Cardiogenic Shock in Perioperative and Intraoperative Settings: A Team Approach.

Cardiogenic shock (CS) is a multifactorial disease process with high morbidity and mortality. When it occurs in a peri- or intraoperative setting, factors such as surgery, anesthesia, and post-surgical physiology can negatively affect patient outcomes. Since patient needs often escalate during CS-from medications to mechanical support to palliative care-this disease demands a multidisciplinary approach that encompasses all aspects of medical delivery. Preliminary studies have indicated that a multidisciplinary team approach to CS results in earlier diagnosis and treatment and improves patient outcomes. Here we discuss various management strategies for CS from an anesthesiology, surgery, and critical care perspective.

Comparative study of select biochemical markers in cerebrospinal fluid of healthy dogs before and after treatment with nutraceuticals.

BACKGROUND: Several studies indicate that changes in cerebrospinal fluid (CSF) composition depend on the disease stage and reflect modification of brain energy metabolism (BEM). Also, it has been reported that a decline in cognitive functions may be mitigated by incorporating nutraceuticals in the diet. OBJECTIVE: Assuming the beneficial effect of nutraceuticals on BEM and oxidative damage, the aim of this study was to determine if the administration of a nutraceutical compound results in changes of select CSF biomarkers in healthy adult Beagle dogs. METHODS: Two separate CSF and blood samples were obtained from 11 healthy adult Beagle dogs, before and after 50 days of treatment with a veterinary combined nutraceutical. CSF analysis included a total nucleated cell count, total protein, glucose, sodium, chloride, potassium, pyruvate, and lactate concentrations, and calculation of lactate/pyruvate ratio. CBC and serum biochemistry were also performed. The Wilcoxon test was used to analyze the significance of the changes after nutraceutical treatment. RESULTS: All studied variables remained within reference intervals, before and after treatment. A significant increase in CSF sodium and glucose concentration, and a decrease in lactate levels, was observed after treatment (P < .05), and the lactate/pyruvate ratio was decreased after treatment (P = .05). In serum, sodium and chloride concentrations were significantly increased (P < .05), and creatinine concentration was significantly decreased (P < .05) after treatment. CONCLUSIONS: After 50 days of treatment with a nutraceutical compound, CSF glucose, sodium, and lactate concentrations, and L/P ratio were significantly different, suggesting an influence of nutraceuticals' administration on CSF composition.

Líneas de Beau y enfermedad de Kawasaki / Beau’s lines and Kawasaki disease

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Antimicrobial activity in methanolic extracts of several plant species from northern Argentina.

Thirty-nine native plant species were collected from the provinces of Chaco and Formosa, in northern Argentina, and were screened for antimicrobial activity. The plants were dried and extracted thoroughly with methanol. The dry extracts, dissolved in dimethylsulfoxide, were tested for inhibition of microbial growth via microplate assay with an oxidation-reduction dye. The test organisms were: Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecium. Inhibition of respiratory activities in some of these microbial species was produced by the extracts of Astronium balansae, Geoffroea decorticans, Peltophorum dubium, Geoffroea spinosa, Lantana balansae, Prosopis kuntzei, Prosopis ruscifolia and Bulnesia sarmientoi, with minimal inhibitory concentrations (MIC) ranging from 0.08 to 0.5 mg dry matter/ml. Further in vitro experiments measuring the growth of S. aureus in liquid culture confirmed that all of the above extracts at 2 x MIC were able to inhibit bacterial growth effectively, and that some of them (A. balansae, G. decorticans, P. dubium, G. spinosa, P. kuntzei and B. sarmientoi) were able to reduce the initial number of viable counts by at least one order of magnitude in 10 hours, indicating that these extracts should be investigated further for the possible presence of bactericidal components.

[Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation]. / Sindrome de Wallemberg secundario a disección de la arteria vertebral por manipulación quiropráctica.

INTRODUCTION: Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. CASE REPORT: We describe the case of a young patient who suffered from incomplete Wallenberg s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. CONCLUSIONS: The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion.

Síndrome de Wallemberg secundario a disección de la arteria vertebral por manipulación quiropráctica / Wallenberg´s syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation

Introducción. Las manipulaciones cervicales quiroprácticas son técnicas que se emplean cada vez con mayor frecuencia para el tratamiento de numerosas patologías osteomusculares, y pueden producir complicaciones importantes, como la disección de las arterias cervicales. La disección de la arteria vertebral se manifiesta generalmente por un síndrome alterno, de los cuales el síndrome de Wallemberg completo o incompleto es el más frecuente. En este artículo se revisa la bibliografía existente sobre la patogenia, factores de riesgo, clínica, cronopatología, diagnóstico, tratamiento y pronóstico de esta complicación. Caso clínico. Se expone el caso de un paciente joven que sufre un síndrome de Wallemberg incompleto, horas después de una única sesión quiropráctica cervical, y se muestran las imágenes de resonancia que se emplearon para apoyar el diagnóstico. Conclusiones. La aparición de cerviconucalgia y sintomatología neurológica en un paciente que se haya sometido a manipulación quiropráctica en las horas o días previos debe hacer pensar en la disección de las arterias cervicales. La disección de la arteria vertebral suele causar un síndrome alterno, de los que el infarto bulbomedular lateral o síndrome de Wallemberg por oclusión proximal de la arteria cerebelosa posteroinferior es el más frecuente. La angiorresonancia de los troncos supraaórticos y la resonancia magnética craneal son técnicas válidas para demostrar la disección arterial y la lesión isquémica asociada (AU)

Introduction. Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg’s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. Case report. We describe the case of a young patient who suffered from incomplete Wallenberg’s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. Conclusions. The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg’s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra-aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion (AU)

Screening of some plants from Northern Argentina for their antimicrobial activity.

AIMS: Screening of antimicrobial activity in 25 plant species from Northern Argentina. METHODS AND RESULTS: Inhibition of microbial growth was measured by a microplate assay with an oxidation-reduction indicator (Alamar Blue). Test organisms were: Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecium. Weak inhibitory activities (MIC=0.5 mg dry matter ml(-1)) were found in methanolic extracts of Rivina humilis, Crateva tapia, Funastrum claucum and Schinopsis balansae. Stronger bacteriostatic power was detected in Vassobia breviflora (MIC=0.25 mg ml(-1) against Staphylococcus aureus, and 0.5 mg ml(-1) against Enterococcus faecium). This activity was purified five-fold by extraction with dichloromethane, and it was found equally effective against susceptible or antibiotic-resistant strains of Staph. aureus. In addition, the purified extract was synergistic with gentamicin, and it was bactericidal at 24 h, with a concentration of 0.25 mg ml(-1). CONCLUSION: There is a significant antimicrobial activity in Vassobia breviflora. SIGNIFICANCE AND IMPACT OF THE STUDY: Further studies will be required to disclose the potential importance of these findings.

Antitubercular activity of triterpenoids from Lippia turbinata.

Assay-guided fractionation of the antitubercular MeOH-CH(2)Cl(2) extract obtained from Lippia turbinata led to the isolation of four novel triterpenoids-3beta,25-epoxy-3alpha,21alpha-dihydroxy-22beta-(3-methylbut-2-en-1-oyloxy)olean-12-ene-28-oic acid (1); 3beta,25-epoxy-3alpha,21alpha-dihydroxy-22beta-angeloyloxyolean-12-ene-28-oic acid (2); 3beta,25-epoxy-3alpha,21alpha-dihydroxy-22beta-tigloyloxyolean-12-ene-28-oic acid (3); and 3beta,25-epoxy-3alpha-hydroxy-22beta-(2-methylbutan-1-oyloxy)olean-12-ene-28-oic acid (4)-together with the known triterpenoids lantanilic acid (5), camaric acid (6), lantanolic acid (7), and rehmannic acid (8). The MIC values of 1-8 for growth inhibition of Mycobacterium tuberculosis were determined in the radiorespirometric BACTEC system.

Antitubercular activity of pentacyclic triterpenoids from plants of Argentina and Chile.

Screening of plants from South America for antitubercular activity and subsequent assay-guided fractionation resulted in the isolation and characterization of several pentacyclic triterpenoids. The MIC values of 22 triterpenoids were determined using the radiorespiratory BACTEC assay and range from 8 microM to above 128 microM. The structure-activity relationships are discussed.

A new antitubercular mulinane diterpenoid from Azorella madreporica Clos.

Bioactivity-guided fractionation of the petroleum ether extract of Azorella madreporica Clos has led to the isolation of the novel, antitubercular mulinane diterpenoid 1. The structure has been elucidated on the basis of its 1D and 2D NMR spectra and by comparison with mulinolic acid 2 and a dehydration product 3 obtained from 1. The MIC of 1 for growth inhibition of the H37Rv strain of Mycobacterium tuberculosis was determined as 20 microg/mL. LC-MS and NMR have suggested the presence of this new compound in four other species of Azorella.