Improving the Composition and Bioactivity of Cocoa (Theobroma cacao L.) Bean Shell Extract by Choline Chloride-Lactic Acid Natural Deep Eutectic Solvent Extraction Assisted by Pulsed Electric Field Pre-Treatment.

An environmentally friendly method for the release of cocoa bean shell (CBS) extracts is proposed in this paper. This work aims to investigate the effect of pulsed electric field (PEF) pre-treatment on subsequent solid-liquid extraction (SLE) of metabolites with choline chloride-lactic acid natural deep eutectic solvent (NaDES) and bioactivity of cocoa bean shell (CBS) extract. Two different media for PEF application were evaluated: water and chlorine chloride-lactic acid. Total polyphenols (TPC), total flavonoids (TFC), individual major compounds, and antioxidant and antibacterial activity of CBS extracts were assessed. The performance of PEF-assisted extraction was compared with SLE and ultrasound-assisted extraction (UAE). The proposed method improved the release of TPC up to 45% and TFC up to 48% compared with the conventional extraction. The CBS extract showed medium growth inhibition of Escherichia coli and high growth inhibition of Salmonella sp, Listeria monocytogenes, and Staphylococcus aureus. Thus, an extract with enhanced antioxidant and antibacterial properties was obtained.

Effect of choline chloride-based deep eutectic solvents on polyphenols extraction from cocoa (Theobroma cacao L.) bean shells and antioxidant activity of extracts.

The effective extraction of natural compounds from cocoa bean shells using deep eutectic solvents could contribute to the sustainable valorization of this waste material. The objective of this study was to: (1) analyze the extraction kinetics of polyphenols released from cocoa (Theobroma cacao L.) bean shells (CBS) by the solid-liquid extraction method using choline chloride-based deep eutectic solvents (ChCl-DES) and their aqueous solutions; (2) investigate the effect of choline chloride-based deep eutectic solvents (ChCl-DES) aqueous solutions on in-vitro antioxidant capacity and the main individual compounds of the extracts. ChCl-DES were prepared with lactic acid, glycerol, and ethylene glycol in a 1:2 ratio. Aqueous solutions (30%, 40%, and 50% water) to obtain solvents with different physicochemical properties were performed. The total phenolic content (TPC) was determined by the Folin-Ciocalteu method. The solution of Fick's law model for plate geometry particles was applied to fit the experimental data and calculate the effective diffusivity coefficient (De). The antioxidant capacity of the extracts was analyzed by a combination of 2,2-diphenyl-1-(2,4,6-trinitrophenyl) hydrazyl (DPPH) free radical scavenging capacity and ferric-reducing antioxidant power (FRAP) assays. The main bioactive compounds were quantified by high-performance liquid chromatography. The results showed that the type of hydrogen bond donor influences the total phenolic content, antioxidant activity and the main individual compounds in the extracts. Moreover, the washing/diffusion mechanism adequately depicts the extraction kinetics data for total phenolic content. However, the influence of an additional mechanism that enhanced the extraction capacity of deep eutectic solvents compared with organic solvent was confirmed.

Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate.

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998-24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402-5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

Persistência de via cava superior esquerda e implante de marca-passo bicameral: resumo / Persistence of left superior vena cava and bicameral pacemaker implantation

Resumo 57028: trabalho apresentado no 37º Congresso de Cardiologia da SOCERJ

Chemoprotective and antiobesity effects of tocols from seed oil of Maqui-berry: Their antioxidative and digestive enzyme inhibition potential.

Maqui-berry (Aristotelia chilensis) is the emerging Chilean superfruit with high nutraceutical value. Until now, the research on this commodity was focused on the formulations enriched with polyphenols from the pulp. Herein, contents of tocols were compared in the seed oil of Maqui-berry obtained through three different extraction methods followed by determining their antioxidative and enzyme inhibitions in-vitro. Firstly, oilseed was extracted with n-hexane (Soxhlet method), chloroform/methanol/water (Bligh and Dyer method) and pressing (industrial). These samples were used to access their effects against DPPH, HORAC, ORAC, FRAP, Lipid-peroxidation (TBARS), α-amylase, α-glucosidase, and pancreatic lipase. All the isomers of tocopherol and tocotrienol were identified, and ß-sitosterol was the only sterol found in higher amounts than other vegetable oils. The Bligh and Dyer method could lead to the highest antioxidative capacity compared to Soxhlet and press methods likely because the latter have a higher amount of tocopherols. Further, seed oil from Maqui berry and their tocols (α, ß, γ, δ-tocopherols, tocotrienols, and ß-sitosterol) warrant clinical investigation for their antioxidative and antiobesity potential. Taken together, these findings provide relevant and suitable conditions for the industrial processing of Maqui-berry.

Survival of Critically Ill Oncologic Patients Requiring Invasive Ventilatory Support: A Prospective Comparative Cohort Study With Nononcologic Patients.

PURPOSE: Cancer is in the process of changing to become a chronic disease; therefore, an increasing number of oncologic patients (OPs) are being admitted to intensive care units (ICUs) for supportive care of disease or therapy-related complications. We compare the short- and long-term outcomes of critically ill mechanically ventilated OPs with those of their nononcologic counterparts. PATIENTS AND METHODS: We performed a prospective study of patients admitted to our ICU between October 2017 and February 2019. Demographic, physiologic, laboratory, clinical, and treatment data were obtained. The primary outcome was survival at 28 days and at the end of the follow-up period. Secondary outcomes were survival according to acute severity scoring (Acute Physiology and Chronic Health Evaluation II score), Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson comorbidity index. RESULTS: A total of 1,490 patients were admitted during the study period; 358 patients (24%) were OPs, and 100 of these OPs were supported with mechanical ventilation. Seventy-three percent of OPs had an ECOG performances status of 0 or 1, and 90% had solid tumors. Reason for admission to the ICU was postoperative admission in 44 patients and neutropenic infection in 10 patients. The follow-up period was 148 days (range, 42 to 363 days). Survival at 28 days was similar between OPs and nononcologic patients and associated with the Acute Physiology and Chronic Health Evaluation II score. However, long-term survival was lower in OPs compared with nononcologic patients (52% v 76%, respectively; P < .001) and associated with poor ECOG performance status. CONCLUSION: Short-term survival of critically ill, mechanically ventilated OPs is similar to that of their nononcologic counterparts and is determined by the severity of the critical illness.

[Deep brain stimulation in Parkinson's disease]. / Estimulación cerebral profunda en enfermedad de Parkinson.

BACKGROUND: Deep brain stimulation is an essential therapeutic tool in Parkinson's disease. AIM: To assess the results of a series of patients with Parkinson's disease treated with micro-electrode guided subthalamic nucleus stimulation. MATERIAL AND METHODS: Twenty patients with idiopathic Parkinson's disease were studied (10 males). Three months after surgery, we analyzed the change in motor disturbances, medication need to control symptoms and quality of life. RESULTS: We observed a significant improvement in all the assessed variables. Motor involvement determined as OFF hours and expressed as percentage of the day changed from 30 ± 15 to 10 ± 7% in the preoperative and postoperative periods, respectively. ON hours without dyskinesia changed from 17 ± 16 to 78 ± 21%. ON hours with dyskinesia changed from 53 ± 23 to 12 ± 15%. Medication need changed from 1,505 ± 499 to 1,214 ± 528 levodopa equivalents. Parkinson's Disease Questionnaire 39 score changed from 62.9 ± 22.7 to 34.3 ± 18.5. During the 5-year follow-up a continuous improvement of symptoms was observed. CONCLUSIONS: Micro-electrode guided subthalamic nucleus functional surgery in patients with Parkinson's disease has good immediate and late results.

Estimulación cerebral profunda en enfermedad de Parkinson / Deep brain stimulation in Parkinson's disease

Background: Deep brain stimulation is an essential therapeutic tool in Parkinson's disease. Aim: To assess the results of a series of patients with Parkinson's disease treated with micro-electrode guided subthalamic nucleus stimulation. Material and Methods: Twenty patients with idiopathic Parkinson's disease were studied (10 males). Three months after surgery, we analyzed the change in motor disturbances, medication need to control symptoms and quality of life. Results: We observed a significant improvement in all the assessed variables. Motor involvement determined as OFF hours and expressed as percentage of the day changed from 30 ± 15 to 10 ± 7% in the preoperative and postoperative periods, respectively. ON hours without dyskinesia changed from 17 ± 16 to 78 ± 21%. ON hours with dyskinesia changed from 53 ± 23 to 12 ± 15%. Medication need changed from 1,505 ± 499 to 1,214 ± 528 levodopa equivalents. Parkinson's Disease Questionnaire 39 score changed from 62.9 ± 22.7 to 34.3 ± 18.5. During the 5-year follow-up a continuous improvement of symptoms was observed. Conclusions: Micro-electrode guided subthalamic nucleus functional surgery in patients with Parkinson's disease has good immediate and late results.

[Validation of transcranial Doppler in the diagnosis of brain death]. / Validez del Doppler transcraneal en el diagnóstico de muerte encefálica.

BACKGROUND: The clinical diagnosis of brain death is complex. AIM: To evaluate the diagnostic accuracy of transcranial Doppler (TCD) for brain death. PATIENTS AND METHODS: Patients seen on the intensive care unit of a private hospital between January 2004 to December 2008, were included if they were in structural coma, had no craniectomy and had a blind evaluation by a neurologist and TCD done in less than three hours. The diagnosis of brain death was based on a clinical evaluation that considered the absence of sedative drugs, median blood pressure>60 mmHg, body temperature over 35 masculine Celsius and complete absence of brainstem reflexes. An expert neurosonologist, with a TCD-PMD-100, 2 Mhz transducer, used an institutional protocol that considers the examination as positive for brain circulatory arrest when there is presence of reverberating, small systolic peaks or the disappearance of a previous signal present on both middle cerebral arteries and intracranial vertebral arteries. RESULTS: Fifty three patients were evaluated, 25 with clinical brain death. On 45 cases (84.9%), the interval between both evaluations was less than one hour. The sensitivity, specificity, positive and negative predictive values for the diagnosis of brain death with TCD were 100, 96, 96.1 and 100% respectively. Positive and negative likelihood ratios for brain death were 28 and 0, respectively. CONCLUSIONS: TCD is a valid and useful technique for the diagnosis of brain death and can be used on complicated cases.

[Ten myths about withdrawal of mechanical ventilation in terminal patients]. / Diez mitos sobre el retiro de la ventilación mecánica en enfermos terminales.

The most difficult of treatment limitation decisions, both for physicians and families, is the withdrawal of mechanical ventilation (MV). Many fears and uncertainties appear in this decision. They are described as ten myths whose falseness is argued in this article. The myths are: 1) Withdrawing MV causes the patients death; 2) Withdrawing MV is euthanasia; 3) Withholding and withdrawing MV are morally different; 4) MV can be withdrawn only when the patient has asked for it; 5) Chilean law only authorizes to withdraw VM when brain death has occurred; 6) Withdrawing MV cannot be done if the patient is not an organ donor; 7) Physicians who withdraw MV are in high risk of legal claims; 8) To withdraw MV the physician needs an authorization from the hospital ethics committee, lawyer or institutional authority; 9) There is only one way to withdraw MV; 10) Withdrawing MV produces great suffering to the patients family. Making clear that these myths are false facilitates appropriate decisions, therefore preventing therapeutic obstinacy and more suffering of terminally ill patients, which favors their peaceful death. For the physician this goal should be as rewarding as preventing the death of a curable patient.

Validez del Doppler transcraneal en el diagnóstico de muerte encefálica / Validation of transcranial Doppler in the diagnosis of brain death

Background: The clinical diagnosis of brain death is complex. Aim: To evaluate the diagnostic accuracy of transcranial Doppler (TCD) for brain death. Patients and Methods: Patients seen on the intensive care unit of a private hospital between January 2004 to December 2008, were included if they were in structural coma, had no craniectomy and had a blind evaluation by a neurologist and TCD done in less than three hours. The diagnosis of brain death was based on a clinical evaluation that considered the absence of sedative drugs, median blood pressure >60 mmHg, body temperature over 35º Celsius and complete absence of brainstem refexes. An expert neurosonologist, with a TCD-PMD-100, 2 Mhz transducer, used an institutional protocol that considers the examination as positive for brain circulatory arrest when there is presence of reverberating, small systolic peaks or the disappearance of a previous signal present on both middle cerebral arteries and intracranial vertebral arteries. Results: Fifty three patients were evaluated, 25 with clinical brain death. On 45 cases (84.9 percent), the interval between both evaluations was less than one hour. The sensitivity, specifcity, positive and negative predictive values for the diagnosis of brain death with TCD were 100, 96, 96.1 and 100 percent respectively. Positive and negative likelihood ratios for brain death were 28 and 0, respectively. Conclusions: TCD is a valid and useful technique for the diagnosis of brain death and can be used on complicated cases.

[Addition of an arterio-venous shunt during veno-arterial extracorporeal life support in a patient with Hantavirus pulmonary syndrome]. / Adición de un cortocircuito arterio-venoso durante el soporte vital extracorpóreo veno-arterial de un paciente con síndrome cardiopulmonar por Hantavirus. Caso clínico.

A subgroup of patients infected with the Hantavirus develops a pulmonary syndrome (HPS) characterized by severe acute respiratory failure and myocardial depression, that has a high mortality rate. Extracorporeal life support (ECLS) could be a valuable therapeutic tool in such patients. We report a 24 years old male with HPS that was successfully managed when an arterio-venous shunt was added to a conventional veno-arterial ECLS technique. Precise criteria have been developed to predict which patients should be considered for this treatment.

[Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients]. / Volumen sanguíneo intratorácico versus presión arterial de oclusión pulmonar como estimadores de precarga cardíaca en pacientes críticos.

BACKGROUND: Monitoring of cardiac preload by determination of pulmonary artery occlusion pressure (PAOP) has been traditionally used to guide fluid therapy to optimize cardiac output (CO). Since factors such as intrathoracic pressure and ventricular compliance may modify PAOP, volumetric estimators of preload have been developed. The PiCCO system is able to measure CO and intrathoracic blood volume (ITBV) by transpulmonary thermodilution. AIM: To compare a volumetric (ITBV) versus a pressure (PAOP) determination to accurately estimate cardiac preload in severely ill patients. PATIENTS AND METHODS: From June 2001 to October 2003, 22 mechanically ventilated patients with hemodynamic instability underwent hemodynamic monitoring with pulmonary artery catheter (PAC) and PiCCO system. ITBV index (ITBVI), PAOP and CI were measured simultaneously by both methods. One hundred thirty eight deltas (D) were obtained from the difference of ITBVI, PAOP, CI-PAC and CI-PiCCO between 6-12 am and 6-12 pm. Linear regression analysis of DITBVI versus Eth CI-PiCCO and Eth PAOP versus DCI-PAC were made. RESULTS: Mean age of patients was 60.8 +/- 19.4 years. APACHE II was 23.9 +/- 7. Fifteen patients met criteria for acute respiratory distress syndrome (ARDS). Delta ITBVI significantly correlated with DCI-PiCCO (r=0.54; 95% confidence interval = 0.41-0.65; p <0.01). There was no correlation between DPAOP and DCI-PAC. CONCLUSION: ITBVI correlated better with CI than PAOP, and therefore it seems to be a more accurate estimator of preload in unstable, mechanically ventilated patients.