Prebiotic Properties of Non-Fructosylated α-Galactooligosaccharides from PEA (Pisum sativum L.) Using Infant Fecal Slurries.

The interest for naturally-occurring oligosaccharides from plant origin having prebiotic properties is growing, with special focus being paid to supplemented products for infants. Currently, non-fructosylated α-galactooligosaccharides (α-GOS) from peas have peaked interest as a result of their prebiotic activity in adults and their mitigated side-effects on gas production from colonic bacterial fermentation. In this study, commercially available non-fructosylated α-GOS from peas and ß-galactooligosaccharides (ß-GOS) derived from lactose were fermented using fecal slurries from children aged 11 to 24 months old during 6 and 24 h. The modulatory effect of both GOS on different bacterial groups and bifidobacteria species was assessed; non-fructosylated α-GOS consumption was monitored throughout the fermentation process and the amounts of lactic acid and short-chain fatty acids (SCFA) generated were analyzed. Non-fructosylated α-GOS, composed mainly of manninotriose and verbascotetraose and small amounts of melibiose, were fully metabolized and presented remarkable bifidogenic activity, similar to that obtained with ß-GOS. Furthermore, non-fructosylated α-GOS selectively caused an increase on the population of Bifidobacterium longum subsp. longum and Bifidobacterium catenulatum/pseudo-catenulatum. In conclusion, non-fructosylated α-GOS could be used as potential ingredient in infant formula supplemented with prebiotic oligosaccharides.

The cytotoxic effect of Bowman-Birk isoinhibitors, IBB1 and IBBD2, from soybean (Glycine max) on HT29 human colorectal cancer cells is related to their intrinsic ability to inhibit serine proteases.

Bowman-Birk inhibitors (BBI) from soybean and related proteins are naturally occurring protease inhibitors with potential health-promoting properties within the gastrointestinal tract. In this work, we have investigated the effects of soybean BBI proteins on HT29 colon adenocarcinoma cells, compared with non-malignant colonic fibroblast CCD-18Co cells. Two major soybean isoinhibitors, IBB1 and IBBD2, showing considerable amino acid sequence divergence within their inhibitory domains, were purified in order to examine their functional properties, including their individual effects on the proliferation of HT29 colon cancer cells. IBB1 inhibited both trypsin and chymotrypsin whereas IBBD2 inhibited trypsin only. Despite showing significant differences in their enzyme inhibitory properties, the median inhibitory concentration values determined for IBB1 and IBBD2 on HT29 cell growth were not significantly different (39.9+/-2.3 and 48.3+/-3.5 microM, respectively). The cell cycle distribution pattern of HT29 colon cancer cells was affected by BBI treatment in a dose-dependent manner, with cells becoming blocked in the G0-G1 phase. Chemically inactive soybean BBI had a weak but non-significant effect on the proliferation of HT29 cells. The anti-proliferative properties of BBI isoinhibitors from soybean reveal that both trypsin- and chymotrypsin-like proteases involved in carcinogenesis should be considered as potential targets of BBI-like proteins.

In-hospital prognosis of prosthetic valve endocarditis after urgent surgery.

INTRODUCTION AND OBJECTIVES: Prosthetic valve endocarditis is associated with high morbidity and mortality, particularly when urgent surgery is needed. The identification of factors that predict a poor prognosis is the first step in improving outcomes. The study objectives were to characterize patients with prosthetic valve endocarditis who need urgent surgery and to identify factors that predict in-hospital mortality in this high-risk group. METHODS: From a database of 648 consecutive patients with infective endocarditis diagnosed between 1996 and 2006 at four tertiary-care centers with cardiac surgery facilities, 46 patients with left-sided prosthetic valve endocarditis who needed urgent surgery were identified. A retrospective study was carried out to determine these patients' main characteristics and to identify predictors of in-hospital mortality. RESULTS: The main indications for urgent surgery were heart failure (57%) and persistent infection (33%). In-hospital mortality was 41%. Factors significantly associated with a poor prognosis were fever at admission, persistent infection, positive blood cultures, persistently positive cultures, and echocardiographic evidence of vegetations (P< .05). No specific microorganism was associated with a poor prognosis. CONCLUSIONS: Prosthetic valve endocarditis was associated with high mortality when urgent surgery was needed. Although heart failure was the principle reason for urgent surgery, it did not lead to a worse in-hospital prognosis. The presence of vegetations and uncontrolled infection were the main factors associated with higher in-hospital mortality in patients with left-sided infective endocarditis who needed urgent surgery.

Pronóstico hospitalario de la endocarditis protésica tras cirugía urgente / In-hospital prognosis of prosthetic valve endocarditis after urgent surgery

Introducción y objetivos. La endocarditis protésica conlleva una alta morbimortalidad, más aún si precisa cirugía urgente. Determinar los factores predictores de mal pronóstico es el primer paso para disminuirla. Nuestro objetivo es definir el perfil de los pacientes con endocarditis protésica que precisan cirugía urgente e identificar los factores predictores de mortalidad hospitalaria en este grupo de alto riesgo. Métodos. De una base de datos que incluye un total de 648 casos de endocarditis infecciosa diagnosticados consecutivamente en cuatro centros terciarios con cirugía cardiaca entre 1996 y 2006, 46 fueron endocarditis protésicas izquierdas y precisaron cirugía urgente. Hemos realizado un estudio retrospectivo de las principales características de estos pacientes y un análisis para determinar los factores asociados a una mayor mortalidad hospitalaria. Resultados. Las principales indicaciones de cirugía urgente fueron la insuficiencia cardiaca (57%) y la infección persistente (33%). La mortalidad hospitalaria fue del 41%. Los factores asociados a un peor pronóstico (p < 0,05) fueron: fiebre al ingreso, infección persistente, hemocultivos positivos y persistentemente positivos y vegetaciones en el ecocardiograma. Ningún microorganismo se asoció a peor pronóstico. Conclusiones. La endocarditis protésica es una enfermedad con una alta mortalidad cuando precisa cirugía urgente. Aunque la insuficiencia cardiaca es la principal causa de cirugía urgente, no empeora el pronóstico hospitalario. Las vegetaciones y la falta de control de la infección son los factores asociados a mortalidad hospitalaria en los pacientes con endocarditis infecciosa izquierda intervenidos urgentemente (AU)

Introducción y objetivos. La endocarditis protésica conlleva una alta morbimortalidad, más aún si precisa cirugía urgente. Determinar los factores predictores de mal pronóstico es el primer paso para disminuirla. Nuestro objetivo es definir el perfil de los pacientes con endocarditis protésica que precisan cirugía urgente e identificar los factores predictores de mortalidad hospitalaria en este grupo de alto riesgo. Métodos. De una base de datos que incluye un total de 648 casos de endocarditis infecciosa diagnosticados consecutivamente en cuatro centros terciarios con cirugía cardiaca entre 1996 y 2006, 46 fueron endocarditis protésicas izquierdas y precisaron cirugía urgente. Hemos realizado un estudio retrospectivo de las principales características de estos pacientes y un análisis para determinar los factores asociados a una mayor mortalidad hospitalaria. Resultados. Las principales indicaciones de cirugía urgente fueron la insuficiencia cardiaca (57%) y la infección persistente (33%). La mortalidad hospitalaria fue del 41%. Los factores asociados a un peor pronóstico (p < 0,05) fueron: fiebre al ingreso, infección persistente, hemocultivos positivos y persistentemente positivos y vegetaciones en el ecocardiograma. Ningún microorganismo se asoció a peor pronóstico. Conclusiones. La endocarditis protésica es una enfermedad con una alta mortalidad cuando precisa cirugía urgente. Aunque la insuficiencia cardiaca es la principal causa de cirugía urgente, no empeora el pronóstico hospitalario. Las vegetaciones y la falta de control de la infección son los factores asociados a mortalidad hospitalaria en los pacientes con endocarditis infecciosa izquierda intervenidos urgentemente (AU)

Calcified right ventricular thrombus and antiphospholipid syndrome.

Antiphospholipid syndrome has been associated with venous and arterial thrombotic events but intracardiac thrombosis is rare. We describe a case about a 30-year-old woman, admitted with a 6-month history of arthralgia, fatigue, and intermittent fever. Subsequent investigation revealed the presence of a large and calcified mass in the right ventricular outflow tract attached to the subvalvular tricuspid apparatus. Cardiac surgery was performed and histological examination demonstrated it to be composed entirely of calcified thrombus. Screening laboratory evaluation for hypercoagulable states confirmed the diagnosis of antiphospholipid syndrome.

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)

Encuesta piloto comparativa de opinión de médicos, enfermeras y estudiantes de medicina sobre el suicidio asistido en un hospital privado del Distrito Federal / First comparative opinion survey among medical doctors, nurses and students of medicine about assisted suicide in a private hospital at the Federal District

Para conocer las opiniones del personal de salud respecto del suicidio asistido por médicos, se realizó una encuesta de opinión anónima y confidencial, tipo Likert, en un hospital privado del Distrito Federal. La población en la que se llevó acabo constó de 99 personas, de las cuales 33 son médicos, 33 son enfermeras y 33 son estudiantes de Medicina. El manejo estadístico tuvo una distribución de dos colas de ji-cuadrado, con la determinación del coeficiente de error de Pearson. El resultado principal de la encuesta muestra una diferencia significativa entre las poblaciones de estudiantes, médicos y enfermeras respecto de la aplicación del suicidio asistido por razón de calidad de vida, al que favorecen estas últimas. En las conclusiones se apunta la necesidad de impulsar el manejo de cuidados paliativos a fin de aumentar la calidad de vida de los pacientes y con ello disminuir la demanda de eutanasia. Se señala que ella es antiética, según todos los códigos deontológico mundiales, e ilegal en la mayoría de los países del mundo.