Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges.

The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.

Influence of the particle size and hydrocolloid type on lipid digestion of thickened emulsions.

Hydrocolloids are used as stabilizing agents in order to enhance the physical stability of emulsions during their storage. However, they can also play an important role in nutrient release and bioavailability. In this context, the aim of this research was to study the effect of the emulsion type and thickener type on the physical-structural changes and free fatty acid release during in vitro digestion. Oil-in-water emulsions were prepared with different particle sizes (CE: conventional emulsions and NE: nanoemulsions) and thickening agents (starch and xanthan gum). The experimental conditions of homogenization used allowed food emulsions to be obtained at the microscale and nanoscale, with particle sizes ranging among 3.2-3.4 µm and 78-107 nm for CE and NE, respectively. The addition of thickening agents (XG and ST) modified the physical properties of emulsions (particle size, zeta potential and stability) slightly, and thickened samples with similar viscosity were obtained. The kinetics of FFAs released during the in vitro intestinal digestion showed no significant differences (p > 0.05) in the digestion rate among samples; however, emulsion and thickener types decreased the final extent of free fatty acids, being more evident for those samples with starch. Xanthan gum kept the particle size of nanoemulsions stable during the oral and gastric phases, which promoted the release of FFAs during the intestinal phase. Therefore, xanthan gum could be used as a thickening agent of nanoemulsions exerting a minor impact on their lipid bioaccessibility.

Quantitative analysis of blood cells and inflammatory factors in wounds.

OBJECTIVE: The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds. METHOD: Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study. RESULTS: We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (p<0.001), while the number of lymphocytes, was significantly lower in exudate from wounds in the inflammatory phase (p<0.001). Wound c-reactive protein (CRP) and immunoglobulin G (IgG) levels were higher in the inflammatory group (p<0.001). We found a significantly positive correlation between CRP levels and the percentage of neutrophils and monocytes (r=0.346, p=0.004; r=0.293, p=0.015), and a significantly negative correlation between CRP levels and the percentage of lymphocytes (r=-0.503, p<0.001). A stepwise logistic regression analysis was used to identify an optimal combination of these biomarkers. The optimal biomarker combinations were neutrophils + monocytes + platelets + IgG + CRP, with an area under the curve (AUC) of 0.981 [confidence interval (CI) 95%: 0.955-1.000, p<0.001] for the diagnosis of wounds in the inflammatory phase. The optimal cutpoint yielded 96.9 % sensitivity and 94.6 % specificity. The biomarker combination predicted the inflammatory phase and was superior to individual biomarkers. CONCLUSION: Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.

Comparison of two angiographic systems in paediatric interventional cardiology.

The aim of this work was to analyse the radiation dose for patients and staff between X-ray systems, a new biplane with flat-panel detectors (FDs) and a conventional system equipped with image intensifier (II). Entrance surface air kerma (ESAK) and scatter doses were measured on polymethyl methacrylate (PMMA) phantoms of different thicknesses (from 4 to 16 cm). The ESAK values for the different acquisition modes and PMMA thicknesses were higher for the II in comparison with FDs. For the II, the scatter dose rates ranged from 0.67 to 12.2 mSv h(-1) at the eye position of the cardiologist during fluoroscopy and cine modes. At the lower extremities, these values were 1.11 and 24.24 mSv h(-1). In the case of the FDs, these values ranged from 0.24 to 0.67 mSv h(-1) for eye lens and from 0.73 to 2.01 mSv h(-1) for the position of cardiologist's ankle. The newly installed X-ray system showed an average reduction factor of up to 9.7 times for ESAK values. For the staff with an average reduction factor of 15.9 times at the eye position during fluoroscopy and cine modes, no protective tools are used. At the lower extremities, this value was 7.6 times.

Effect of physical state of gelatin-plasticizer based films on to the occurrence of Maillard reactions.

The aim of this study was to evaluate the occurrence of the Maillard reaction on gelatin-based films (bovine and salmon) in the glassy state, in mixtures with low molecular weight plasticizers (e.g. glycerol, glucose and trehalose) at different storage times. For testing, the gelatin-plasticizer films were stored under glassy conditions (Tg-10°C), previously determined by calorimetric tests. Studies under accelerated conditions (T ≫ Tg) were also developed. Color, opacity and browning index (Br) were evaluated by computer vision at all storage times. Results showed in samples stored under glassy conditions that the Maillard reaction did not occur, independent of gelatin origin and type of plasticizer. Changes in color stated by opacity and Br were only significant (p < 0.05) in gelatin-glucose systems under accelerated storage conditions. The inhibition of reaction in gelatin films in the glassy state was related to the well-known conditions of low molecular mobility of glassy matrices, but also with the non-Maillard reactive characteristics of glycerol and trehalose.

Endothelin-1 levels and biomarkers of oxidative stress in glaucoma patients.

To investigate the levels of endothelin-1 (ET-1), homocysteine (Hcy), vitamins A, E, B12 and folic acid in plasma of patients with different types of glaucoma: primary open-angle glaucoma (POAG) and normotensive glaucoma (NTG). Patients were classified into 3 groups: group POAG comprised 48 patients, group NTG comprised 15 patients, and control group that comprised 75 healthy subjects. ET-1 levels were measured by ELISA, Vitamins A and E by HPLC, and Vitamin B12, homocysteine, and folic acid levels were determined by chemiluminescent immunoassay. The ET-1 and Hcy levels were significantly higher (p = 0.002) in the POAG group compared to NTG and control group. Vitamin E levels were significantly lower (p = 0.001) in the NTG group compared to POAG and control group. The increase of Hcy and ET-1 in POAG patients is related to vascular endothelial dysfunction. Thus results may play a key role in the development of this disease. Lower levels of Vitamin E in the NTG group suggest that oxidative process plays an early role in the development of this type of glaucoma.

Órganos abdominales: peso del hígado, bazo y riñones en relación a sexo, grupo étnico, edad e índice de masa corporal en individuos chilenos / Abdominal organs: weight of the liver, spleen and kidneys in relation to sex, ethnic group, age and body mass index in Chilean individuals

El aumento del peso de los órganos puede ser signo de enfermedades o anormalidades patológicas. Diversos estudios han llevado a la elaboración de tablas con los pesos estándar de los diferentes órganos en diversos grupos poblacionales. Basados en esta premisa, determinamos el peso del hígado, bazo y riñones en dos grupos de individuos Chilenos, Mapuches (M) y No-Mapuches (n-M), de ambos sexos y relacionamos los resultados con la edad e índice de masa corporal (IMC). El peso promedio del hígado en el hombre, con relación a la edad, aumenta levemente (n-M) o disminuye en un pequeño porcentaje (M). Sin embargo, en la mujer (M) el peso aumentó en un 22,8% En relación al IMC, el peso promedio del hígado, aumenta en los hombres de ambos grupos étnicos en alrededor de un tercio del peso registrado en personas con IMC de 20­25; en mujeres de ambos grupos el peso disminuye levemente. El peso del bazo, en relación a la edad, disminuye alrededor de un 4%, en hombres de ambos grupos étnicos y mujeres (n-M) a diferencia de las mujeres (M) que se incrementa en un 18%. En relación al IMC, el peso del bazo aumenta en los hombres de ambos grupos étnicos en alrededor de un 40%. Los riñones tienen un leve incremento en su peso promedio en ambos grupos. De acuerdo al IMC, el peso de los riñones aumenta en hombres de ambos grupos. En las mujeres (M) el peso se mantiene o disminuye levemente; en las mujeres (n-M) ambos riñones incrementan su peso. Los datos aportados en esta investigación servirán de referencia a la anatomía clínica y quirúrgica de los órganos abdominales de nuestra población.

The increase of organ weight may be a sign of disease or pathological abnormalities. Several studies have led to the development of tables with standard weights of different organs in various population groups. Based on this premise, we determined the weight of the liver, spleen and kidneys in two groups of Chilean individuals, Mapuche (M) and non-Mapuche (nM) of both sexes and related the results with age and body mass index (BMI). The average weight of the liver in man in relation to age, slightly increases (nM)) or decreases in small percentage (M). However, in women (M) its weight increased by 22.8% in relation to BMI, the average weight of the liver increases in males of both ethnic groups in about a third of the weight recorded in people with BMI 20­25; in women of both groups the weight decreases slightly. Spleen weight in relation to age, decreases by about 4% in men and women from both ethnic (nM) groups, unlike that of Mapuche women (M) where weight increased by 18%. In relation to BMI, spleen weight increased in males of both ethnic groups by about 40%. The kidneys had a slight increase in average weight in both groups. According to BMI, the kidney weights increased in males of both groups. In women (M) the weight is maintained or decreased slightly; in women (nM) both kidneys increase their weight. The data provided in this study will serve as a reference for clinical and surgical anatomy of the abdominal organs of our population.

Peso del corazón y pulmones en relación al sexo, grupo étnico, edad e índice de masa corporal en individuos chilenos / Weight of the heart and lungs with regard to sex, ethnic group, age and body mass index in Chilean individuals

Diversos factores pueden influir en el peso de las vísceras torácicas y/o abdominales. Con el propósito de conocer el peso promedio del corazón y pulmones de individuos chilenos, se obtuvo la información de estos órganos procedentes de 775 necropsias de cadáveres frescos, entre los años 2009-2013, considerando su procedencia étnica (Mapuches y no Mapuches), edad, sexo e índice de masa corporal. Se estudiaron los datos de órganos sin lesiones ni enfermedades aparentes. En relación a la edad, el peso promedio del corazón se incrementó en ambos grupos étnicos y ambos sexos. Este incremento fue similar en los individuos de sexo masculino de ambos grupos étnicos, con un valor de 13%. En los individuos de sexo femenino hubo un aumento de 36% en el grupo étnico Mapuche, mientras que en el grupo No-Mapuche fue de un 8%. Con respecto a los pulmones, no hubo incremento de su peso promedio en individuos masculinos del grupo Mapuche, pero si lo hubo en el sexo femenino, donde hubo un incremento sobre el 40% Entre el grupo de 20-29 años y el de 30-39 años, ambos pulmones aumentaron sus pesos promedios en 35%. En el grupo No-Mapuche, en ambos sexos, el peso promedio de estos órganos aumentó menos de un 10%. Estos resultados son comparados con otros grupos poblacionales del mundo y son un aporte al conocimiento morfológico de las vísceras torácicas.

Several factors can influence the weight of the thoracic and/or abdominal viscera. In order to know the average weight of the heart and lungs of Chilean individuals, information of these organs was obtained from 775 necropsies of fresh cadavers, between 2009-2013, considering ethnicity (non-Mapuche and Mapuche), age, sex and body mass index. We studied organs without apparent injury or disease. When considering age, the average heart weight showed an increase in both ethnic groups and both sexes. This increase was similar in male individuals from both ethnic groups, with a value of 13%. In female individuals there was an increase of 36% in the Mapuche ethnic group, while that of non-Mapuche was 8%. With regard to the lungs, there was no increase in their average weight in male individuals of Mapuche group, in females however, the increase was about 40%. Among the group of 20­29 years and 30­39 y, both lungs increased their average weights at 35%. In the non-Mapuche group, in both sexes, the average weight of these organs increased by less than 10%. These results are compared with other population groups in the world and are a contribution to morphological knowledge of the thoracic viscera.

Características Biométricas del Cuerpo Calloso en Individuos chilenos / Biometric Characteristics of the Corpus Callosum in Chilean Subjects

El cuerpo calloso conecta ambos hemisferios cerebrales y se ubica en el fondo de la fisura longitudinal del cerebro. Con el propósito de complementar el conocimiento sobre esta importante estructura del sistema nervioso en nuestra población, determinamos diversos parámetros biométricos, que incluyeron su localización respecto a los márgenes anterior y posterior de los hemisferios cerebrales, longitud, espesor a diversos niveles, entre otras variables. Se utilizaron 20 cerebros frescos, de individuos adultos, a los cuales se fotografió la cara medial de sus hemisferios, los que fueron acompañados con una regla antes de obtener la fotografía, con el objetivo de trabajar sobre la imagen y, de este modo, registrar las variables planificadas. Estas medidas fueron registradas con un caliper digital de 0,05 mm de precisión. La distancia promedio obtenida entre la parte más prominente de la rodilla del cuerpo calloso y el margen anterior del hemisferio cerebral fue de 35,4 mm y, entre la parte más prominente del esplenio y el margen posterior del hemisferio cerebral fue de 52,8 mm. La longitud antero-posterior del cuerpo calloso fue, en promedio, 88,2 mm. La distancia antero-posterior promedio de la parte media de la rodilla fue 13,2 mm y la de la parte media del esplenio 15,7 mm. Los datos obtenidos son un aporte al conocimiento biométrico y morfológico de esta importante estructura comisural, en nuestro grupo poblacional.

The corpus callosum is a structure of white matter connecting the two cerebral hemispheres and is located at the bottom of the longitudinal fissure of the brain. In order to complement the understanding of this important structure of the nervous system in our population, we determined various biometric parameters, which included its location in relation to the anterior and posterior margins of the cerebral hemispheres, length, thickness at various levels, among other variables. To do this, we used 20 fresh brains of adult individuals which the medial aspect of the hemispheres was photographed, and were accompanied with a ruler before you get the picture, with the aim of working on the image and thus record the planned variables. The average distance obtained between the most prominent part of the knee of the corpus callosum and the anterior margin of the cerebral hemisphere was 35.4 mm and among the most prominent part of the splenium and the posterior margin of cerebral hemisphere was 52.8 mm. Antero-posterior length of the corpus callosum was on average 88.2 mm, the average antero-posterior diameter from the middle of the knee was 13.2 mm and that of the middle part of splenius 15.7 mm. The data obtained contribute to the biometric and morphological knowledge of this important commissural structure in our population group.

Oligonucleotides specific for pathogenic and saprophytic leptospira occurring in water.

Sets of primers specific for both pathogenic (SPL) and saprophytic (SSL) Leptospira were designed from ribosomal 16S genes (rrs) available in databases. They were used as two sets of primer pairs for the PCR amplification of known pathogenic and saprophytic strains. It was possible to identify pathogenic strains by the use of SPL primers and saprophytic ones by SSL primers. Serovars from L. meyeri, of controversial pathogenicity status, confirmed the heterogeneity of the species representatives in this respect. Serovars ranarum, sofia and perameles were amplified by SPL and not SSL. Conversely, serovar semaranga was amplified by SSL and not SPL. In order to use SPL primers for the detection of pathogenic leptospires from a natural water environment, we set up an additional semi-nested PCR by employing a second internal primer which succeeded in detecting as few as 5 pathogenic leptospires per ml of water.

Two new leptospiral serovars in the Hebdomadis serogroup isolated from Zimbabwe cattle.

Four strains belonging to the genus Leptospira serogroup Hebdomadis were isolated from Zimbabwe cattle at slaughter. These isolates were subjected to cross-agglutinin absorption tests and to restriction fragment length polymorphism and pulsed-field gel electrophoresis analyses of their genomic DNAs. One of these strains represents a new serovar, for which the name mhou is proposed; strain SBF 40 is the reference strain of this serovar. The other three strains belong to a second new serovar, for which the name marondera is proposed; the reference strain of this serovar is strain SBF 5. The three strains of serovar marondera could be differentiated by their restriction fragment polymorphism and pulsed-field gel electrophoretic patterns.

Effects of serotonin uptake blockers and of 5-hydroxytryptophan on the voluntary consumption of ethanol, water and solid food by UChA and UChB rats.

The effects of zimelidine, fluvoxamine, and citalopram (serotonin uptake blockers), as well as those of 5-hydroxytryptophan (serotonin precursor), on the voluntary consumption of 10% ethanol solution, distilled water and solid food were tested in UChA (genetically low ethanol consumer) and UChB (genetically high ethanol consumer) rats. Since it is well known that drugs which stimulate central serotonergic synapses decrease food and water intake, the data concerning the difference of the respective consumption during the treatment period and the pretreatment one were analysed with a method previously proposed (Alcohol 5:15-19; 1988) to recognize specific effects on ethanol intake. The results showed that while the decrease of ethanol consumption induced by the three serotonin uptake blockers appeared not to be specific of ethanol, the effects of 5-hydroxytryptophan in UChB rats satisfy the criteria for being considered as an expression of a decrease of the specific appetite--or increase satiety--for ethanol. Experimental results cannot help in the explanation of this difference.

A method for recognizing specific effects on ethanol intake by experimental animals.

A method of mathematical treatment of data concerning changes in voluntary consumption of ethanol solution, water and solid food, induced by experimental treatments in animals, in order to recognize effects on mechanisms involved in specific appetite and satiety for calories, water and ethanol is proposed. The need of such method arises from the fact that several experimental treatments tested by the effects on ethanol consumption alter at the same time the appetite or satiety for calories and/or for water, as well as ingestive behavior. The results of testing the method with the data obtained by treatment of UChA and UChB rats with disulfiram or cyanamide were consistent with the expected ones.

Effects of different diets on voluntary consumption of ethanol in UChA and UChB rats.

Based on the decrease of voluntary consumption of ethanol observed in rats of UChA (low ethanol consumer) and UChB (high ethanol consumer) strains, coincident to the use of a new issue of a commercial diet, the effects of two new diets devoid of animal food were studied. One of these diets (Diet 3) induced an increase of the voluntary consumption of ethanol in a proportion of UChA rats, in such a way that its frequency distribution curve resulted in a bimodal one because of the presence of individuals which drank as much alcohol as UChB rats. This diet is a useful tool for the study of eventual nutrimental factors which decrease ethanol intake.

Effects of different diets on voluntary consumption of ethanol in UChA and UChB rats.

Based on the decrease of voluntary consumption of ethanol observed in rats of UChA (low ethanol consumer) and UChB (high ethanol consumer) strains, coincident to the use of a new issue of a commercial diet, the effects of two new diets devoid of animal food were studied. One of these diets (Diet 3) induced an increase of the voluntary consumption of ethanol in a proportion of UChA rats, in such a way that its frequency distribution curve resulted in a bimodal one because of the presence of individuals which drank as much alcohol as UChB rats. This diet is a useful tool for the study of eventual nutrimental factors which decrease ethanol intake.

Thirty-two years of selection of rats by ethanol preference: UChA and UChB strains.

An overview of the development of two strains of rats with low and high consumption of ethanol is reported. Voluntary consumption of water and various concentrations of ethanol solution were studied in these strains as a function of diet, supplementation with vitamin B complex components, housing conditions and coefficient of heredity. Both distribution factor of the consumption of ethanol in hybrids and the course of voluntary intake of ethanol have been described. In addition, a comparison was made between these rat strains developed for low and high preference to ethanol drinking in reference to their voluntary intake of ethanol, water and food. The metabolic concomitant to these two strains has been studied in relationship to ethanol metabolism and to other substrates, i.e., acetate, pyruvate, glucose, citrate and fructose. Behavioral studies were also performed. This included the measurements of duration of ethanol narcosis and evaluation of tolerance to ethanol drinking.