Suctioning of clear amniotic fluid at birth: A systematic review.

Context: Upper airway suctioning at birth was considered standard procedure and is still commonly practiced. Negative effects could exceed benefits of suction. Question: In infants born through clear amniotic fluid (P) does suctioning of the mouth and nose (I) vs no suctioning (C) improve outcomes (O). Data sources: Information specialist conducted literature search (12th September 2021, re-run 17th June 2022) using Medline, Embase, Cochrane Databases, Database of Abstracts of Reviews of Effects, and CINAHL. RCTs, non-RCTs and observational studies with a defined selection strategy were included. Unpublished studies, reviews, editorials, animal and manikin studies were excluded. Data extraction: Two authors independently extracted data, risk of bias was assessed using the Cochrane ROB2 and ROBINS-I tools. Certainty of evidence was assed using the GRADE framework. Review Manager was used to analyse data and GRADEPro to develop summary of evidence tables. Meta-analyses were performed if ≥2 RCTs were available. Outcomes: Primary: assisted ventilation. Secondary: advanced resuscitation, oxygen supplementation, adverse effects of suctioning, unanticipated NICU admission. Results: Nine RCTs (n = 1096) and 2 observational studies (n = 418) were identified. Two RCTs (n = 280) with data concerns were excluded post-hoc. Meta-analysis of 3 RCTs, (n = 702) showed no difference in primary outcome. Two RCTs (n = 200) and 2 prospective observational studies (n = 418) found lower oxygen saturations in first 10 minutes of life with suctioning. Two RCTs (n = 200) showed suctioned newborns took longer to achieve target saturations. Limitations: Certainty of evidence was low or very low for all outcomes. Most studies selected healthy newborns limiting generalisability and insufficient data was available for planned subgroup analyses. Conclusions: Despite low certainty evidence, this review suggests no clinical benefit from suctioning clear amniotic fluid from infants following birth, with some evidence suggesting a resulting desaturation. These finding support current guideline recommendations that this practice is not used as a routine step in birth. Funding: The International Liaison Committee on Resuscitation provided access to software platforms, an information specialist and teleconferencing. Clinical Trial Registration: This systematic review was registered with the Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/prospero/) (identifier: CRD42021286258).

Actividad antiparasitaria in vitro de plantas de la medicina tradicional Tacana sobre Plasmodium faciparum a través del método fluorométrico-SYBR GreenI / In vitro antiparasitic activity from plants of the Tacana traditional medicine on Plasmodiumfaciparum through thefluorometric method-SYBR GreenI

INTRODUCCIÓN: la presencia de compuestos activos en las plantas las posiciona como una fuente alternativa para el descubrimiento de nuevos fármacos. OBJETIVO: realizar la bioprospección de plantas utilizadas en la medicina tradicional tacana frente a cultivos de Plasmodium falciparum. MÉTODOS: se obtuvieron extractos por maceración en etanol a temperatura ambiente, de 31 órganos colectados de 23 plantas, estos fueron evaluados sobre cultivos asincrónicos de la cepa de Plasmodium falciparum resistente a la Cloroquina (FCR3). A los extractos que mostraron actividad antiplasmódica (CI50<20µg/mL), se evaluó la citotoxicidad (DL50) frente a células HeLa y se calculó el índice de selectividad (IS=DL50/CI50). Los extractos que dieron resultados IS>5, fueron seleccionados como promisorios. RESULTADOS: se obtuvieron 3 plantas muy activas (CI50<10µg/mL); 2 moderadamente activas (10µg/mL20µg/mL). De las 9 plantas que presentaron actividad, solo 2 plantas presentaron IS>5. CONCLUSIONES: incorporar los conocimientos del uso tradicional para realizar las evaluaciones biológicas es de mucha ayuda en la selección de plantas con efectos antiplasmódicos.

INTRODUCTION: the presence of active compounds in plants, converts them as an alternative to find new drugs. OBJECTIVE: carry out the bioprospecting of plants used in Tacana traditional medicine against Plasmodium falciparum cultures. METHODS: from the 31 collected organs of 23 plants, raw extracts were obtained by ethanolic maceration at room temperature and these were evaluated on asynchronic cultures of the strain Plasmodium falciparum resistant to Chloroquine (FCR3). The active extracts (IC50<20µg/mL), were evaluated for cytotoxicity (LD50) against HeLa cells and the Selectivity Index (IS=DL50/IC50) was calculated. The extracts that sowed IS>5were selected as promising. RESULTS: a total of 3 species were very active (IC50<10µg/mL); 2 were moderately active (10µg/mL20µg/mL). From the 9 active plants only 2 presented IS>5. CONCLUSIONS: incorporating the traditional knowledge to carry out biological evaluations is very helpful in the selection of plants with antiplasmodial effects.

Aplicación del método bioquímico-colorimétrico para identificar agentes trypanocidas / Application of the biochemical-colorimetric method to identify trypanocidal agents

La tripanosomiasis americana es una enfermedad infecciosa desatendida, causada por el parásito protozoo Trypanosoma cruzi, que no cuenta con tratamiento en la fase crónica de esta enfermedad mortal, uno de los desafíos es encontrar terapias efectivas para esta compleja enfermedad, dado que no presenta síntomas asociables a la parasitosis por lo que es desconocida entre los médicos tradicionales. Nuestra Facultad está evaluando la medicina tradicional tacana como fuente de agentes antiparasitarios potenciales. El objetivo de este trabajo fue identificar productos naturales trypanocidas utilizando el método colorimétrico XTT-PMS. Para ello, se realizaron curvas de crecimiento de epimastigotes de T. cruzi y determinamos el tiempo óptimo de realización de los ensayos. Se seleccionó la población inicial de trabajo (3x106 parásitos/mL), las condiciones de incubación (medio LIT, 27ºC, 72 horas) y revelado (XTT-PMS, 4 horas). Con el protocolo optimizado, se realizaron evaluaciones de actividad de drogas control, controles naturales y 20 extractos crudos de plantas medicinales de la amazonía. La actividad se basó en cálculos de concentración inhibitoria media y se consideraron activos las sustancias con CI50<50µg/mL. De los 20 extractos evaluados, el 40% fueron activos. Las plantas más interesantes fueron Sipu sipu (CI50=8.9±1.7µg/mL), Ejije bid'u (CI50=9.1±1.5µg/mL) e Id'ene eidhue (CI50=10.8±1.1µg/mL) con valores de CI50 cercanos a los controles, confirmando la utilidad y potencial del protocolo desarrollado

American trypanosomiasis is listed among the unattended infectious disease, is caused by the protozoan parasite Trypanosoma cruzi, and has no treatment in the chronic phase of this deadly disease. One of the challenges is finding effective therapies for this complex disease, given that it does not present any associated symptoms to the parasitism and is unknown among traditional doctors. Our Faculty is evaluating tacana traditional medicine as a source of potential antiparasitic agents. The objective of this work was to identify trypanocidal natural products using the XTTPMS colorimetric method. For this, growth curves of T. cruzi epimastigotes were made to determine the optimal time to carry out the tests. The initial work population (3x106 parasites/mL), the incubation conditions (medium LIT, 27ºC, 72 hours) and revealed process (XTT-PMS, 4 hours) were selected. With the optimized protocol, activity evaluations of control drugs, natural controls and 20 crude extracts of medicinal plants of the Amazon were carried out. The activity was based on calculations of mean inhibitory concentration and substances with IC50 <50µg/mL were considered active. Of the 20 extracts evaluated, 40% were active. The most interesting plants were Sipu sipu (IC50=8.9±1.7µg/mL), Ejije bid'u (IC50=9.1±1.5µg/mL) and Id'ene eidhue (IC50=10.8±1.1µg/mL) with values of IC50 close to the controls, confirming the usefulness and potential of the developed protocol.

Estudio piloto de diagnóstico de parasitosis intestinal y respuesta al uso de Mebendazol en niños de edad escolar en las escuelas Charcas II, El Sillar y la Cascada, gestión 2010 La Paz / Pilot study of intestinal parasitosis diagnostic and response to Mebendazol on school age children at schools in Charcas II, El Sillar and La Cascada, year 2010 La Paz

El proyecto IDH 09: Desparasitación de niños en escuelas rurales", llevo adelante un trabajo piloto experimental de diagnóstico sobre parásitos intestinales en niños en las Escuelas de las Comunidades: Charcas II; La Cascada y El Sillar, Provincia Sud Yungas, Departamento de La Paz, Bolivia. El análisis coproparasitológico fue en 93 muestras tomadas entre Inicial y quinto de primaria, con edades entre 5 y 12 años. En promedio, el 97,9% de las muestras indicaron presencia de Protozoarios y hasta un 54,5% de Helmintos, concomitantemente, con una relación promedio de 2,0 veces más Protozoarios. En las escuelas de Charcas II y La Cascada la relación fue de 1,8 y en El Sillar fue de 2,5. Hasta 12 parásitos fueron identificados entre los Protozoarios: Blatocystis hominis (92,7%); Entamoeba coli (50,3%); Endolimax nana (44,0%); Giardia lamblia (39,3%); Iodamoeba bütschlii (25,0%) y Chilomastix mesnili (8,3%) y entre los Helmintos: Ascaris lumbricoides (30,0%); Uncinaria spp (21,7%), Strongyloides stercoralis (9,0%); Hymenolepis nana (7,0%) y Trichuris trichiura (5,7%), en una muestra se detectó Enterobius vermicularis. En la escuela Charcas II, de acuerdo a sus programas de desparasitación, los niños recibieron tratamiento con Mebendazol y el efecto de la medicación fue evaluado, aleatoriamente, a los 7 días, sobre un total de 21 niños. El Mebendazol (1200mg) elimino 50% de los Helmintos. A. lumbricoides fue eliminado de todas las muestras, Uncinaria spp, S. stercoralisy T. trichiura fueron eliminados en un 50%, mientras que H. nana persistió en todas las muestras, mientras que los Protozoarios fueron eliminados solo en un 19% de las muestras.

The Project Deworming of children in rural schools carried out a pilot experimental field work to determine intestinal parasites levels in kids in rural schools, at Charcas II, La Cascada and El Sillar communities, South Yungas province, Department of La Paz, Bolivia. The coproparasitologic studies were carry out on 93 feces samples, from kids from initial to fifth grade, within ages from 5 to 12 years. An average of 97,9% of the samples showed presence of protozoa parasites and up to 54,5% showed, additionally, presence of Helminthes, with a general ratio of Protozoan to Helminthes of 2,0. At Charcas II School and La Cascada School the ratio was of 1,8; while at El Sillar gave a ratio of 2,5. A total of 12 parasites were identified, among the protozoa: Blatocystishominis (92,7%); Entamoeba coli (50,3%); Endolimax nana (44,0%); Giardia lamblia (39,3%); Iodamoeba bütschlii (25,0%) and Chilomastix mesnili:(8,3%) and among the Helminthes: Ascaris lumbriocoides (30,0%); Uncinaria spp (21,7%), Strongyloides stercoralis (9,0%); Hymenolepis nana (7,0%) and Trichuris trichiura (5,7%) and in one sample we detected Enterobius vermicularis. According to their deworming program, at Charcas II School, kids received treatment with Mebendazol (1200mg) and the effect was evaluated 7 days after treatment. On a total of 21 children. Mebendazol eliminated 50% of Helminthes. A. lumbricoides was eliminated from all samples; Uncinaria spp, S. stercoralis y T. trichiura only from 50% of the samples and H. nana persisted in all samples, while Protozoan parasites were eliminated on nearly 19% of the samples

Leishmanicidal and cytotoxic activity from plants used in Tacana traditional medicine (Bolivia).

ETNOPHARMACOLOGICAL RELEVANCE: Thirty-eight Tacana medicinal plant species used to treat skin problems, including leishmania ulcers, skin infections, inflammation and wound healing, were collected in the community of Buena Vista, Bolivia, with the Tacana people. Twenty two species are documented for the first time as medicinal plants for this ethnic group living in the northern area of the Department of La Paz. AIM OF THE STUDY: To evaluate the leishmanicidal effect (IC50) and cytotoxicity (LD50) of the selected plants. To carry out bioguided studies on the active extracts. To assess the potential of Bolivian plant biodiversity associated with traditional knowledge in the discovery of alternative sources to fight leishmaniasis. MATERIALS AND METHODS: Seventy three ethanol extracts were prepared from 38 species by maceration and were evaluated in vitro against promastigotes of Leishmania amazonensis and L. braziliensis. Active extracts (IC50 ≤ 50 µg/mL) were fractionated by chromatography on Silica gel column and the fractions were assessed against the two Leishmania strains. The most active fractions and the crude extracts were evaluated against reference strains of L. amazonensis, L. braziliensis, L. aethiopica, two native strains (L. Lainsoni and L. braziliensis) and for cytotoxicity against HeLa cells. The chromatographic profile of the active fractions was obtained by reverse phase chromatography using HPLC. RESULTS: From the 73 extracts, 39 extracts (53.4%) were inactive and 34 showed activity. Thirteen species were sselected for bioguided studies. The crude extracts and their 36 fractions were evaluated against two Leishmania strains. The most active fraction were tested in a panel of five leishmania strains and for cytotoxicity. The Selective Index (SI = LD50/IC50) was calculated, and were generally low. Retention time and UV spectra were recorded for the active fractions by HPLC-DAD using a reverse phase column. Profiles were very different from each other, showing the presence of different compounds. CONCLUSION: Bolivian traditional knowledge from the Tacanba was useful to identify plants with effect on Leishmania promastigotes. Chromatographic bioguided studies showed stronger leishmanicidal and cytotoxic activity for the medium polar fraction. HPLC analysis showed different chromatographic profiles of the active fractions.

Estudios de susceptibilidad de cepas de Leishmania aethiopica frente a alcaloides de Galipea longiflora (Evanta) / Susceptibility studies on Leishmania aethiopica strains against total alkaloids from Galipea longiflora (Evanta)

El Instituto de Investigaciones Fármaco Bioquímicas (IIFB), de la Facultad de Ciencias Farmacéuticas y Bioquímicas, de la UMSA, desarrolla trabajos sobre la actividad leishmanicida, de los alcaloides totales (CAT) obtenidos de la corteza de la especie medicinal amazónica conocida como Evanta (Galipea longiflora) por los Pueblos Tacana, Tsimane y Mosetene. Como parte de las actividades del Proyecto UMSA-ASDI Biomoleculas de interés medicinal e industrial (antiparasitarios) hemos podido contar con la estadía, en el IIFB, de un investigador del Armauer Hansen Research Institute (AHRI) de Etiopia, lo que nos ha permitido desarrollar evaluaciones de CAT, Miltefocine y Amfotericina B, frente a cepas de Leishmania aethiopica, agente causante de las diversa formas de Leishmaniais cutánea en Etiopía. Un total de seis cepas, de L. aethiopica, fueron adaptadas a condiciones in vitro y mostraron un comportamiento homogéneo frente a CAT, cinco de estas cepas mostraron un valor promedio de IC50 = 8,68 ±1,56 mg/mL, valor algo inferior a los calculados para nuestras cepas de referencia, L. amazonensis y L. braziliensis con IC50 = 11,73 ± 4,32 mg/mL y IC50 = 12,28 ±- 2,95 mg/mL, respectivamente. Excepto por una cepa de L. aethiopica que mostro valores consistentemente más elevados que el resto con IC50= 14,37 ± 3,58 mg/mL. Como consecuencia de esta interacción científica, la Universidad Mayor de San Andrés (UMSA) ha firmado un Memorandum de Entendimiento para el desarrollo de investigaciones conjuntas, con el Armauer Hansen Research Institute (AHRI), dependiente del Ministerio de Salud de Etiopia y explorar la posibilidad de que nuestra experiencia de validación clínica con Evanta en el tratamiento de leishmaiasis cutánea, en Bolivia, podría ser replicada en Etiopía, donde se reportan entre 20,000 a 30,000 nuevos casos de Leismaniasis por año.

The Instituto de Investigaciones Fármaco Bioquímicas (IIFB), at the Faculty of Pharmaceutical and Biochemical Sciences, from UMSA, carry out work related to the leishmanicidal activity of the total alkaloids (CAT) obtained from the bark of the Amazonian medicinal species known as Evanta (Galipea longiflora) by the Tacana, Tsimane y Mosetene people. As part of the activities develop by the UMSA-ASDI Project Biomolecules of medicinal and industrial Interest (antiparasitic) we had a visit, in our laboratories at IIFB, of a researcher from The Armauer Hansen Research Institute (AHRI) from Ethiopia, during his stay we were able to carry out evaluations of CAT, Miltefocine and Anphotericin B, against strains of L. aethiopica, causative agent of the different manifestations of cutaneous leishmaniasis in Ethiopia. A total of six strains of L. aethiopica, were adapted to in vitro a conditions, at IIFB; and did show homogenous behavior against CAT. Five of the strains, showed an average calculated value for IC50 = 8.68 ±1.56 mg/mL, a value somewhat lower to the calculated for the reference strains L. amazonensis and L. braziliensis with IC50 = 11.73 ± 4.32 mg/mL and IC50 = 12.28 +/- 2.95 mg/mL, respectively. Except for one strain that showed values somewhat higher, to the other strains, consistently through our studies, with IC50 = 14.37 ± 3.58 mg/mL. As a consequence of our scientific interaction, the Universidad Mayor de San Andrés (UMSA) has signed a Memorandum of Understanding for the development of joint research with the Armauer Hansen Research Institute (AHRI) that belongs to the Ministry of Health in Ethiopia, and explore the possibilities to replicate the Bolivian clinical validation experience of Evanta in the treatment of cutaneous leishmaniasis, in Ethiopia where the annual incidence is estimated to be between 20, 000 to 30, 0000.

Nutritional needs of the micropreterm infant.

We have used an expansive definition of a micropreterm infant as <30 weeks' gestation to provide a global perspective to a "high risk" group of preterm infants for which there are little published data to guide nutritional management. Consensus nutritional guidelines for preterm infants have been developed for infants >1000 g birth weight and >28 weeks' gestational age. Micropreterm infants have greater nutritional deficits at birth than more mature preterm infants and accumulate greater postnatal deficits. Nutritional guidelines based on the needs of preterm infants born >28 weeks' gestation are unlikely, on a theoretical basis, to meet nutritional requirements of micropreterm infants. Unfortunately, very few good quality studies have addressed the nutritional requirements of this group specifically; this makes it difficult to formulate solid, evidence-based nutritional recommendations for these neonates. Nutritional management of micropreterm infants is based on recommendations established for preterm infants, which are adjusted after considering an infant's gestational age, birth weight, and clinical status. Minimal enteral feeding should commence on the first or second day of life, with incremental advancement and fortification of human milk when 100 mL/kg is tolerated. Early use of parenteral nutrition is recommended, ideally initiated within the first hours of life and enteral feeds are being established; this will help prevent the accumulation of nutritional deficits and incidence of growth failure. Fortified human milk should be given in order to meet nutritional requirements. When human milk is not available in sufficient quantity, a preterm formula should be given.

Validación del método analítico para la cuantificación de alcaloides quinolínicos del extracto de Galipea longiflora Krause Kallunki / Validation of the analytical method for the quantification of quinoline alkaloids of Galipea longiflora extract Krause Kallunki

El presente artículo describe la validación de un método de cuali-cuantificación de alcaloides quinolínicos por espectrofotometría UV con máximos de absorción de 330-335nm de longitud de onda. Para su cuantificación el extracto de alcaloides es disuelto en ácido clorhídrico 1N, al 0,05 %p/v y se preparan 12 diluciones 1:2. El método cumple con los requerimientos de exactitud y precisión con límites de detección y cuantificación entre 0,567-7,81 µg/mL y 1,72-7,81 µg/mL para los alcaloides quinolínicos respectivamente. Se obtuvieron respuestas lineales entre 0,244­7,81 µg/mL con un coeficiente de determinación de 0,997. Se verificó la robustez del procedimiento aplicando tres variables, temperatura, luz UV y pH. (AU)