https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)62072-9.pdf

A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial

Health risk assessment of acrylamide in bread in Iran using LC-MS/MS.

Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia-related entries in patients' records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds of patients (n = 475, 64.5%, 95%CI 60.9-67.8%) received no physician-documented pain assessment during the 24-h study period. Just under one-third (n = 215, 28.6%, 95%CI 25.5-32.0%) received no nursing-documented pain assessment, and over one-fifth (n = 159, 21.2%, 95%CI 19.2-23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/anae.13786

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Acrylamide is a water-soluble toxicant found in high-protein and carbohydrate-containing foods exposed to high temperature like bread as the staple foodstuff This toxicant is mainly formed via Maillard reaction The potential adverse effects of acrylamide especially possible carcinogenicity in human through dietary exposure necessitate its monitoring Regarding the existence of its precursors in wheat bread formulation as well as extreme consumption of bread by most population and diversity of bread types, its acrylamide level needs to be investigated The indicative value for acrylamide in wheat bread is set at 80 μg/kg Consequently, its determination using liquid chromatography–tandem mass spectrometry (LC-MS/MS), gas chromatography–mass spectrometry (GC-MS), or capillary electrophoresis can be helpful considering both the risk assessment and quality control aspects In this respect, methods based on LC-MS/MS show good recovery and within laboratory repeatability with a limit of detection of 3–20 μg/kg and limit of quantification of 10–50 μg/kg which is suitable for the immediate requirements for food product monitoring and calculation of consumer exposure

Acrylamide in bread: a review on formation, health risk assessment, and determination by analytical techniques.

Acrylamide, formed in baked and fried plant-based foods, is reported to induce numerous adverse effects in cells, animals, and humans. Examples from the literature show that processed potato- and cereal-based products are two major food types that seem to contribute the highest amounts of acrylamide to the diet worldwide. To meet both the demand for gluten-free products and the interest in alternative grains, we previously developed recipes for flatbreads using a variety of different grains. In this study, we determined the acrylamide content of 15 experimental flatbreads made from a variety of flours and 21 commercial flatbreads. The application of a validated, highly sensitive HPLC/MS method revealed that flatbreads made with the following flours baked at 195.5 °C for 2 min had very low (<10 μg/kg) levels of acrylamide: brown rice, buckwheat, cornmeal, millet, oat, and quinoa. The acrylamide levels of the following flatbreads were 14 to 59 μg/kg: rye, sorghum, soy, wheat, commercial pita, pita crackers, pizza, naan, and lavash. Wheat-based matzo breads, which are rapidly baked to a crisp texture at high heat (∼400 °C), contained 101 to 504 μg/kg acrylamide. Potato-based products were some of the highest of the products tested, ranging from 153 (potato pancakes) to 2,070 (potato-containing gluten-free matzos) μg/kg acrylamide. Except for the potato-containing products, the flatbreads made in this study were lower in acrylamide content (<3 to 21.3 μg/kg) than any of the commercial products tested. Of these experimental flatbreads, wheat- and sorghum-based products were the highest. Flatbreads from alternative grains can result in gluten-free products with high nutritional value and less acrylamide. PRACTICAL APPLICATION: Acrylamide formation is dependent on both the composition of the food product and the method of cooking. Flatbreads have the potential to be high in acrylamide due to cooking methods which lead to the development of desirable browning products. Flatbreads developed in this study using alternative and ancient grains were mostly lower in acrylamide content than their wheat counterpart, suggesting that they can serve as a low-acrylamide, gluten-free functional food.

Acrylamide Content of Experimental and Commercial Flatbreads.

MISAGE project (LISBOA-01-0145-FEDER-024172). This
project has received financial support from the Fundacao para a
Ciencia e a Tecnologia (FCT), Portugal. This work was supported by ELEMENTARIA-2013DAN850 project.

/pdf/determination-of-acrylamide-in-portuguese-bread-by-uplc-ms-2rflfzythc.pdf

Determination of Acrylamide in Portuguese Bread by UPLC-MS/MS: metrological and chemometric tools

RESUMO Objetivo: Avaliar o impacto de um protocolo de manejo da dor e reducao do consumo de opioides no consumo geral de opioides e nos desfechos clinicos. Metodos: Estudo em centro unico, quasi-experimental, retrospectivo, de coortes antes e depois. Utilizamos uma serie temporal interrompida para analisar as alteracoes no nivel e na tendencia de utilizacao de diferentes analgesicos. Foram usadas comparacoes bivariadas nas coortes antes e depois, regressao logistica e regressao quantilica para estimativas ajustadas. Resultados: Incluimos 988 pacientes no periodo pre-intervencao e 1.838 no periodo pos-intervencao. O consumo de fentanil teve ligeiro aumento gradual antes da intervencao (β = 16; IC95% 7 - 25; p = 0,002), porem diminuiu substancialmente em nivel com a intervencao (β = - 128; IC95% -195 - -62; p = 0,001) e, a partir de entao, caiu progressivamente (β = - 24; IC95% -35 - -13; p < 0,001). Houve tendencia crescente de utilizacao de dipirona. A duracao da ventilacao mecânica foi significantemente menor (diferenca mediana: - 1 dia; IC95% -1 - 0; p < 0,001), especialmente para pacientes mecanicamente ventilados por periodos mais longos (diferenca no 50o percentil: -0,78; IC95% -1,51 - -0,05; p = 0,036; diferenca no 75o percentil: -2,23; IC95% -3,47 - -0,98; p < 0,001). Conclusao: Um protocolo de manejo da dor conseguiu reduzir o consumo de fentanil na unidade de terapia intensiva. Esta estrategia se associou com menor duracao da ventilacao mecânica.

Implantação de um Protocolo de Manejo de Dor e Redução do Consumo de Opioides na Unidade de Terapia Intensiva: Análise de Série Temporal Interrompida

RESUMO Objetivo: Descrever as caracteristicas e os desfechos de pacientes submetidos a retirada da ventilacao mecânica e comparar a pacientes com ventilacao mecânica e limitacoes de terapias de suporte a vida (limitar ou retirar), porem sem remocao da ventilacao mecânica. Metodos: Este foi um estudo de coorte retrospectiva realizado entre janeiro de 2014 e dezembro de 2018 com pacientes em ventilacao mecânica com alguma limitacao de suporte artificial de vida admitidos a uma unica unidade de terapia intensiva. Foram comparados os pacientes submetidos a retirada da ventilacao mecânica e os que nao passaram por esse procedimento com relacao a mortalidade na unidade de terapia intensiva e ao tempo de permanencia no hospital, em uma analise nao ajustada e em uma amostra pareada por escore de propensao. Analisou-se tambem o tempo desde a retirada da ventilacao mecânica ate o obito. Resultados: Dentre 282 pacientes com limitacoes a terapias de suporte a vida, 31 (11%) foram submetidos a retirada da ventilacao mecânica. Nao houve diferencas iniciais entre os grupos. As taxas de mortalidade na unidade de terapia intensiva e no hospital foram, respectivamente, de 71% versus 57% e 93% versus 80%, entre os pacientes submetidos a retirada da ventilacao mecânica e os que nao o foram. O tempo mediano de permanencia na unidade de terapia intensiva foi de 7 versus 8 dias (p = 0,6), e o tempo de permanencia no hospital foi de 9 versus 15 dias (p = 0,015). A mortalidade hospitalar nao foi significantemente diferente (25/31; 81% versus 29/31; 93%; p = 0,26) apos o pareamento. O tempo mediano desde a retirada da ventilacao mecânica ate o obito foi de 2 dias [0 - 5] e 10/31 (32%) dos pacientes morreram dentro de 24 horas apos a retirada dessa ventilacao. Conclusao: Neste relato brasileiro, a retirada da ventilacao mecânica representou 11% de todos os pacientes com limitacao do tratamento e nao se associou com aumento da mortalidade hospitalar apos pareamento por escore de propensao das covariaveis relevantes.

Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit.

Minimally processed vegetables and fruits are the main ingredients of ready-to-eat salads, often sold in convenient packaging. The increased consumption of ready-to-eat products is a result of a fast lifestyle and awareness on their nutritional attributes. Additionally, the processing technology is well documented. This study aimed to determine the microbiological quality of shredded Iceberg lettuce (Lactuca sativa var. capitata), sliced tomato (Solanum lycopersicum) and diced mango (Mangifera indica L.). From each batch, five random units were selected, one of which was analyzed on the day of production (initial sample—IS) and the other four after their shelf life (final sample—FS). The samples were tested for aerobic colony count (ACC) 30 °C, Enterobacteriaceae, Enterococcus spp., Pseudomonas spp., Aeromonas hydrophila, molds and yeasts. The results showed that ACC of diced mango and shredded lettuce had a similar median of 6.20 and 6.08 log g−1, respectively, and sliced tomato had the lowest one (5.40 log g−1). The median value found for Enterobacteriaceae was 3.47 log g−1. The FS for Enterococcus of diced mango and shredded lettuce had a similar median (1.00 log g−1) and sliced tomato had the highest (2.54 log g−1). Both IS and FS had higher unsatisfactory rate for Aeromonas hydrophila. All samples revealed acceptable rate for molds and yeasts. This study found high microbial loads in ready to eat vegetables. Data showed that this type of product should be subject to a more stringent quality control, so that the consumers could be provided not only with easy to consume products but also with microbiological quality products during their shelf life.

Microbiological quality in convenient ready-to-eat vegetables during shelf life

Pear peels are seen as potentially valuable for their low-cost beneficial components content such as polyphenols. These may reveal acrylamide (AA) mitigation effect and thus their application in a susceptible food matrix, such as bread, should be considered. Aiming to assess the AA reduction potential of Rocha pear peels in bread and the effects on its sensory quality, two types of bread highly consumed in Portugal - wheat (WB) and rye (RB) – were assayed with the extract of these by-products, in two forms aqueous [a] and dry [d]. Eight bread batches were produced (4 WB; 4 RB); each composed of one control sample and five replicates added with extract. The process included controlled fermentation, and cooking in a traditional oven (TO) and convection oven (CO). Hedonic evaluation was made to samples of each batch. Overall, slight differences were observed for WB and RB hedonic evaluation between the control sample and those with both extract forms. Lower scores were observed in both bread types baked in CO, with [d] comparing with the control; for bread with [a], oven influence varied; higher scores for WB in CO and for RB baked in TO, comparing with the control. Regarding AA reduction, the highest mitigation rate was accomplished by the [d] in WB cooked in a CO, 27.3%. However, for RB the best formulation was obtained with [d] in the TO, 19.2%. These results support the importance of selecting the best baking process according to the varieties of bread and AA reduction.

Carlos Brandão

Papers

Determination of Acrylamide in Portuguese Bread by UPLC-MS/MS: metrological and chemometric tools

Implantação de um Protocolo de Manejo de Dor e Redução do Consumo de Opioides na Unidade de Terapia Intensiva: Análise de Série Temporal Interrompida

Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit.

Microbiological quality in convenient ready-to-eat vegetables during shelf life

Effect of Rocha Pear Peel Extracts Added to Wheat and Rye Bread Formulations on Acrylamide Reduction and Sensory Quality Maintenance