Mucilage of Opuntia ficus-indica (OFI) was extracted and characterized by its composition and molecular weight distribution. Mucilage film-forming dispersions were prepared under different pHs (3, 4, 5.6, 7, and 8) and calcium concentration (0% and 30% of CaCl(2), with respect to mucilage's weight), and their particle size determined. Mucilage films with and without calcium (MFCa and MF, respectively) were prepared. The effect of calcium and pH on mucilage films was evaluated determining thickness, color, water vapor permeability (WVP), tensile strength (TS), and percentage of elongation (%E). The average molecular weight of the different fractions of mucilage was: 3.4 x 10(6) (0.73%), 1 x 10(5) (1.46%), 1.1 x 10(3) (45.79%), and 2.4 x 10(2) Da (52.03%). Aqueous mucilage dispersions with no calcium presented particles with an average size d(0.5) of 15.4 microm, greater than the dispersions with calcium, 13.2 microm. MFCa films showed more thickness (0.13 mm) than the MF films (0.10 mm). The addition of calcium increased the WVP of the films from 109.94 to 130.45 gmm/m(2)dkPa. Calcium and pH affected the mechanical properties of the films; the largest TS was observed on MF films, whereas the highest %E was observed on MFCa films. The highest differences among MF and MFCa films were observed at pHs 5.6 and 7 for TS and at pHs 4 and 8 for %E. No effect of pH and calcium was observed on luminosity and hue angle. Chroma values were higher for MF when compared with MFCa, and increased as pH of the films increased. Practical Application: In this study mucilage from nopal was extracted and characterized by its ability to form edible films under different pHs, and with or without the addition of calcium. Opuntia ficus-indica mucilage had the ability to form edible films. In general, it can be considered that mucilage films without modification of pH and without the addition of calcium have the best water vapor barrier properties and tensile strength. Mucilage from nopal could represent a good option for the development of edible films in countries where nopal is highly produced at low cost, constituting a processing alternative for nopal.

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La neuropatía diabética (ND) es la complicación microvascular más frecuente y más precoz asociada a la diabetes mellitus (DM), no obstante esta situación, es la más olvidada y la menos diagnosticada. Al mismo tiempo es de amplio conocimiento que el síndrome metabólico (SM) tiene una elevada prevalencia, y que la relación entre este estado y el compromiso macrovascular está documentada. Es de interés para el Comité de Neuropatía Diabética analizar la afectación neuropática en el marco del SM y en el de uno de sus componentes constitutivos como es la disglucemia no diabética. El subdiagnóstico de esta entidad y el aumento del riesgo de la morbimortalidad de los pacientes que la padecen hacen importante alertar a la comunidad médica de la existencia de esta complicación microvascular que excede el marco de la DM y se presenta también en el SM y en la disglucemia tanto de ayunas como posprandial.

Background/Aims Severe infections are the most important causes of morbidity and mortality in children with cancer. In Peru, a major limitation for an optimal treatment of children with fever and neutropenia due to chemotherapy is the delay in the administration of the first dose of antibiotics. We performed an intervention aimed to decrease the time to antibiotics (TTA) in pediatric patients presenting to the emergency room (ER) with fever and neutropenia: We increased the perception risk of neutropenic fever to the ER medical staff by explaining the importance of a timely administration of antibiotics as part of the initial approach of children with fever and neutropenia. This study forms part of a larger project (DoTT project) that is being implemented in Peru, and is aligned to the WHO Global Initiative of Childhood Cancer in Peru. Methods This study was performed at Hospital Nacional Edgardo Rebagliati, which is a tertiary care National Hospital located in Lima. We included patients younger than 14 years with hemato-oncological conditions who arrived at the Pediatric Emergency Room. The DoTT project consists in an quality improvement educational intervention for health care providers in the Pediatric ED and the Oncology and Hematology Departments, based on the Kern’s six-steps (i) Problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) evaluation. We defined time-to-antibiotic (TTA) by measuring the time elapsed between patient′s arrival to the ER and the administration of the fist dose of an antibiotic. We compared the TTA between thirteen patients admitted from July to December 2020 with fever and neutropenia (after intervention), and historical data from 2017–2018. Results Median age was 7 years. 9/13 patients had leukemia and 4 patients had malignant solid tumors receiving oncological treatment. Mean pre-hospital delay was 176 minutes (range, 14–906 minutes) and TTA was 133 minutes (range, 34–400 minutes). One patient died of sepsis. Age, sex, source and timing of antibiotics did not significantly affect hospital stay, antifungal use and/or antibiotic turnover. Based on our historical data, mean TTA was 206 minutes (range, 137–390). Early results indicate a decrease in the TTA, although not statistically significant, likely due to the sample size. General and targeted needs assessment was performed by the DoTT project team and administrators at Rebagliati hospital, which lead to develop a curriculum based on a 5-lectures mini-course for health care providers. Conclusions The TTA exceeds the recommended time at international level, causing the evitable morbimortality. It is necessary to perform a multidisciplinary intervention to improve antibiotic start time. Ongoing educational intervention refinement and testing of the instruments are planned.

Background During the first year of the current COVID-19 pandemic, health systems around the world have faced the challenge of maintaining health services for patients with non-communicable diseases, despite the logistical and personnel constraints. Despite SARS-CoV-2 infection is usually more benign in children, there is limited information about how this pandemic affected their healthcare at a population level. Methods We performed a cross sectional study at the Peruvian National Children′s Hospital San Borja, which is a 312-bed tertiary National referral health center, in Lima. We include all hospital admissions during 2020, with respect to the two previous years. We defined hospital admission as the permanence at the hospital for more than 24 hours irrespectively of patient′s initial destination (emergency observation unit, regular medical floor, or intensive care unit). We described demographic characteristics among hospitalized patients and compared them between 2018–19 and 2020 using standard descriptive tests. We use the International Classification of Diseases 10th (ICD-10) codes from the electronic patient registration system to ascertain three major non-communicable conditions: congenital cardiopathies, hematooncological disorders and burns non-communicable conditions. We set level for statistical significance at 0.05. Results There were 11635 patients admitted during 2018–19 period and 3480 patients admitted during 2020. The average daily hospital admission during 2018–19 was different compared to 2020 (15.9±6.1 vs. 9.6±6.0, p<0.001). There were also differences in the frequency of the gender (male 55.1% vs. 58.9%, p<0.001) and if the patient′s place of origin was outside Lima (49.0% vs. 41.1%, p<0.001). Among hospitalized patients, 3036 presented one of the three non-communicable conditions during the baseline period and 871 during 2020. There was a significant difference between the distribution of hospitalization among patients with one of the three non-communicable conditions (p<001), towards a decrease in hospitalizations due to congenital heart disease, and an increase in the hospitalizations due to burns. Conclusion During the first year of COVID-19 pandemic, there was a decrease in the number of hospitalizations of children with non-communicable conditions compared to the previous two years. It will be important to consider the implementation of public health policies aimed to increase accessibility to health care for children with non-communicable conditions during the coming months of the pandemic in Peru.