Purification and identification of antibacterial phenolics from Tripodanthus acutifolius leaves.

AIMS: To perform an activity-guided purification, identification and quantification of antibacterial compounds from Tripodanthus acutifolius infusion. To validate the antibacterial activity of purified substances. METHODS AND RESULTS: Bioautographic methods were employed as screening assays for purifying bioactive substances. Purification procedures included sephadex LH-20 column chromatography and reverse phase HPLC. Identification was achieved by spectroscopic methods (UV-Vis, MS, NMR and polarimetry) and chromatographic assays (paper chromatography and HPLC). Antibacterial activity was studied by microdilution, colony count and photometric assays, Sytox green stain and transmission electron microscopy (TEM). Four glycoflavonoids (rutin, nicotiflorin, hyperoside and isoquercitrin) and an unusual phenylbutanoid glycoside (tripodantoside) were purified and identified. Tripodantoside was found at 6.59 +/- 0.82 g per 100 g of dry leaves. The flavonoids showed bactericidal effect at a concentration of 4 mg ml(-1) against Staphylococcus aureus and Pseudomonas aeruginosa strains from American Type Culture Collection, while tripodantoside was almost four times more active than those compounds, with a minimum bactericidal concentration = 1.024 mg ml(-1) against these strains. Tripodantoside aglycone showed bacteriolytic effects on the assayed strains, causing evident damages on cell wall and membrane, while tripodantoside did not exhibit those effects. CONCLUSIONS: The antibacterial activity of T. acutifolius infusion would be partially attributed to the purified glycoflavonoids and mainly to tripodantoside. SIGNIFICANCE AND IMPACT: The high extraction yield and the antibacterial activity exhibited by tripodantoside makes this chemical structure of interest to support further studies dealing with chemical modifications to increase the antibacterial activity or to seek another activities.

Carvedilol stability in paediatric oral liquid formulations.

OBJECTIVE: Two carvedilol aqueous solutions and one carvedilol aqueous suspension for paediatric oral use (1mg/ml) were studied to determine their stability. METHOD: All samples were stored at 4, 25 and 40°C. Carvedilol content of each of the three formulations was tested using high performance liquid chromatography (HPLC). Each sample was analysed in triplicate at 0, 3, 7, 14, 28 and 56 days. RESULTS: Carvedilol stayed stable in the acidic aqueous solution at the three different temperatures during the 56 days of the study. In the alkaline solution, carvedilol was stable during 56 days at 25°C, but only 28 days at 4 and 40°C. In the aqueous suspension, carvedilol was stable during 56 days at 4 and 25°C, but only 28 days at 40°C. CONCLUSIONS: All the formulations that were tested can be stored at 25°C for at least 56 days.

Does combined multichannel intraluminal esophageal impedance and manometry predict postoperative dysphagia after laparoscopic Nissen fundoplication?

Laparoscopic Nissen fundoplication (LNF) is an effective treatment for gastroesophageal reflux disease; however, some patients develop dysphagia postoperatively. Manometry is used to evaluate disorders of peristalsis, but has not been proven useful to identify which patients may be at risk for postoperative dysphagia. Multichannel intraluminal impedance (MII) evaluates the effective clearance of a swallowed bolus through the esophagus. We hypothesized that MII combined with manometry may detect those patients most at risk of developing dysphagia after LNF. Between March 2003 and January 2007, 74 patients who agreed to participate in this study were prospectively enrolled. All patients completed a preoperative symptom questionnaire, MII/manometry, and 24-h pH monitoring. All patients underwent LNF. Symptom questionnaires were administered postoperatively at a median of 18 months (range: 6-46 months), and we defined dysphagia (both preoperatively and postoperatively) as occurring more than once a month with a severity >or=4 (0-10 Symptom Severity Index). Thirty-two patients (43%) reported preoperative dysphagia, but there was no significant difference in pH monitoring, lower esophageal sphincter pressure/relaxation, peristalsis, liquid or viscous bolus transit (MII), or bolus transit time (MII) between patients with and without preoperative dysphagia. In those patients reporting preoperative dysphagia, the severity of dysphagia improved significantly from 6.8 +/- 2 to 2.6 +/- 3.4 (P < 0.001) after LNF. Thirteen (17%) patients reported dysphagia postoperatively, 10 of whom (75%) reported some degree of preoperative dysphagia. The presence of postoperative dysphagia was significantly more common in patients with preoperative dysphagia (P= 0.01). Patients with postoperative dysphagia had similar lower esophageal sphincter pressure and relaxation, peristalsis, and esophageal clearance to those without dysphagia. Neither MII nor manometry predicts dysphagia in patients with gastroesophageal reflux disease or its occurrence after LNF. The presence of dysphagia preoperatively is the only predictor of dysphagia after LNF.

Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: evaluation with multichannel intraluminal impedance.

BACKGROUND: Morbid obesity is associated with gastroesophageal reflux disease (GERD), and both have an independent association with motility disorders. Impaired esophageal function is thought to play a role in the development of dysphagia after fundoplication and bariatric procedures (especially restrictive procedures). The authors aimed to define both the physiology and the underlying pathophysiology of swallowing using a novel technique, multichannel intraluminal impedance (MII), which can accurately determine the clearance of a swallowed bolus through the esophagus, in combination with traditional manometry, which can measure peristalsis. METHODS: Simultaneous MII, manometry, and pH monitoring were performed for 10 asymptomatic subjects, 22 consecutive nonobese patients with GERD (GERD), and 22 consecutive morbidly obese patients with GERD (MO-GERD) who were under evaluation for antireflux and bariatric surgery at the University of Washington. In this study, MII was defined as abnormal if less than 80% of swallowed liquid boluses cleared the esophagus completely. RESULTS: All GERD and MO-GERD patients had abnormal pH monitoring. The manometric findings were similar for the GERD and MO-GERD patients. All the asymptomatic subjects had normal manometry and impedance test results. Abnormal manometry would have predicted that approximately 23% of GERD and MO-GERD patients had defective emptying. However, when measured with impedance, esophageal clearance was found to be defective in two times as many GERD and nearly three times as many MO-GERD patients. CONCLUSIONS: In patients with GERD, impedance often detects impairments in esophageal motility not identified by manometry. Morbidly obese patients with GERD have a higher incidence of impaired esophageal motility than nonobese patients with GERD. This may have implications for bariatric procedures, especially those that are restrictive.

Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder.

UNLABELLED: A strong link exists between gastroesophageal reflux disease (GERD) and airway diseases. Surgical therapy has been recommended as it is more effective than medical therapy in the short-term, but there is little data on the effectiveness of surgery long-term. We analyzed the long-term response of GERD-related airway disease after laparoscopic anti-reflux surgery (LARS). METHODS: In 2004, we contacted 128 patients with airway symptoms and GERD who underwent laparoscopic antireflux surgery (LARS) between 12/1993 and 12/ 2002. At median follow-up of 53 months (19-110 mo) we studied the effects on symptoms, esophageal acid exposure, and medication use and we analyzed the data to determine predictors of successful resolution of airway symptoms. RESULTS: Cough, hoarseness, wheezing, sore throat, and dyspnea improved in 65-75% of patients. Heartburn improved in 91% (105/116) of patients and regurgitation in 92% (90/98). The response rate for airway symptoms was the same in patients with and without heartburn. Almost every patient took proton pump inhibitors (PPIs) preoperatively (99%, 127/128) and 61% (n = 78) were taking double or triple dose. Postoperatively, 33% (n = 45) of patients were using daily antiacid therapy but no one was on double dose. The only factor that predicted a successful surgical outcome was the presence of abnormal reflux in the pharynx as determined by 24-hour pharyngeal pH monitoring. One hundred eleven (87%) patients rated their results as excellent (n = 78, 57%) or good (n = 33, 24%). CONCLUSION: LARS provides an effective and durable barrier to reflux, and in so doing improves GERD-related airway symptoms in approximately 70% of patients and improves typical GERD symptoms in approximately 90% of patients. Pharyngeal pH monitoring identifies those patients more likely to benefit from LARS, but better diagnostic tools are needed to improve the response of airway symptoms to that of typical esophageal symptoms.

Medium- and long-term outcome of laparoscopic redo fundoplication.

BACKGROUND: For a small subset of patients, laparoscopic fundoplication fails, typically resulting in recurrent reflux or severe dysphagia. Although redo fundoplications can be performed laparoscopically, few studies have examined their long-term efficacy. METHODS: Using a prospectively maintained database, the authors identified and contacted 41 patients who had undergone redo laparoscopic fundoplications at the University of Washington between 1996 and 2001. The median follow-up period was 50 months (range, 20-95 months). Current symptoms were compared with those acquired and entered into the authors' database preoperatively. Patients also were asked to return for esophageal manometry and pH testing. RESULTS: All redo fundoplications were performed laparoscopically. There were no conversions. The most common indication for redo fundoplication was recurrent reflux. The most common anatomic abnormality was a herniated wrap. Heartburn improved in 61%, regurgitation in 69%, and dysphagia in 74% of the patients. Complete resolution of these symptoms was achieved, respectively, in 45%, 41% and 38% of these same patients. Overall, 68% of the patients rated the success of the procedure as either "excellent" or "good," and 78% said they were happy they chose to have it. For those who underwent reoperation for gastroesophageal reflux disease, distal esophageal acid exposure according to 24-h pH monitoring decreased after redo fundoplication from 15.7% +/- 18.1% to 3.4% +/- 3.6% (p = 0.041). CONCLUSION: Although not as successful as primary fundoplication, a majority of patients can expect durable improvement in their symptoms with a laparoscopic redo fundoplication.

Purification and characterization of the invertase from Pycnoporus sanguineus.

A constitutive invertase (EC 3.2.1.26) was isolated and purified by the first time from Pycnoporus sanguineus. The enzyme is a glycoprotein. Its relative molecular mass is about 84,000 and its structure is dimeric, with two identical subunits (about 41,000). The enzyme is able to attack sucrose, raffinose, stachyose, inulin and levan, being sucrose the preferred substrate (Km 4.89 +/- 0.13 mM). Fructose was a classical competitive inhibitor, but glucose was not an inhibitor of the enzyme. Lectins with specificity toward glucose are inhibitors of the enzyme. Glucose was present in invertase acid hydrolysates. Unlike higher plant invertases, bovine serum albumin is not an effector of the Pycnoporus sanguineus enzyme, and the inhibition by fructose is not suppressed by this protein. The properties of the Pycnoporus sanguineus enzyme are discussed with reference to higher plant invertases.

Comparison between measured and fick-derived values of hemodynamic and oxymetric variables in patients with acute myocardial infarction.

PURPOSE: Previous studies have compared the relationship between directly measured values for cardiac output, systemic oxygen consumption (VO2), and arteriovenous oxygen difference (D(A-v)O2) with those calculated by the Fick principle. However, the validity of Fick's principle in critically ill patients undergoing physiologic changes and pharmacologic interventions is unknown. The purpose of our study was to compare directly measured values for hemodynamic and oxymetric variables with those calculated by the Fick equation in patients with acute myocardial infarction, at baseline and after the hemodynamic changes produced by pharmacologic interventions. PATIENTS AND METHODS: Cardiac output, (VO2), and (D(A-v)O2) were measured in 33 patients with acute myocardial infarction, at baseline (50 +/- 30 hours after the onset of symptoms) and after pharmacologic intervention to relieve pulmonary congestion. These values were then compared with indirect values derived from the Fick equation. RESULTS: High and significant correlations were found between thermodilution and Fick-derived cardiac output at baseline (r = 0.91, p less than 0.001) and post-intervention (r = 0.92, p less than 0.001). Similarly, VO2 values measured by expired gas analysis showed a significant correlation with VO2 calculated by the Fick principle, at baseline (r = 0.85, p less than 0.001) and post-intervention (r = 0.84, p less than 0.001). Lastly, when D(A-v)O2 of arterial and mixed venous samples was measured by spectrophotometry and compared with calculated values, there was a significant correlation at baseline (r = 0.85, p less than 0.001) and after intervention (r = 0.85, p less than 0.001). Analysis of variance revealed no difference between measured and calculated values for the three variables under those two conditions. CONCLUSION: In patients with acute myocardial infarction, cardiac output, VO2, and D(A-v)O2 indirectly calculated by the Fick principle are equivalent to directly measured values, despite the various degrees of hemodynamic dysfunction and the currently used therapeutic interventions.

The variability of platelet-collagen interaction. Its influence on aspirin-induced inhibition of platelet aggregation.

A study of platelet aggregation induced by progressive concentrations of collagen was performed in 40 normal persons, equally grouped by sex, immediately before, and 90 min after, the ingestion of 0.500 g aspirin. Simultaneously, serum ASA-esterase activity and plasmatic salicylic acid levels were investigated in the pre- and post-ASA samples respectively. Wide individual variations in platelet responsiveness to collagen were found when the minimal amount of the aggregating agent necessary to provoke significant aggregation was located. The percentage of aggregation and the slope were the most sensible indicators of both the individual variances and the ASA-induced inhibition. Correlation was found in both groups between the minimal amounts of collagen required for initiating aggregation pre- and post-ASA. Also positive correlation was found between the minimal collagen concentration required to initiate aggregation pre-ASA and the aspirin-induced inhibition in the aggregation produced by a higher collagen concentration. Important individual and sexual differences were detected in the serum content of ASA-esterase activity. A negative significant correlation was demonstrated between the ASA-esterase activity and the differences in collagen concentrations necessary to start aggregation pre- and post-aspirin in the men group. Failure to consider individual variances in platelet reactivity may lead to false conclusions about the ASA affectiveness as an antithrombotic agent.

Screening antifungal activities of selected medicinal plants.

Plants synthesise a vast array of secondary metabolites that are gaining importance for their biotechnological applications. The antifungal activity of the ethanolic extracts of ten Argentinean plants used in native medicine is reported. Antifungal assays included radial growth inhibition, disk and well diffusion assays and growth inhibition by broth dilution tests. The chosen test fungi were yeasts, microfungi and wood-rot causing Basidiomycetes. Extracts of Larrea divaricata, Zuccagnia punctata and Larrea cuneifolia displayed remarkable activity in the assays against the majority of the test fungi. In addition to the former plants, Prosopanche americana also inhibited yeast growth.

Extemporaneous clobazam suspensions for paediatric use prepared from commercially available tablets and pure drug.

OBJECTIVE: Two clobazam aqueous suspensions for paediatric oral usage (5 mg/ml) were investigated to determinate its physicochemical stability under different storage conditions. METHOD: Formulations were stored at 4 and 25 °C and the clobazam content was determined by High Performance Liquid Chromatography. Each sample was analyzed by triplicate at different time points (0, 7, 14, 28 and 56 days). RESULTS: Liquid suspensions were successfully formulated from pure drug and commercially available tablets. In both cases, samples showed suitable physical stability. Clobazam was chemically stable in aqueous suspension during the 56 days of the study at the two storage temperatures. CONCLUSIONS: All the tried oral liquid formulations can be conserved at 4 and 25 °C at least 56-day period.

Objetivo: Dos suspensiones orales acuosas de clobazam para uso pediátrico (5 mg/ml) fueron evaluadas para determinar su estabilidad fisicoquimica bajo diferentes condiciones de almacenamiento. Métodos: Las formulaciones fueron conservadas a 4 y 25 °C y el contenido de clobazam fue determinado mediante Cromatografía Líquida de Alta Performance. Cada una de las muestras fue analizada por triplicado a diferentes tiempos (0, 7, 14, 28 y 56 días). Resultados: Las suspensiones fueron formuladas satisfactoriamente a partir del principio activo puro y de comprimidos disponibles comercialmente. En ambos casos, las muestras presentaron una adecuada estabilidad física. El clobazam fue químicamente estable en las suspensiones acuosas durante los 56 días de duración del estudio a las dos temperaturas elegidas para su conservación. Conclusiones: Todas las formulaciones orales líquidas formuladas y evaluadas en este estudio pueden ser conservadas a 4 y 25 °C por al menos 56 días.

Fractional statistical theory of adsorption applied to protein adsorption.

Experimental adsorption isotherms of bovine serum albumin (BSA) adsorbed on sulfonated microspheres were described by means of two analytical models: the first is the well-known Langmuir-Freundlich model (LF), and the second, called fractional statistical theory of adsorption (FSTA), is a statistical thermodynamics model developed recently by Ramirez-Pastor et al. [Phys. Rev. Lett. 93 (2004) 186101]. The experimental data, obtained by Hu et al. [Biochem. Eng. J. 23 (2005) 259] for different concentrations of sulfonate group on the surface of the microspheres, were correlated by using a fitting algorithm based on least-squares statistics. The combination of LF and FSTA models, along with the choice of an adequate fitting procedure, allowed us to obtain several conclusions: (i) as previously reported in the literature, the maximum amount adsorbed increases as the amount of sulfonate group increases; (ii) the equilibrium constant does not appear as a sensitive parameter to the amount of sulfonate group on the surface of the microspheres; and (iii) the values of the fitting parameters obtained from FSTA may be indicative of a mismatch between the equilibrium separation of the intermolecular interaction and the distance between the adsorption sites. The exhaustive study presented here has shown that FSTA model is a good one considering the complexity of the physical situation, which is intended to be described and could be more useful in interpreting experimental data of adsorption of molecules with different sizes and shapes.

Extemporaneous clobazam suspensions for paediatric use prepared from commercially available tablets and pure drug

Objective: Two clobazam aqueous suspensions for paediatric oral usage (5 mg/ml) were investigated to determinate its physicochemical stability under different storage conditions. Method: Formulations were stored at 4 and 25 oC and the clobazam content was determined by High Performance Liquid Chromatography. Each sample was analyzed by triplicate at different time points (0, 7, 14, 28 and 56 days). Results: Liquid suspensions were successfully formulated from pure drug and commercially available tablets. In both cases, samples showed suitable physical stability. Clobazam was chemically stable in aqueous suspension during the 56 days of the study at the two storage temperatures. Conclusions: All the tried oral liquid formulations can be conserved at 4 and 25 oC at least 56-day period (AU)

Objetivo: Dos suspensiones orales acuosas de clobazam para uso pediátrico (5 mg/ml) fueron evaluadas para determinar su estabilidad fisicoquimica bajo diferentes condiciones de almacenamiento. Métodos: Las formulaciones fueron conservadas a 4 y 25 oC y el contenido de clobazam fue determinado mediante Cromatografía Líquida de Alta Performance. Cada una de las muestras fue analizada por triplicado a diferentes tiempos (0, 7, 14, 28 y 56 días). Resultados: Las suspensiones fueron formuladas satisfactoriamente a partir del principio activo puro y de comprimidos disponibles comercialmente. En ambos casos, las muestras presentaron una adecuada estabilidad física. El clobazam fue químicamente estable en las suspensiones acuosas durante los 56 días de duración del estudio a las dos temperaturas elegidas para su conservación. Conclusiones: Todas las formulaciones orales líquidas formuladas y evaluadas en este estudio pueden ser conservadas a 4 y 25 oC por al menos 56 días (AU)

Antibacterial activity of plant extracts from northwestern Argentina.

AIMS: To determine the antibacterial and cytotoxic activities of aqueous and ethanolic extracts of northwestern Argentinian plants used in folk medicine. To compare the mentioned activities with those of five commercial antibiotics. To identify the compounds responsible for the antibacterial activity. METHODS AND RESULTS: Plant extracts were prepared according to traditional uses in northwestern Argentina. Antibacterial activity was assayed by agar dilution in Petri dishes and broth dilution in 96-well plates. Lethal dose 50 (LD(50)) was determined by the Artemia salina assay. Phytochemical analysis was performed by sample adsorption on silica gel, thin-layer chromatography (TLC), bioautography and UV-visible spectra. The results showed that Tripodanthus acutifolius aqueous extracts have lower minimal inhibitory concentrations (MIC) (502 and 506 microg of extracted material (EM) per ml for infusion and decoction, respectively) than cefotaxim MIC (640 microg ml(-1)) against Acinetobacterfreundii (303). These data were lower than their LD(50). Tripodanthus acutifolius tincture showed lower MIC (110 microg of EM per ml) and minimal bactericidal concentration (MBC) (220 microg of EM per ml) than cefotaxim (MIC and MBC of 320 microg ml(-1)) for Pseudomonasaeruginosa. This extract also showed a MIC/MBC of 110/220 microg of EM per ml, lower than oxacillin (MIC/MBC of 160/220 microg ml(-1)) for Staphylococcus aureus (ATCC 25923). The cytotoxicity of all extracts were compared with that of commercial antibiotics. Rutin (3,3',4',5,7-pentahydroxyflavone 3-beta-rhamnosilglucoside), iso-quercitrin (3,3',4',5,7-pentahydroxyflavone 3-beta-glucoside) and a terpene would be partially responsible for the antibacterial activity of T. acutifolius infusion. CONCLUSIONS: Tripodanthus acutifolius extracts had the ability to inhibit bacterial growth. The antibacterial activity differs with the applied extractive method, and it could be partially attributed to glycoflavonoids. This paper contributes to the knowledge of antibacterial capacity of plants from northwestern Argentina. SIGNIFICANCE AND IMPACT OF THE STUDY: These antibacterial activities support further studies to discover new chemical structures that can contribute to alleviate or cure some illnesses.

Prevalencia de Síndrome metabólico en niños y adolescentes según diferentes criterios diagnósticos y su correlación con niveles de leptina y adiponectina / Prevalence of Metabolic Syndrome in Children and Adolescents by Different Diagnostic Criteria and their Correlation with Levels Leptin and Adiponectin

Los objetivos del trabajo fueron detectar sujetos con obesidad, sobrepeso y con afecciones que componen el Síndrome Metabólico (SM) en una población infantojuvenil. Determinar la frecuencia de SM según distintos criterios y comparar entre ellos, los valores de leptina y adiponectina. Se evaluó a 700 sujetos entre 6 y 19 años mediante encuestas, medidas antropométricas y registros de presión arterial. En aquellos con 1 o más componentes del SM (n: 138-20 %) se efectuaron dosajes de glucosa, insulina, perfil lipídico, leptina y adiponectina. El SM se definió de acuerdo a Cook, a De Ferranti y a Weiss. El análisis estadístico comprendió el estudio descriptivo de medias e intervalos del 95 % de confianza (IC) y el de asociación mediante test t y chi cuadrado con un nivel de significación del 5 %. De acuerdo al índice de masa corporal, el 14 % de la muestra presentó obesidad y el 22 %, sobrepeso. Según la circunferencia de cintura, el 15 % tuvo obesidad y 6 % sobrepeso. Hubo asociación significativa entre individuos obesos o con sobrepeso con la hipertensión arterial y en menor grado con otros parámetros como el índice HOMA, c-HDL y triglicéridos. La frecuencia de SM fue según Cook del 15 %, De Ferranti de 18 % y Weiss de 14 %. La mayor proporción que se obtuvo con los criterios de De Ferranti, se debe probablemente a que los percentiles y los valores de corte son más estrictos. La media de leptina fue significativamente mayor y la media de adiponectina fue significativamente menor en los pacientes con diagnóstico de SM de acuerdo las tres clasificaciones que se utilizaron (p < 0,01). Es necesario establecer criterios uniformes para diagnosticar al SM en la infancia y adolescencia ya que no existe acuerdo respecto a su definición, pues el desarrollo y crecimiento a estas edades, dificultan el establecimiento de valores de referencia precisos. Los autores declaran no poseer conflictos de interés.(AU)

The study aims were to detect subjects with obesity, overweight and components of Metabolic Syndrome (MS) in a child and adolescent populations. Also to determine the frequency of MS according to different criteria and compare them with Leptin and Adiponectin levels. 700 subjects between 6 and 19 years through standardized surveys, anthropometric and blood pressure measurements were studied. In those with 1 or more components of MS (n: 138-20 %), blood glucose, insulin, lipid profile, leptin and adiponectin were analyzed. MS were defined according criteria of Cook, or De Ferranti or Weiss. A descriptive statistical analysis showing the mean and 95 % confidence intervals (CI) were made. The association analysis was performed by t and chi-square tests with a significance level of 5 %. In the population studied by body mass index there were a 14 % of obesity and 22 % of overweight and through a waist circumference 15 % of obesity and 6 % of overweight. There was a strong association between overweight/obesity with hypertension and in a lesser degree, with other risk factors as HOMA index, HDL-cholesterol and triglycerides. The prevalence of MS according Cook was 15 %, according to De Ferranti 18 % and Weiss was 14 %. We speculate that the major percentage was obtained with the De Ferranti criteria, because the percentiles and cut-offs are more demanding. The mean value of leptin was significantly higher and the mean value of adiponectin was significantly lower in patients with MS according to the three criteria used (p < 0.01). It is necessary to establish a uniform standards and criteria to characterize MS in childhood and adolescence because there is no agreement on its definition, due to changes during growth and development that prevent the establishment of precise cut-off values. The authors do not have conflicts of interest.(AU)

Prevalencia de Síndrome metabólico en niños y adolescentes según diferentes criterios diagnósticos y su correlación con niveles de leptina y adiponectina / Prevalence of Metabolic Syndrome in Children and Adolescents by Different Diagnostic Criteria and their Correlation with Levels Leptin and Adiponectin

Los objetivos del trabajo fueron detectar sujetos con obesidad, sobrepeso y con afecciones que componen el Síndrome Metabólico (SM) en una población infantojuvenil. Determinar la frecuencia de SM según distintos criterios y comparar entre ellos, los valores de leptina y adiponectina. Se evaluó a 700 sujetos entre 6 y 19 años mediante encuestas, medidas antropométricas y registros de presión arterial. En aquellos con 1 o más componentes del SM (n: 138-20 %) se efectuaron dosajes de glucosa, insulina, perfil lipídico, leptina y adiponectina. El SM se definió de acuerdo a Cook, a De Ferranti y a Weiss. El análisis estadístico comprendió el estudio descriptivo de medias e intervalos del 95 % de confianza (IC) y el de asociación mediante test t y chi cuadrado con un nivel de significación del 5 %. De acuerdo al índice de masa corporal, el 14 % de la muestra presentó obesidad y el 22 %, sobrepeso. Según la circunferencia de cintura, el 15 % tuvo obesidad y 6 % sobrepeso. Hubo asociación significativa entre individuos obesos o con sobrepeso con la hipertensión arterial y en menor grado con otros parámetros como el índice HOMA, c-HDL y triglicéridos. La frecuencia de SM fue según Cook del 15 %, De Ferranti de 18 % y Weiss de 14 %. La mayor proporción que se obtuvo con los criterios de De Ferranti, se debe probablemente a que los percentiles y los valores de corte son más estrictos. La media de leptina fue significativamente mayor y la media de adiponectina fue significativamente menor en los pacientes con diagnóstico de SM de acuerdo las tres clasificaciones que se utilizaron (p < 0,01). Es necesario establecer criterios uniformes para diagnosticar al SM en la infancia y adolescencia ya que no existe acuerdo respecto a su definición, pues el desarrollo y crecimiento a estas edades, dificultan el establecimiento de valores de referencia precisos. Los autores declaran no poseer conflictos de interés.

The study aims were to detect subjects with obesity, overweight and components of Metabolic Syndrome (MS) in a child and adolescent populations. Also to determine the frequency of MS according to different criteria and compare them with Leptin and Adiponectin levels. 700 subjects between 6 and 19 years through standardized surveys, anthropometric and blood pressure measurements were studied. In those with 1 or more components of MS (n: 138-20 %), blood glucose, insulin, lipid profile, leptin and adiponectin were analyzed. MS were defined according criteria of Cook, or De Ferranti or Weiss. A descriptive statistical analysis showing the mean and 95 % confidence intervals (CI) were made. The association analysis was performed by t and chi-square tests with a significance level of 5 %. In the population studied by body mass index there were a 14 % of obesity and 22 % of overweight and through a waist circumference 15 % of obesity and 6 % of overweight. There was a strong association between overweight/obesity with hypertension and in a lesser degree, with other risk factors as HOMA index, HDL-cholesterol and triglycerides. The prevalence of MS according Cook was 15 %, according to De Ferranti 18 % and Weiss was 14 %. We speculate that the major percentage was obtained with the De Ferranti criteria, because the percentiles and cut-offs are more demanding. The mean value of leptin was significantly higher and the mean value of adiponectin was significantly lower in patients with MS according to the three criteria used (p < 0.01). It is necessary to establish a uniform standards and criteria to characterize MS in childhood and adolescence because there is no agreement on its definition, due to changes during growth and development that prevent the establishment of precise cut-off values. The authors do not have conflicts of interest.

Multichannel intraluminal impedance for the assessment of post-fundoplication dysphagia.

Dysphagia often occurs after fundoplication, although its pathophysiology is not clear. We sought to better understand postfundoplication dysphagia by measuring esophageal clearance with multichannel intraluminal impedance (MII) along with more traditional work-up (manometry, upper gastrointestinal imaging [UGI], endoscopy). We evaluated 80 consecutive patients after laparoscopic fundoplication between April 2002 and November 2004. Patients were evaluated clinically and underwent simultaneous manometry and MII, 24-hour pH monitoring, endoscopy, and UGI. For analysis, patients were divided into the following groups based on the presence of dysphagia and fundoplication anatomy (by UGI/endoscopy): (1) Dysphagia and normal anatomy; (2) Dysphagia and abnormal anatomy; (3) No dysphagia and abnormal anatomy; and (4) No dysphagia and normal anatomy. Patients with dysphagia (Groups 1 & 2) had similar peristalsis (manometry), but were more likely to have impaired clearance by MII (32 pts, 62%) than those without dysphagia (9 pts, 32%, P = 0.01). Patients with abnormal anatomy (Groups 2 & 3) were also more likely to have impaired esophageal clearance (66%vs. 38%, P = 0.01). Finally, of patients that had normal fundoplication anatomy, those with dysphagia were much more likely to have impaired clearance (12 pts, 52%) than those with dysphagia (4 pts, 21%, P = 0.03). MII after fundoplication provides objective evidence of esophageal clearance, and is commonly abnormal in patients with abnormal fundoplication anatomy and/or dysphagia. Esophageal clearance is impaired in the majority of patients with postoperative dysphagia, even with normal fundoplication anatomy and normal peristalsis. MII may detect disorders in esophageal motility not detected by manometry.

Propolis from the northwest of Argentina as a source of antifungal principles.

AIMS: To determine the antimycotic and cytotoxic activities of partially purified propolis extract on yeasts, xylophagous and phytopathogenic fungi. To compare these activities with pinocembrin and galangin isolated from this propolis and with the synthetic drugs ketoconazole and clortrimazole. METHODS AND RESULTS: Ethanolic propolis extract was partially purified by cooling at -20 degrees C. Two of its components were isolated by HPLC and identified as pinocembrin and galangin. The antifungal activity was assayed by bioautography, hyphal radial growth, hyphal extent and microdilution in liquid medium. Cytotoxicity was studied with the lethality assay of Artemia salina. The obtained results were compared with the actions of ketoconazole and clortrimazole. The results showed that the antifungal potency of ketoconazole and clortrimazole is higher than pinocembrin, galangin and the partially purified propolis extract in this order. Otherwise, the cytotoxicity of the synthetic drugs is also the highest. CONCLUSIONS: Partially purified propolis extract inhibits fungal growth. The comparison of its relative biocide potency and cytotoxicity with synthetic drugs and two components of this propolis (pinocembrin and galangin) showed that the propolis from 'El Siambón', Tucumán, Argentina, is a suitable source of antifungal products. SIGNIFICANCE AND IMPACT OF THE STUDY: The partially purified propolis extract and its isolated compounds, pinocembrin and galangin, have the capacity of being used as antifungals without detriment to the equilibrium of agroecosystems. The impact of this study is that the preparation of agrochemicals with reduced economic costs using a partially purified preparation as the active principle is possible.