Harnessing probiotic foods: managing cancer through gut health.

One of the greatest threats to global health is cancer. Probiotic foods have been shown to have therapeutic promise in the management of cancer, even though traditional treatments such as radiation therapy, chemotherapy, and surgery are still essential. The generation of anticarcinogenic compounds, immune system stimulation, and gut microbiota regulation are a few ways that probiotics when taken in sufficient quantities, might help health. The purpose of this review is to examine the therapeutic potential of probiotic foods in the management of cancer. Research suggests that certain strains of probiotics have anticancer effects by preventing the growth of cancer cells, triggering apoptosis, and reducing angiogenesis in new tumors. Probiotics have shown promise in mitigating treatment-related adverse effects, such as diarrhea, mucositis, and immunosuppression caused by chemotherapy, improving the general quality of life for cancer patients. However, there are several factors, such as patient-specific features, cancer subtype, and probiotic strain type and dosage, which affect how effective probiotic therapies are in managing cancer. More research is necessary to find the long-term safety and efficacy characteristics of probiotics as well as to clarify the best ways to incorporate them into current cancer treatment methods. Graphical abstract: Graphical representation showing the role of probiotic foods in cancer management.

Cancer Cachexia in STK11/LKB1 -mutated NSCLC is Dependent on Tumor-secreted GDF15.

Cachexia is a wasting syndrome comprised of adipose, muscle, and weight loss observed in cancer patients. Tumor loss-of-function mutations in STK11/LKB1 , a regulator of the energy sensor AMP-activated protein kinase, induce cancer cachexia (CC) in preclinical models and are associated with cancer-related weight loss in NSCLC patients. Here we characterized the relevance of the NSCLC-associated cachexia factor growth differentiation factor 15 (GDF15) in several patient-derived and genetically engineered STK11/LKB1 -mutant NSCLC cachexia lines. Both tumor mRNA expression and serum concentrations of tumor-derived GDF15 were significantly elevated in multiple mice transplanted with patient-derived STK11/LKB1 -mutated NSCLC lines. GDF15 neutralizing antibody administered to mice transplanted with patient- or mouse-derived STK11/LKB1 -mutated NSCLC lines suppressed cachexia-associated adipose loss, muscle atrophy, and changes in body weight. The silencing of GDF15 in multiple human NSCLC lines was also sufficient to eliminate in vivo circulating GDF15 levels and abrogate cachexia induction, suggesting that tumor and not host tissues represent a key source of GDF15 production in these cancer models. Finally, reconstitution of wild-type STK11/LKB1 in a human STK11/LKB1 loss-of-function NSCLC line that normally induces cachexia in vivo correlated with the absence of tumor-secreted GDF15 and rescue from the cachexia phenotype. The current data provide evidence for tumor-secreted GDF15 as a conduit and a therapeutic target through which NSCLCs with STK11/LKB1 loss-of-function mutations promote cachexia-associated wasting.

Encapsulation of debittered pomelo juice using novel Moringa oleifera exudate for enrichment of yoghurt: A techno-functional approach.

Debittering of pomelo juice was conducted using 3.7 g of activated resin, resulting in a 36.8% reduction in bitterness without affecting the bioactive properties of juice. The debittered juice was then encapsulated with Moringa oleifera exudate at various ratios (1-5%), yielding a powder with a slightly rough surface. Total phenol content (TPC) increased by 46-56% compared to the debittered juice. Functional yoghurt containing encapsulates at concentrations of 1% and 2% demonstrated that the 2% concentration led to longer storage duration, resulting in increased acidity and syneresis compared to the control. TPC of the yoghurt (161.89-198.22 µg Gallic acid equivalent (GAE)/g) remained significantly higher (p < 0.05) than that of the control (47.15 µg GAE/g) and acacia gum-based yoghurt (141.89-171.37 µg GAE/g), decreasing with storage duration. Addition of encapsulates significantly altered the yoghurt's texture, resulting in lower firmness (0.57 to 0.64 N) compared to the control, while adhesiveness values remained comparable (6.33 to 6.25 g.s). The highest values of G' and G" were observed in samples containing 2% encapsulates with moringa compared to those with acacia gum. This study suggests potential avenues for further exploration in functional foods with enhanced health benefits.

Chylothorax in Infants and Children After Congenital Heart Surgery: Approach and Review.

Chylothorax in infants after surgery for congenital heart disease is associated with significant morbidity and mortality. Numerous management modalities applied alone or in various combinations have been utilized but definitive guidelines have not yet been established. We present two infants who developed refractory chylothorax after congenital heart surgery. We also reviewed evidence for the use of available treatment modalities. In our experience, the use of lymphangiography followed by pleurodesis by povidone-iodine was safe and our impression was that it may have played a decisive role in controlling the lymph leak.

Evaluation of Infantile Brachial Plexopathy Using 3T MRI and High-Resolution Ultrasound: Experience From a Tertiary Care Centre.

BACKGROUND: Currently, clinical assessment is the main tool for the evaluation of brachial plexus injury, complemented by electrophysiologic studies (EPS), and imaging studies whenever available. Imaging plays an important role as it enables the differentiation of pre-ganglionic and postganglionic injuries, and adds objectivity to presurgical evaluation. OBJECTIVES: The primary objective was to evaluate the utility of magnetic resonance imaging (MRI) and high-resolution ultrasonography (USG) in the localization and characterization of brachial plexus injury in infants. MATERIALS AND METHODS: In this prospective study, 34 infants with signs and symptoms of brachial plexus injury were evaluated by clinical examination, EPS, MRI, and USG. Imaging findings were correlated with intraoperative findings in infants who underwent surgical management. The association between EPS and MRI findings, and USG and MRI findings were assessed using Fisher's exact test. Semi-quantitative subjective analysis of various MRI sequences was done as well. RESULTS: The most common findings of preganglionic injury and postganglionic injury, in our study, were pseudomeningocele and nerve thickening, respectively. MRI detection of injuries had a significant association with EPS findings. All MRI-detected injuries had a muscle power of grade 3 or less. muscle. Three-dimensional (3D) short tau inversion recovery (STIR) sequence was found to be superior for detecting postganglionic injuries (P < 0.05). CONCLUSION: Imaging studies enable localization of the site of injury, determining the extent, and nature/morphology of injury. The gamut of findings obtained from MRI is far wider compared to that from USG. USG can be used as the first-line screening investigation.

Biofortification as a solution for addressing nutrient deficiencies and malnutrition.

Malnutrition, defined as both undernutrition and overnutrition, is a major global health concern affecting millions of people. One possible way to address nutrient deficiency and combat malnutrition is through biofortification. A comprehensive review of the literature was conducted to explore the current state of biofortification research, including techniques, applications, effectiveness and challenges. Biofortification is a promising strategy for enhancing the nutritional condition of at-risk populations. Biofortified varieties of basic crops, including rice, wheat, maize and beans, with elevated amounts of vital micronutrients, such as iron, zinc, vitamin A and vitamin C, have been successfully developed using conventional and advanced technologies. Additionally, the ability to specifically modify crop genomes to improve their nutritional profiles has been made possible by recent developments in genetic engineering, such as CRISPR-Cas9 technology. The health conditions of people have been shown to improve and nutrient deficiencies were reduced when biofortified crops were grown. Particularly in environments with limited resources, biofortification showed considerable promise as a long-term and economical solution to nutrient shortages and malnutrition. To fully exploit the potential of biofortified crops to enhance public health and global nutrition, issues such as consumer acceptance, regulatory permitting and production and distribution scaling up need to be resolved. Collaboration among governments, researchers, non-governmental organizations and the private sector is essential to overcome these challenges and promote the widespread adoption of biofortification as a key part of global food security and nutrition strategies.

N-Butyl cyanoacrylate embolization of an extremely rare variant of sequestration complex - a high-flow left-to-left shunt between systemic artery and pulmonary vein.

A 19-year-old female presented with hemoptysis. Computed tomography (CT) pulmonary angiography revealed aberrant vessels from descending thoracic aorta, draining into pulmonary veins (left-to-left shunt). She was managed by transcatheter embolization of the aberrant vessels using N-butyl cyanoacrylate (NBCA) with balloon occlusion. A systemic artery to pulmonary vein fistula is one of the least common congenital anomalies. Most of the reported cases have been managed by surgery. Only a few patients have been treated by transcatheter embolization, using coils or vascular plugs as the embolizing agents. To our knowledge, this is the first case of its kind that was managed by glue embolization. Favorable post-procedure results have led us to believe that glue embolization can be considered a suitable alternative to thoracotomy in such patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01659-5.

Influence of diffusion weighted imaging and contrast enhanced T1 sequences on the diagnostic accuracy of magnetic resonance enterography for Crohn's disease.

OBJECTIVES: To evaluate the additional diagnostic benefit of diffusion weighted imaging (DWI) and contrast enhanced (CE) images during MR enterography (MRE) of Crohn's disease. METHODS: Datasets from 73 patients (mean age 32; 40 male) (28 new-diagnosis, 45 relapsed) were read independently by two radiologists selected from a pool of 13. Radiologists interpreted datasets using three sequential sequence blocks: (1) T2 weighted and steady state free precession gradient echo (SSFP) images alone (T2^); (2) T2 weighted and SSFP images with DWI (T2 + DWI^) and; (3) T2 weighted images, SSFP, DWI and post-contrast enhanced (CE) T1 images (T2 + DWI + CE^), documenting presence, location, and activity of small bowel disease. For each sequence block, sensitivity and specificity (readers combined) was calculated against an outcome-based construct reference standard. RESULTS: 59/73 patients had small bowel disease. Per-patient sensitivity for disease detection was essentially identical (80 % [95 % CI 72, 86], 81 % [73,87], and 79 % [71,86] for T2^, T2 + DWI^and T2 + DWI + CE^respectively). Specificity was identical (82 % [64 to 92]). Per patient sensitivity for disease extent was 56 % (47,65), 56 % (47,65) and 52 % (43 to 61) respectively, and specificity was 82 % (64 to 92) for all blocks. Sensitivity for active disease was 97 % (90,99), 97 % (90,99) and 98 % (92,99), and specificity was also comparable between all sequence combination reads. Results were consistent across segments and newly diagnosed/relapse patients. CONCLUSION: There is no additional diagnostic benefit of adding either DWI or CE to T2 FSE and SSFP sequences for evaluating small bowel Crohn's disease, suggesting MRE protocols can be simplified safely.

Intravoxel incoherent motion and diffusion kurtosis imaging and their machine-learning-based texture analysis for detection and assessment of prostate cancer severity at 3 T.

OBJECTIVES: To evaluate the role of combined intravoxel incoherent motion and diffusion kurtosis imaging (IVIM-DKI) and their machine-learning-based texture analysis for the detection and assessment of severity in prostate cancer (PCa). MATERIALS AND METHODS: Eighty-eight patients underwent MRI on a 3 T scanner after giving informed consent. IVIM-DKI data were acquired using 13 b values (0-2000 s/mm2) and analyzed using the IVIM-DKI model with the total variation (TV) method. PCa patients were categorized into two groups: clinically insignificant prostate cancer (CISPCa) (Gleason grade ≤ 6) and clinically significant prostate cancer (CSPCa) (Gleason grade ≥ 7). One-way analysis-of-variance, t test, and receiver operating characteristic analysis was performed to measure the discriminative ability to detect PCa using IVIM-DKI parameters. A chi-square test was used to select important texture features of apparent diffusion coefficient (ADC) and IVIM-DKI parameters. These selected texture features were used in an artificial neural network for PCa detection. RESULTS: ADC and diffusion coefficient (D) were significantly lower (p < 0.001), and kurtosis (k) was significantly higher (p < 0.001), in PCa as compared with benign prostatic hyperplasia (BPH) and normal peripheral zone (PZ). ADC, D, and k showed high areas under the curves (AUCs) of 0.92, 0.89, and 0.88, respectively, in PCa detection. ADC and D were significantly lower (p < 0.05) as compared with CISPCa versus CSPCa. D for detecting CSPCa was high, with an AUC of 0.63. A negative correlation of ADC and D with GS (ADC, ρ = -0.33; D, ρ = -0.35, p < 0.05) and a positive correlation of k with GS (ρ = 0.22, p < 0.05) were observed. Combined IVIM-DKI texture showed high AUC of 0.83 for classification of PCa, BPH, and normal PZ. CONCLUSION: D, f, and k computed using the IVIM-DKI model with the TV method were able to differentiate PCa from BPH and normal PZ. Texture features of combined IVIM-DKI parameters showed high accuracy and AUC in PCa detection.

Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population.

Purpose: To understand the impact of subjectivity on diagnosis rates of dry eye disease (DED) in an unbiased population. Patients and Methods: A multicenter study enrolled 818 subjects with complete report forms (465 females, 67.1 ± 16.7 years, 353 males, 65.0 ± 15.9 years). Subjects were evaluated for staining, TBUT, tear osmolarity, meibomian gland disease, and OSDI. Results: Physicians diagnosed 48.7% of subjects as having DED, ranging from 42.9% to 62.3% between sites. Positivity rates for staining (≥ grade 1) ranged from 41.3% to 84.1% (mean = 0.8 ± 0.9 grade), TBUT (<10s) ranged from 39.1% to 61.6% (mean = 10.4 ± 6.6 seconds), osmolarity (>308 mOsm/L) ranged from 63.7% to 72.4% (mean = 319.7 ± 20.8), MGD grading ranged from 28.9% to 51.3% (mean = 0.5 ± 0.7), and symptoms measured by OSDI ranged from 57.6% to 71.0% (mean = 23.5 ± 20.5) between sites. Tear osmolarity was the most consistent between sites (max/min positivity = 114%), followed by OSDI (123%), TBUT (158%), MGD (178%), and staining (204%). DED markers were uncorrelated (average r2 = 0.05 ± 0.07). A substantial number of subjects (N = 110) exhibited positive symptoms (OSDI = 32.4 ± 15.7) and hyperosmolarity (338.1 ± 20.1 mOsm/L) but no other obvious signs of DED (MGD grade = 0.2 ± 0.4, TBUT = 13.5 ± 7.0 seconds, staining grade = 0.4 ± 0.5). Conclusion: Subjective signs of DED varied considerably, whereas objective measurements of OSDI and osmolarity were the most consistent between sites. A large proportion of subjects exhibited high symptoms and hyperosmolarity but no other obvious signs of dry eye disease, most of whom were undiagnosed by clinical assessment without access to the osmolarity measurement.

Sensitization Lectures for Reducing Weight Bias in Undergraduate Medical Students.

INTRODUCTION: Discrimination exists in one form or another in every society, usually against those who are weaker, in fewer numbers, or different from the rest. Most physicians are empathetic towards their patients but can either not keep an eye on their subordinates or lack the power to act against such employees. Persons experiencing discrimination in healthcare centers may try to avoid or postpone future visits, resulting in delayed diagnosis and treatment of ailments. Obesity bias present in society has crept into healthcare centers and intimidates persons with obesity who are seeking medical aid. Implicit and explicit obesity bias has been recorded in healthcare students. METHODS: Data from 102 undergraduate medical students (23 female) who completed this study was analyzed. Implicit bias (tested online using the Implicit Association Test) and explicit bias (measured using four types of tool kits) were measured before and after conducting an obesity sensitization program (OSP) comprising four lectures on the causes and consequences of obesity and obesity discrimination and its consequences. RESULTS: The change in implicit bias was not significant. However, a significant reduction was noted in the four different types of tools for explicit bias after conducting the OSP. CONCLUSION: OSP helped medical students identify obesity bias and reduce explicit bias. Sensitization lectures conducted in medical colleges and schools can help reduce such discrimination in healthcare centers.

Role of whole body MRI in paraneoplastic/autoimmune syndromes: An MRPET study to standardize protocols, pattern interpretation, and establish yield of MRI.

Imaging a case of autoimmune encephalitis (AIE) can be challenging as the underlying tumor may be occult. The aim of this retrospective case-based study is to evaluate role of whole-body MRI/Positron emission tomography (PET) in workup of AIE. Standardizing the whole-body MRI/PET protocol, Cross modality yield with serology and magnetic resonance/PET (MR/PET) and finally highlight the advantage of hybrid MR/PET. We present the retrospective review data from January 2016 to December 2019 referred for whole body MR/PET with suspected AIE/Paraneoplastic syndrome, per consensus criteria, treated at a single tertiary center. Analysis is done group wise based on referral being for oncological, immunological or neuropsychiatric condition. Detailed results with sensitivity and specificity are presented in tabular format with case-based review in our series for protocols and advantages of MR/PET. Among total of 600 MR/PET cases, 227 were suspected of AIE/paraneoplastic syndrome and were referred for whole body imaging. Distribution of Group 1 Known oncology group (n = 10), Group 2 Non oncological systemic illness group (n = 174) and group 3 the primary neuropsychiatric illness (n = 43) with Group 2 being largest. The gender distribution was similar and mean age was 42 years. Seronegative cases (n = 130) were greater than seropositive cases (n = 97). Seropositivity was in the following order Autoimmune > Paraneoplastic > Myositis panel. Whole body MRPET yielded occult malignancy in 9% and imaging abnormality in 88% of cases. Whole body MR/PET has an important role in workup of AIE. Selection of the appropriate protocol is important, especially when history and physical examination are nonspecific.

Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors.

Aim: Neonatal resuscitation guidelines promote the laryngeal mask (LM) interface for positive pressure ventilation (PPV), but little is known about how the LM is used among Neonatal Resuscitation Program (NRP) Providers and Instructors. The study aim was to characterize the training, experience, confidence, and perspectives of NRP Providers and Instructors regarding LM use during neonatal resuscitation at birth. Methods: A voluntary anonymous survey was emailed to all NRP Providers and Instructors. Survey items addressed training, experience, confidence, and barriers for LM use during resuscitation. Associations between respondent characteristics and outcomes of both LM experience and confidence were assessed using logistic regression. Results: Between 11/7/22-12/12/22, there were 5,809 survey respondents: 68% were NRP Providers, 55% were nurses, and 87% worked in a hospital setting. Of these, 12% had ever placed a LM during newborn resuscitation, and 25% felt very or completely confident using a LM. In logistic regression, clinical or simulated hands-on training, NRP Instructor role, professional role, and practice setting were all associated with both LM experience and confidence.The three most frequently identified barriers to LM use were insufficient experience (46%), preference for other interfaces (25%), and failure to consider the LM during resuscitation (21%). One-third (33%) reported that LMs are not available where they resuscitate newborns. Conclusion: Few NRP providers and instructors use the LM during neonatal resuscitation. Strategies to increase LM use include hands-on clinical training, outreach promoting the advantages of the LM compared to other interfaces, and improving availability of the LM in delivery settings.

Sustainable Management of Keratin Waste Biomass: Applications and Future Perspectives

Keratin is a durable, fibrous protein which is mainly present in higher vertebrates (mammals, birds and reptiles) and humans epithelial cells. Food industry especially the meat market, slaughter house and wool industry produces million of tons of keratin containing biomass. These industries are constantly growing and the major producers include USA, Brazil and China, account for more than 40 million tons per year. These proteins constitute keratin by-products have from 15 to 18% nitrogen, 2-5% sulphur, 3.20% mineral elements and 1.27% fat and 90% of proteins. The organic waste rich in keratin can be utilized as a natural source using chemical and mechanical methods. The natural keratin obtained by biomass does not contain any harmful chemical and can be used directly to produce variety of cosmetics, creams, shampoos, hair conditioners and biomedical products. The natural protein is more compatible to use or apply on human skin and hairs. The monomeric units of natural keratin can penetrate in the skin and hair cuticle and able to nourish the skin without any side effects. In the present review various strategies for the purification and separation of keratin from the organic waste have been described and use of natural keratin in cosmetics and pharmaceutical industry has also been explored.

An Alternative Approach for Acetylation of Amine Terminated Polyamidoamine (PAMAM) Dendrimer / Un enfoque alternativo para la acetilación de la amina terminal del dendrímero de poliamidoamina (PAMAM)

Aim. Polyamidoamine (PAMAM) dendrimers inherent properties have made it the nanocarrier of choice in the current era of innovation. Dendrimer based products are growing and mushrooming like anything in the current time. Although it suffer from hemolytic toxicity which could be reduced by protecting free amino group. Methods. In the present work alternate acetylated method for PAMAM dendrimers was discussed. 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide Linker was used for acetylation. The acetylated conjugate was evaluated for color reaction, Ultraviolet–visible spectroscopy, Fourier Transform infrared spectroscopy, Differential scanning calorimetric, Nuclear magnetic resonance spectra studies. Results. The PAMAM dendrimers were synthesized using divergent approach and further acetylated. Change in λmax values from 282.0 to 282.5 nm was observed for acetylated dendrimers. Characteristic peak of N-H stretch of primary amine at 3284.16 cm-1 was disappeared due to conversion of primary amine to secondary amine. A new peak of -(CO)-NH stretch was obtained at 1640.28 cm-1 (medium) which shows attachment of acetic acid surface group. The changes in Endothermic peak from 120.56 to 110.400C were observed which shows the PAMAM dendrimers surface modifications The peak of –NH2 at 2.99 ppm was replaced by (–NHCOCH3) at 2.42 ppm further supports the proof of acetylation. Conclusions. The spectral data clearly revealed that this approach for acetylation gives considerable amount of acetylation in less time duration with elimination of organic solvent. This method could be employed for regular acetylation of amine terminated nanocarriers. EDC linker mediated capping of amine groups opened a new avenue for acetylation of amine terminated protein/peptides

Objetivos. Las propiedades inherentes de la poliamidoamina (PAMAM) la han convertido en el nanotransportador de elección en la era actual de la innovación. A pesar de que sufren de toxicidad hemolítica que podría ser reducido mediante la protección del grupo amino libre. En el presente trabajo se discutió el método alternativo de acetilación para los dendrímeros PAMAM. Material y Métodos. El enlazador 1-Etill-3-(3-dimetilaminopropil) carbodiimida (EDC) se utilizó para la acetilación. El conjugado acetilado se evaluó mediante la reacción de color, mediante espectroscopia Ultravioleta visible, espectroscopia infrarroja con transformado de Fourrier, Calorimetría Diferencial de barrido y los estudios de los espectros de Resonancia magnetica nuclear. Resultados. Los dendrímeros PAMAM se sintetizaron utilizando el método divergente y más acetilado. Cambio en los valores λmax 282,0 a 282,5 nm se observó para dendrímeros acetilados. El pico característico del NH de amina primaria a 3284,16 cm-1, desapareció debido a la conversión de amina primaria a amina secundaria. Un nuevo pico de - (CO) -NH se obtuvo a 1640,28 cm-1 (medianas), que muestra la unión de grupo de superficie de ácido acético. Se observaron los cambios en el pico endotérmico de 120,56 a 110.40 ºC que muestra las modificaciones superficiales de dendrímeros PAMAM. El pico de -NH2 en 2,99 ppm fue sustituido por (-NHCOCH3) a 2,42 ppm apoya aun más la prueba de acetilación. Conclusión. Los datos espectrales revelaron claramente que este enfoque para la acetilación da considerable cantidad de acetilación en menos tiempo de duración con la eliminación de disolvente orgánico. Este método podría ser empleado para regular la acetilación de las aminas terminales de nanovehículos. El enlazador EDC de grupos amino abre una nueva vía para la acetilación de amina terminales de proteínas / péptidos

Manejo anestésico de un paciente hemofílico con trombofilia / Anaesthetic management of a haemophiliac patient with thrombophilia

Haemophiliac patient are known to have increased mortality and morbidity in the past due to previous non existence of practice of blood banking. Mainly morbidity increased due to the complications arises such as recurrent bleeding episodes, painful haemarthroses and permanent disability secondary to ankylosed joints. This case enlightens the role and impact of undetected changes in Hemophilia A patient with Buerger’s disease, highlighting the importance of vigilance on the part of the anesthesiologist, who must ensure the adequacy of hemostatic monitoring in these patients. The clinical presentation of Haemophilia A disease with Buerger’s disease is a rare entity and can be challangeable for practicing anaesthesiology.

En el pasado, los pacientes hemofílicos han tenido una mortalidad y morbilidad aumentada debido a la inexistencia de los bancos de sangre. La morbilidadaumentada está dada principalmente porlas complicaciones como episodios de sangrados recurrentes, hemartrosis dolorosas y discapacidad permanente secundaria a articulaciones anquilosadas. Este caso ilustra el rol y el impacto de los cambios no detectados en un paciente con hemofilia A que cursa también con enfermedadde Buerger, lo que enfatiza la importancia de la vigilancia por parte del anestesiólogo quien debe garantizar una monitoría adecuada de la hemostasia en estos pacientes. La aparición clínica de un caso de hemofilia A asociado a la enfermedad de Buerger es muy infrecuente y es un reto parael anestesiólogo.

Atenuación de la respuesta presora a la laringoscopia e intubación entre diltiazem y esmolol en pacientes hipertensos controlados / Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous diltiazem and esmolol intravenous in controlled hypertensive surgical patients

Introduction. Tachycardia and hypertension are well documented sequels of laryngoscopy and endotracheal intubation which is transient, highly variable and is generally well tolerated in healthy patients. In hypertensive patients, cardiovascular response to laryngoscopy and intubation is exaggerated. The aim of this study intended to find a better alternative by comparision amongst diltiazem and esmolol to attenuate the pressor response to laryngoscopy and intubation in Kasmiri Population. Materials & Methods. Randomized placebo controlled double blind study. One hundred fifty hypertensive patients of both sexes (ASA II), controlled on antihypertensive drugs, between age hinrange of 40-60 years scheduled for routine surgical procedures were divided into 3 groups Group A (10 ml of 5 % Dextrose), Group B (Diltiazem 0.2 mg/Kg) and Group C (Esmolol 1.5 mg/Kg). Baseline parameters, i.e. heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product were noted at baseline level, at 1 min., 3min. and 5min after tracheal intubation. Results. Both Esmolol and Diltiazem showed statistically significant attenuation of rise in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product when compared to control. However Diltiazem failed to attenuate rise in heart rate. Conclusions. We conclude that Esmolol is a very effective agent in attenuating the pressor response to laryngoscopy and intubation in controlled hypertensive patients.

Introducción. La taquicardia e hipertensión son efectos bien documentados de la laringoscopia e intubación orotraqueal que son transitorios, muy variables y generalmente bien toleradas en los pacientes sanos. Sin embargo, en los pacientes hipertensos, la respuesta cardíaca a la laringoscopia e intubación es exagerada. El objetivo de este estudio es encontrar la mejor alternativa entre diltiazem y esmolol para atenuar la respuesta presora a la laringoscopia e intubación en una población de Cachemira. Materiales y métodos. Estudio aleatorizado controlado doble ciego. Ciento cincuenta pacientes hipertensos de ambos sexos (ASA II), controlados con drogas antihipertensivas con edades entre los 40 y 60 años programados para cirugías rutinarias fueron divididos en tres grupos, grupo A (10 ml de dextrosa al 5 %), grupo B (diltiazem 0,2 mg por kilo), y grupo C (esmolol 1,5 mg por kilo). Los parámetros de base como frecuencia cardíaca, presión arterial sistólica, presión arterial diastólica, presión arterial media y doble producto, fueron anotados al inicio al minuto 1 al minuto 3 y al minuto 5 después de la intubación traqueal. Resultados. Tanto el esmolol como el diltiazem demostraron atenuación estadísticamente significativa de la presión arterial sistólica, diastólica y media, y del doble producto, cuando se compararon al control. Sin embargo el diltiazem no pudo evitar un aumento de la frecuencia cardíaca. Conclusiones. Concluimos que el esmolol es un agente muy efectivo para atenuar la respuesta presora a la laringoscopia e intubación en pacientes hipertensos controlados.

Implicaciones anestésicas de un caso de leucodistrofia metacromática / Anaesthetic implications in a case of metabolic leukodystrophy

Metachromatic leukodystrophy is a progressive, inherited and neurodegenerative disease. A patient suffering from this disease poses a lot of anaesthetic problems. We have successfully anaesthetized a female child with general anaesthesia who was suffering from metabolic leukodystrophy.

La leucodistrofia metacromática es una enfermedad progresiva hereditaria y neurodegenerativa. Un paciente que sufre de esta enfermedad representa múltiples problemas anestésicos. Hemos anestesiado exitosamente una niña que sufre de leucodistrofia metacromática con anestesia general.