Functional properties of cream from dairy cows with experimentally altered milk fat composition.

Modification of milk fat composition might be a desirable method to alter manufacturing characteristics or produce dairy products low in saturated fat that more closely meet consumer dietary preferences. The aim of this research was to evaluate functional properties of cream obtained from milks with fat composition modified by altering the profile of long-chain fatty acids (FA) absorbed from the intestine. A control and 5 mixtures of long-chain free FA were infused into the abomasum of lactating dairy cows in a 6 × 6 Latin square design with 21-d periods. Treatments were as follows: (1) control (no FA infused), (2) mostly saturated FA (C16:C18 = 0.74), (3) low linoleic palm FA (C16:C18 = 0.73), (4) palm FA (C16:C18 = 0.73), (5) soy FA (C16:C18 = 0.10), and (6) high palmitic soy FA (C16:C18 = 0.73). All treatments included meat solubles and Tween 80 as emulsifiers. Viscosity, overrun, whipping time, foam firmness, and foam stability were evaluated in creams (33% fat). Cream from cows infused with soy FA (treatment 5) had the longest whipping time and lowest overrun, foam stability, viscosity, melting point, firmness, and solid fat content at 5 and 20°C because the fat had the highest unsaturated FA content. Increasing palmitic acid content of soy FA (treatment 6) improved functional variables in cream relative to soy FA alone. Differences among treatments 1 to 4 were less pronounced because of the effect of C18:1 trans in treatments 3 and 4 on milk fat yield and composition. Milk fat from cows infused with palm FA (treatment 4) exhibited comparable or better functionality than control cream. Increased polyunsaturated FA in milk fat resulted in increased amounts of triglyceride (TG) fractions with 28, 30, 38, and 40 carbon numbers, increased oleic acid resulted in increased 50-carbon TG, and higher palmitic and myristic acids resulted in greater 44, 46, and 48 carbon number TG. These TG groups consistently correlated with functional properties of creams from different treatments. Our results indicated that optimal functionality of cream is dependent more on its content of palmitic acid than on unsaturated FA. However, an optimal composition of milk fat for cream functional characteristics might be obtained through nutritional manipulation of diets for dairy cows to deliver an optimal profile of FA.

A quantitative PCR assay for antiviral activity screening of medicinal plants against Herpes simplex 1.

Herpes simplex virus one is one of the most prevalent pathogens worldwide. Strains resistant to current treatment have been reported, so it is necessary to search for new antiviral molecules. The most common method to quantify antiviral activity from natural products is the plaque reduction assay, a technically demanding method. In order to provide a simple alternative to this method, we have established a procedure for viral quantification by qPCR, and coupled with a cytotoxicity evaluation system using resazurin. In this way, it is possible to obtain both the estimation of cytotoxicity and the antiviral activity simultaneously, allowing rapid screening of plant extracts. Ten out of twenty-eight Paraguayan medicinal plant extracts evaluated using this method showed antiviral activity, and the EC50, CC50, and SI values were calculated for each extract. Our experience supports the employment of the described method for a rapid identification of plant extracts with antiviral activity.

Extensive preclinical evaluation of an infliximab biosimilar candidate.

Infliximab is therapeutic monoclonal antibody (mAb) against TNF-α employed in the treatment of immunoinflammatory diseases. The development of biosimilar mAbs is a global strategy to increase drug accessibility and reduce therapy-associated costs. Herein we compared key physicochemical characteristics and biological activities produced by infliximab and infliximab-Probiomed in order to identify functionally relevant differences between the mAbs. Binding of infliximab-Probiomed to TNF-α was specific and had kinetics comparable to that of the reference product. Both mAbs had highly similar neutralizing efficacy in HUVEC cell cultures stimulated with TNF-α. In vitro induction of CDC and ADCC were also similar between the evaluated products. In vivo comparability was assessed using a transgenic mouse model of arthritis that expresses human TNF-α in a 13-week multiple-administration study. Infliximab and infliximab-Probiomed showed comparable efficacy, safety, and pharmacokinetic profiles. Our results indicate that infliximab-Probiomed has highly similar activities to infliximab in preclinical models, warranting a clinical evaluation of its biosimilarity.

Transport of fatty acids within plasma lipoproteins in lactating and non-lactating cows fed on fish oil and hydrogenated palm oil.

The aim of this study was to elucidate the effect of dietary fish oil (FO) and a blend of FO and hydrogenated palm oil (FOPO) on transport of fatty acids (FA) within plasma lipoproteins in lactating and non-lactating cows. Two trials were conducted (one with lactating and another with non-lactating dairy cows) in two 3 × 3 Latin squares that included three periods of 21 days. Dietary treatments for lactating cows consisted of a basal diet (Control; no fat supplement), and fat-supplemented diets containing FO (500 g/day/cow) and FOPO (250 FO + 250 g/day/cow hydrogenated palm oil). For non-lactating cows, dietary treatments consisted of a basal diet (Control; no fat supplement), and fat-supplemented diets containing FO (170 g/day/cow) and FOPO (85 FO + 85 hydrogenated palm oil g/day/cow). In lactating cows, compared with control and FOPO, FO increased C16:0, C18:3 cis-9, 12, 15, C18:2 cis-9, trans-11 and total saturated and polyunsaturated FA in plasma and increased C16:0, C18:2 cis-9, trans-11, total polyunsaturated and total polyunsaturated n-6 in high-density lipoprotein (HDL), whereas in non-lactating cows, compared with control and FOPO, FO increased C16:0, C18:1 trans-11, C18:2 trans-9, 12, C18:2 cis-9, trans-11, C20:5 n-3 and total saturated and polyunsaturated FA in plasma; C16:0, C18:1 trans-11, C18:1 cis-9, C18:2 trans-9, 12, C20:5 n-3 and total monounsaturated FA in HDL; and C18:1 trans-6-8, C18:1 trans-9, C18:1 trans-10, C18:1 trans-11, C18:3 cis-9, 12, 15 and C20:5 n-3 in low-density lipoprotein (LDL). FO increased C20:5 n-3 in plasma and lipoproteins in non-lactating cows and increased C18:3 cis-9, 12, 15 in plasma (in lactating cows) and LDL (in non-lactating cows). We concluded from results of this study that in bovine plasma, the LDL fraction appears to be the main lipoprotein transporting C18:1 trans isomers and is more responsive than other lipoprotein fractions to variation in supply of dietary lipids.

Safety assessment of a traditionally used extract from leaves of Boldoa purpurascens.

ETHNOPHARMACOLOGICAL RELEVANCE: Boldoa purpurascens Cav. (Nyctaginaceae) is a plant species used in traditional medicine in Cuba as a diuretic. AIM OF THE STUDY: The aim of the present investigation was to evaluate the safety profile of a hydroalcoholic extract from leaves of Boldoa purpurascens. MATERIALS AND METHODS: First, an experimental study to assess the oral acute toxicity at a dose of 2000mg/kg body weight of the extract was carried out. Potential genotoxicity of the extract was evaluated using the Ames test and the micronucleus induction assay in mouse bone marrow. In the Ames test a concentration range of 50, 100, 150, 300 and 500µg/plate was tested. In the micronucleus induction assay, doses of 500, 1000 and 2000mg/kg of body weight were tested. For completeness, since the extract contains saponins, the evaluation of the hemolytic activity, ocular and skin irritation were included. RESULTS: No signs or symptoms of toxicity were observed in the oral acute toxicity test (body weight at baseline, seven days and end of the experiment of 236.41±20.07, 256.81±30.44 and 240.02±26.16 respectively for the treated group). The hydroalcoholic extract from the leaves was not mutagenic in the Ames test, and no genotoxicity was observed in the micronucleus assay. A hemolysis test at concentration of 1mg/mL confirmed hemolytic activity, which is not a safety concern since saponins are not absorbed after oral administration. In order to evaluate the percentage of protein denaturation, the ocular irritability index was calculated. The extract was found to be irritating. Finally, skin irritability was evaluated and the irritation index was equal to zero. CONCLUSIONS: Based on the toxicological evaluation of a traditionally used hydroalcoholic extract from the leaves of Boldoa purpurascens we can confirm the safety of its oral use.

Nuclear abnormalities in buccal mucosa cells of patients with type I and II diabetes treated with folic acid.

Diabetes mellitus (DM) is characterized by high blood glucose. Excessive production of free radicals may cause oxidative damage to DNA and other molecules, leading to complications of the disease. It may be possible to delay or reduce such damage by administration of antioxidants such as folic acid (FA). The objective of this study was to determine the effect of FA on nuclear abnormalities (NAs) in the oral mucosa of patients with DM. NAs (micronucleated cells, binucleated cells, pyknotic nuclei, karyorrhexis, karyolysis, abnormally condensed chromatin, and nuclear buds) were analyzed in 2000 cells from 45 healthy individuals (control group) and 55 patients with controlled or uncontrolled type I or II DM; 35 patients in the latter group were treated with FA. Samples were taken from the FA group before and after treatment. An increased rate of NAs was found in patients with DM in comparison with that of the control group (P<0.001). FA supplementation in patients with DM reduced the frequency of NAs (20.4 ± 8.0 before treatment vs. 10.5 ± 5.2 after treatment; P<0.001). The type I and type II DM and controlled and uncontrolled DM subgroups were analyzed in terms of sex, age, and smoking habit. The significantly reduced frequencies of buccal mucosa cells with micronuclei, binucleation, pyknosis, karyorrhexis, karyorrhexis+abnormally condensed chromatin, karyolysis, and nuclear buds produced by FA supplementation in DM patients (P<0.02) are consistent with the idea that free radicals are responsible for the increased frequency of NAs in DM patients.

Effect of silymarin plus vitamin E in patients with non-alcoholic fatty liver disease. A randomized clinical pilot study.

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized health problem. Various treatment strategies such as thiazolidinediones, metformin, lipid-lowering agents and antioxidants have been evaluated. So far, no single intervention has convincingly improved liver histology. Experience of using silymarin alone or in combination with other agents in patients with NAFLD is limited in the medical literature. The present study was conducted to evaluate the efficacy of silymarin plus vitamin E in the treatment of NAFLD. PATIENTS AND METHODS: A sample of 36 patients was enrolled. The diagnosis of NAFLD was confirmed by percutaneous liver biopsy. All patients were randomized to one of the following intervention groups: group I: treated with 2 tablets per day of silymarin plus vitamin E (Eurosil 85®, MEDAS SL) and a lifestyle modification program consisting of hypocaloric diet (1520 kcal, 52% of carbohydrates, 25% of lipids and 23% of proteins) and exercise for 3 months and group II (only with the hypocaloric diet). Anthropometric variables as waist circumference, weight, body mass index (BMI) were measured. Biochemical parameters: Glucose, triglycerides, AST, ALT, GGt levels and insulin resistance (HOMA-IR) were determined under fasting conditions. Non-invasive NAFLD-index were applied before and after the treatments: Fatty liver index (FLI), liver accumulation product (LAP) and NAFLD-Fibrosis score (FS). RESULTS: The mean age was 47.4 ± 11.2 years old (range 18-67); 22 men and 14 women. In group I, 11 patients (61%) have a NAS-score > 5 and 10 (55.5%) in the group II (NS). Anthropometric parameters decreased after treatment in both groups. Patients in both groups showed a decrease in GGt levels after treatment (group I: 68 IU/L vs. 46.2 ± 27 IU/L; p < 0.05 and group II 80.5 ± 46 IU/L vs. 50.3 ± 27 IU/L; p < 0.05). Only in group II we observed a significant decrease in AST and ALT levels. In both groups, we observed a decrease in: FLI index (group I: 86.2 ± 19 vs. 76.9 + 20; p < 0.05 and in group II: 85.2 ± 18 vs. 77.5 ± 23; p < 0.05), and NAFLD-FS index (group I: -1.6 ± 1.8 vs. -2.1 ± 1.5; p < 0.05 and in group II -1 ± 1.9 vs. -1.5 ± 2.1; p < 0.05). Patients in group I who did not get a 5% loss of weight also displayed decreased GGt levels, and in the FLI and NAFLD-FS indexes; whereas patients in group II without decrease of 5% by weight showed no improvement in any of the analyzed parameters. CONCLUSIONS: Treatment with silymarin plus vitamin E and a hypocaloric diet ameliorate function hepatic test, and non-invasive NAFLD index. Silymarin can be an alternative valid therapeutic option particularly when other drugs are not indicated or have failed or as a complementary treatment associated with other therapeutic programs.

Multicenter evaluation of MIC distributions for epidemiologic cutoff value definition to detect amphotericin B, posaconazole, and itraconazole resistance among the most clinically relevant species of Mucorales.

Clinical breakpoints (CBPs) have not been established for the Mucorales and any antifungal agent. In lieu of CBPs, epidemiologic cutoff values (ECVs) are proposed for amphotericin B, posaconazole, and itraconazole and four Mucorales species. Wild-type (WT) MIC distributions (organisms in a species-drug combination with no detectable acquired resistance mechanisms) were defined with available pooled CLSI MICs from 14 laboratories (Argentina, Australia, Canada, Europe, India, Mexico, and the United States) as follows: 10 Apophysomyces variabilis, 32 Cunninghamella bertholletiae, 136 Lichtheimia corymbifera, 10 Mucor indicus, 123 M. circinelloides, 19 M. ramosissimus, 349 Rhizopus arrhizus, 146 R. microsporus, 33 Rhizomucor pusillus, and 36 Syncephalastrum racemosum isolates. CLSI broth microdilution MICs were aggregated for the analyses. ECVs comprising ≥95% and ≥97.5% of the modeled populations were as follows: amphotericin B ECVs for L. corymbifera were 1 and 2 µg/ml, those for M. circinelloides were 1 and 2 µg/ml, those for R. arrhizus were 2 and 4 µg/ml, and those for R. microsporus were 2 and 2 µg/ml, respectively; posaconazole ECVs for L. corymbifera were 1 and 2, those for M. circinelloides were 4 and 4, those for R. arrhizus were 1 and 2, and those for R. microsporus were 1 and 2, respectively; both itraconazole ECVs for R. arrhizus were 2 µg/ml. ECVs may aid in detecting emerging resistance or isolates with reduced susceptibility (non-WT MICs) to the agents evaluated.

Short communication: Chemical composition, fatty acid composition, and sensory characteristics of Chanco cheese from dairy cows supplemented with soybean and hydrogenated vegetable oils.

Lipid supplements can be used to alter fatty acid (FA) profiles of dairy products. For Chanco cheese, however, little information is available concerning effects of lipid supplements on sensorial properties. The objective of this study was to examine effects of supplementation of dairy cow diets with soybean (SO) and hydrogenated vegetable (HVO) oils on chemical and FA composition of milk and cheese and sensory characteristics of cheese. Nine multiparous Holstein cows averaging 169±24d in milk at the beginning of the study were used in a replicated (n=3) 3×3 Latin square design that included 3 periods of 21d. All cows received a basal diet formulated with a 56:44 forage:concentrate ratio. Dietary treatments consisted of the basal diet (control; no fat supplement), and the basal diet supplemented with SO (unrefined oil; 500g/d per cow) and HVO (manufactured from palm oil; 500g/d per cow). Milk fat yield was lower with HVO compared with control and SO. Cheese chemical composition and sensory profile were not affected by dietary treatment. Vaccenic (C18:1 trans-11) and oleic (C18:1 cis-9) acids were higher for SO than for control and HVO. Compared with control and HVO, SO decreased saturated FA and increased monounsaturated FA. The thrombogenic index of milk and cheese produced when cows were fed SO was lower than when cows were fed on control and HVO. The outcome of this study showed that, compared with control and HVO, supplementing dairy cow diets with SO improves milk and cheese FA profile without detrimental effects on the chemical composition of milk and cheese and the sensory characteristics of cheese.

Results in laparoscopic living donor nephrectomy: a multicentric experience.

OBJECTIVE: Renal transplantation is the most successful therapy to improve survival and quality of life for patients with end-stage renal disease. Living donors have been used as an alternative to reduce the stay on the waiting list. Laparoscopic living donor nephrectomy has become the standard procedure for renal transplantation. Minimally invasive surgery involves less postoperative pain with less analgesic requirements allowing shorter hospital stay for the donor. MATERIAL AND METHODS: We retrospectively analyzed demographic and intraoperative data and surgical complications for 46 patients who underwent laparoscopic living donor nephrectomy between March 2001 and March 2011. RESULTS: Mean donor age was 41 years. Mean operative time was 170 ± 45 minutes. The average cold ischemic time was 40 minutes and warm ischemic time was 26 minutes. Twenty-one patients were donors for pediatric receptors. Fourty patients underwent left laparoscopic nephrectomy, the other 6 patients underwent right laparoscopic nephrectomy due to vascular anatomic variant. Right laparoscopic nephrectomy was converted in 1 case (2.2%) due to renal vein laceration without donor morbidity and without compromise of graft function. Renal function at the second day post donor nephrectomy was measured using serum creatinine averaged 1.2 mg/dL with a mean increase of 0.4 mg/dL from baseline, with normalization after 30 days. No patient required blood transfusion, and there were no immediate surgical complications, infections, or mortality. One patient developed an incisional hernia in relation to the site of kidney removal. The mean hospital stay was 5 ± 1 days. CONCLUSIONS: Laparoscopic nephrectomy in our experience is a safe technique without postoperative morbidity or mortality. It is associated with low levels of pain, early discharge and early return to physical activity and work, good sense of aesthetic results, and long-term graft function comparable to traditional nephrectomy and cadaveric grafts.

Interlaboratory variability of Caspofungin MICs for Candida spp. Using CLSI and EUCAST methods: should the clinical laboratory be testing this agent?

Although Clinical and Laboratory Standards Institute (CLSI) clinical breakpoints (CBPs) are available for interpreting echinocandin MICs for Candida spp., epidemiologic cutoff values (ECVs) based on collective MIC data from multiple laboratories have not been defined. While collating CLSI caspofungin MICs for 145 to 11,550 Candida isolates from 17 laboratories (Brazil, Canada, Europe, Mexico, Peru, and the United States), we observed an extraordinary amount of modal variability (wide ranges) among laboratories as well as truncated and bimodal MIC distributions. The species-specific modes across different laboratories ranged from 0.016 to 0.5 µg/ml for C. albicans and C. tropicalis, 0.031 to 0.5 µg/ml for C. glabrata, and 0.063 to 1 µg/ml for C. krusei. Variability was also similar among MIC distributions for C. dubliniensis and C. lusitaniae. The exceptions were C. parapsilosis and C. guilliermondii MIC distributions, where most modes were within one 2-fold dilution of each other. These findings were consistent with available data from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (403 to 2,556 MICs) for C. albicans, C. glabrata, C. krusei, and C. tropicalis. Although many factors (caspofungin powder source, stock solution solvent, powder storage time length and temperature, and MIC determination testing parameters) were examined as a potential cause of such unprecedented variability, a single specific cause was not identified. Therefore, it seems highly likely that the use of the CLSI species-specific caspofungin CBPs could lead to reporting an excessive number of wild-type (WT) isolates (e.g., C. glabrata and C. krusei) as either non-WT or resistant isolates. Until this problem is resolved, routine testing or reporting of CLSI caspofungin MICs for Candida is not recommended; micafungin or anidulafungin data could be used instead.

Tumor mesenquimatoso fosfatúrico de fosa nasal con compromiso intracraneano: reporte de un caso y revisión de la literatura / Nasal fossa phosphaturic mesenchymal tumor with intracraneal compromise: case report and review of the literature

El tumor mesenquimatoso fosfatúrico (TMF) es una enfermedad extremadamente rara. Según evidencia reciente es causado por la sobreexpresión del factor de crecimiento fibroblástico 23 (FGF23), el cual genera hipofosfemia y osteomalacia. A continuación presentamos el caso de un paciente de 42 años con un tumor mesenquimatoso fosfatúrico de fosa nasal izquierda con extenso compromiso intracraneano. Cabe destacar que hasta la fecha hay 142 casos reportados de TMF en la literatura de los cuales solo 11 se ubican en fosa nasaly cavidades sinusales, y sólo dos de ellos ubicados en fosa nasal¹. El paciente tuvo una exitosa resolución quirúrgica con la consecuente normalización de parámetros analíticos (incluido el FGF23), mejoría sintomática y ausenia de recidiva hasta la fecha.

The phosphaturic mesenchymal tumor (PMT) is an extremely rare disease. According to recent evidence is caused by overexpression of fibroblast growth factor 23 (FGF23) which generates hypophosphatemia and osteomalacia. We report the case of a 42 year old patient with a left nasal fossa phosphaturic mesenchymal tumor with intracranial involvement. Should be noted that to date there are 142 reported cases of PMT in the literature of which only 11 are located in nasal fossa and sinus cavities, two of them located in nasal fossa¹. The patient had a successful surgical resolution with consequent normalization of analytical parameters (including FGF23), absence of symptoms and no recurrence to date.

Location of periventricular nodular heterotopia is related to the malformation phenotype on MRI.

BACKGROUND AND PURPOSE: Periventricular nodular heterotopia are common malformations of cortical development that are associated with many clinical syndromes and with many different neuroimaging phenotypes. The purpose of this study was to determine whether specific malformation phenotypes may be related to location, side, or number of PNH as assessed by MR imaging. MATERIALS AND METHODS: MR images of 200 patients previously diagnosed with PNH were retrospectively analyzed. PNH were classified according to their location along the ventricles (anterior, posterior, or diffuse), side (unilateral or bilateral), and number of nodules (<5, 6-10, or >10). The cerebrum, brain stem and cerebellum were analyzed to assess associated anomalies. Associations between PNH location and the presence of other anomalies were tested by using Fisher exact test and χ2 test. RESULTS: Posterior PNH were significantly associated with malformations of the cerebral cortex, diminished white matter volume, and mid-/hindbrain anomalies. Diffuse PNH were associated with diminished white matter volume, callosal "anomalies," and the presence of megacisterna magna. Unilateral PNH were strongly associated with cortical malformations. CONCLUSIONS: Certain malformation complexes are associated with PNH in specific locations: posterior PNH with cerebral cortical and mid-/hindbrain malformations and diffuse PNH with callosal anomalies and megacisterna magna. Knowledge of these associations should allow more directed analyses of brain MR imaging in patients with PNH. In addition, knowledge of these associations may help to direct studies to elucidate the causes of these malformation complexes.

Miomas sintomáticos: ¿miomectomía o embolización de las arterias uterinas? / Symptomatic uterine leiomyoma: myomectomy or uterine artery embolization?

Objetivo: Evaluar las complicaciones asociadas a la miomectomía laparotómica y a la embolización de las arterias uterinas en mujeres con miomas sintomáticos. Métodos: Estudio descriptivo restrospectivo efectuado en el Complejo Hospitalario Universitario de Vigo desde el año 2008 al 2010. La población en estudio la conformaron aquellas mujeres sometidas a una miomectomía laparotómica o a una embolización de las arterias uterinas. Se recopilaron las complicaciones registradas en las historias clínicas de las pacientes tras las técnicas. Resultados: La tasa de complicaciones en el grupo de las pacientes sometidas a miomectomía fue de 15,2 por ciento; las más frecuentes fueron fiebre, anemia, necesidad de trasfusión y hematoma subcutáneo. La tasa de complicaciones en el grupo de embolización fue de 4,5 por ciento recogiéndose casos de síndrome postembolización, mioma parido y un caso de histerectomía. Conclusión: La adecuada indicación de cada técnica es fundamental para tener una baja tasa de complicaciones. Se debe tener en cuenta la sintomatología, tipo y número de miomas, edad y deseo genésico de cada paciente.

Objective: This study was undertaken to evaluate the complications after laparotomy myomectomy and uterine artery embolization in women with symptomatic uterine leiomyoma. Methods: This was a descriptive and retrospective study of patients who were treated with embolization and myomectomy for leiomyomas from 2008-2010. Complications were measured. Results: The rate of complications collected in the myo-mectomy group was 15.2 percent; there were cases of fever, anemia, need for transfusion and subcutaneous hematoma. The rate of complications collected in the embolization group was 4.5 percent; there were cases of embolization syndrome, transcervical fibroid expulsion and a case of hysterectomy. Conclusion: The suitable indication of every tecnic is fundamental to have a low rate of complications. It is necessary to bear in mind the symptomatology, type and number of myomas and age and reproductive desire of each patient.

Tumores cardiacos fetales: diagnóstico ecográfico, evolución y tratamiento / Fetal cardiac tumors: diagnosis, clinical course and management

Objetivos: Analizar el diagnóstico ecográfico, la evolución y el tratamiento de los tumores cardiacos fetales diagnosticados en el Hospital La Paz de Madrid, entre los años 1995 y 2010. Método: Se realizó un estudio retrospectivo descriptivo recogiendo los principales datos ecográficos, de la historia clínica materna, neonatal y pediátrica. Resultados: En el periodo de estudio se diagnosticaron ecográficamente 28 tumores cardiacos fetales, 21 casos fueron catalogados como rabdomiomas. Once de ellos tuvieron una regresión prácticamente completa, con ocho casos diagnosticados hasta el momento de esclerosis tuberosa. Hubo 2 muertes intraútero, 1 interrupción legal del embarazo y 4 diagnósticos ecográficos de rabdomiomas, no se confirmaron al nacimiento. Se diagnosticaron prenatalmente dos fibromas; de ellos una gestante optó por la interrupción legal del embarazo y en el otro caso se produjo la muerte neonatal. Dos neonatos fueron sometidos a cirugía con una resección completa del tumor, con resultado anatomopatológico de heman-gioma capilar en uno y teratoma en el otro. En un caso se realizó una biopsia que confirmó la presencia de un hemangiopericitoma auricular que se redujo posteriormente con quimioterapia. Conclusiones: Los tumores cardiacos son una patología poco frecuente. La mayor parte de ellos son rabdomiomas, cuya sin-tomatología y evolución depende de su localización. Estos suelen regresar espontáneamente, pero pueden asociarse al diagnóstico de esclerosis tuberosa, lo que empeora su pronóstico.

Aims: To analize the diagnosis, clinical course and management of fetal cardiac tumors diagnosed at La Paz Hospital (Madrid) between 1995 and 2010. Methods: We performed a retrospective descriptive study collecting the main ultrasound dates of the maternal, newborn and pediatric history. Results: During the study period, 28 fetal cardiac tumors were dignosed. Rhabdomyomas were diagnosed in 21 fetuses; 11 rhabdom-yomas returned almost completely. Eight of them were diagnosed of tuberous sclerosis up to the moment. Other two cases died in utero. One pregnant decided to be practised a miscarriage and four rhabdomyomas which were diagnosed by ultrasound, were not found in the newborns. Two fibroms were diagnosed by ultrasound; one of the pregnant woman decided to be practised a miscarriage and the other fetus died when he was born. Two newborns were operated, with the pathological anatomy result of a hemangioma and a teratoma. A biopsy was made that confirmed the presence of an atrial hemangiopericitoma which was treated by quimiotherapy. Conclusion: Fetal cardiac tumors are a rare disease. Most of them are rhabdomyomas which syntomatology and clinical course depend on its location. They usually regret spontaneously, but they can be associated with tuberous sclerosis, and this aggravates their prognosis.

Diferencias en el metabolismo lipídico, niveles de homocisteína, folato y vitamina B12 entre gestaciones gemelares y únicas / Differences in lipid metabolism, homocysteine levels, serum folic acid and vitamin B12 between single and twin pregnancies

Antecedentes: Se están usando diferentes tipos de suplementación nutricional durante la gestación, sin embargo, existen escasez de estudios que se centren en los resultados metabólicos de los mismos. Objetivos: Comprobar si mediante la suplementación se logra el control del impacto de los múltiples cambios metabólicos que conlleva una gestación múltiple, usando análisis comunes. Método: Comparamos tres diferentes grupos de pacientes entre la semana gestacional 25 y 27. Un grupo de 46 gestaciones únicas, un grupo de 38 gestaciones gemelares espontáneas y otro grupo de 32 gestaciones gemelares tras técnicas de reproducción asistida. Comparamos niveles de colesterol LDL, HDL, triglicéridos, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Resultados: Los niveles de triglicéridos fueron más altos en ambos grupos de gemelares (p<0,001) y los niveles de colesterol fueron similares en los tres grupos. Las concentraciones de folato sérico fueron mayores en las gestaciones gemelares (p<0,001). El resto de parámetros estudiados fueron similares en los tres grupos. Conclusión: La suplementación siguiendo las recomendaciones de la ACOG y la SEGO es efectiva en el control de colesterol LDL, HDL, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Sólo los niveles de triglicéridos no se relacionan con la suplementación y pueden estar relacionados con mayor incidencia de colestasis y preeclampsia en gestaciones múltiples.

Background: Different ways of nutritional supplementation are being advised by physicians during pregnancy, but there is a lack of literature focused on its metabolical results. Aims: Check if the control of the impact that the multiple metabolic changes related to multiple pregnancies have on the mother's homeostasis is achieved with the supplementation, through common used blood tests. Method: We compare three different groups of patients between the 25 and 27th week of gestation. One group of 46 single pregnancies, a second group of 38 spontaneous twin pregnancies and another group of 32 twin pregnancies after assisted reproduction techniques. We compare the levels of LDL, HDL-cholesterol, triglycerides, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Results: The levels of triglycerides were higher in both groups of twin pregnancies (p<0.001), but the levels of cholesterol remain similar. Folic acid concentrations were higher in the groups of twin pregnancies (p<0.001). The rest of levels studied were similar in the 3 groups. Conclusion: The supplementation following the ACOG and SEGO recommendations seems to be effective in controlling the values of LDL, HDL-cholesterol, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Only the levels of triglycerides appear unaffected by the supplementation and can be related with the higher incidence of preeclampsia and cholestasis seemed among twin pregnancies.

Eficacia de los enemas salinos en el tratamiento de la impactación fecal en urgencias de pediatría / Saline enemas as treatment of faecal impaction in paediatric emergencies

Objetivo: Evaluar la eficacia y tolerabilidad del tratamiento, además de conocer la percepción y aceptación del procedimiento por parte del paciente y su familia y del personal sanitario. Material y método: Estudio descriptivo prospectivo de los niños y niñas, de entre 0 y 14 años, que al acudir al servicio de Urgencias del Hospital de Cruces fueron diagnosticados de impactación fecal y el facultativo que les atendió decidió realizar un tratamiento con enemas salinos. Se recogieron en un formulario los datos. Resultados: Durante el periodo de tiempo comprendido entre enero a junio del 2008, fueron estudiados 79 pacientes, con una edad media de 5,8 ± 3,4 años. El tiempo de respuesta medio tras la administración del enema fue de 26 ± 24,16 minutos. Un 38% de los niños refirieron no tener alivio y un 62% si presentó alivio, de los que el 49,4% fue alivio sintomático y un 12,7% alivio completo. De los niños 7 años el 75 %. Según el peso, el 48,6% de los niños de de 30k. En la valoración del tratamiento de los padres y del investigador, la puntuación media en una escala de 0 (totalmente insatisfactorio) a 10 (muy satisfactorio), fue de 5. Un 50% de los niños refirieron algún grado de molestias, en un 83% de los casos, leves. Conclusiones: La administración de enemas de suero salino produce alivio sintomático de la impactación fecal en un porcentaje elevado de los pacientes. Este tratamiento es en general bien tolerado, sin efectos adversos importantes y aceptablemente valorado por la familia del niño y por el personal sanitario (AU)

Objective: To evaluate the efficacy and tolerability of the treatment and to know the perception and acceptance of the procedure on the part of the patient, his family and the sanitary staff. Material and methods: Descriptive and prospective study of the children between 0 and 14 years of age who were diagnosed of faecal impaction at the time when they came to the Paediatric Emergency Department of the Cruces Hospital and the professional who cared for them decided to make a treatment with saline enemas. In a form were picked up the variables. Results: During the period of time between January and June of 2008, 79 patients were studied, with a mean age of 5,8 ± 3,4 years. The mean time response after the enema administration was 26 ± 24,16 minutes. A 38% of the children reported to have no relief and a 62% did report relief, of which 42,9% felt a symptomatic relief and 12,7% a complete relief. Of the child <3 years, the 48,6% showed some degree of relief, between 3 and 7 years the 70,4% and the >7 years the 75%. According to the weight, the 48,6% of the children <20kg felt relief, the 78,3% of the children between 20 and 30kg and the 65% of the >30kg. In the evaluation of the treatment by the parents and the investigator, the mean punctuation in a scale from 0 (completely unsatisfactory) to 10 (very satisfactory), was of 5. A 50% of the children referred some degree of discomfort, in the 83% of cases, slight (AU)

[Saline enemas as treatment of faecal impaction in paediatric emergencies]. / Eficacia de los enemas salinos en el tratamiento de la impactación fecal en urgencias de pediatría.

OBJECTIVE: To evaluate the efficacy and tolerability of the treatment and to know the perception and acceptance of the procedure on the part of the patient, his family and the sanitary staff. MATERIAL AND METHODS: Descriptive and prospective study of the children between 0 and 14 years of age who were diagnosed of faecal impaction at the time when they came to the Paediatric Emergency Department of the Cruces Hospital and the professional who cared for them decided to make a treatment with saline enemas. In a form were picked up the variables. RESULTS: During the period of time between January and June of 2008, 79 patients were studied, with a mean age of 5.8 +/- 3.4 years. The mean time response after the enema administration was 26 +/- 24.16 minutes. A 38% of the children reported to have no relief and a 62% did report relief, of which 42.9% felt a symptomatic relief and 12.7% a complete relief. Of the child <3 years, the 48.6% showed some degree of relief, between 3 and 7 years the 70.4% and the >7 years the 75%. According to the weight, the 48.6% of the children <20 kg felt relief, the 78.3% of the children between 20 and 30 kg and the 65% of the >30 kg. In the evaluation of the treatment by the parents and the investigator, the mean punctuation in a scale from 0 (completely unsatisfactory) to 10 (very satisfactory), was of 5. A 50% of the children referred some degree of discomfort, in the 83% of cases, slight. CONCLUSIONS: The administration of saline enemas relieves the symptoms of faecal impaction in a high percentage of patients. This treatment is generally well tolerated, with no significant adverse effects and is well accepted by the children's families and by the healthcare staff.

Efecto de sistemas de renovación en la producción de palma de aceite en la Zona Norte de Colombia / Effect of the renovation system on oil palm yield in the Northern Region of Colombia

Cerca del 11% del área sembrada en palma de aceite en Colombia tiene una edad superior a los 25 años y ha finalizado su ciclo económico, por lo cual debe ser renovada. La práctica de renovación es costosa y afecta el flujo de caja de las empresas, debido al período improductivo del cultivo joven en las primeras etapas. Con el fin de disminuir este impacto económico se han diseñado diferentes métodos de renovación que afectan de manera diferencial la fisiología del cultivo joven, especialmente por el sombreamiento causado por las palmas viejas. Este artículo presenta resultados del seguimiento, durante cinco años, de variables fisiológicas y de producción de palmas en siembras nuevas con diferentes grados de interferencia del cultivo viejo. Se evaluaron sistemas sin interferencia del cultivo viejo (remoción completa), con interferencia por estípites del cultivo viejo en el suelo (apilar), con diferentes grados de interferencia por sombreamiento causado por la permanencia de diversos porcentajes de palmas del cultivo viejo sin erradicar, y entre siembra de la siembra nueva (entre siembra con erradicación 50% a los 12 meses y 50% restante a los 18 ó 24 meses; entre siembra sin erradicación por 36 meses con uso de podas). Los registros de producción muestran que las palmas del cultivo viejo sin erradicar influyeron negativamente en el proceso productivo de las palmas de la siembra nueva; se presentaron reducciones hasta del 44,7% en la producción de rff respecto al tratamiento apilar. La producción de la siembra nueva en el tratamiento de apilar presentó diferencias estadísticas con los demás tratamientos, y fue la mejor para las variables área y peso seco foliar, altura y producción.

About 11% of the area planted to oil palm in Colombia is older than 25 years and has completed its economic cycle; therefore, it must be replanted. Replacing old trees and replanting is a costly undertaking and it affects the cash flow of the plantations because of the unproductive period of young palms in the early stages. To lessen this economic impact, different replanting methods have been designed that differentially affect the physiology of the young crop, especially by the shading caused by the old palms. This paper presents the results of a 5-year monitoring of physiological and production variables of new palm plantings, with different degrees of interference by the old crop. Various systems were evaluated: without interference from the old crop (complete removal), with interference by felled old trunks on the floor (stacked), with different degrees of interference by shading caused by various percentages of standing old palms, intercropping with old palms (intercropping with 50% removal at 12 months and the remaining 50% at 18 or 24 months, intercropping without removal for 36 months with use of pruning). Production records show that old palms not removed adversely affected the production process of the new planting. Reductions of up to 44.7% in FFB production were found, compared to the stacking treatment. The production of the new planting under stacking conditions showed statistically significant differences with other treatments, and was the best treatment in terms of leaf area and dry weight, height and production variables.

Teratocarcinosarcoma rinosinusal: reporte de un caso / Rhinosinusal teratocarcinosarcoma: a case report

Teratocarcinosarcoma rinosinusal es una neoplasia maligna infrecuente y rara, que combina elementos de teratoma y carcinosarcoma. Se compone de epitelio benigno o maligno (fibroblastos), mesénquima (cartílago, hueso o músculo liso) y elementos neurales. Hasta el año 2008 se han reportado un total de 63 casos de ubicación rinosinusal. Presentamos el caso de un teratocarcinosarcoma de fosa nasal, en un hombre de 67 años de edad, que consultó por obstrucción nasal rápidamente progresiva. La lesión se resecó completamente por abordaje endoscópico. El diagnóstico fue confirmado por histopatología e inmunohistoquímica. Se realizó tratamiento complementario con radioterapia, sin evidencia de recidiva al año después de la cirugía.

Rhinosinusal teratocarcinosarcoma is a rare malignant neoplasm, which combines teratoma and carcinoma elements. It is composed of benign or malignant epithelium (fibroblasts), mesenchymatic (cartilage, bone or smooth muscle) and neural elements. Until 2008, a total of 63 cases of rhinosinusal location have been reponed. We present the case of a nasal cavity teratocarcinosarcoma ín a 67 year old man that presented with rapidly progressing nasal obstruction. The lesion was completely resected by endoscopic approach. Diagnosis was confirmed by histological pathology and immunohistochemistry Additional treatment by radiotherapy was administered, with no evidence of recurrences a year after surgery.