Pomegranate peel extract reduced colonic damage and bacterial translocation in a mouse model of infectious colitis induced by Citrobacter rodentium.

The pomegranate fruit peel is a rich source of polyphenols including punicalins, punicalagins, and ellagic acids, but is considered an agricultural waste product. Pomegranate derived products have been reported to have a wide variety of health promoting benefits including antibacterial properties in vitro but there is limited evidence of their antibacterial properties in vivo. The purpose of this study was to test the in vivo antibacterial properties of a pomegranate peel extract (PPX) containing punicalin, punicalagin, and ellagic acid. C3H/He mice were orally pre-treated with water or PPX prior to infection with the mouse bacterial pathogen, Citrobacter rodentium (Cr) that mimics many aspects of human enteropathogenic Escherichia coli infections. Fecal excretion of Cr was monitored and mice were euthanized on day 12 post-infection to assess Cr colonization of the colon and spleen, histological changes, and gene expression. PPX-treatment reduced Cr infection induced weight loss and mortality that was observed in water-treated infected mice. However, Cr colonization of the colon and clearance was unaffected by PPX-treatment. Consistent with this, PPX treatment did not alter the potent Th1/Th17 pro-inflammatory response elicited by Cr infection. Significant colonization of the spleen was only seen in water-treated infected mice and was inversely correlated with the dose of PPX administered. PPX treatment decreased the extent of Cr-induced colon damage that correlated with decreased mortality and reduced colonization of the spleen. Thus, a pomegranate peel extract contains bioactive compounds that mitigate the deleterious effects of an in vivo infection with the model enteropathogenic bacteria, Cr.

Endobronchial ultrasound for tubercular mediastinal adenopathy and its comparison with traditional tools.

SETTING: Endobronchial ultrasound (EBUS) is now the preferred tool to sample malignant mediastinal lesions. Data on its role in tubercular mediastinal adenopathy are limited.OBJECTIVE: To evaluate the efficacy of EBUS in diagnosing tubercular mediastinal lymphadenopathy and correlate the cytological and microbiological results obtained on aspirate with standard methods (radiology and the tuberculin skin test) suggesting tuberculosis (TB).DESIGN: A prospective study of 125 patients with suspected tubercular mediastinal lymphadenopathy who underwent EBUS-transbronchial needle aspiration. Only patients with a microbiologically confirmed diagnosis or unequivocal clinico-radiological response to anti-TB treatment during follow-up were included.RESULTS: A total of 122 patients showed findings suggesting TB on cytopathology (sensitivity 97.6%), 105 (84%) of whom had microbiological evidence of TB (positive smear/culture or both). Performing staining for acid-fast bacilli on slides prepared during the procedure vs. only on samples submitted in saline significantly improved the yield. Only 92 patients (73.6%) were Mantoux-positive. Cytology was more sensitive than computed tomography in picking up necrosis. Granulomas, with or without necrosis, were equally likely to be microbiologically positive. However, presence of only necrosis in a TB-endemic region invariably points towards TB diagnosis.CONCLUSIONS: EBUS was highly sensitive and specific for diagnosis of mediastinal TB and may be considered the investigation of choice for tubercular mediastinal adenopathy.

Arthropod Deterrents from Artemisia pallens (Davana Oil) Components.

Davanone, a key sesquiterpene component of davana oil, has been synthesized in five convenient steps. Oxygenated sesquiterpenes have been linked to insect deterrent properties. Based on initial screening of davana oil, davanone and its hydroxy precursors have been generated and are being evaluated as arthropod deterrents against disease vectors.

Ciceribacter lividus gen. nov., sp. nov., isolated from rhizosphere soil of chick pea (Cicer arietinum L.).

The taxonomic position of strain MSSRFBL1(T), isolated from chickpea rhizosphere soil from Kannivadi, India, was determined. Strain MSSRFBL1(T) formed bluish black colonies, stained Gram-negative and was motile, aerobic, capable of fixing dinitrogen, oxidase-negative and catalase-positive. Q-10 was the major respiratory quinone. Major fatty acids of strain MSSRFBL1(T) were C18 : 1ω7c and C19 : 0cycloω8c. Minor amounts of C18 : 0, C12 : 0, C14 : 0 3-OH, C18 : 0 3-OH, C16 : 0, C16 : 1ω6c/C16 : 1ω7c, C17 : 0 3-OH and C20 : 1ω7c were also present. Polar lipids included diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylmethylethanolamine, phosphatidylcholine and two unidentified glycolipids. Bacteriohopane derivatives (BHD1 and 2), diplopterol, diploptene, bishomohopanediol, adenosylhopane and 2ß-methyl bacteriohopanetetrol were the major hopanoids of strain MSSRFBL1(T). The genomic DNA G+C content was 71 mol%. EzTaxon-e-based blast analysis of the 16S rRNA gene indicated the highest similarity of strain MSSRFBL1(T) to Ensifer adhaerens LMG 20216(T) (97.3 %) and other members of the genus Ensifer (<96.9 %) in the family Rhizobiaceae of the class Alphaproteobacteria. However, phylogenetic analysis based on 16S rRNA, recA, thrC and dnaK gene sequences showed distinct out-grouping from the recognized genera of the family Rhizobiaceae. Based on phenotypic, genotypic and chemotaxonomic characters, strain MSSRFBL1(T) represents a novel species in a new genus in the family Rhizobiaceae for which the name Ciceribacter lividus gen. nov., sp. nov. is proposed. The type strain of Ciceribacter lividus is MSSRFBL1(T) ( = DSM 25528(T) = KCTC 32403(T)).

A rare cause for acute cor pulmonale.

A number of diseases may cause right atrial mass. Primary cardiac tumors range from 0.002 to 0.25%. Intracardiac manifestation and pulmonary embolism of hepatocellular carcinoma (HCC) is a very rare finding and uncommon even at autopsy. Here we describe the case of a 32-year-old Asian man who was referred for shortness of breath lasting for a month, along with unproductive cough. He was a manual laborer with a history of diabetes, alcoholism, and smoking. Clinically he was diagnosed as having pulmonary embolism. Echocardiogram showed a mass in the right atrium. Magnetic resonance imaging showed that he had a large mass in the right atrium extending down into the inferior vena cava. Further evaluation showed that he had chronic liver disease with portal hypertension and was hepatitis B surface antigen-positive, indicating hepatitis B infection. He underwent excision of the mass, and the pathological report showed metastasis of HCC with multiple vascular emboli in the lungs. As this is the second reported case of this kind in the literature, we highlight the need of screening at least 6-monthly all patients with chronic liver disease, hepatitis B and C virus infection for the early detection of HCC.

Selection of antigens and development of prototype tests for point-of-care leprosy diagnosis.

Leprosy can be a devastating chronic infection that causes nerve function impairment and associated disfigurement. Despite the recent reduction in the number of registered worldwide leprosy cases as a result of the widespread use of multidrug therapy, the number of new cases detected each year remains relatively stable. The diagnosis of leprosy is currently based on the appearance of clinical signs and requires expert clinical, as well as labor-intensive and time-consuming laboratory or histological, evaluation. For the purpose of developing an effective, simple, rapid, and low-cost diagnostic alternative, we have analyzed the serologic antibody response to identify Mycobacterium leprae proteins that are recognized by leprosy patients. More than 100 recombinant antigens were analyzed in a protein array format to select those with discriminatory properties for leprosy diagnosis. As expected, multibacillary leprosy patients recognized more antigens with stronger antibody responses than paucibacillary leprosy patients. Our data indicate, however, that multibacillary patients can be distinguished from paucibacillary patients, and both of these groups can be segregated from endemic control groups. We went on to confirm the diagnostic properties of antigens ML0405 and ML2331 and the LID-1 fusion construct of these two proteins by enzyme-linked immunosorbent assay. We then demonstrated the performance of these antigens in rapid test formats with a goal of developing a point-of-care diagnostic test. A serological diagnostic test capable of identifying and allowing treatment of leprosy could reduce transmission, prevent functional disabilities and stigmatizing deformities, and facilitate leprosy eradication.

Interpretation of mycobacterial antibodies in the cerebrospinal fluid of adults with tuberculous meningitis.

OBJECTIVE: Microbiological identification of Mycobacterium tuberculosis is insensitive and slow, and clinical distinction of tuberculous meningitis (TBM) from other subacute or chronic meningoenchephalitides (SACM) is difficult. Successful use of highly specific M. tuberculosis serological assays on cerebrospinal fluid has been reported, but their performance for diagnosis in a tuberculosis endemic country where they would be of most value is unclear. We sought to determine the biological basis for the uncertainty in interpretation of antibody detection in the CSF of TBM patients. METHODS: We identified prospectively 46 adults with SACM and explored the concordance between TBM diagnosis and detection of highly specific M. tuberculosis antibodies in CSF. The source of antibodies in CSF was explored by evaluating the correlation between antibody titres in CSF with those in serum, or with the albumin quotient. Intrathecal IgG synthesis was assessed by the IgG index. RESULTS: Positive antibody titres were more frequent among TBM patients (76%), but were also present in individuals with other SACM (59%). A positive correlation between antibody titres in CSF with those in serum, or with the albumin quotient, supported the leakage of antibodies from plasma to CSF through an increased blood-brain barrier permeability. Intrathecal IgG synthesis was only detected in 35% of the TBM cases. CONCLUSION: Plasma antibodies likely synthesized in response to previous tuberculosis infections were a major source of mycobacterial antibodies in CSF due to leakage through an impaired blood-brain barrier. Interpretation of mycobacterial antibodies in CSF of adults for TBM, however specific, must take into account the contribution of antibodies from plasma, and hence, has questionable use for diagnosis.

A new Hg(2+) -selective fluorescent sensor based on a 1,3-alternate thiacalix[4]arene anchored with four 8-quinolinoloxy groups.

A new thiacalix [4]arene derivative in a 1,3-alternate conformation bearing four quinolinoloxy groups through propyl chains has been synthesized, and its metal ion-binding and fluorescence-sensing properties were investigated in both THF and 10% H2O-THF systems. The designed ligand exhibited pronounced Hg2+ -selective on-off type fluoroionophoric properties among the representative transition and heavy metal ions including Cu2+. The detection limit for Hg2+ was found to be 2.0 x 10(-6) M in the mixed H2O-THF system. Detailed spectral studies including 1H NMR and MALDI-TOF mass spectroscopy reveal the unusual formation of a tetramercury complex with the ligand, in which the four propyl arms containing the quinolinoloxy groups adopt a "tetrapodand" conformation enclosing one Hg2+ ion each in the four cavities thus formed.

El consentimiento informado en la cirugía de columna / The informed consent in spine surgery

The informed consent is a legal demand for all surgical actions, pursuing a basic and essential principle, which is to allow the patient to be the effective owner of his own destiny. The consent has gone through many stages, and has been one of the most important factors in judicial processes. Currently, there is a sort of fear of future lawsuits after surgical procedures. This has resulted in a series of forms of informed consent, not always adequately protocolized. We consider that these protocols should be generic, and should be specifically supplemented in function of the act to be carried out. General contracts should be avoided because they don't give any kind of information, nor respond to the particular necessities of the patient. We have developed a consent form for spine surgery that has been in use since 2001. The use of this form has contributed to enhance the sincereness and to enrich the fundamental relationship with the patients, while helping in teaching purposes.

El consentimiento informado es una exigencia legal para toda acción médico quirúrgica, persiguiendo un principio básico y esencial, el cual es permitir al paciente ser dueño efectivo de su destino. El consentimiento ha pasado por muchas etapas y ha sido una de las causas más importantes de los procesos judiciales en contra de los médicos. En la actualidad existe una especie de psicosis de la clase médica por dejar documentado la aceptación del paciente frente a actos quirúrgicos sometidos con el propósito de protegerse contra futuras reclamaciones. Consideramos que los protocolos de información deben ser genéricos y complementarse específicamente en función al acto a realizar, evitando esa especie de “contratos de adhesión” que no entregan información clara ni responden a las necesidades de cada paciente en particular. Confeccionamos un consentimiento específico para la cirugía de columna, el cual estamos utilizando desde el año 2001, y que ha contribuido a sincerar y enriquecer la relación médico-paciente, fundamental en nuestro diario quehacer, a la vez que servir de ayuda docente para la formación de pre- y de postgrado.

Vertebroplastía: puesta al día / Vertebroplasty: Update

Vertebroplasty: Update Vertebroplasty is a surgical procedure that has been used over the last 20 years in the management of certain vertebral diseases. Despite being a procedure used by many specialists, there are still questions about it that have no been satisfactorily answered. In this update, we review the available literature and present our experience using this procedure.

Antibody profiles characteristic of Mycobacterium tuberculosis infection state.

The relationship between specific antibody profiles and tuberculosis (TB) state was investigated by measuring serum antibody levels to six Mycobacterium tuberculosis antigens in human subjects grouped into four diagnostic categories: active disease, inactive (past) tuberculosis, latent infection without radiographic chest abnormalities, and infection free. Statistical data analyses showed that the latter two groups were serologically indistinguishable and that active tuberculosis and inactive tuberculosis were characterized by different antibody profiles. Antibodies to the 38-kDa antigen, alanine dehydrogenase, and Rv2626c were associated with active TB, while antibodies to the 16-kDa antigen, ferredoxin A, and ESAT-6 were associated with inactive TB. Thus, the targets of the immune response vary with tuberculosis state. The correlation between bacterial antigen production and infection stage was investigated in mice infected with M. tuberculosis by bacterial transcription profiling. It was found that levels of transcripts encoding the six M. tuberculosis antigens varied during infection. Together, the data indicate that antigen composition of tubercle bacilli varies with stage of infection and that immunoprofiling can distinguish between tuberculosis states.

Detection of early secretory antigenic target-6 antibody for diagnosis of tuberculosis in non-human primates.

Tuberculosis is one of the most economically devastating, zoonotic infections of captive non-human primates. The limitations of the tuberculin skin test, which is currently used to diagnose tuberculosis in living non-human primates, make it necessary to find new, simple, and economical diagnostic methods. We describe use of an enzyme-linked immunoassay to detect IgG antibodies against early secretory antigenic target (ESAT)-6, a small protein secreted by virulent tubercle bacilli, in paired (pre- and post-outbreak) sera from 57 non-human primates involved in an outbreak of Mycobacterium bovis infection in a research colony. Of 25 animals with tuberculosis lesions at necropsy, 22 (88%) had high serum levels of the ESAT-6 antibody. The ESAT-6 antibody was found in 16% (5/32) of post-outbreak sera from animals in which tuberculosis could not be confirmed at necropsy. The strong association between the ESAT-6 antibody and tuberculosis in non-human primates documented in this study, together with the robustness of the serologic assay, make the ESAT-6 ELISA a valuable tool for diagnosis of tuberculosis in captive non-human primates.

[Bochdalek's diaphragmatic hernia in adults. Description of a clinical case]. / Ernia diaframmatica di Bochdalek nell'adulto. Presentazione di un caso clinico.

Bochdalek's hernia is a congenital posterior diaphragmatic defect, resulting from persistence of the pleuroperitoneal canal of embryonic life. Bochdalek's hernias are rare occurrences in adult patients and they present commonly with digestive symptoms and need surgical therapy. This article describes a case of an 88-year-old female with symptomatic right Bochdalek defect containing intra-abdominal viscera with no hernial sac.

[Perforation of primary non-Hodgkin's lymphoma during chemotherapy. Clinical evaluation and therapeutic strategy]. / Perforazione di linfoma non-Hodgkin del cieco dopo chemioterapia. Valutazione clinica e strategia terapeutica.

Primary cecal lymphoma are very rare. The case is reported of an elderly woman having voluntary preliminary chemotherapy with consequent cecum perforation due to tumoral necrosis, some days after the first chemotherapy. The diagnostic, clinical and therapeutic protocol is analysed and stress is laid on the rare clinical cases described. Resection is advisable in the still delimited forms in order to avoid surgical complications due to preliminary chemotherapy and in order to classify precisely the neoplasm.

[Synchronous carcinoma of the colon and rectum]. / Il tumore sincrono del colon-retto.

The incidence of synchronous carcinoma of colon-rectus is rising in relation to a greater oncogenic environmental charge and increased average life expectancy. There is also a risk of not recognising the disease (especially small carcinoma or multicentric neoplasm). After a Literature review, two clinical cases are described by the authors. They recommend an extensive use of preoperative colonoscopy and a careful intraoperative exploration of the viscera. It is also important that patients undergo periodical postoperative endoscopic controls.

[Clinical evaluation and therapeutic strategy in necrotizing fasciitis or Fournier's syndrome. 2 case reports]. / Valutazione clinica e strategia terapeutica della fascite necrosante o sindrome di fournier. Presentazione di due casi clinici.

Fournier's syndrome or necrotizing fasciitis is a rare infection with high mortality rate. Old patients especially with diabetes mellitus, liver and renal failure are more affected. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support and immediate extensive surgical debridement are necessary. Two clinical cases are presented.

[Intraoperative calibration of the Vater's papilla using Fogarty's biliary catheter]. / Calibratura intraoperatoria della papilla di Vater mediante catetere biliare di Fogarty.

The study included 20 patients affected by cholelithiasis and choledocholithiasis. Al patients underwent cholecystectomy; after choledochotomy, choledochal stones were removed using a Fogarty's biliary catheter (no. 5) and, subsequently, the papilla was calibrated by inserting the end balloon of the catheter, which and been filled with 0.3 cc of water, beyond the level of the papilla itself. The catheter was then withdrawn. No T-tubes were left in the common bile duct in any patient, no post-operative complications were observed and all patients were dismissed within seven days.

[Complicated torsion of the gallbladder. Presentation of a clinical case]. / Torsione complicata della colecisti. Presentazione di un caso clinico.

A case of gallbladder torsion complicated by sigmoid volvulus and sub-torsion of the ileus is reported because of the difficulty of diagnosis, conditioned by polymorphic symptomatology, the expression of a variety of causes and contributing causes that play an important role in the greater or less onset of dramatic symptomatology, and because of the rarity of the pathology.

[Proposal for anatomo-functional instrumental control of dysfunctional bilio-digestive Roux-en-Y anastomosis]. / Proposta di controllo strumentale anatomo-funzionale di anastomosi bilio-digestiva su ansa defunzionalizzata secondo Roux.

Various techniques are used for the anatomo-functional study of bilio-digestive anastomoses on jejunal loop autonomized according to Roux. Here a transparietojejunal endoscopic investigation is proposed that permits direct sight of the anastomosis, biliary sampling for cultural examination and dilatative type therapeutic manoeuvres, biopsies or extractions of residual stones from the bile ways that would not otherwise be possible without further surgery. A clinical case is reported.