La infusión intracerebroventricular prolongada de líquido cefalorraquídeo procedente de pacientes con esclerosis lateral amiotrófica provoca cambios histológicos en el cerebro y la médula espinal de la rata similares a los hallados en la enfermedad / Histological changes in the rat brain and spinal cord following prolonged intracerebroventricular infusion of cerebrospinal fluid from amyotrophic lateral sclerosis patients are similar to those caused by the disease

INTRODUCCIÓN: La exposición de líquido cefalorraquídeo (LCR) de pacientes con esclerosis lateral amiotrófica (ELA) induce efectos citotóxicos en cultivos celulares de neuronas motoras in vitro. MATERIAL Y MÉTODOS: Se seleccionó LCR de 32 pacientes con ELA que previamente habían demostrado efectos citotóxicos. Se implantaron con minibombas osmóticas intracerebroventriculares (ICV) en 28 ratas macho adultas y se dividieron en 3 grupos: 9 ratas de LCR de pacientes no-ELA, 15 ratas de ELA-LCR citotóxico y 4 ratas de una solución salina fisiológica. El LCR se administró por vía ICV de forma continua durante periodos de 20 o 43 días. Se realizó la evaluación clínica, electromiográfica y análisis de tejidos después de sacrificio a los 20, 45 y 82 días tras la cirugía. RESULTADOS: Los estudios inmunohistoquímicos muestran daño en los tejidos con características similares a las encontradas en formas esporádicas de ELA, tales como sobre expresión de cistatina C, transferrina y la proteína en el TDP-43 citoplasmática. Los primeros cambios observados parecían jugar un papel protector por la sobreexpresión de periferina, panAKT, fosfoAKT y metalotioneínas; esta expresión habría disminuido al momento de analizar las ratas que se sacrificaron al día 82, en el que hay un aumento de apoptosis. Los primeros cambios celulares identificados fueron la constatación de activación de la microglía seguido por astrogliosis con sobreexpresión de GFAP y proteína S100B. CONCLUSIONES: Nuestros datos parecen indicar que la ELA podría propagarse a través del LCR, y que la administración ICV de ELA-LCR citotóxico produce cambios similares a los encontrados en las formas esporádicas de la enfermedad

INTRODUCTION: Cerebrospinal fluid (CSF) from amyotrophic lateral sclerosis (ALS) patients induces cytotoxic effects in in vitro cultured motor neurons. MATERIAL AND METHODS: We selected CSF with previously reported cytotoxic effects from 32 ALS patients. Twenty-eight adult male rats were intracerebroventricularly implanted with osmotic mini-pumps and divided into 3 groups: 9 rats injected with CSF from non-ALS patients, 15 rats injected with cytotoxic ALS-CSF, and 4 rats injected with a physiological saline solution. CSF was intracerebroventricularly and continuously infused for periods of 20 or 43days after implantation. We conducted clinical assessments and electromyographic examinations, and histological analyses were conducted in rats euthanised 20, 45, and 82days after surgery. RESULTS: Immunohistochemical studies revealed tissue damage with similar characteristics to those found in the sporadic forms of ALS, such as overexpression of cystatin C, transferrin, and TDP-43 protein in the cytoplasm. The earliest changes observed seemed to play a protective role due to the overexpression of peripherin, AKTpan, AKTphospho, and metallothioneins; this expression had diminished by the time we analysed rats euthanised on day 82, when an increase in apoptosis was observed. The first cellular changes identified were activated microglia followed by astrogliosis and overexpression of GFAP and S100B proteins. CONCLUSION: Our data suggest that ALS could spread through CSF and that intracerebroventricular administration of cytotoxic ALS-CSF provokes changes similar to those found in sporadic forms of the disease

Histological changes in the rat brain and spinal cord following prolonged intracerebroventricular infusion of cerebrospinal fluid from amyotrophic lateral sclerosis patients are similar to those caused by the disease. / La infusión intracerebroventricular prolongada de líquido cefalorraquídeo procedente de pacientes con esclerosis lateral amiotrófica provoca cambios histológicos en el cerebro y la médula espinal de la rata similares a los hallados en la enfermedad.

INTRODUCTION: Cerebrospinal fluid (CSF) from amyotrophic lateral sclerosis (ALS) patients induces cytotoxic effects in in vitro cultured motor neurons. MATERIAL AND METHODS: We selected CSF with previously reported cytotoxic effects from 32 ALS patients. Twenty-eight adult male rats were intracerebroventricularly implanted with osmotic mini-pumps and divided into 3 groups: 9 rats injected with CSF from non-ALS patients, 15 rats injected with cytotoxic ALS-CSF, and 4 rats injected with a physiological saline solution. CSF was intracerebroventricularly and continuously infused for periods of 20 or 43days after implantation. We conducted clinical assessments and electromyographic examinations, and histological analyses were conducted in rats euthanised 20, 45, and 82days after surgery. RESULTS: Immunohistochemical studies revealed tissue damage with similar characteristics to those found in the sporadic forms of ALS, such as overexpression of cystatinC, transferrin, and TDP-43 protein in the cytoplasm. The earliest changes observed seemed to play a protective role due to the overexpression of peripherin, AKTpan, AKTphospho, and metallothioneins; this expression had diminished by the time we analysed rats euthanised on day 82, when an increase in apoptosis was observed. The first cellular changes identified were activated microglia followed by astrogliosis and overexpression of GFAP and S100B proteins. CONCLUSION: Our data suggest that ALS could spread through CSF and that intracerebroventricular administration of cytotoxic ALS-CSF provokes changes similar to those found in sporadic forms of the disease.

Cerebrospinal fluid cytotoxicity does not affect survival in amyotrophic lateral sclerosis.

OBJECTIVES: Cerebrospinal fluid (CSF) from some patients with amyotrophic lateral sclerosis (ALS) has been demonstrated to significantly reduce the neuronal viability of primary cell cultures of motor neurons. We aimed to study the potential clinical consequences associated with the cytotoxicity of CSF in a cohort of patients with ALS. METHODS: We collected CSF from thirty-one patients with ALS. We analysed cytotoxicity by incubating it into the primary cultures of motor cortex neurons. Neural viability was quantified after 24 hours using the colorimetric MTT reduction assay. All patients were followed up from the moment of diagnosis to death, and a complete evaluation during disease progression and survival was performed, including gastrostomy and respiratory assistance. RESULTS: Twenty-one patients (67.7%) presented a cytotoxic CSF. There were no significant differences between patients with and without cytotoxicity regarding mean time from symptom onset to the diagnosis, from the diagnosis to death, from the diagnosis to respiratory assistance with BIPAP, from diagnosis to gastrostomy and from the onset of symptoms to death. In Cox regression analysis, bulbar onset, but not cytotoxicity, gender or age at onset, was associated with a lower risk of survival. CONCLUSIONS: Cerebrospinal fluid cytotoxicity was not associated with differential survival rates. This suggests that the presence of cytotoxicity in CSF, measured through neuronal viability in primary cultures of motor cortex neurons, could reflect different mechanisms of the disease, but it does not predict disease outcome.

Effects of power training in mechanical stiffness of the lower limbs in soccer players / / Efeitos do treinamento de potência sobre rigidez mecânica dos membros inferiores em atletas de futebol / / Efectos del entrenamiento de potencia sobre la rigidez mecánica de miembros inferiores en jugadores de fútbol

Objetivo. El objetivo de este estudio fue evaluar si la rigidez de la pierna (Kleg) cambia después de un período de entrenamiento de potencia. Métodos. Cuarenta jugadores profesionales de fútbol se dividieron en 2 grupos (20 se asignaron al grupo entrenado y 20 al grupo control). Se realizó un estudio cuasi-experimental con pre-post intervención para estimar Kleg antes (periodo 1) y después de 6 semanas de entrenamiento de potencia (período 2). Se cuantificó Kleg mediante la reconstrucción de imágenes en 3 dimensiones mientras los sujetos corrían en una cinta a 13 km/h. Se midieron las alturas de squat jumps (SJ) y countermovment jumps (CMJ) y se calculó el pre-stretch augmentation (PSA) antes y después del período de entrenamiento para ambos grupos. Resultados. Se encontró un aumento significativo en Kleg después del programa de entrenamiento. Se encontraron correlaciones lineales positivas entre Kleg y la altura de los SJ en ambos períodos para los 2 grupos, mientras que la altura CMJ no se correlacionó con Kleg únicamente en el grupo entrenado durante el periodo 2. No se encontraron relaciones significativas entre Kleg y PSA. Conclusiones. Llegamos a la conclusión de que Kleg puede cambiar significativamente como producto del entrenamiento de potencia. Basados en nuestros resultados y considerando estudios previos sugerimos que estos cambios podrían estar asociados principalmente con adaptaciones a nivel del control muscular (AU)

Objetivo. O objetivo deste estudo foi avaliar mudanças na rigidez da perna (Kleg) após um período de treinamento de potência. Método. Quarenta jogadores de futebol profissionais foram divididos em 2 grupos (foram designados 20 ao grupo treinado e 20 ao grupo controle). Se realizou um estudo quase experimental com uma intervenção pré/pós teste para estimar a Kleg antes (período 1) e após 6 semanas de treinamento de potência (período 2). A Kleg foi quantificada através de um método de filmagem tridimensional enquanto os sujeitos corriam em uma esteira a 13 km/h. Foram medidas as alturas nos testes squat jumps (SJ) e countermovment jumps (CMJ), e foi medido e calculado o aumento pré-estiramento (PSA), antes e depois do período de treinamento para ambos os grupos. Resultados. Foi encontrado um aumento significativo em Kleg após o programa de treinamento. Foi encontrado uma correlação linear positiva entre a Kleg e a altura do SJ em ambos os períodos para os dois grupos, enquanto a altura do CMJ somente não se correlacionou com a Kleg no grupo treinado durante o período 2. Não foram encontradas relações significativas entre a Kleg e o PSA. Conclusão. Chegamos à conclusão que a Kleg pode mudar significativamente como resultado ao treinamento de potencia de curta duração. Com base em nossos resultados e considerando estudos anteriores, sugerimos que estas alterações podem estar associadas, principalmente, com adaptações a nível de controle muscular (AU)

Objective. The aim of this study was evaluate whether leg stiffness (Kleg) changes after power training. Methods. Forty professional soccer players were divided into 2 groups (20 were assigned to the trained group and 20 to the control group). A quasi-experimental study with pre–post intervention was conducted to estimate Kleg before (period 1) and after a six-week period of power training (period 2). Leg stiffness was measured using a three-dimensional filming method while soccer players ran on a treadmill at 13 km/h. The heights of squat jumps (SJ) and countermovement jumps (CMJ) were measured and the pre-stretch augmentation (PSA) was calculated before and after the training period in both groups. Results. We found a significant increase in Kleg after the power training program. Significant positive linear relationships between Kleg and SJ height were found in both periods and groups, while CMJ height was not correlated with Kleg in the trained group during period 2. No significant relationships were found between Kleg and PSA in either case. Conclusions. We concluded that Kleg can change significantly after a short power training program. Based on our results and previous studies, we suggest that these changes could be mainly associated with adaptions at muscle control level (AU)

Água salina e biofertilizante bovino na produção de frutos e alocação de biomassa em noni (Morinda citrifolia L. ) / Saline water and bovine biofertilizer on yield and biomass allocation in noni plants (Morinda citrifolia L. )

RESUMO: Têm sido evidenciado que os compostos orgânicos exercem ação mitigadora dos efeitos tóxicos dos sais às plantas, promovendo maior crescimento e desenvolvimento em solos com excesso de sais. Nessa direção, um experimento foi desenvolvido para avaliar os efeitos do biofertilizante bovino na produção de frutos e alocação de biomassa pelos diversos órgãos de plantas de noni, irrigadas com águas salinas. Os tratamentos foram distribuídos em blocos ao acaso, com quatro repetições e duas plantas por parcela, adotando o arranjo fatorial 5 x 2, correspondente a salinidade das águas de irrigação de 0,5; 1,5; 3,0; 4,5; 6,0 dS m-1, em substratos sem e com biofertilizante bovino, aplicado uma única vez, em volume correspondente a 10% do volume do substrato, um dia antes da instalação do experimento. As variáveis avaliadas foram: salinidade do solo, expressa pela condutividade elétrica do extrato de saturação do solo; número de frutos; massa média de fruto; produção de frutos por planta; e alocação de biomassa pelas raízes, caules, folhas e frutos. O aumento da salinidade da água de irrigação elevou o caráter salino do solo desde "não salino" para "fortemente salino" e, inibiu a produção de frutos e a acumulação de biomassa seca das plantas de noni em geral, mas, com maior intensidade nos tratamentos sem o insumo orgânico. O biofertilizante estimula o crescimento e a produção de plantas de noni cultivadas sob irrigação com águas de alta salinidade.

ABSTRACT: Organic compounds have shown to exercise a mitigating action on salts in plants and they promote growth and development in salt stress environments. In this sense, an experiment was carried out in order to evaluate the effects of saline water irrigation and bovine biofertilizer on yield and biomass allocation by the various organs of noni plants. Treatments were arranged in a randomized block design with four replications and two plants per plot using the 5 x 2 factorial design, which correspond to the salinity levels of irrigation water of 0.5, 1.5, 3.0, 4.5 and 6.0 dS m-1 in substrates with and without bovine biofertilizer, applied to the soil once, in the volume corresponding to 10% of the volume of the substrate one day before the implementation of the experiment. The variables evaluated were soil salinity, expressed as electrical conductivity of the soil saturation extract, fruit number, fruit weight and fruit yield per plant, and biomass allocation by roots, stems, leaves and fruit. The increasing salinity of the water for irrigation increased the saline character of the soil from non-saline to saline soil and inhibited the production and accumulation of dry biomass in noni plants in general but with more intensity in the plants of the treatments without bovine biofertilizer applied to the soil in liquid form. The biofertilizer stimulates the growth and production of noni plants grown under irrigation with high salinity water.

Corticoides antenatales y prevención del distrés respiratorio del recién nacido prematuro: utilidad de la terapia de rescate / Ante-natal corticosteroids and prevention of respiratory distress in the premature newborn: Usefulness of rescue treatment

Aunque se conoce la efectividad de la corticoterapia materna para la maduración pulmonar fetal en prematuros, no hay seguridad acerca del tiempo en que el tratamiento continúa siendo efectivo. Realizamos un estudio descriptivo y longitudinal, para relacionar el tiempo transcurrido desde la administración de glucocorticoides maternos, y la necesidad o no de surfactante, y a partir de qué punto se debería considerar la repetición de las dosis de corticoides maternos. Se incluyeron 91 prematuros de ≤32 semanas y/o ≤1.500g (límite 34+6 semanas) cuyas madres habían recibido una pauta completa de corticoides. En los pacientes de 27-34+6 semanas, comprobamos que a mayor tiempo transcurrido entre el parto y la administración de corticoides, mayor probabilidad de necesitar tratamiento con surfactante (p=0,027). La curva ROC calculada determinó un punto de corte de 8 días a partir del cual debería valorarse el repetir la dosis de corticoide

The effectiveness of antenatal corticosteroid therapy for foetal lung maturation in pre-term infants is well known, but there is uncertainty about the time that the treatment remains effective. A descriptive, longitudinal study was conducted to determine whether the need for surfactant administration was determined by the time-lapse between corticosteroids administration and delivery, and when repeating the doses of maternal corticosteroids should be considered. A total of 91 premature infants ≤32 weeks and/or ≤1,500 g (limit 34+6 weeks) whose mothers had received a complete course of corticosteroids were included. In patients at 27-34+6 weeks, we found that the longer the time elapsed between delivery and administration of corticosteroids, most likely were the babies to require treatment with surfactant (P=.027). The resulting ROC curve determined an 8-days cut-off after which repeating a dose of corticosteroids should be assessed

[Ante-natal corticosteroids and prevention of respiratory distress in the premature newborn: usefulness of rescue treatment]. / Corticoides antenatales y prevención del distrés respiratorio del recién nacido prematuro: utilidad de la terapia de rescate.

The effectiveness of antenatal corticosteroid therapy for foetal lung maturation in pre-term infants is well known, but there is uncertainty about the time that the treatment remains effective. A descriptive, longitudinal study was conducted to determine whether the need for surfactant administration was determined by the time-lapse between corticosteroids administration and delivery, and when repeating the doses of maternal corticosteroids should be considered. A total of 91 premature infants ≤32 weeks and/or ≤1,500 g (limit 34+6 weeks) whose mothers had received a complete course of corticosteroids were included. In patients at 27-34+6 weeks, we found that the longer the time elapsed between delivery and administration of corticosteroids, most likely were the babies to require treatment with surfactant (P=.027). The resulting ROC curve determined an 8-days cut-off after which repeating a dose of corticosteroids should be assessed.

Meduloblastoma congénito gigante de presentación y localización atípicas / Congenital giant medulloblastoma with atypical presentation and location

El meduloblastoma congénito es uno de los tumores intracraneales más frecuentes en la edad pediátrica; sin embargo, su presentación es poco frecuente antes de los 2 meses de vida. Presentamos el caso deun recién nacido con un meduloblastoma congénito gigante, con sintomatología en el periodo neonatal inmediato y de localización atípica. Este tipo de tumor debe ser tenido en consideración al realizar el diagnóstico diferencial de la hidrocefalia congénita (AU)

Congenital medulloblastoma is one of the most frequent pediatric intracranial tumors, however, it is unusual its presentation before the two months of life. We are presenting the case of a new-born infant with a giant congenital medulloblastoma, with symptoms in the immediate neonatal period and atypical location. This kind of tumor must be taken on account when making a differential diagnosis of congenital ventricular hydrocephalus (AU)

Termómetros de mercurio, aún tóxicos aún presentes / Mercury thermometers, still toxic, still present

Los termómetros de mercurio han sido y son, a pesar de la prohibición de su fabricación, una de las principales fuentes de exposición en la edad pediátrica al mercurio (Hg) elemental en nuestro medio. La toxicidad producida por el Hg elemental depende de la vía de exposición y de la duración de la misma. La exposición a través del tracto digestivo no produce prácticamente toxicidad, pero la inoculación subcutánea o endovenosa y la inhalación puede producir lesiones a nivel local o sistémico. Presentamos el caso clínico de una niña, que presentó inoculación de mercurio líquido en tejido subcutáneo tras la rotura de un termómetro de cristal, produciéndose daño a nivel local con este atonecrosis del tejido. El diagnóstico se realizó mediante estudio radiológico y precisó intervención quirúrgica urgente con escisión en cuña de piel y tejido subcutáneo, guiada con radioscopia. Se descartó la extensión a nivel sistémico, comprobándose la normalidad de los niveles de mercurio en sangre y orina(AU)

Mercury thermometers are and have been, despite their manufacture being banned, one of the main sources of exposure at the paediatric age to elementary mercury (Hg) in our environment. The toxicityproduced by elementary Hg depends on the exposure channel and its length. Exposure through the digestive tract produces hardly any toxicity, but subcutaneous or intravenous inoculation and inhalation of mercury may produce damages at a local or system level. We present the case of a child who showed inoculation of liquid mercury in subcutaneous tissue after a liquid-in-glass thermometer broke. This provoked damages at a local level with steatonecrosis of the tissue. The diagnosis was decided through a radiological test and required urgent surgery with excision of skin and subcutaneous tissue, guided by radioscopy. Any spread at a system level was discarded. The levels of mercury in the bloodstream and in the urine were regular (AU)

Contaminant concentrations, biochemical and hematological biomarkers in blood of West Indian manatees Trichechus manatus from Brazil.

The West Indian manatee Trichechus manatus is threatened with extinction in Brazil, and this study focused on nondestructive blood samples analyzed for metals, polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs), as well as biochemical and hematological biomarkers. Studied manatees were kept at Projeto Peixe-Boi headquarters in Pernambuco State, and at two natural areas in estuaries where they are released to the wild. Manatees kept at the natural estuary in Paraiba State have blood concentrations of Al, Pb, Cd, Sn that are 11, 7, 8 and 23 times greater, respectively, than the concentrations found in blood of animals from the same species in Florida, USA. An inhibition of butyrylcholinesterase in manatees kept at the two reintroduction sites in Alagoas and Paraiba States indicated possible exposure of the animals to cholinesterase inhibitor insecticides. PCBs and OCPs were not detected. Results from this study will help delineate conservation efforts in the region.

¿Mejora el aporte proteico precoz el crecimiento extrauterino en recién nacidos pretérmino de bajo peso? / Does early parenteral protein intake improve extrauterine growth in low birth weight preterms?

Introducción: El retraso de crecimiento postnatal es frecuente en los recién nacidos pretérmino (RNPT) de bajo peso. La administración precoz de proteínas en su nutrición parece mejorar el crecimiento extrauterino y las comorbilidades asociadas. Evaluamos el impacto sobre el crecimiento posnatal de un nuevo protocolo de nutrición parenteral con aporte precoz de aminoácidos en recién nacidos < 1.500g. Material y métodos: Estudio observacional de casos-controles sobre una muestra de 58 RNPT < 1.500g. El grupo de casos lo formaron 29 RNPT que recibieron al menos 1,5g/kg/día de aminoácidos vía parenteral en las primeras 24h de vida, con aumentos diarios hasta alcanzar al menos 3,5g/kg/día al 3.°-4.° día, comparándose con un grupo control de 29 RNPT en los que el aporte de aminoácidos se inició el 2.°-3.° día de vida a 1g/kg/día, con incrementos menores diariamente. Valoramos la evolución somatométrica de ambos en el primer mes de vida. Resultados: No había diferencias en las características basales (sexo, edad gestacional, parámetros somatométricos) entre ambos grupos. Los RNPT que recibieron proteínas a dosis mayores y más precozmente tuvieron una ganancia de peso significativamente mayor que el grupo control (423±138g vs. 315±142g; p=0,005), presentando también una mayor velocidad de ganancia ponderal diaria (19,4±3,3 vs. 16,5±4,8; p=0,010) y una recuperación más precoz del peso al nacimiento (11,5±3,3 días vs. 14,5±4,5 días; p=0,045). No se observó mayor incidencia de complicaciones. Conclusiones: El aporte precoz de aminoácidos a dosis más altas mejora la ganancia ponderal en RNPT sin observarse un riesgo añadido para el paciente(AU)

Introduction: Extrauterine growth restriction affects most premature newborns. Early and higher parenteral protein intake seems to improve postnatal growth and associated comorbidities. We evaluate the impact of a new parenteral nutrition protocol based on early amino acid administration on postnatal growth in premature infants with a birth weight < 1,500 grams. Material and methods: A case-control study in 58 premature newborns with a birth weight < 1,500 grams. In the case group we included 29 preterm neonates who received at least 1.5g/kg/day parenteral amino acid during the first 24hours after birth, reaching a maximum dose of 3.5g/kg/day on the 3rd-4th day after birth. The control group was formed by 29 preterm neonates for whom protein support began on the 2nd-3rd day after birth with a dose of 1g/kg/day with lower daily increases than the case group. Growth rates and complications were followed until 28 days of life or discharge from NICU. Results: There were no differences between groups in baseline characteristics. Premature newborns who received higher and earlier doses of proteins had a greater weight gain than the control group, and this difference was statistically significant (423±138g vs. 315±142g; P=.005). In addition, they had a higher daily weight gain rate (19.4±3.3 vs. 16.5±4.8; P=.010) and they regained birth weight earlier (11.5±3.3 days vs. 14.5±4.5 days; P=.045). A higher incidence of complications was not observed. Conclusions: Early and higher amino acid administration improves growth rate in premature neonates with no apparent increase in risks for the patient(AU)

Trombosis intracardiaca neonatal ligada a catéter: utilidad del activador tisular del plasminógeno recombinante / Neonatal intracardiac thrombosis related to catheter: use of recombinat tissue plasminogen activator

La utilización de catéteres venosos centrales en las unidades de cuidados intensivos neonatales es una práctica habitual no exenta de complicaciones. Dentro de dichas complicaciones, las más frecuentes son las de tipo infeccioso, aunque no podemos desdeñar las de tipo mecánico y trombótico. La incidencia de trombosis ligada al catéter es variable, y la actitud que cabe tomar ante dicho cuadro sigue siendo controvertida en el periodo neonatal. Presentamos el caso de un recién nacido a término que, debido a su patología de base, precisó un acceso venoso central mediante canalización umbilical. Al tercer día de vida se detectó por ecocardiografía la existencia de un trombointra auricular derecho, que se resolvió mediante tratamiento fibrinolítico local con activador tisular del plasminógeno recombinante, administrado a través de catéter silástico central, sin observarse complicaciones mayores(AU)

The use of central venous catheters in the intensive neonatal care units is a common practice not without complications, being infections its most common type, although mechanic and thrombotic ones are also common. The incidence of thrombosis related to catheter varies, and the attitude in the neonatal period remains controversial. We are discussing a case of a term new born suffering from a previous pathology, and central venous access via umbilical pipe was required. On its third day of life, the newborn was detected a right a trial thrombus by means of echocardiography, that was resolved with local thrombolytic therapy with r TPA, administered through central silastic catheter with no further complications observed(AU)

[Does early parenteral protein intake improve extrauterine growth in low birth weight preterms?]. / ¿Mejora el aporte proteico precoz el crecimiento extrauterino en recién nacidos pretérmino de bajo peso?

INTRODUCTION: Extrauterine growth restriction affects most premature newborns. Early and higher parenteral protein intake seems to improve postnatal growth and associated comorbidities. We evaluate the impact of a new parenteral nutrition protocol based on early amino acid administration on postnatal growth in premature infants with a birth weight < 1,500 grams. MATERIAL AND METHODS: A case-control study in 58 premature newborns with a birth weight < 1,500 grams. In the case group we included 29 preterm neonates who received at least 1.5 g/kg/day parenteral amino acid during the first 24 hours after birth, reaching a maximum dose of 3.5 g/kg/day on the 3(rd)-4(th) day after birth. The control group was formed by 29 preterm neonates for whom protein support began on the 2(nd-)3(rd) day after birth with a dose of 1g/kg/day with lower daily increases than the case group. Growth rates and complications were followed until 28 days of life or discharge from NICU. RESULTS: There were no differences between groups in baseline characteristics. Premature newborns who received higher and earlier doses of proteins had a greater weight gain than the control group, and this difference was statistically significant (423 ± 138 g vs. 315 ± 142 g; P=.005). In addition, they had a higher daily weight gain rate (19.4 ± 3.3 vs. 16.5 ± 4.8; P=.010) and they regained birth weight earlier (11.5 ± 3.3 days vs. 14.5 ± 4.5 days; P=.045). A higher incidence of complications was not observed. CONCLUSIONS: Early and higher amino acid administration improves growth rate in premature neonates with no apparent increase in risks for the patient.

Fructose 1-6 bisphosphate versus University of Wisconsin solution for rat liver preservation: does FBP prevent early mitochondrial injury?

BACKGROUND: Fructose 1,6-biphosphate (FBP) has been shown to exert therapeutic effects in models of ischemia-reperfusion in organs other than the liver. This study compared FBP and University of Wisconsin (UW) solution during cold storage and reperfusion, among mitochondria of adult male Wistar rat livers. METHODS: Adult male Wistar rats were assigned to two groups according to the preservation solution used; UW or FBP Aspartate transaminase (AST), alanine transferase (ALT); and lactic dehydrogenase (LDH) were measured in samples of the storage solution obtained at 2, 4 and 6 hours of preservation. After 6 hours of cold storage, we reperfused the liver, taking blood samples to measure AST, ALT, LDH, and throbarbituric acid reactive substances (TBARS). Hepatic fragments were processed for histologic analysis; for determinations of TBARS, catalase, and nitric oxide as well as for mitochondrial evaluation by infrared spectroscopy. RESULTS: During cold preservation, levels of AST and LDH in the storage solution were lower among the FBP group, but after reperfusion, serum levels of AST, ALT, and LDH were higher in this group, as was catalase activity. TBARS and nitric oxide were comparable between the groups. In the UW group there was a higher amide I/amide II ratio than in the FBP group, suggesting an abnormal protein structure of the mitochondrial membrane. No signs of preservation injury were observed in any liver biopsy, but sinusoidal congestion was present in livers preserved with FBP. CONCLUSION: FBP showed a protective effect for preservation during cold storage seeming to protect the mitochondrial membrane although it did not prevent reperfusion injury.

Alteraciones de la coagulación neonatal tras una gestación gemelar con mola hidatiforme completa / Alterations in neonatal coagulation after twin pregnancies with complete hydatidiform mole

La enfermedad trofoblástica gestacional consistente en una mola hidatiforme completa con un feto gemelar vivo, es una complicación obstétrica infrecuente. Conlleva un riesgo importante de complicaciones para la madre y el feto, por lo que son pocas las gestaciones que se dejan evolucionar; de ahí que sea poco lo que conocemos acerca de la patología que puede afectar a estos recién nacidos. Presentamos el caso de una gestación gemelar de estas características, que finalizó con cesárea la semana 32 + 3. Durante el ingreso, el recién nacido presentó datos de coagulación intravascular diseminada sin repercusión clínica, lo que requirió tratamiento con vitamina K, y con resolución espontánea. Descartadas otras posibles causas, se atribuyó a la gestación trofoblástica. No hemos encontrado casos documentados en la bibliografía de alteraciones de la coagulación tras gestaciones trofoblásticas, probablemente debido a los pocos casos con evolución natural. Deberíamos prestar atención a este nuevo aspecto, ya que puede constituir un riesgo añadido para el neonato (AU)

The gestational trophoblastic disease with a complete hydatidiform mole and a alive twin fetus is an infrequent obstetrical complication. As it carries an important risk of complications for both the mother and the fetus, since the gestations are only a few which we can see their evolution, as a result we know little about the pathology than can appear in the newborn. We report a case of a twin pregnancy with these characteristics, which ended with a cesarean section at by 32+3 weeks of gestational age. During the admission, the newborn had data of disseminated intravascular coagulation without clinical manifestations, requiring treatment with K vitamin and a spontaneous resolution. As we discarded other causes, these alterations were attributed to the trophoblastic disease. We haven’t found on the literature other cases with coagulation disorders on trophoblastic gestations, maybe because of the infrequency of a natural evolution on these cases. We must take this new aspect into account, since it can constitute an added risk for the newborn (AU)

Eficacia analgésica de citrato de fentalino transmucosa oral (CFOT) en histeroscopias / Analgesic efficacy of transmucosal fentanyl for hysteroscopies

ObjetivoEl objetivo de este estudio fue valorar la eficacia del fentanilotransmucosa oral como analgésico, sedante y ansiolítico en pacientes sometidas a histeroscopia diagnóstica y terapéutica.MétodosSe estudiaron 40 pacientes programadas para histeroscopiadiagnóstica y/o terapéutica. Los criterios de inclusión fueron:pacientes ASA I y II, con 8 h. de ayuno. Los criterios deexclusión fueron: embarazo y ASA >=3. Ninguna de las pacientesestaba en tratamiento con antidepresivos y/o ansiolíticos.Se dividieron en 2 grupos: Grupo A (n=20), pacientesprogramas para histeroscopia diagnóstica, que recibieron 200 mg de CFOT 20 min. antes del procedimiento. A aquellas pacientesen las que el procedimiento diagnóstico se convertíaen terapéutico, o la dosis era insuficiente, se les administrabaotra dosis de 200 mg. Grupo B (n=20), pacientes programadaspara histeroscopia terapéutica, que recibieron 400 mg.A aquellas pacientes en las que se consideraba que la dosisinicial era insuficiente, se les administraba otra dosis de 200 mg. Se estudiaron: 1. Presión arterial (PA), Frecuencia Cardiaca(FC) y Saturación de O2 (Sat O2), cada 10 min. 2. Nivelde analgesia, sedación y grado de ansiedad, durante todoel proceso. Tiempo transcurrido desde la premedicación hastael alta. Efectos indeseables. Satisfacción del paciente. Parala valoración del dolor se utilizó una escala de 1 a 5. Parael nivel de sedación, se utilizó la escala de Ramsay de 1 a 6.Para el grado de ansiedad se utilizó Spielberger State-TraitAnxiety Inventory Short Form. Resultados: La PA, FC y SatO2, se mantuvo estable en todas las pacientes desde la premedicaciónhasta el alta. El nivel medio de analgesia, el gradode sedación y de ansiedad fue satisfactorio durante todo elestudio. La dosis de CFOT consumido A: 210 mg y B 434.78mg y los tiempos premedicación - alta fueron: A 1.8 ± 0.7 h.y B 2.6 ± 1 1 h.La satisfacción fue buena/excelente en el 99.3% de loscasos. Conclusiones: este estudio demostró que el CFOT esun buen analgésico, ansiolítico y sedante en histeroscopias (AU)

Background: The aim of this study was to evaluate the effectiveness of the OTFC as analgesic, sedative and anxiolytic in patients who undergo diagnostic and therapeutic hysteroscopy. Methods: We carried out a prospective study in 40 patients who were programmed for diagnostic and therapeutic hysteroscopy. The inclusion’s criteria were: Patients with ASA I y II and who were nil by mouth for 8 hours. The exclusion’s criteria were: pregnancy and ASA > 3. None of the patients consumed antidepressants and/or anxiolytics. The patients were divided en 2 groups. Group A (n =20), patients planned for undergo diagnostic hysteroscopy received OTFC 20 minutes before surgery. The doses administrated were 200 μg. In those patients in which the diagnostic procedure was converted to the therapeutic, and the doses were insufficient an other dose of 200 μg was given 30 minutes after the first one. Group B (n = 20), patients planned for therapeutic hysteroscopy received 400 μg, 20 minutes before the procedure. In those patients in which we consider that the initial dose was insufficient, we given them a second dose of 200 μg 30 minutes after the first one. It was studied: 1. Blood pressure, heart rate and oxygen saturation, every 10 minutes from the premedication up to the discharge. 2. Level of analgesia, sedation and anxiety from the premedication up to the discharge. 3. Times between premedication up to the discharge. 4. Side effects. 5. Satisfaction of the patients: bad, regular, good and excellent. To evaluate the pain, we used a scale from 1 to 5. To evaluate the level of sedation, we used the scale of Ramsay from 1 to 6. To evaluate the grade of anxiety we used the Spilberger State-Trait Inventory sort form. Results: The blood pressure, heart rate and pulse oxymetry were constant in both groups from from the premedication up to the discharge. The level of analgesia, the grade of sedation and anxiety in both groups were satisfactory. The average of OTFC used was 210 μg and 434.78 μg in the group A and B respectively. Times between the premedication up to the discharge were: A 1.8 ± 0.7 h. y B 2.6 ± 1 1 h. 99.3% of the patients found OTFC excellent. Conclusions: This study demonstrates that the OTFC is an effective anxiolytic in patients who undergo diagnostic and therapeutic hysteroscopy