Management of the neonate with patent ductus arteriosus

[Effectiveness and safety of the surgical closure of permeable arteriosus conduct by the general pediatric surgeon: clinical trial]

Antecedentes:

El conducto arterioso permeable (CAP) es un defecto cardiaco congénito y se considera un problema de salud pública. Se presenta en un alto porcentaje de recién nacidos y en algunos mayores de 1 mes. El cierre farmacológico es el tratamiento inicial preferido, ya que ha tenido excelentes resultados; sin embargo, en aquellos casos en los que no es posible, está indicado el cierre quirúrgico.

Objetivo:

Evaluar la eficacia y la seguridad del cierre quirúrgico del CAP por cirujanos pediatras sin especialidad en cirugía cardiovascular.

Método:

Ensayo clínico realizado en pacientes del Hospital General de Occidente, centro hospitalario público de segundo nivel, con diagnóstico de CAP, que requirieron corrección quirúrgica. Se revisaron en forma retrospectiva los expedientes de enero de 2001 a diciembre de 2018.

Resultados:

Se incluyeron 224 pacientes divididos en dos grupos: grupo I, con 184 (82%) recién nacidos, y grupo II, con 40 (18%) niños grandes de 2 meses a 8 años de edad. A todos se les realizó cierre quirúrgico: 3 por toracoscopía y 221 por toracotomía posterolateral izquierda. Presentaron complicaciones 36 pacientes, lo que representa el 16% del total; solo el 5.3% fueron complicaciones mayores. Fallecieron 24 pacientes en el posoperatorio, lo que representa una mortalidad del 10.7%; ninguno falleció por complicaciones transquirúrgicas. El CAP es un defecto cardíaco congénito que se presenta en alto porcentaje en pacientes prematuros. El cierre farmacológico es el principal tratamiento por tener excelentes resultados en recién nacidos; sin embargo, en aquellos casos en los que no sea posible está indicado el cierre quirúrgico. Todos los pacientes fueron operados por cirujanos pediatras generales, con una sobrevida global del 92%.

Conclusiones:

En los hospitales donde no hay cirujano cardiovascular pediátrico ni cardiólogo intervencionista, la corrección quirúrgica del CAP puede ser llevada a cabo por un cirujano pediatra. La técnica es reproducible, fácil de realizar y con mínimas complicaciones.

Significant role of high-valent iron-oxo species in the degradation and detoxification of indomethacine

A novel high-valent iron-oxo species (Fe(IV) = O) generated from Iron hexadecachlorophthalocyanine (FePcCl₁₆)-mediated peroxymonosulfate (PMS) activation under visible light illumination for the degradation of a special group of compounds, indomethacine (IDM), containing methoxy, carboxyl, chloro, and amide groups was investigated. The experimental results indicate that Fe(IV) = O was able to selectively attack the carbonyl C-N bond on twisted amide groups, which exerts a strong toxic effect, and could therefore, effectively degrade and detoxify IDM and its byproducts. Twelve byproducts were identified by HPLC/MS/MS and calculation of frontier electron densities (FEDs), with all amide-group breakage products detected, and the possible pathways were deduced, which mainly consisted of Fe(IV) = O-induced cleavage of amide groups and radicals-induced reactions. Ecological risk assessment further confirmed a decrease in toxicity towards IDM degradation, which provides a promising Fe(IV) = O species for selective oxidation and detoxification of destabilized ground-state amides in drinking-water and wastewater treatment.

Deleterious effects of indomethacin in the mid-gestation human intestine

The use of the anti-inflammatory drug indomethacin (INDO) in preterm infants has been associated with an increased risk of developing enteropathies. In this study, we have investigated the direct impact of INDO on the human mid-gestation intestinal transcriptome using serum-free organ culture. After determining the optimal dose of 1 μM of INDO (90% inhibition of intestinal prostaglandin E2 production and range of circulating levels in treated preterm babies), global gene expression profiles were determined using Illumina bead chip microarrays in both small and large intestines after 48 h of INDO treatment. Using Ingenuity Pathway Analysis software, we identified critical metabolic pathways that were significantly altered by INDO in both intestinal segments including inflammation and also glycolysis, oxidative phosphorylation and free radical scavenging/oxidoreductase activity, which were confirmed by qPCR at the level of individual genes. Taken together, these data revealed that INDO directly exerts multiple detrimental effects on the immature human intestine.