[The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: a safe and advisable technique]

The bidirectional cavopulmonary (Glenn) shunt is almost a routine first step procedure for total cavopulmonary connection in children with single-ventricle cardiac anomalies. It is usually performed with cardiopulmonary bypass, of which adverse effects can be especially deleterious in these cardiac conditions. To avoid these adverse effects, we performed the cavopulmonary shunt in 5 children through sternotomy without cardiopulmonary bypass. There was no mortality nor morbidity. We think that this technique is safe, reproducible, and even advisable in children with single-ventricle anomalies.

[Premature labor with intact membranes: microbiology of the amniotic fluid and lower genital tract and its relation with maternal and neonatal outcome]

BACKGROUND

The prevalence of idiopathic spontaneous premature labor or without an evident clinical cause, has not been reduced with tocolytic treatments, suggesting that premature labor has multiple causes and infections play a not well-defined role.

AIM

To perform microbiological studies of the amniotic fluid and of the lower genital tract in women with idiopathic premature labor and intact membranes, relating these findings with maternal and neonatal outcomes.

PATIENTS AND METHODS

Women with pregnancies between 24 and 34 weeks, with premature labor and without an evident clinical cause were enrolled. Amniotic fluid and genital tract samples were obtained for traditional microbiological cultures. This information was related with delivery events and neonatal outcome.

RESULTS

Sixty-three patients were included. The overall frequency of microbial invasion of amniotic cavity was 23.8% and of cervical or vaginal infection was 63.5% (in 39.7% there was only cervical or vaginal infection without involvement of the amniotic sac). Absence of infection was documented in 36.5% of women. Compared to patients without infection, women with microbial invasion of amniotic cavity had a higher rate of prematurity (73.3% p < 0.05), a higher rate of prematurity of less than 34 weeks (60% p < 0.01), a higher frequency of preterm rupture of membranes (40% p < 0.001), a shorter admission-to-delivery interval (median 3.0 days p < 0.01) and lower gestational age at delivery (median 33 weeks p < 0.01). Clinical chorioamnionitis and endometritis (20% p < 0.01) was observed only in patients with amniotic cavity infections. Severe asphyxia (26.7% p < 0.05) and neonatal admission to Intensive Care Units (46.7% p < 0.05) were more frequent and neonatal weight was less in the offspring of women with microbial invasion of amniotic cavity (2020 g median p < 0.01).

CONCLUSIONS

In preterm labor with intact membranes, intraamniotic infection is the most frequent cause of prematurity and is associated with a higher prevalence of maternal and neonatal problems.

Peripheral versus central effects of glucagon-like peptide-1 receptor agonists on satiety and body weight loss in Zucker obese rats

The present study explores the potential utility of peripheral versus central administration of glucagon-like peptide-1 (GLP-1) receptor agonists in the regulation of feeding behavior in Wistar and Zucker obese rats. Acute central (intracerebroventricular [i.c.v.]) and peripheral (subcutaneous [s.c.]) administration of both GLP-1 (7-36) amide and exendin-4 resulted in a reduction in food intake for at least 4 hours, exendin-4 being much more potent than GLP-1 (7-36) amide, especially after peripheral administration. Both Zucker obese rats (fa/fa) and their lean littermates (Fa/-) responded to acute central and peripheral administration of exendin-4. Moreover, in situ hybridization revealed specific labeling for the mRNA for GLP-1 receptors in several brain areas of both the obese and lean rats. The presence of this receptor was also detected by affinity cross-linking assays. Long-term s.c. administration of exendin-4 (1 single injection per day, 1 hour prior to the onset of the dark phase of the cycle) decreased daily food intake and practically blocked weight gain in obese rats. In contrast to previous studies, these findings show that peripheral (s.c.) administration of both GLP-1 receptor agonists also induces satiety and weight loss in rats, and suggest the potential usefulness of exendin-4 as a therapeutic tool for the treatment of diabetes and/or obesity.

Microbial study of farmhouse ewe cheese during storage in olive oil

The effect of storing farmhouse ewe cheese in oil and in vacuo over long periods of time on physicochemical properties (water activity and pH) and the microbiota of the cheese was investigated. The storage conditions were found to scarcely influence the sample pH. Also, the initial water activity (a(w) = 0.961) and its value after 9 months of storage (0.927) were both very similar to those for naturally ripened cheese. The incidence of pathogenic microbial groups was found to decrease with storage time (counts fell below 1 log CFU/g). The flora that effects proteolytic changes in cheese consisted of lactic microorganisms (viz. lactococci and lactobacilli), in addition, after 6 months of storage, of enterococci. The last are responsible for the formation of large amounts of soluble nitrogen (SN), non-protein nitrogen (NPN) and aminoacid nitrogen (NH2-N), which provide this type of cheese with very special sensory features while preventing dehydration and thus lengthening its shelf life.

Prevalence of anti-hepatitis A antibodies in an urban middle class area of Argentina: some associated factors

OBJECTIVE

This study evaluated the seroprevalence of hepatitis A virus (HAV) antibodies in 360 middle-class subjects from Buenos Aires City and its outskirts.

METHODS

The study population included 360 individuals between 10 and 89 years of age, from the socioeconomic middle class in Buenos Aires City and some suburban areas of Buenos Aires province. Antibodies to hepatitis A virus were determined by enzyme immunoassay test kits.

RESULTS

The overall prevalence of HAV antibodies was 42.2%. The highest percentage of seronegativity was found in the subgroup of younger people without a history of symptomatic hepatitis and living in houses with more than one bathroom (86.9%). In the subgroup aged 21 to 60 years, the highest rates of seronegativity were found in individuals with higher level of education living in houses with tap water (66.6%). In both groups, seronegativity may be correlated with a higher socioeconomic status.

CONCLUSIONS

In the middle-class community studied, more than 50% of people under 30 years of age were unprotected against HAV. Thus, the use of a vaccine against hepatitis A has to be considered for the prevention of symptomatic hepatitis, especially in adults at risk of infection, such as those who travel to areas with poor sanitation, taking into consideration that the severity of the disease increases with age.

Chemical and microbiological characteristics of ewes' milk cheese manufactured with extracts from flowers of Cynara cardunculus and Cynara humilis as coagulants

The chemical and microbial characteristics as well as the flavor and aroma of Los Pedroches cheese made using aqueous extracts of Cynara cardunculus L. flowers were compared with those of cheeses manufactured with extracts of Cynara humilis L. throughout ripening. The two thistle species assayed were found to have no appreciable effect on the moisture, fat, protein, and NaCl contents of the cheese or on its water activity, flavor, and aroma; however, the use of C. humilis resulted in reduced lactic acid content (p < 0.001) and higher pH values (p < 0.05) relative to those of cheese specimens produced with C. cardunculus. The protein breakdown of the cheeses was assessed in terms of soluble nitrogen (SN), nonprotein nitrogen (NPN), and amino acid nitrogen (AAN). Proteolysis was more marked and rapid in cheese containing C. cardunculus as coagulant, the SN and NPN contents of which were significantly higher (p < 0. 01) than those of the cheese obtained with the species C. humilis; AAN contents were similar in both species of Cynara throughout ripening. Although total viable, coliform, and lactobacilli counts were similar in cheeses produced with both types of plant coagulant throughout ripening, enterobacteria and yeasts counts (p < 0.01) and molds counts (p < 0.05) were higher in cheese produced with C. humilis than in cheese obtained with C. cardunculus.

A new antibiotic nortriterpene quinone methide from Maytenus catingarum

15alpha-Hydroxy-21-keto-pristimerine (1), a new nortriterpene quinone methide was isolated from the root bark of Maytenus catingarum along with other well-known related compounds, including pristimerine (2), tingenone, and 20alpha-hydroxy-tingenone. The structure of 1 was determined by means of 1H and 13C NMR spectroscopy, including homonuclear and heteronuclear correlations. Compound 1 showed antibiotic activity against Gram-positive bacteria.

Ayahoasca: an experimental psychosis that mirrors the transmethylation hypothesis of schizophrenia

The experimental psychosis observed after drinking Ayahoasca, a South American hallucinogenic beverage from the Amazon Indians, reproduces the pathologic transmethylation theory of schizophrenia. This theory postulates a decrease in the monoamine oxidase (MAO) activity, which results in the accumulation of methylated indolealkylamines, such as bufotenin (5-hydroxy-N,N-dimethyltryptamine), N,N-dimethyltryptamine (DMT) and 5-methoxy-N,N-dimethyltryptamine. These substances are strong hallucinogens as has been previously confirmed experimentally. On the other hand, it is known that Ayahoasca is a beverage usually prepared by boiling two plants, one of them rich in beta-carbolines, which are naturally occurring strong inhibitors of MAO, and the other with high quantities of DMT. This particular combination reproduces what is supposed to occur under pathologic conditions of different psychoses. The effects of Ayahoasca were studied in subjects, assessing urine levels of DMT by gas chromatography-mass spectrometry (GC-MS) before and after the intake of the beverage. The results of this study confirm that the hallucinogenic compounds detected in the healthy subjects' (post-Hoasca, but not before) urine samples are the same as those found in samples from acute psychotic unmedicated patients. The chemical composition of the Ayahoasca beverage, and of the plant material used for its preparation are also reported as well as psychometric and neuroendocrine subject parameters.

Substitution of Asp-309 by Asn in the Arg-Asp-Pro (RDP) motif of Acetobacter diazotrophicus levansucrase affects sucrose hydrolysis, but not enzyme specificity

beta-Fructofuranosidases share a conserved aspartic acid-containing motif (Arg-Asp-Pro; RDP) which is absent from alpha-glucopyranosidases. The role of Asp-309 located in the RDP motif of levansucrase (EC 2.4.1.10) from Acetobacter diazotrophicus SRT4 was studied by site-directed mutagenesis. Substitution of Asp-309 by Asn did not affect enzyme secretion. The kcat of the mutant levansucrase was reduced 75-fold, but its Km was similar to that of the wild-type enzyme, indicating that Asp-309 plays a major role in catalysis. The two levansucrases showed optimal activity at pH 5.0 and yielded similar product profiles. Thus the mutation D309N affected the efficiency of sucrose hydrolysis, but not the enzyme specificity. Since the RDP motif is present in a conserved position in fructosyltransferases, invertases, levanases, inulinases and sucrose-6-phosphate hydrolases, it is likely to have a common functional role in beta-fructofuranosidases.

[Extracorporeal membrane oxygenation in myocardial failure after pediatric heart surgery]

In spite of progressive improvement not only in myocardial protection but also in anesthetic and surgical techniques, the repair of complex congenital heart defects can still lead to cardiopulmonary compromise refractory to conventional treatment. We describe two patients in whom successful surgical repair of congenital heart defects was followed by severe heart failure refractory to medical treatment. Both patients were managed by extracorporeal membrane oxygenation (ECMO). We discuss the indications, contraindications and use of ECMO in the postoperative intensive care unit.