuales siete mujeres (asintomáticas) mostraron niveles < 1 al inmunoensayo para anticuerpos. De los 51 trabajadores con resultado RT-PCR negativo, 3 mostraron títulos de anticuerpos elevados. La sensibilidad del test fue de 89,3%, la especificidad de 94,1% y la exactitud 91,6%. No se observó correlación entre el nivel global de anticuerpos y la edad (r 0,09; p 0,52) así como tampoco con las comorbilidades. Finalmente, los trabajadores con síntomas persistentes, tuvieron niveles de anticuerpos. Conclusión: La prueba de detección de anticuerpos anti-N para SARS-CoV-2 tuvo un buen desempeño diagnóstico, mostrando algunos falsos negativos a la RT-PCR, confirmando su utilidad para los estudios de seroprevalencia. Los niveles de anticuerpos fueron más elevados en los trabajadores con síntomas persistentes.

Resumen: De acuerdo con la Secretaría de Salud de México, el primer caso confirmado de COVID-19 (SARS-CoV-2) en nuestro país ocurrió el 27 de febrero de 2020. Desde su llegada, el personal dedicado a la atención pediátrica ha desarrollado estrategias de capacitación con la finalidad de atender a sus pacientes y ser parte del personal de respuesta ante la pandemia. El aprendizaje de los mecanismos de bioseguridad resulta significativo para evitar mayor propagación del virus y fortalecer al personal de salud, evitando el contagio. Es por ello que consideramos que los pediatras del país deben estar capacitados para determinar el tipo de equipo de protección personal y las estrategias de protección antes, durante y después de someter a ventilación a los pacientes; asimismo, al realizar maniobras de reanimación cardiopulmonar, conocidas como procedimientos generadores de aerosoles (PGA). Considerando que se prevé una epidemia larga en nuestro país, presentamos este artículo de revisión que sirva como parte del acervo que se requiere para documentar buenas prácticas ante COVID-19.

Abstract: The first confirmed case of COVID-19 (SARS-CoV-2) in our country occurred on February 27, 2020, according to the Mexican Ministry of Health. The staff engaged in pediatric care has developed training strategies to serve their patients and to be part of the pandemic response staff. Learning biosecurity mechanisms is significant to prevent further spread of the virus and strengthen health care teams with the purpose of preventing contagion. That is why we consider that the pediatricians in Mexico should be trained to determine the type of personal protective equipment and protection strategies before, during and after ventilating patients, also when performing cardiopulmonary resuscitation maneuvers, procedures that are aerosol generators. Considering that a long epidemic is expected in our country, we present this article that serves as part of the knowledge required to document good practices for treating COVID-19.

Abstract Advances in Information and Communication Technologies (ICT) provide real-time access to a vast amount of data, through which it is possible to know the behavior of social facts. In this scenario, the current SARS-CoV-2 pandemic has allowed, under questionable criteria of immediacy and urgency, to circulate information that generates reality and impacts on decision-making; and has also favored the appropriation of the data, exposing people to violations of their fundamental rights. Both issues are sensitive to Latin America and the Caribbean, a region that today is presented itself not only as the epicenter of the pandemic but also of inequalities. The contribution that bioethical reflection and deliberation can make in this matter, acquires special relevance with a view to generating a new covenant for the treatment of data.

Resumen Los avances de las Tecnologías de la Información y la Comunicación (TIC) permiten acceder en tiempo real a una cantidad ingente de datos, a través de los cuales es posible conocer el comportamiento de hechos sociales. En este escenario, la actual pandemia por SARS-CoV-2 ha permitido, bajo cuestionables criterios de inmediatez y urgencia, circular información que genera realidad e impacta en la toma de decisiones; y, además, ha favorecido la apropiación del dato, exponiendo a las personas a violaciones de sus derechos fundamentales. Ambos asuntos son sensibles para América Latina y el Caribe, región que hoy se presenta no sólo como el epicentro de la pandemia sino también de las desigualdades. La contribución que desde la reflexión y deliberación bioética puede realizarse en esta materia, adquiere especial relevancia con vistas a generar un nuevo pacto para el tratamiento de los datos.

Resum Els avenços de les Tecnologies de la Informació i la Comunicació (TIC) permeten accedir en temps real a una quantitat ingent de dades, a través dels quals és possible conèixer el comportament de fets socials. En aquest escenari, l'actual pandèmia per SARS-CoV-2 ha permès, sota qüestionables criteris d'immediatesa i urgència, circular informació que genera realitat i impacta en la presa de decisions; i, a més, ha afavorit l'apropiació de la dada, exposant a les persones a violacions dels seus drets fonamentals. Tots dos assumptes són sensibles per a Amèrica Llatina i el Carib, regió que avui es presenta no només com l'epicentre de la pandèmia sinó també de les desigualtats. La contribució que des de la reflexió i deliberació bioètica pot realitzarse en aquesta matèria, adquireix especial rellevància amb vistes a generar un nou pacte per al tractament de les dades.

Resumen: Cuando la falla intestinal ocurre luego de una resección intestinal masiva se denomina síndrome de intestino corto. Es una entidad rara, con un espectro clínico que va desde una disfunción leve y reversible hasta una condición grave e incapacitante. Presenta una elevada morbimortalidad, altos costos de atención médica e importante impacto en la calidad de vida. El 50% de los pacientes con síndrome de intestino corto no se adaptan espontáneamente ni mejoran la absorción por el intestino remanente, por lo que deben recurrir de por vida a la nutrición parenteral. La terapia nutricional especializada y el tratamiento hormonal focalizado en el intestino son pilares en la rehabilitación promoviendo la adaptación intestinal, logrando independencia de la nutrición parenteral y evitando el trasplante intestinal. Actualmente, teduglutide es el tratamiento de referencia en estos pacientes, pero hasta el momento inaccesible en Uruguay por su elevado costo. Presentamos el único caso en nuestro país de un paciente de 23 años portador de falla intestinal crónica por síndrome de intestino corto que depende de la nutrición parenteral desde hace 17 años y presenta complicaciones graves asociadas a esta técnica.

Abstract: Short bowel syndrome consists of intestinal failure after a massive intestinal resection. It is an unusual condition, ranging from a mild and reversible malfunction to a severe condition causing inability. Short bowel syndrome has high morbimortality, high medical costs and a significant impact on quality of life. 50% of patients with short bowel syndrome do not spontaneously adapt and neither does absorption improve by the remaining intestine, thus they depend on parenteral nutrition for the rest of their lives. Specialized nutritional therapy and focalized hormone therapy in the intestine are pillars in rehabilitation. They promote intestine adaptation and achieve independence from parenteral nutrition and avoid intestinal transplant. Today, Teduglutide is the reference treatment for these patients, although it is still not available in Uruguay due to its high cost. The study presents a 23 year old patient carrier of chronic intestinal failure due to short bowel syndrome who has depended on parenteral nutrition for 17 years and presents severe complications associated to this technique.

Resumo: Quando a falência intestinal ocorre depois de uma ressecção intestinal massiva é chamada Síndrome de intestino curto. É uma entidade rara, com um espectro clínico que pode manifestar-se por uma disfunção leve e reversível até um quadro grave e incapacitante. Apresenta alta morbimortalidade, altos custos de atenção médica e grande impacto sobre a qualidade de vida do paciente. 50% dos pacientes com síndrome de intestino curto não se adaptam espontaneamente nem conseguem uma melhoria da absorção pelo intestino restante sendo obrigados a utilizar nutrição parenteral de forma permanente. A terapia nutricional especializada e o tratamento hormonal focado no intestino são as bases da reabilitação promovendo a adaptação intestinal, diminuindo a dependência da nutrição parenteral e evitando o transplante intestinal. Atualmente o Teduglutide é o tratamento de referência para estes pacientes, porém devido ao seu elevado custo não é acessível aos pacientes no Uruguai. Apresentamos o único caso no país, de um paciente de 23 anos portador de falência intestinal crônica por síndrome de intestino curto que depende de nutrição parenteral há 17 anos e apresenta complicações graves associadas a esta técnica.

Abstract The objective of the work was to know the nutritional contribution of gluten-free bread made with Prosopis nigra flour, and the acceptability measured by celiac and non celiac persons. Gluten-free bread was made from a mixture of corn, rice and Prosopis nigra flours. To achieve better technological characteristics, xanthan gum and whey concentrate were added. A portion of bread (50g) provided 19% of DRI for protein for children aged 4 to 8 years, while for a pregnant or lactating woman, this value reached 5%. Regarding the fibers, 50g of bread covered 16% and 14% of the DRI for these biological moments. The fat requirement was covered by 16% for all biological moments analyzed. The dietary contribution of this bread surpasses in proteins and fiber to the commercial ones. Bread made with Prosopis nigra flour presented a balanced caloric distribution, contributing a high proportion of proteins, fats, dietary fiber (mainly of the insoluble fraction), and low quantity of carbohydrates available, characteristics that make it a recommendable product for celiac persons in different biological moments.

Resumen Los hemangiomas son las neoplasias más comunes en la infancia; incluyen diferentes tipos según su histología, expresión proteica y curso clínico. Por lo general, aparecen en piel y tejidos blandos. Son lesiones raras a nivel intestinal, y más aún en un recién nacido; por ello, decidimos publicar un caso que ocurrió en nuestro hospital y el manejo que se le dio; revisamos la literatura.

Abstract The most common neoplastic lesions in the infancy are hemangiomas; they are classified according to their histology, proteic expression, and clinical presentation. They normally appear in the skin and soft tissue. They are very rare in the viscera, in the stomach, and in neonates they are even more unusual; this is the reason why we decided to review the literature and present this case.

The aim of this work was to study the changes induced by BG in the behaviour of wheat starch, and observe the influence of these variations on the quality of a basic white bread. The effect of four BG addition levels in the wheat flour functional characteristics (WAI, WSI, and pasting properties) and bread quality (physical parameters, crumb grain structure, moisture and hardness) was investigated. The highest levels of BG (1% and 2%) decreased the peak viscosity, and increased the stability and setback of the flour. This was due to a lower gelatinization of the starch granules, caused by a competition for water between the hydrocolloid and starch. These changes influenced the bread quality. The loaves added with 1% and 2% of BG presented smaller alveoli: this resulted in more compact, hard and less airy crumbs. Nevertheless, the moisture of the samples at 1% and 2% of added gum was higher than the control bread. However, the incorporation of BG at 0.5% did not affect the pasting parameters and bread quality, but increased moisture of crumb, so this concentration would be most recommended for baking, since higher humidity could favour the shelf- life of the product.

The effect of protein lupine isolate (LI) and addition of brea gum (BG) on a basic bread formulation is described. The major objective of this research was to evaluate the influence of the addition of LI on the quality and quantity of the proteins of fresh bread with BG. Protein quality was determinate by the Chemical Score method corrected for protein digestibility (CSCD%). The bread dough characteristics were determined by farinograph and alveograph. Fresh bread characterization was performed by measuring the physical parameters and evaluating the crumb structure. The effect of LI and BG on available lysine, the loss of available lysine ratio, and the chemical composition of the breads were also determined. The addition of LI on the bread formulation improved the protein content and the CSCD% of lysine. The dough with LI was less resistant to prolonged kneading and less manageable. With BG addition, the dough became stickier. The quality of fresh bread was affected by the addition of LI: the fresh bread had lower specific volume and more heterogeneous crumbs than that of the control group. The addition of BG did not influence the quality of the bread made with the mixed flour, but it had a positive effect on the loss of available lysine.

The effect of Brea Gum (BG) addition on a basic bread formulation is described. The aim of the study was to investigate the effect of BG on the characteristics of wheat bread in terms of changes in moisture, texture, retrogradation of amylopectin, and microstructure. Bread quality was assessed by the physical parameters (volume, specific volume index, width/height ratio, crumb moisture, color, and hardness) and crumb grain structure (total cell number, total cell area, average size of cells, and number of cells per unit area). The effect of BG on the characteristics of the crumb during 24, 48, and 72 hours of storage was determined according to changes in moisture, hardness, and amylopectin retrogradation. Furthermore, the microstructure of the crumb was analyzed by scanning electron microscopy (SEM). The results show the ability of BG to retain moisture in the bread crumb, which was expressed by the lower hardness of the bread crumbs with the addition of the hydrocolloid at 48 and 72 hours of storage. This effect was also evident in the microstructure.