High-throughput synchronous erythrocyte cellular antioxidant activity and protection screening of phenolic-rich extracts: Protocol validation and applications

Oxidative/nitrosative damage takes part in chronic disease development, which generates an urgent need for intervention and better therapies to manage them. The scientific community has demanded easy-to-run, cheap, and reliable methods for cellular antioxidant activity assays. This work standardised and validated an erythrocyte cellular antioxidant activity and membrane protection/injury (HERYCA-P) protocol to study food-derive extracts. The method measures intracellular reactive oxygen species (ROS) generation, lipoperoxidation, and haemolysis induced by 2,2'-azobis(2-amidinopropane) dihydrochloride. Quercetin decreased ROS generation by 50.4% and haemolysis by 2.2%, while ascorbic acid inhibited lipid peroxidation by 40.1%. Total phenolic contents of teas were correlated with decreased ROS generation (r = -0.924), lipoperoxidation (r = -0.951), and haemolysis (r = -0.869). The erythrocyte ROS generation and lipoperoxidation were also associated with CUPRAC (r = -0.925; r = -0.951) and hydroxyl radical scavenging activity (r = -0.936; r = -0.949). The precision rates of antioxidant standards and tea samples were below 15%. HERYCA-P is feasible as a complementary antioxidant assay for food matrices.

Optimization of the Green Chemistry-like Extraction of Phenolic Compounds from Grape (Vitis labrusca L.) and Blackberry (Rubus fruticosus L.) Seeds with Concomitant Biological and Antioxidant Activity Assessments

The objective of this work was to determine the phenolic composition, chemical and cellular antioxidant activity, cytotoxicity in human cells, and peroxidative inhibition of the defatted fraction of grape (Vitis labrusca) and blackberry (Rubus fruticosus) seeds. Soxhlet extraction (Sox) was used to extract the fat and obtain the degreased material. A statistical optimization study was developed to maximize the extraction of bioactive compounds and antioxidant activity from defatted grape and blackberry seeds. Simultaneous optimization was applied with a combination of 35.9 min of extraction and a solid-to-solvent ratio of 1 g of defatted grape seed to 61.28 mL of an extracting solvent (60% ethanol) and 62.1 min of extraction and a solid-to-solvent ratio of 1 g of defatted blackberry seed to 64.1 mL of an extracting solvent (60% ethanol). In the cell viability assay, HepG2 cancer cells seemed more sensitive to grape and blackberry extracts, while Ea.hy926 hybrid cells showed more resistance to their effects. In general, the extracts presented low/no cytotoxicity, exhibited a protective effect against H₂O₂-induced ROS production, and demonstrated antioxidant activity and a protective effect on the erythrocytes when subjected to hypotonic and isotonic conditions not presenting hemolytic behavior (5.0 to 10.0 μg GAE/mL). Thus, the results provided a broad assessment of the bioactivity of the extracts obtained using a simple and low-cost process developed by employing non-toxic solvents and with the potential to be used in technological applications.

Sustainable and effective approach to recover antioxidant compounds from purple tea (Camellia sinensis var. assamica cv. Zijuan) leaves

Camellia sinensis var. assamica cv. Zijuan (purple tea) is known for its content of anthocyanins, flavan-3-ols, and bioactivities. This study aimed to verify the influence of solvent polarity, in a solid-liquid extraction, on the content of phenolic compounds and chlorophylls, instrumental color, and antioxidant activity. Different proportions of water and ethanol (0:100, 25:75, 50:50, 75:25, and 100:0 v/v) were used for extraction. The results showed that the hydroalcoholic extract (75 % ethanol + 25 % water) had the highest contents of total flavonoids, total anthocyanins, chlorophyll A, and total carotenoids, as well as presenting the highest color intensity, proportion of yellow pigments, and antioxidant activity (total reducing capacity and scavenging of the DPPH free radical). Twenty-two compounds were identified, with chlorogenic acid, hesperidin, (-)-epicatechin, (-)-epigallocatechin gallate, and isoquercitrin being the main phenolics. This phenolic-rich extract inhibited lipoperoxidation induced in egg yolk homogenate (IC₅₀ = 455 mg/L), showed no hemolytic behavior when human erythrocytes were subjected to osmotic stress, and exerted in vitro cytotoxic effects against cancer and hybrid cells. The extract obtained with the mixture of non-toxic solvents presented critical bioactivities, as well as a comprehensive identification of phenolic compounds in the cultivar, and has potential to be used in technological applications.

From the forest to the plate - Hemicelluloses, galactoglucomannan, glucuronoxylan, and phenolic-rich extracts from unconventional sources as functional food ingredients

This study aimed to characterise pressurised hot water (PHW) extracts from nonconventional sources of functional carbohydrates and phenolic compounds in terms of antioxidant capacity, antiviral activity, toxicity, and human erythrocytes' protection antidiabetic potential. PHW extracts of Norway spruce bark (E1 + E2) and Birch sawdust (E3 + E4) contained mostly galactoglucomannan and glucuronoxylan. In contrast, samples E5 to E9 PHW extracted from Norway spruce, and Scots pine bark are rich sources of phenolic compounds. Overall, phenolic-rich extracts presented the highest inhibition of α-amylase and α-glucosidase and protection against stable non-enveloped enteroviruses. Additionally, all extracts protected human erythrocytes from hemolysis. Cell-based experiments using human cell lines (IMR90 and A549) showed extracts' non-toxicin vitroprofile. Considering the relative toxicological safety of extracts from these unconventional sources, functional carbohydrates and polyphenol-rich extracts can be obtained and further used in food models.

Plant cell cultures of Nordic berry species: Phenolic and carotenoid profiling and biological assessments

Plant cell cultures from cloudberry (CL), lingonberry (LI), stone berry (ST), arctic bramble (AB), and strawberry (SB) were studied in terms of their polyphenol and carotenoid composition, antioxidant activity, antihemolytic activity and cytotoxicity effects on cancerous cells. High-resolution mass spectrometry data showed that LI, presented the highest antioxidant activity, contained the highest contents of flavones, phenolic acids, lignans, and total carotenoids, while CL, ST and SB presented the opposite behavior. AB and SB presented the lowest FRAP and CUPRAC values, while AB and CL presented the lowest reducing power. SB presented the lowest antioxidant activity measured by single electron transfer assays and the lowest content of lignans, phenolic acids, and flavones. CL and LI decreased the viability of in vitro mammary gland adenocarcinoma while only LI decreased the viability of in vitro lung carcinoma and showed protective effects of human erythrocytes against mechanical hemolysis.

Extraction optimization of bioactive compounds from ora-pro-nobis (Pereskia aculeata Miller) leaves and their in vitro antioxidant and antihemolytic activities

Ora-pro-nobis (Pereskia aculeata Miller) is a non-conventional food plant common in Brazil. The objective of this study was to optimize the extraction of bioactive phenolic compounds from ora-pro-nobis leaves by employing solvent mixtures. Ten extracts were obtained with water, ethanol, acetone, and their binary and ternary mixtures, evaluating the chemical composition, antioxidant activity and bioactivities in vitro. The response surface methodology was applied to model the results and calculate the optimal solvent composition, which is 60% water, 40% ethanol and 0% acetone. The optimized extract is rich in phenolic compounds (64 mg GAE/g) and proteins (823 mg/g) and presents antioxidant activity (in intracellular media as well) and inhibits lipid peroxidation (32%) along with hypotonic hemolysis (H₅₀ = 0.339%), it does not present toxicity in vitro against cancer and normal cells. This is the first report of chicoric, caffeoyl-hexaric and coumaroyl-hexaric acids and some glycosylate derivatives of flavonols in ora-pro-nobis leaves.

Polyphenols of jabuticaba [Myrciaria jaboticaba (Vell.) O.Berg] seeds incorporated in a yogurt model exert antioxidant activity and modulate gut microbiota of 1,2-dimethylhydrazine-induced colon cancer in rats

The chemical composition, antioxidant activity (AA), cytotoxic activity, antihemolytic effects, and enzyme inhibition (EI) of lyophilized jabuticaba (Myrciaria jaboticaba) seed extract (LJE) was studied. The main compounds found were castalagin, vescalagin, procyanidin A2, and ellagic acid. LJE was more toxic to cancer cells than to normal cells, meaning relative toxicological safety. This cytotoxic effect can be attributed to the pro-oxidant effect observed in the reactive oxygen species (ROS) generation assay. LJE inhibited α-amylase, α-glucosidase, and ACE-I activities and protected human erythrocytes from hemolysis. LJE was incorporated into yogurts at different concentrations and the total phenolic content, AA, and EI increased in a dose-dependent manner. LJE-containing yogurt presented 86% sensory acceptance. The yogurt was administered to Wistar rats bearing cancer and it modulated the gut bacterial microbiota, having a prebiotic effect. LJE is a potential functional ingredient for food companies looking for TPC, AA, and prebiotic effect in vivo.

A new analytical concept based on chemistry and toxicology for herbal extracts analysis: From phenolic composition to bioactivity

Studies regarding the bioactivity of teas are mainly based on the phenolic composition and in vitro antioxidant activity of the herbal species used in their preparation. The aim of this study was to compare the in vitro and ex vivo antioxidant activity, cytotoxic/antiproliferative activity against cancer cells, the inhibitory activity of α-amylase, α-glucosidase and angiotensin I-converting enzymes, as well as the inhibition of DNA-induced fission of the peroxyl radical, in relation to aqueous extracts of Camellia sinensis var. sinensis (CS), Ilex paraguariensis (IP), Aspalathus linearis (AL) and an optimised extract (OT) containing the three herb species. A bivariate and multivariate statistical approach was employed to associate functional activities with individual phenolic composition. The CS and OT extracts showed the highest levels of hesperidin, quercetin-3-rutinoside, (-)-epigallocatechin-3-gallate and isoquercitrin. The CS and OT extracts showed the highest antioxidant activity, greater ability to inhibit α-amylase and proliferation of HCT8 cells, and greater ability to reduce Folin-Ciocalteu reagent. The AL extract, which is the major source of quercetin-3-rutinoside, hesperidin and isoquercitrin, showed the highest ability to inhibit α-glucosidase, the inhibition of LDL oxidation and protection of human erythrocytes. The IP extract showed the highest inhibition of lipoperoxidation in brain homogenate of Wistar rats, antihypertensive activity, and A549 cell proliferation; chlorogenic acid was its major phenolic compound. In general, the in vitro functionality of each extract was dependent on its chemical composition and the OT extract presented the most varied phenolic composition, and biological activity similar to the CS sample. In conclusion, the mixture of CS, AL, and IP represents a chemical and functional-based strategy to develop functional teas.

From the Field to the Pot: Phytochemical and Functional Analyses of Calendula officinalis L. Flower for Incorporation in an Organic Yogurt

Edible flowers have been used as ingredients because of their biological activities, taste, and overall appearance. This research was aimed to characterize the chemical composition and in vitro antioxidant activity of the marigold flower (Calendula officinalis L.) extracted with different proportions of water and ethyl alcohol, and the lyophilized extract with higher content of antioxidant compounds was incorporated into an organic yogurt. Results showed that the hydroalcoholic extract (50:50 v/v) presented the highest total phenolic content (TPC), flavonoids, and antioxidant activity (ferric reducing antioxidant power (FRAP), total reducing capacity (TRC), and Cu²⁺/Fe²⁺ chelating ability). Phenolic acids and flavonoids were quantified in the extract by LC-DAD, while 19 compounds were tentatively identified by ESI-MS/MS. The lyophilized marigold extract (LME) also inhibited 12% of Wistar rat’s brain lipid oxidation in vitro, inhibited α-amylase, and α-glucosidase activities, but showed no cytotoxicity towards cancerous cells (HCT8 and A549). However, marigold flower extract protected human erythrocytes against mechanical stress. When added into an organic yogurt model (0 to 1.5%), LME increased TPC and antioxidant activity (2,2-diphenyl-1-picrylhydrazyl (DPPH) and TRC), and the sensory analysis showed that the organic yogurt had an acceptance of 80.4%. Our results show that the use of LME may be a technological strategy to increase the content of bioactive compounds in yogurts.

Flaxleaf Fleabane Leaves (Conyza bonariensis), A New Functional Nonconventional Edible Plant?

This work aimed to investigate the phytochemical composition, nutritional value, antioxidant, antihemolytic, antihyperglycemic, and antiproliferative activities of flaxleaf fleabane (Conyza bonariensis) leaves. Different concentrations of water and ethanol (0:100, 25:75, 50:50, 75:25, and 100:0 v/v) were used in the extraction process and results showed that the hydroalcoholic extract (50:50 v/v) presented the highest total phenolics, ortho-diphenolics, Folin-Ciocalteu reducing capacity, FRAP, and Fe²⁺ chelating ability values. Flaxleaf fleabane leaves (FFL) contained 19.6 g/100 g of fibers and 26 g/100 g of proteins. Ellagic acid, procyanidin A2, caffeic, rosmarinic, gallic, and 2,5-dihydroxybenzoic acids were the main phenolics. This phenolic-rich extract inhibited the lipid oxidation of Wistar rat brain (IC₅₀ = 863.0 mg GAE/L), inhibited α-glucosidase activity (IC₅₀ = 435.4 µg/mL), protected human erythrocytes against mechanical hemolysis at different osmolarity conditions, and showed cytotoxic/antiproliferative effects against human ileocecal adenocarcinoma cells (HCT8; IC₅₀ = 552.6 µg/mL) but no cytotoxicity toward noncancerous human lung fibroblast (IMR90). Overall, FFL showed potential to be explored by food companies to be a source of proteins, natural color substances, and phenolic compounds. PRACTICAL APPLICATION: Flaxleaf fleabane leaves (FFL) are usually burnt or partially given to cattle, without a proper utilization as a source of nutrients for human nutrition. Here, we studied the nutritional composition, phenolic composition, and toxicological aspects of FFL using different biological protocols. FFL was proven to be a rich source of proteins and dietary fibers and showed antioxidant activity measured by chemical and in vitro biological assays. Additionally, as it did protected human red cells and did not show cytotoxicity, we assume FFL has relative safety to be consumed as a nonconventional edible plant.

Red Chicory (Cichorium intybus) Extract Rich in Anthocyanins: Chemical Stability, Antioxidant Activity, and Antiproliferative Activity In Vitro

Red chicory leaves are appreciated sensorially and their constituents contain bioactive properties. The objectives of this study were as follows: to use an experimental design to extract anthocyanins from red chicory in aqueous solution at pH 2.5; to determine the stability of the extracts in relation to temperature and pH; and to evaluate the antioxidant activity and in vitro cytotoxic effect of the lyophilized and purified extracts. The best extraction conditions for the bioactive compounds from red chicory were a temperature of 64.2 °C for 25 min; the anthocyanin content was 73.53 ± 0.13 mg per 100 g fresh weight basis sample. The EC50 (Half maximal effective concentration) value for the antioxidant activity assay in relation to DPPH (2,2-diphenyl-1-picrylhydrazyl) with optimized extract was 0.363, which corresponds to a concentration of 39.171 µmol/L of anthocyanins. The activation energy for the degradation reaction of the anthocyanins from the red chicory extract was 84.88 kJ/mol. The optimized extract, which was rich in anthocyanins, showed chemical and biological antioxidant activity (protection against erythrocyte hemolysis) and inhibited lipid peroxidation in vitro. The Cichorium intybus L. extracts interfered on the levels of reactive oxygen species generation and the crude extract did not present procarcinogenic effect. PRACTICAL APPLICATION: Red chicory is basically consumed as a part of traditional dishes worldwide. Here, we developed a process to extract and purify the anthocyanins from Cichorium intybus leaves and test the extracts in terms of the chemical composition, thermal stability, antioxidant activity, and antiproliferative effects. The anthocyanin-rich extract presented antioxidant activity in chemical and biological assays and low cytotoxicity and cytoprotective effects in relation to HepG2, HCT8, and Caco-2 cell lines. Additionally, the red chicory extract protected human erythrocytes against hemolysis. This extract may be used as a natural colorant/antioxidant in foods.

Reduction of doxorubicin-induced genotoxicity by Handroanthus impetiginosus in mouse bone marrow revealed by micronucleus assay

Handroanthus impetiginosus has long been used in traditional medicine and various studies have determined the presence of bioactive chemical compounds and potential phytotherapeutics. In this study, the genotoxicity of the lyophilized tincture of H. impetiginosus bark (THI) was evaluated in mouse bone marrow using micronucleus assays. The interaction between THI and genotoxic effects induced by the chemotherapeutic agent, doxorubicin (DXR), was also analyzed. Experimental groups were evaluated 24 to 48 h after treatment with N-nitroso-N-ethylurea (NEU; 50 mg/kg), DXR (5 mg/kg), sodium chloride (NaCl; 150 mM), and THI (0.5-2 g/kg). Antigenotoxic assays were carried out using THI (0.5 g/kg) in combination with NEU or DXR. Analysis of the micronucleated polychromatic erythrocytes (MNPCEs) indicated no significant differences between treatment doses of THI (0.5-2 g/kg) and NaCl. Polychromatic erythrocyte (PCE) to normochromatic erythrocyte (NCE) ratios did not indicate any statistical differences between DXR and THI or NaCl, but there were differences between THI and NaCl. A significant reduction in MNPCEs and PCE/NCE ratios was observed when THI was administered in combination with DXR. This study suggested the absence of THI genotoxicity that was dose-, time-, and gender-independent and the presence of moderate systemic toxicity that was dose-independent, but time- and gender-dependent. The combination of THI and DXR also suggested antigenotoxic effects, indicating that THI reduced genotoxic effects induced by chemotherapeutic agents.

Anti-Blood Group Antibodies in Intravenous Immunoglobulin May Complicate Interpretation of Antibody Titers in ABO-Incompatible Transplantation

Patients receiving ABO-incompatible (ABOi) kidney transplants are treated before and after transplant with combination therapy, such as intravenous immunoglobulin (IVIG) and therapeutic plasma exchange, to prevent allograft rejection by reducing anti-A and anti-B titers. Although generally considered safe, it is well known that commercial IVIG products contain detectable anti-A and anti-B, which can be associated with hemolysis. Different preparative manufacturing techniques during the production of IVIG affect ABO antibody levels in IVIG preparations; therefore, some manufacturers now use new methods to reduce anti-A/B levels at the preproduction stage. The variations in implementing these strategies creates the potential for significant variation in antibody titers between products and, in some cases, even between lots of the same IVIG product. We report a case of persistently elevated anti-A titers in an ABOi kidney transplant recipient associated with elevated ABO antibody titers present in the preparation of IVIG used at our facility.

High-sensitivity dispersive Mach-Zehnder interferometer based on a dissimilar-doping dual-core fiber for sensing applications

A dual-core fiber in which one of the cores is doped with germanium and the other with phosphorus is used as an in-line Mach-Zehnder dispersive interferometer. By ensuring an equal length but with different dispersion dependencies in the interferometer arms (the two cores), high-sensitivity strain and temperature sensing are achieved. Opposite sensitivities for high and low wavelength peaks were also demonstrated when strain and temperature was applied. To our knowledge this is the first time that such behavior is demonstrated using this type of in-line interferometer based on a dual-core fiber. A sensitivity of (0.102±0.002)  nm/με, between 0 and 800  με and (-4.2±0.2)  nm/°C between 47°C and 62°C is demonstrated.

Membrane attack complex generation increases as a function of time in stored blood

OBJECTIVE

To determine if the complement system, a potent mediator of inflammation, contributes to haemolysis during red blood cell (RBC) storage.

BACKGROUND

RBCs in storage undergo structural and biochemical changes that may result in adverse patient outcomes post-transfusion. Complement activation on leukodepletion and during storage may contribute to the RBC storage lesion.

METHODS/MATERIALS

We performed a cross-sectional analysis of aliquots of leukoreduced RBC units, stored for 1-6 weeks, for the levels of C3a, C5a, Bb, iC3b, C4d and C5b-9 [membrane attack complex (MAC)] by enzyme-linked immunosorbent assay (ELISA).

RESULTS

We observed that only MAC levels significantly increased in RBC units as a function of storage time. We also observed that the level of C5b-9 bound to RBCs increased as a function of storage time.

CONCLUSION

MAC levels increased over time, suggesting that MAC is the primary complement-mediated contributor to changes in stored RBCs. Inhibition of the terminal complement pathway may stabilise RBC functionality and extend shelf life.

An inquiry into the relationship between ABO blood group and thrombotic thrombocytopenic purpura

BACKGROUND AND OBJECTIVES

ABO blood group accounts for up to 40% of the variability in plasma von Willebrand factor (VWF) levels, which vary in the rank order AB > B > A > O > Bombay. This may be due in part to the influence of ABO-associated oligosaccharides on the proteolysis of VWF by the metalloprotease ADAMTS13, which is markedly deficient in thrombotic thrombocytopenic purpura (TTP). Using ABO blood group as a surrogate for baseline VWF levels as well as susceptibility to proteolysis by ADAMST13, we set out to determine whether ABO blood group influences the clinical course of TTP.

METHODS

We conducted a retrospective analysis of the clinical course of 76 patients with primary, sporadic TTP treated at two institutions over the past 10 years.

RESULTS

We found no significant differences between group O and non-O patients with respect to presenting platelet count and lactate dehydrogenase concentration, maximum serum creatinine concentration, and total number of therapeutic plasma exchanges per episode.

CONCLUSIONS

Substrate-related contributors to the highly variable phenotype and clinical course of TTP warrant further investigation.

Patients with thrombotic thrombocytopenic purpura commonly develop metabolic alkalosis during therapeutic plasma exchange

Thrombotic thrombocytopenic purpura (TTP) and myasthenia gravis (MG) are category I indications for therapeutic plasma exchange (TPE). This study was based on the hypothesis that the development of metabolic alkalosis during TPE is more common in TTP than in MG, based on our previous observations. In order to test it, we compared the levels of bicarbonate and potassium in both groups of patients undergoing plasmapheresis. Fifteen patients with TTP (190 procedures) and ten MG patients seen concurrently were studied. While baseline bicarbonate levels were similar among all patients, the post-procedure bicarbonate levels in TTP patients were mostly elevated with a mean +/- SD of 29.4 +/- 3.5 mEq/L, as opposed to decreased or unchanged in MG patients 26.3 +/- 3.1 mEq/L (mean +/- SD) (P = 1.4 x 10(-8)). Furthermore, alkalosis in the TTP group persisted throughout subsequent daily treatments. There was also a significant decrease between pre- and post-TPE potassium levels in TTP patients (P = 3 x 10(-21)) by paired Student's t test. Additionally, samples with levels <3.3 mEq/L were alkalotic 75% of the time. In the MG group, however, potassium was normal in 85% and 83% of the pre- and post-TPE samples, respectively. Consequently, the hypokalemia was significantly more marked in the TTP group (P = 0.0008). These data confirm that plasmapheresis commonly induces metabolic alkalosis in TTP patients, probably due to high citrate in fresh frozen plasma, the frequency of treatments, and perhaps decreased renal clearance due to disease involvement of the kidneys.

When to suspect hypercoagulability and how to investigate it

The authors summarize the current knowledge in the area of novel risk factors for venous thrombosis, both genetic and acquired causes of hypercoagulability. Because the list of genetic defects that predispose carriers to develop thrombosis has increased significantly in recent years, along with the available assays to test for them, hypercoagulability has been a subject of much discussion. This review highlights the issues on hypercoagulability that pathologists who are not specialists in coagulation should be familiar with, in order to provide consultation to other physicians. An educated approach to the diagnosis of this newly described group of disorders will ensure more cost-effective and efficient care to patients at risk.

Defining/measuring the value of clinical information

Laboratory test results are of limited use in the absence of corresponding clinical information. The range of necessary and pertinent information is broad, but may be as narrow as knowing the patient's age and gender or the site from where a culture specimen was collected, up to the knowledge of the complete clinical history and physical examination for proper interpretation of a test result. Several issues are involved in the utilization of the clinical laboratory from the perspective of clinical appropriateness. In this article, we try to define and elaborate on how critical clinical information is for the pathologists and clinicians alike with the ultimate goal of optimal patient care.

[Pharmaceutical patents and the accessibility of drugs in Brazil]

Passage of Patent Law 9279/96, in effect since April 1997, has made relations between pharmaceutical patents and accessibility to medicine in Brazil complex. Under the new law, patents may extend to chemical inventions (products and process) and transgenic microorganisms. The issue is analyzed from two specific yet inter-related approaches: science and technology policy and health-care policy. The conclusion draws attention to the main future consequences of current international trends, both legal and regulatory. Brazil should ready its legal framework to respond to the negative consequences that genome patenting can be expected to have on the flow of scientific information and on access to pharmaceutical drugs.

Histologic examination of bone marrow core biopsy specimens has limited value in the diagnosis of mycobacterial and fungal infections in patients with the acquired immunodeficiency syndrome

Bone marrow cultures and biopsy specimens are commonly obtained to rule out disseminated infections, especially in persons with the acquired immunodeficiency syndrome (AIDS) and cytopenias. Using culture as the gold standard, we reviewed 130 consecutive bone marrow cores obtained from 114 AIDS patients along with results of concurrent blood and/or bone marrow aspirate cultures to determine the usefulness of histologic examination for diagnosis of mycobacterial and fungal infections. We also compared the ability of Ziehl-Neelsen, auramine-rhodamine (AR), polyclonal antibody to Mycobacterium bovis (Ab), and Gomori's methenamine silver staining to detect infections. Twenty-seven patients had mycobacterial infection (25 Mycobacterium avium-intracellulare complex cases and two Mycobacterium tuberculosis cases) detected by blood and/or bone marrow cultures. The maximum sensitivity of histology was 50% when the auramine-rhodamine stain and the polyclonal antibody to M bovis were used in combination. The single best stain was auramine-rhodamine, with a sensitivity of 44%, followed by the polyclonal antibody to M bovis (35%). Granulomas were observed in nine cases of mycobacterial infection and did not correlate with the presence of stainable organisms. Of seven patients with positive fungal cultures of bone marrow, four had granulomas and a positive Gomori's methenamine silver stain, one had only a positive stain, and two had neither granulomas nor a diagnostic stain. Overall, granulomas were not sensitive for the detection of infections when culture-proven mycobacterial and fungal cases were evaluated together. We conclude that bone marrow examination has a limited value in the routine evaluation of common opportunistic infections in AIDS patients and recommend that less-invasive tests, such as blood cultures, be obtained initially in most circumstances.

Cross-validation of modified fatness-specific bioelectrical impedance equations

The Segal fatness-specific bioelectrical impedance (BIA) equations are useful for predicting fat-free mass (FFM). Stolarczyk et al. Proposed a modified method of averaging the two equations for individuals who are neither lean nor obese, thus eliminating the need to know % BF a priori. To cross-validate this modification, we compared FFM determined using the averaging method versus hydrostatic weighing for 76 adults. Per the averaging method, accuracy for males was excellent (r =.91, SEE = 2.7 kg, E = 2.7 kg), with 78% of individuals within +/- .5% BF predicted by hydrostatic weighing. Accuracy for females was lower (r =.88, SEE = 3.0 kg, E = 3.1 kg), with % BF of 51% within +/- 3.5% of the reference method. The relative ease and practicality of the averaging method and the results of this study indicate this method may be useful with a diverse group.

Two acute pediatric abdominal catastrophes from strangulated left paraduodenal hernias

We present two cases of catastrophic intestinal obstruction from to strangulation of a left paraduodenal hernia (PDH). PDH is the most common internal hernia. Early diagnosis and treatment are essential because of the high morbidity and mortality associated with strangulation. Early involvement of the surgical team without an overly extensive evaluation in the emergency department is important if this diagnostic suspicion exists. PDH should also be considered when there is a history of chronic, intermittent abdominal pain of unclear cause. To our knowledge, these cases are the first described cases of sudden demise within a few hours of onset of symptoms of a left PDH.

The yield of bone marrow biopsy and culture compared with blood culture in the evaluation of HIV-infected patients for mycobacterial and fungal infections

PURPOSE

To compare the clinical utility of bone marrow biopsy and culture specimens with blood cultures for mycobacterial and fungal infections among human immunodeficiency virus (HIV)-infected patients.

PATIENTS AND METHODS

All bone marrow biopsies obtained from HIV-infected patients at the University of Alabama at Birmingham (UAB) Medical Center during 1993 to 1995 were blindly reviewed in a standardized format. Bone marrow culture results and blood culture results obtained within 6 weeks of each bone marrow study were compiled. Medical records were reviewed to determine indications for performing bone marrow biopsies, empiric or prophylactic antimicrobial therapies preceding the biopsy, and CD4 counts.

RESULTS

Eighty-two bone marrow studies were obtained from 76 patients. Most were performed during the evaluation of fever, cytopenia, or weight loss. Of 55 bone marrow mycobacterial cultures, 13 yielded Mycobacterium avium complex (MAC) and 2 yielded M tuberculosis (MTB). Of 51 bone marrow fungal cultures performed, 2 yielded Cryptococcus neoformans and 1 Histoplasma capsulatum. All patients with a bone marrow culture positive for MAC had a CD4 count of 20 cells/mm3 or less. The mean CD4 count in this group (+/-95% confidence interval) (8+/-3 cells/mm3) was lower than that of culture-negative cases (41+/-25 cells/mm3); P <0.015). When bone marrow cultures and mycobacterial blood cultures were concurrently obtained, results were usually in agreement between the two sites. The mean time until the report of positive mycobacterial bone marrow cultures (22+/-5 days) was similar to that for blood cultures (24+/-3 days). Most (84%) patients with multiple mycobacterial cultures had completely concordant results (all positive or all negative). When blood or bone marrow culture yielded mycobacteria, only 29% of the corresponding bone marrow examinations revealed stainable acid-fast bacilli (AFB). In contrast, all 3 cases with positive fungal bone marrow cultures also had stainable organisms on histologic examination.

CONCLUSIONS

The combined use of bone marrow biopsy and culture as well as blood cultures provide the maximum diagnostic yield when evaluating patients with AIDS for mycobacterial or fungal infections. However, when mycobacterial infections were diagnosed, bone marrow results seldom provided more immediate or specific information than lysis centrifugation blood cultures. A single lysis centrifugation blood culture should be the first step in the routine evaluation of HIV-infected patients when disseminated MAC infection is suspected.

Genotypic investigation of multidrug-resistant Acinetobacter baumannii infections in a medical intensive care unit

Multi-resistant Acinetobacter baumannii isolates obtained from 13 hospitalized patients over a six-month period were evaluated. One patient had an isolate susceptible only to imipenem; the next three had isolates susceptible to imipenem and ampicillin/sulbactam; the next six patients had isolates which were susceptible to imipenem, amikacin, and ampicillin/sulbactam; while the final three patients had isolates which were susceptible to imipenem and ampicillin/sulbactam. Ten patients died, five within 10 days of a positive culture. Five of six patients with bacteraemia succumbed to the infection. DNA extracted from all isolates was amplified by polymerase chain reaction using four random primers (RAPD). The resulting band patterns were compared and strains identified. In addition, all isolates were biotyped. RAPD analysis and biotyping showed that there were two distinct strains involved. The first four patients were infected with one strain (genotype ¿A', biotype 9), the subsequent nine patients were infected with a second strain (genotype ¿B', biotype 1). These results suggested that there was patient-to-patient spread of strains. Institution of, and strict adherence to, isolation procedure and other infection control practices controlled the spread of infection. These data emphasize the need for active surveillance for multidrug-resistant organisms in critically ill patients, and the value of molecular typing of strains in a hospital setting to investigate spread of infection.

Comparative in vitro antimicrobial susceptibilities of nosocomial isolates of Acinetobacter baumannii and synergistic activities of nine antimicrobial combinations

The in vitro susceptibilities of 69 nosocomial Acinetobacter isolates were determined by the broth microdilution method. Fourteen (20%) isolates were resistant to at least two aminoglycosides and two extended-spectrum penicillins. Nine antimicrobial combinations were then tested for synergy against these 14 isolates by checkerboard titration: imipenem with ciprofloxacin, amikacin, and tobramycin and ampicillin-sulbactam, piperacillin-tazobactam, and ticarcillin-clavulanate with amikacin and tobramycin. Synergy was detected with one or more antimicrobial combinations against 9 of 14 (64%) isolates, partial synergy was detected with one or more combinations against all 14 isolates, and an additive effect alone was observed with two different combinations against two isolates. No antagonism was detected with any combination. Imipenem plus either amikacin or tobramycin resulted in a synergistic or partial synergistic response against all 14 isolates. Specific combinations showing synergy against A. baumannii isolates were imipenem with tobramycin (four isolates), imipenem with amikacin (three isolates), ampicillin-sulbactam with tobramycin (six isolates), ampicillin-sulbactam with amikacin (three isolates), and ticarcillin-clavulanate with tobramycin (one isolate). Genotyping by randomly amplified polymorphic DNA analysis showed that 9 of the 14 isolates were of one strain, 4 isolates were of a second strain, and the remaining isolate was of a different strain. Eight of 14 (57%) patients infected with resistant A. baumannii isolates died. Only 3 of 14 patients had received a therapeutic regimen which was tested for synergy. Clinical studies are needed to determine the significance of these findings.

An overview of health-related industrial biotechnology in Latin America and the Caribbean

There is some uncertainty about the extent to which Latin America and the Caribbean have participated in the advances of health-related industrial biotechnology. This article reviews the available literature and seeks to provide an overview of the prevailing situation. In general, national governments and multinational agencies have provided most of the health-related biotechnology investments within this region. Efforts to achieve technology transfers, a subject of prime concern, have been developed by a number of programs including the WHO Special Program for Research and Training in Tropical Diseases, the UNDP/UNESCO/UNIDO Regional Biotechnology Program for Latin America and the Caribbean; PAHO's Program for the Regional Development of Biotechnology as Applied to Health; The PAHO/WHO Expanded Program on Immunization (EPI); and PAHO's Regional System of Vaccines (SIREVA). Regarding current production capacity, some successful efforts have been made to produce a variety of therapeutic products including recombinant and natural interferons, interleukins, insulin, and recombinant streptokinase; but in general the region's current potential in this area is at best incipient and uncertain. However, the region does have a limited ability to make diagnostic products and a well-established capacity for vaccine development. Overall, this picture suggests that the region has the potential to play a small but significant role in health-related biotechnology.

Hyaluronate capsule and surface M protein in resistance to opsonization of group A streptococci

The major virulence determinant of group A streptococci is the ability to resist opsonization and phagocytic ingestion. The present studies were performed to compare the mechanisms of resistance to opsonization of type 18 and type 24 streptococci and to determine the relative roles of M protein-fibrinogen interaction and the hyaluronate capsule in preventing phagocytic ingestion and killing. By use of parent strains and acapsular transposon mutants in the presence and absence of fibrinogen, we show that type 18 and type 24 streptococci rely on somewhat different mechanisms for resistance to opsonization. Type 24 streptococci bound fibrinogen avidly to their surfaces, and encapsulated organisms were completely resistant to opsonization only in the presence of fibrinogen. In contrast, type 18 streptococci bound 10-fold less fibrinogen than type 24 streptococci and were fully resistant to phagocytosis only when they expressed capsule. The general structural characteristics of the amino-terminal halves of type 18 and type 24 M proteins differed in that type 18 M protein contained only one complete B repeat, whereas type 24 M protein contained five complete B repeats, a structural difference which could potentially be related to the differences in fibrinogen binding between the two serotypes. Immunofluorescence assays of complement deposition were used in combination with 125I-C3 binding assays to show that encapsulated type 24 streptococci were fully resistant to opsonization by C3 only in the presence of plasma. Encapsulated and unencapsulated type 18 streptococci were equally opsonized by C3 in either plasma or serum, yet only encapsulated organisms resisted phagocytic killing in blood. The results of this study indicate that opsonization by C3 does not necessarily lead to phagocytic ingestion and that the hyaluronate capsule and M proteins are variably important in resistance to different group A streptococci to opsonization and phagocytic killing.

[Assessing the Brazilian network of poison control centers]

General concern about increasing reports of emergencies caused by or attributed to the exposure of human beings to various toxic agents has created demand for assessing the informational performance of a Brazilian network of 34 poison control centers (PCCs), located in different regions of the country and pertaining to the National Poison Information System (SINITOX). The primary purpose of these PCCs is to inform the public, prevent cases of poisoning, and provide medical care. This paper analyzes the available resources for identifying cases of poisoning, preventing new occurrences, and monitoring the consequences of toxic agents. This paper also analyzes data recorded front 1990 to 1992. The objective is to identify the main constraints to using health-data and management information as decision-making tools at the local level.

[Emerging infectious diseases in the realm of complexity: implications for scientific and technological policies]

The current emergence and global dissemination of some new and resurgent infectious diseases have surpassed national frontiers, increasingly affecting developing and also developed countries. This study stresses that this outburst is affecting the predictability of dominant health transition approaches. This paper analyses, from epistemological and policy viewpoints, alternative approaches in order to confront these new global epidemiological trends.

Functional activity of antibodies to the group B polysaccharide of group B streptococci elicited by a polysaccharide-protein conjugate vaccine

Group B streptococci (GBS) are a major cause of sepsis and meningitis in infants. While antibodies directed to the type-specific GBS capsule have been shown to be protective, it is less clear whether antibodies to the group B polysaccharide, a noncapsular, cell wall-associated antigen, may play a role in immunity. To investigate the functional activity of group B polysaccharide-specific antibodies, we tested sera from rabbits vaccinated with group B polysaccharide coupled to tetanus toxoid (B-TT). Anti-B-TT was weakly opsonic in vitro for a highly encapsulated type III strain, while antiserum elicited by vaccination with type III capsular polysaccharide linked to tetanus toxoid (III-TT) was a very effective opsonin. In contrast to anti-III-TT, anti-B-TT given before or after bacterial challenge was only marginally effective in protecting newborn mice against lethal infection with type III GBS. The number of C3 molecules bound to type III GBS was augmented by anti-III-TT but not by high antibody concentrations of anti-B-TT. These results suggest that the difference in opsonic activity between anti-B-TT and anti-III-TT may be due to a difference in their ability to deposit C3. In addition, the maximum number of antibody molecules bound to the bacterial surface was greater for anti-III-TT than for anti-B-TT. That anti-B-TT binds to fewer sites than anti-III-TT may explain the differences in complement activation and in opsonic and protective efficacy of antibodies to group B polysaccharide compared with antibodies to the type-specific capsular polysaccharide.

Effects of methylmercury exposure during the second stage of rapid postnatal brain growth on negative geotaxis and on delta-aminolevulinate dehydratase of suckling rats

In the present study, we examined the effects of exposure to methylmercury (0, 2.3, 4.6, 6.9 and 9.2 mg/kg, daily for 5 consecutive days, sc) during the second stage of rapid postnatal brain development (8 to 12 days of age) on the sulfhydryl-containing enzyme delta-aminolevulinate dehydratase (ALA-D, E.C. 4.2.1.24) from brain, liver and kidney and on motor performance (latency to complete a negative geotaxis response) of rats. ALA-D specific activity of 13-day old rats of both sexes (7-12 per group) was reduced significantly in rats treated with 6.9 mg/kg and 9.2 mg/kg in brain (about 40%, P < 0.05) and in liver (about 25%, P < 0.05). Renal ALA-D specific activity was not affected by methylmercury treatment. The in vitro IC50 for inhibition of brain, liver and renal ALA-D was 79.3, 81.8 and 39.1 microM, respectively. The latency to complete the negative geotaxis response of 12-day old rats was increased by 6.9 (7.9 +/- 0.7 s, mean +/- SEM) and 9.2 mg/kg methylmercury (7.8 +/- 0.5 s) when compared with control rats (5.8 +/- 0.3 s), suggesting an impairment in motor performance of exposed rats. These results demonstrate that exposure to relatively high doses of methylmercury during the second stage of brain development causes a significant reduction in brain and hepatic ALA-D. The absence of inhibition of ALA-D by lower doses may be related to the relatively low in vitro sensitivity of the enzyme to methylmercury. The possible involvement of ALA-D inhibition on the neurotoxicity of methylmercury deserves additional investigation.

Prevention of C3 deposition by capsular polysaccharide is a virulence mechanism of type III group B streptococci

Strains of type III group B streptococci isolated from patients with neonatal sepsis are generally resistant to complement-mediated phagocytic killing in the absence of specific antibody. It has been suggested that the resistance of type III group B streptococci to phagocytosis results from inhibition of alternative-complement-pathway activation by sialic acid residues of the type III polysaccharide. To better define the relationship between structural features of the type III capsule and resistance of type III group B streptococci to complement-mediated phagocytic killing, we measured deposition of human C3 on group B streptococcal strains with altered capsule phenotypes. C3 binding was quantified by incubating bacteria with purified human 125I-C3 in 10% serum. Wild-type group B Streptococcus sp. strain COH1 bound eightfold fewer C3 molecules than did either of two isogenic mutant strains, one expressing a sialic acid-deficient capsule and the other lacking capsule completely. Similar results were obtained when the incubation with 125I-C3 was performed in serum chelated with Mg-ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'- tetraacetic acid (MgEGTA), suggesting that the majority of C3 deposition occurred via the alternative pathway. In contrast to the wild-type strain, which was relatively resistant, both mutant strains were killed by human leukocytes in 10% serum with or without MgEGTA. We also measured C3 binding to 14 wild-type strains of type III group B streptococci expressing various amounts of capsule. Comparison of degree of encapsulation with C3 binding revealed a significant inverse correlation (r = -0.72; P less than 0.01). C3 fragments released by methylamine treatment of wild-type strain COH1 were predominantly in the form of C3bi, while those released from the acapsular mutant were predominantly C3b and those from the asialo mutant represented approximately equal amounts of C3b and C3bi. We conclude from these studies that the sialylated type III capsular polysaccharide inhibits alternative-pathway activation, prevents C3 deposition on group B streptococci, and protects the organisms from phagocytic killing.

Phosphatidylinositol-specific phospholipase C, a possible virulence factor of Staphylococcus aureus

Phosphatidylinositol-specific phospholipase C (PIPLC), an enzyme that can specifically release phosphatidylinositol-linked proteins from host cells, is one of the extracellular enzymes produced by Staphylococcus aureus. To investigate whether PIPLC might be a virulence factor, we assessed PIPLC production by S. aureus strains that had been isolated from healthy carriers and from infected patients with or without toxic shock syndrome. Although none of five vaginal isolates from healthy women was a PIPLC producer, only 10 of 32 selected pathogenic strains that caused significant infections or toxic shock syndrome elaborated PIPLC enzyme activity. Seven of 24 toxic-shock-associated strains, compared with 3 of 8 non-toxic-shock-associated strains, were positive for PIPLC. The majority of strains that produced PIPLC were negative for toxic shock syndrome toxin 1 (P less than 0.05); this association between PIPLC production and strains negative for toxic shock syndrome toxin 1 was even stronger among strains isolated only from patients with toxic shock syndrome (P less than 0.01). Among all 32 pathogenic isolates, PIPLC-producing S. aureus strains were isolated from four of four patients developing adult respiratory distress syndrome and four of five patients with disseminated intravascular coagulation, suggesting a significant association between PIPLC production and adult respiratory distress syndrome and/or disseminated intravascular coagulation (P less than 0.002). On the basis of these results, we propose that PIPLC is a virulence factor of S. aureus and is implicated in the development of adult respiratory distress syndrome and disseminated intravascular coagulation.