[SUNCT/SUNA: frequently misdiagnosed as trigeminal neuralgia?] / SUNCT/SUNA: ¿frecuentemente mal diagnosticada como neuralgia del trigémino?

OBJECTIVE: Identify the number of cases with a possible diagnosis of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) in patients with a previous diagnosis of Trigeminal Neuralgia (TN) at the Neurology Service of the National Medical Center 20 de Noviembre. This will confirm that these trigeminal-autonomic cephalalgias should be ruled out and considered as differential diagnoses of trigeminal neuralgia. PATIENTS AND METHODS: Cross-sectional and retrospective study. The complete electronic medical records of 100 patients with a diagnosis of TN were evaluated during the period from April 2010 to May 2020. Autonomic symptoms were intentionally searched for in these patients and compared with the diagnostic criteria of SUNCT and SUNA of the 3rd edition of the International Classification of Headache Disorders. Chi-square tests and subsequent bivariate regression were performed to determine the association between variables. RESULTS: One hundred patients with a diagnosis of TN were included. After reviewing the clinical manifestations, 12 patients with autonomic symptoms were found and compared with the diagnostic criteria of SUNCT and SUNA. However, they did not meet the absolute criteria to be diagnosed with the previously mentioned diseases, nor to be ruled out. CONCLUSIONS: TN is a painful and frequent entity that can present with autonomic symptoms, therefore making it important to identify SUNCT and SUNA as differential diagnoses, to recognize them and treat them appropriately.

TITLE: SUNCT/SUNA: ¿frecuentemente mal diagnosticada como neuralgia del trigémino?Objetivo. Identificar el número de casos con posible diagnóstico de cefalea neuralgiforme unilateral de corta duración con inyección conjuntival y lagrimeo (SUNCT) o cefalea neuralgiforme unilateral de corta duración con síntomas autonómicos craneales (SUNA) en pacientes con un previo diagnóstico de neuralgia del trigémino (NT) en el servicio de neurología del Centro Médico Nacional 20 de Noviembre, comprobando así que estas cefaleas trigeminoautonómicas deben ser descartadas y consideradas como diagnósticos diferenciales de la NT. Pacientes y métodos. Estudio transversal y retrospectivo. Se evaluaron los expedientes clínicos electrónicos completos de 100 pacientes con diagnóstico de NT durante el período de abril de 2010 a mayo de 2020. Intencionalmente se buscaron síntomas autonómicos en éstos y se compararon con los criterios diagnósticos de SUNCT y SUNA de la Clasificación Internacional de las Cefaleas, tercera edición. Se realizaron pruebas de chi cuadrado y posteriormente de regresión bivariada para determinar la asociación entre las variables. Resultados. Se incluyó a 100 pacientes con diagnóstico de NT. Tras la revisión de las manifestaciones clínicas, se encontró a 12 pacientes con síntomas autonómicos y se compararon con los criterios diagnósticos de SUNCT y SUNA. Estos no cumplieron los criterios absolutos para ser diagnosticados con las enfermedades previamente mencionadas; sin embargo, cumplieron las características del espectro de cefaleas trigeminoautonómicas. Conclusión. La NT es una entidad dolorosa y frecuente que puede presentar síntomas autonómicos, y es importante pensar en diagnósticos diferenciales, como la SUNCT y la SUNA, para la identificación y el tratamiento correctos.

Design and characterization of immobilized biocatalyst with lipase activity onto magnetic magnesium spinel nanoparticles: A novel platform for biocatalysis.

Lipases (EC 3.1.1.3) are very used industrial enzymes but presents drawbacks such as lack of stability, and poor recyclability. Most of these obstacles can be solved by lipase immobilization. The objective of this work was evaluated to magnetic magnesium spinel nanoparticles as support for lipase immobilization by covalent bound. The techniques used for nanoparticles synthesis presented advantages in the size selection of the nanoparticles obtained (60-100 nm). The immobilization of Candida rugosa lipase (CRL) was optimized. The optimal conditions were determined to be pH 3.7, enzyme concentration of 1.1 mg/mL at 4 °C and an ionic strength of 100 mM. The CRL@MgFe2O4 activity obtained was 3.2 times over the starting conditions (4.03 U/mL). The immobilization of the lipase on Fe3O4 was evaluated and compared. The activity of the CRL@MgFe2O4 was 61% higher than CRL@Fe3O4 and 22% higher than free enzyme. CRL@MgFe2O4 improved the lipase stability at alkaline pH, hydrophilic solvent and high temperatures. The thermogravimetric analysis showed that this new biocatalyst was more stable compared to the free enzyme. Additionally, the immobilized lipase was recycled by magnetic force and used in ten catalysis cycles. The performance of the recycle was improved using butanol or Triton X 100 during washing. Finally, CRL@FeMg2O4 showed hydrolysis and synthesis activity. Thus, CRL@FeMg2O4 as a novel biocatalyst generation presents interesting properties for industrial applications.

Designing cross-linked xylanase aggregates for bioconversion of agroindustrial waste biomass towards potential production of nutraceuticals.

Immobilized biocatalysts design has the potential to efficiently produce valuable bioproducts from lignocellulosic biomass. Among them, the carrier-free immobilization through the cross-linked enzyme aggregates technology is a simple and low-cost alternative. A two steps statistical approach was utilized to evaluate the synthesis of a cross-linked enzyme aggregate from a xylanolytic preparation, which was produced by Cohnella sp. AR92 grown in a peptone-based culture medium. The resulting immobilized biocatalyst, Xyl-CLEA, was significate more stable (25 to 45%) towards temperatures up to 50°C with respect to the free enzyme, and retained over 50% of its initial activity after 5 consecutive cycles of reuse. By means of infrared spectroscopy and electron microscopy, the Xyl-CLEA showed architectural features described as signature of type I and type II of protein aggregates. These, were the result of the simultaneous aggregation of a multiplicity of proteins from the crude enzymatic extract. The enzymatic activity was assessed using alkali pretreated sugar cane bagasse as substrate. Whereas the free enzymatic preparation released xylose as the main product, the immobilized xylanase produced xylooligosaccharides, thus showing that the immobilization procedure modified the potential application of the extracellular xylanase from Conhella sp. AR92.

Architecture and physicochemical characterization of Bacillus biofilm as a potential enzyme immobilization factory.

Biocatalysis for industrial application is based on the use of enzymes to perform complex transformations. However, these systems have some disadvantage related to the costs of the biocatalyst. In this work, an alternative strategy for producing green immobilized biocatalysts based on biofilm was developed.A study of the rheological behavior of the biofilm from Bacillus sp. Mcn4, as well as the determination of its composition, was carried out. The dynamic rheological measurements, viscosity (G") and elasticity (G') module, showed that the biofilm presents appreciable elastic components, which is a recognized property for enzymes immobilization. After the partial purification, the exopolysaccharidewas identified as a levan with a non-Newtonian behavior. Extracellular DNA with fragments between 10,000 and 1000bp was detected also in the biofilm, and amyloid protein in the extracellular matrix using a fluorescence technique was identified. Bacillus sp. Mcn4 biofilms were developed on different surfaces, being the most stable those developed on hydrophilic supports. The biofilm showed lipase activity suggesting the presence of constitutive lipases entrapped into the biofilm. Indeed, two enzymes with lipase activity were identified in native PAGE. These were used as biocatalysts, whose reuse showed a residual lipase activity after more than one cycle of catalysis. The components identified in the biofilm could be the main contributors of the rheological characteristic of this material, giving an exceptional environment to the lipase enzyme. Based on these findings, the current study proposes green and natural biopolymers matrix as support for the enzyme immobilization for industrial applications.

[High volume hemofiltration in septic shock]. / Hemofiltración de alto volumen en shock séptico.

Severe sepsis and septic shock are conditions associated with high morbidity and mortality. The disproportionate release of pro-inflammatory and anti-inflammatory mediators caused by the septic insult is the promoter of multiple organ dysfunction. Conventional hemodialysis, hemofiltration or a combination of both can be a good option to replace the deteriorating renal function in critically ill patients by the removal of nitrogen compounds (small molecules). However, this "renal dose" is insufficient for the removal of inflammatory mediators (medium molecules), and therefore contributes little to the cardiovascular stabilization of patients with septic shock. In this setting, a higher dose of ultrafiltration (> 50 ml/kg/h) or "septic dose" may be needed. In this review article, we have analyzed the clinical and pathophysiological rationale for the use of high volume hemofiltration in patients with septic shock.

[Safety and quality in intensive care medicine]. / Seguridad y Calidad en Medicina Intensiva.

The safety and quality care are two attributes of the health care that are closely intertwined. Quality is a feature of the system that delivers health care, thereby improving it, we need a proper reorganization teamwork. Measurements of quality are intended to assess whether the process of health care reaches the desired objectives, while avoiding the processes that predispose to harm the patient. The critically ill patients are vulnerable to medical errors, and may experience side effects preventable, often associated with: medications, mechanical ventilation, and intravascular devices. The evidence currently available suggest that the safety and quality of care can be improved. In this article presents some of the strategies and interventions developed to optimize the processes of care in critically ill patients, and improve the safety culture in the ICU.

Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Delayed ischemic neurological deficit associated to cerebral vasospasm is the most common cause of sequelae and death that follows the rupture of an aneurysm. The objective of this study was to evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm. PATIENTS AND METHOD: Eight patients diagnosed with aneurysmal subarachnoid hemorrhage who developed symptomatic cerebral vasospasm refractory to conventional medical therapy were enrolled. They received an intra-arterial infusion of Milrinone at a rate of 0.25 mg/min, with a total dose of 10-15 mg. Qualitative evaluation of angiographic response, neurological and systemic complications as well as functional outcome at 3 months were documented. RESULTS: All patients had a significant angiographic response. This was evidenced by a pre-treatment vessel stenosis greater than 70%, that improved to less than 50% after the intra-arterial Milrinone infusion. Three patients developed recurrent vasospasm that improved after a second intra-arterial Milrinone infusion. None of the patients developed neurologic or systemic complications attributed to the intervention. At 3 months follow-up all patients were alive and had a mean modified Rankin scale of 2 +/- 1 and a Barthel index of 83 +/- 10. CONCLUSION: Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

In vitro pulsatile flow study on effective orifice area of prosthetic mechanical heart valves.

The effective orifice area (EOA) of a mechanical heart valve is an index of how well the valve design utilizes its primary orifice area (POA). In vitro measurements of EOA of aortic valves were maintained by means of pressure drop and root mean square flow rate measurements in a pulse duplicator during systole. Edwards-Duromedics, St. Jude Medical, and Carbomedics aortic valves of sizes 19 19 mm, 21 mm, 25 mm, and 27 mm were analyzed over a cardiac output range of 3 to 7 liters/min. The resultant ratios of EOA/POA were in the range of 0.6-0.8. A simplified equation suggested by the FDA was used in this study to calculate EOAs. To agree with original assumptions of the simplification, the entrance flow area (EFA) where upstream pressure is measured, must be large as compared to that of the test valves. If not, the formula can yield questionable results such as implying that the EOA can be larger than the POA (Walker P et al, 1992) [1]. This paper discusses the limitations in using such an equation. In conclusion, we suggest utilizing the parameter square root of 1-(POA/EFA)2 to evaluate the validity of the data processing, before using the equation. The parameter should be close to one, and in this study it was 0.997.