Optimized microwave-assisted azadirachtin extraction using response surface methodology.

The neem tree (Azadirachta indica A. Juss) is grown mainly for shade, fuel, and numerous non-timber forest products using its leaves, fruit, and bark. It produces an essential oil that is used as a source for obtaining bioinsecticides, with a broad spectrum of action in agricultural production. Its bioinsecticidal activity is due to the presence of triterpenes, such as azadirachtin, a product in continued growth of the global biopesticide market. Optimal conditions for neem oil extraction using response surface methodology (RSM) and microwave-assisted extraction (MAE) methods have been defined. However, the extraction conditions for these methods tend to consume high volumes of organic solvent and long extraction times. The aim of the present study is to determine the optimal conditions for the extraction of azadirachtin from neem seeds in a hydroalcoholic medium using MAE and RSM with a Box-Behnken design (BBD). A BBD was applied to evaluate the effects of the factors, magnetron voltage (X1), extraction time (X2), and pH of the extraction medium (X3), on the yield of the azadirachtin extraction process. The effect of each variable on the extraction yield was studied independently, considering the pure coefficients (linear and quadratic) on the three levels that were studied in the experiments. Moreover, the study experiments were conducted in triplicate, data were presented as mean and standard deviation, homogeneity of variances was estimated using Levene's test, and a two-way ANOVA with Tukey's post hoc analysis was performed to identify the experimental conditions that allowed us to find the highest extraction yield and to analyze whether the response surface model adequately described our data. The most significant effects of the model correspond to quadratic and interaction effects (p < 0.0001); the quadratic terms voltage (X1), extraction time (X2), and pH (X3); and the interaction effects between voltage-pH (X1*X3) and time-pH (X2*X3), which had a significant influence on the model. Moreover, a canonical analysis was performed. The optimal conditions were as follows: 69.22 V, 6.89 min, and a pH value of 4.35, coinciding with the zones shown in the contour plots. Furthermore, the response obtained at the optimal conditions was 37.5 µg of azadirachtin per gram of pretreated seed.

Tombstone cost and longevity: The San Pedro Cemetery Museum in Medellín in Colombia.

BACKGROUND: Studies in the West suggest that tombstone cost is associated with longevity. The objective of this observational study was to investigate the association between tombstone cost and longevity in a large cemetery in Latin America. METHODS: Age at death was obtained from 2,273 consecutive death certificates held at the San Pedro Cemetery Museum in Medellín in Colombia. Subjects died in 2022, 2021, or 2020. Tombs are arranged in galleries in the cemetery and tombstone cost was based on the material from which the tombstone was made, its position in the gallery, and its ornamentation. Analysis of variance was used and the assumption of equal variance was not violated. RESULTS: Approximately 77% of tombstones were of low cost, 21% of medium cost, and 2% of high cost. Data from 1,751 subjects were used to investigate differences in longevity according to tombstone cost while adjusting for sex, civil status, violent death, and year of death. Longevity was similar in the low-cost group and medium-cost group: 64.3 years (63.2, 65.3) versus 63.3 years (61.3, 65.3) [estimated mean (95% confidence interval)]. Longevity was lower in the high-cost group: 47.0 years (40.1, 53.9). CONCLUSIONS: The inverse association between tombstone cost and longevity would suggest that people in Medellín are inclined to spend more on tombstones when commemorating the tragic death of a young person.

Abordaje quirúrgico en el fracaso de la terapia de resincronización cardiaca por vía intravascular / Surgical approach to endovascular cardiac resynchronisation after

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El polimorfismo R753Q del toll-like receptor 2 se asocia a un aumento en el riesgo de sufrir endocarditis infecciosa / Toll-like receptor 2 R753Q polymorphisms are associated with an increased risk of infective endocarditis

La capacidad para responder a los ligandos de toll-like receptors (TLR) puede verse afectada por polimorfismos de un solo nucleótido en genes que codifican TLR. Estudiamos la influencia de los polimorfismos TLR2 (R753Q, R677W), TLR4 (D299G, T399I) y CD14 (C-159T) en 65 pacientes consecutivos con endocarditis infecciosa. El grupo control (n=66) estuvo formado por voluntarios sanos. Todos los polimorfismos fueron genotipados mediante análisis de restricción después de su amplificación. Se observó asociación de endocarditis con variantes de TLR2 R753Q (p<0,001) y no se encontró asociación con otros polimorfismos. Los genotipos TLR2 R753Q, codominantes (odds ratio=13,33), recesivo (odds ratio=9,12) y dominantes (odds ratio=3,65) mostraron asociación positiva con el fenotipo de endocarditis infecciosa. El polimorfismo TLR2 R753Q se asoció a una mayor susceptibilidad a sufrir endocarditis infecciosa. Son necesarios futuros estudios para validar estos resultados e identificar otros factores genéticos de riesgo (AU)

The ability to respond to the ligands of toll-like receptors (TLR) could be affected by single nucleotide polymorphisms in TLR codifying genes. The influence of the polymorphisms TLR2 (R753Q, R677W), TLR4 (D299G, T399I) and CD14 (C-159T) was consecutively studied in 65 patients with infective endocarditis. The control group (n=66) consisted of healthy volunteers. All the polymorphisms were genotyped by means of restriction analysis after their amplification. An association between endocarditis and variants of TLR2 R753Q (P<.001) was observed, but no association with other polymorphisms was found. The TLR2 R753Q co-dominant (odds ratio=13.33), recessive (odds ratio=9.12) and dominant (odds ratio=3.65) genotypes showed a positive association with the infective endocarditis phenotype. The polymorphism TLR2 R753Q was associated with a greater susceptibility towards the development of infective endocarditis. Further studies are required to validate these results and identify other genetic risk factors (AU)

[Toll-like receptor 2 R753Q polymorphisms are associated with an increased risk of infective endocarditis]. / El polimorfismo R753Q del toll-like receptor 2 se asocia a un aumento en el riesgo de sufrir endocarditis infecciosa.

The ability to respond to the ligands of toll-like receptors (TLR) could be affected by single nucleotide polymorphisms in TLR codifying genes. The influence of the polymorphisms TLR2 (R753Q, R677W), TLR4 (D299G, T399I) and CD14 (C-159T) was consecutively studied in 65 patients with infective endocarditis. The control group (n=66) consisted of healthy volunteers. All the polymorphisms were genotyped by means of restriction analysis after their amplification. An association between endocarditis and variants of TLR2 R753Q (P <.001) was observed, but no association with other polymorphisms was found. The TLR2 R753Q co-dominant (odds ratio=13.33), recessive (odds ratio=9.12) and dominant (odds ratio=3.65) genotypes showed a positive association with the infective endocarditis phenotype. The polymorphism TLR2 R753Q was associated with a greater susceptibility towards the development of infective endocarditis. Further studies are required to validate these results and identify other genetic risk factors.

Intraoperative PaO2 is not related to the development of surgical site infections after major cardiac surgery.

BACKGROUND: The perioperative use of high inspired oxygen fraction (FIO2) for preventing surgical site infections (SSIs) has demonstrated a reduction in their incidence in some types of surgery however there exist some discrepancies in this respect. The aim of this study was to analyze the relationship between PaO2 values and SSIs in cardiac patients. METHODS: We designed a prospective study in which 1,024 patients undergoing cardiac surgery were analyzed. RESULTS: SSIs were observed in 5.3% of patients. There was not significant difference in mortality at 30 days between patients with and without SSIs. In the uni and multivariate analysis no differences in function of the inspired oxygen fraction administrated were observed. CONCLUSIONS: We observed that the PaO2 in adult cardiac surgery patients was not related to SSI rate.

Membrana biodegradable de colágeno-elastina como sustituto pericárdico en cirugía coronaria / No disponible

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Risk factors for mediastinitis and endocarditis after cardiac surgery.

A prospective open-cohort study was performed in 838 adults undergoing coronary revascularization or valve surgery to define the risk factors for development of surgical site infections. Patients diagnosed with mediastinitis or endocarditis during follow-up were compared with patients with no such infection. After 1 year of follow-up, 22 (2.6%) patients had developed mediastinitis or endocarditis. No preoperative or intraoperative variables were identified as risk factors. By multivariate analysis of postoperative variables, respiratory insufficiency, microorganisms in blood cultures, and intensive care unit stay were independent risk factors for the development of these complications. The type of antibiotic prophylaxis had no influence on the incidence of organ or space infections after cardiac surgery.

Combined surgical treatment in aortic type A dissection.

Acute Stanford type A aortic dissection is a fatal event that, for its high mortality when left untreated, requires urgent surgical intervention. The established treatment includes repair of the ascending aorta and various portions of the aortic arch, leaving the descending aorta untreated. We report the case of a 62-year-old man in whom a combined approach of the ascending aorta with surgical correction and transluminal placement of a stent in the aortic arch was performed.

Building a new annulus: a technique for mitral valve replacement in heavily calcified annulus.

We describe the rationale, methodology, and our preliminary experience with a new surgical technique for mitral valve replacement in patients with severe calcification of the mitral annulus in which the conventional techniques can not be applied. In contrast with other procedures published in the literature for these patients, in which the placement of the prosthesis is supra-annular, we plicate both mitral leaflets and the atrial wall creating a new annulus that allows the intra-annular placement of the prosthesis.

Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery.

OBJECTIVE: Use of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance, lower costs, and fewer problems with drug toxicity and superinfections. We tested the hypothesis that single doses of cefazolin are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac procedures. METHODS: This random, prospective, clinical study included 838 adult patients undergoing elective coronary artery bypass grafting, valve operations, or both. These patients were randomly given a single dose of cefazolin (2 g) or a 24-hour treatment (2-g initial dose, followed by 1 g every 8 hours). Investigators blinded to the drug regimen diagnosed wound infections according to Centers for Disease Control and Prevention criteria. Patient clinical and demographic characteristics were noted, with follow-up for 12 postoperative months. The primary objective was to compare the incidence of surgical infections between groups up to 12 months postoperatively. RESULTS: A total of 419 patients received single-dose cefazolin, and another 419 received the 24-hour treatment. Surgical site infection occurred in 35 (8.3%) patients receiving single doses and 15 (3.6%) patients administered the 24-hour treatment (P = .004). We identified no differences between groups for mortality or duration of hospitalization (preoperative hospitalization, intensive care unit stay, and hospitalization after surgical intervention). The microorganisms isolated showed a similar distribution in both groups. The germs isolated were gram-positive cocci in 86% of the surgical site infections. CONCLUSIONS: Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher surgical site infection rate than the 24-hour, multiple-dose cefazolin regimen.

Isolated right-sided valvular endocarditis in non-intravenous drug users.

INTRODUCTION AND OBJECTIVES: Characteristics of isolated right-sided endocarditis in patients without a pacemaker and who are not intravenous drug users (IVDU) are poorly understood. The aim of this study was to investigate the current frequency of this entity and describe its clinical, microbiological, echocardiographic and prognostic profile. METHODS: We have prospectively analyzed 17 consecutive cases of isolated right-sided endocarditis in non-IVDU who did not have a pacemaker, out of a total of 583 consecutive episodes of endocarditis (2.9%). RESULTS: Mean age was 38+/-15 years; 11 of the 17 patients were men. Almost half of the patients had at least one predisposing disease. An intravascular catheter was the most frequent port of entry (35%). The most common signs and symptoms on admission were fever, dyspnea, septic pulmonary embolisms, pleural effusion and right-sided heart failure. The most frequent microorganism was Staphylococcus aureus (41%). In most cases (82%) the infection was located in the tricuspid valve. Recurrent pulmonary embolisms were the most frequent complication and the main cause for surgery, which was needed in 5 patients (29%). Two patients died during hospitalization (12%), both from septic shock. During follow-up one patient died of unknown causes 1 month after discharge, and other relapsed 3 months after discharge. CONCLUSIONS: Isolated right-sided endocarditis should be included in the differential diagnosis of patients with febrile syndrome, respiratory symptoms and predisposing disease, even when they do not have a pacemaker and are not IVDU. The presence of intravascular catheters and Staphylococcus bacteriemia should heighten suspicion of endocarditis.

Endocarditis derecha aislada en pacientes no adictos a drogas por vía parenteral / Isolated right-sided valvular endocarditis in non-intravenous drug users

Introducción y objetivos. La endocarditis derecha aislada es una entidad poco conocida cuando afecta a pacientes no portadores de marcapasos y no adictos a drogas por vía parenteral (ADVP). Nuestro objetivo es estudiar la frecuencia actual de esta entidad y describir su perfil clínico, microbiológico, ecocardiográfico y pronóstico. Métodos. Hemos analizado 17 casos de endocarditis derecha aislada en pacientes no ADVP y no portadores de marcapasos, de un total de 583 episodios consecutivamente diagnosticados de endocarditis infecciosa (3%). Resultados. La media de edad fue 38 ± 15 años y 11 pacientes eran varones. El 47% de los pacientes presentaban alguna enfermedad predisponente. El catéter intravascular fue la puerta de entrada más frecuente (35%). Los síntomas y signos más comunes al ingreso fueron fiebre, disnea, embolia pulmonar séptica, derrame pleural e insuficiencia cardiaca derecha. El microorganismo más frecuente fue Staphylococcus aureus (41%). La mayoría de los casos asentaron en la válvula tricúspide (82%). La embolia pulmonar recurrente fue la complicación más frecuente y la principal causa de cirugía, que fue precisa en 5 (29%) casos. Fallecieron 2 (12%) pacientes, ambos por shock séptico. En el seguimiento, 1 paciente falleció al mes del alta por causa desconocida y 1 presentó una recaída al tercer mes. Conclusiones. La endocarditis derecha aislada debe incluirse en el diagnóstico diferencial de pacientes con síndrome febril, síntomas respiratorios y alguna enfermedad predisponente, aunque no sean portadores de marcapasos o ADVP. La presencia de catéteres intravasculares y la bacteriemia por estafilococos refuerzan la sospecha de endocarditis en estos pacientes (AU)

Introduction and objectives. Characteristics of isolated right-sided endocarditis in patients without a pacemaker and who are not intravenous drug users (IVDU) are poorly understood. The aim of this study was to investigate the current frequency of this entity and describe its clinical, microbiological, echocardiographic and prognostic profile. Methods. We have prospectively analyzed 17 consecutive cases of isolated right-sided endocarditis in non-IVDU who did not have a pacemaker, out of a total of 583 consecutive episodes of endocarditis (2.9%). Results. Mean age was 38±15 years; 11 of the 17 patients were men. Almost half of the patients had at least one predisposing disease. An intravascular catheter was the most frequent port of entry (35%). The most common signs and symptoms on admission were fever, dyspnea, septic pulmonary embolisms, pleural effusion and right-sided heart failure. The most frequent microorganism was Staphylococcus aureus (41%). In most cases (82%) the infection was located in the tricuspid valve. Recurrent pulmonary embolisms were the most frequent complication and the main cause for surgery, which was needed in 5 patients (29%). Two patients died during hospitalization (12%), both from septic shock. During follow-up one patient died of unknown causes 1 month after discharge, and other relapsed 3 months after discharge. Conclusions. Isolated right-sided endocarditis should be included in the differential diagnosis of patients with febrile syndrome, respiratory symptoms and predisposing disease, even when they do not have a pacemaker and are not IVDU. The presence of intravascular catheters and Staphylococcus bacteriemia should heighten suspicion of endocarditis (AU)

[Effects of simvastatin on acute-phase protein levels after cardiac surgery]. / Efecto de la simvastatina en la concentración de las proteínas de fase aguda después de la cirugía cardíaca.

BACKGROUND AND OBJECTIVE: There is contradictory evidence as to whether the pleiotropic effects of statins improve morbidity/mortality rates in coronary artery bypass grafting with extracorporeal circulation, as they reduce the protein plasma levels in the acute phase. PATIENTS AND METHOD: This randomized prospective study included 44 patients undergoing elective coronary artery bypass grafting with extracorporeal circulation who were allocated to one of 2 groups: group A (n = 22), patients taking simvastatin, and group B, control (n = 22). The plasma levels of interleukin-6, complement 4 and C-reactive protein were determined. RESULTS: No significant differences were noted between the 2 groups with respect to the acute-phase protein levels, or the postoperative complications. In both groups, compared with the initial levels, interleukin-6 levels peaked at 6 h after surgery and C-reactive protein at 48 h. Complement 4 levels decreased from the start of the cardiopulmonary bypass and returned progressively toward the baseline value at 48 h after surgery. CONCLUSIONS: Simvastatin in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass produces no significant differences in the levels of acute-phase protein.