Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico.

Introduction: Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. Methods: This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. Results: The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4-2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8-31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2-14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05-13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9-463) were risk factors for death. Discussion: Mortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

Diagnosis of bacterial meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae using a multiplex real-time PCR technique.

Bacterial meningitis is one of the diseases that, despite the introduction of several vaccines, remains a serious public health concern. Streptococcus pneumoniae (Spn), Neisseria meningitidis (Nm), and Haemophilus influenzae (Hi) are responsible for most cases diagnosed in children, adolescents, and adult population. Rapid, sensitive, and specific laboratory assays are critical for effective diagnosis and treatment, particularly in countries like Mexico in which culture positivity rates are very low due to the use of antibiotics prior to sample collection and to delay in transporting samples to the laboratory. The aim of this study was to evaluate the use of real-time polymerase chain reaction (RT-PCR) of cerebrospinal fluid (CSF) as a rapid diagnostic test for bacterial meningitis and compare these results with bacterial culture in three general hospitals in Mexico. During a 5-year period (2014-2018), a total of 512 CSF samples obtained from patients in whom infectious meningitis was suspected as initial clinical diagnosis were tested with RT-PCR with species-specific targets for the three pathogens. For Spn, 5.07% samples were RT-PCR positive; 0.39% for Nm and none for Hi. Only five RT-PCR Spn positive samples had a positive culture. Sensitivity and specificity estimates for RT-PCR are 100% and 95.46%, respectively. DNA amplification methods can provide better sensitive diagnostic tests than the reference standard, which is culture, particularly when antimicrobial treatment is initiated before clinical samples can be obtained.

A prevalence study in Guadalajara, Mexico, comparing tuberculin skin test and QuantiFERON-TB Gold In-Tube.

BACKGROUND: Tuberculosis (TB) is a prevalent disease throughout the world. The extent of TB illness in childhood is not clear; recent data shows that 10-20% of the cases are found in children under 15 years old. In 2017, 1 million children developed the disease, of which 9% were co-infected with HIV. METHODS: A cross-sectional study that analyzed 48 children diagnosed with HIV-infection in Guadalajara, Mexico. The tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT) were performed and compared to diagnose latent TB infection (LTBI). RESULTS: The average age was 9 years old (± 4), with an age range of 1-16 years; the 6-12-year-old group predominated with 50% of cases. 27 patients (56%) were male; 83% had received the BCG vaccination and 23% had a history of being contacts of TB cases. In the study, 40 patients (83%) were without immunosuppression; seven (15%) with moderate immunosuppression, and only one patient had severe immunodeficiency. Overall, 3 of the 48 children (6.2%) had a positive TST, while 8 out of 48 (16.6%) had a positive QFT. The concordance between the two tests was 89.6% (43/48) with Kappa = 0.5 (95% CI, 0.14-0.85). CONCLUSIONS: The QFT test represents an opportunity in the diagnosis of LTBI, particularly in pediatric HIV- patients. This is the first study that compares the two tests (TST and QFT) in children with HIV-infection in Guadalajara, Mexico.

Métodos no invasivos de oxigenación en pacientes con COVID-19. Revisión descriptiva / Non-invasive methods of oxygenation in patients with COVID-19. Descriptive review / Métodos não invasivos de oxigenação em pacientes com COVID-19. Revisão descritiva

Resumen: En diciembre de 2019 varias personas con neumonía de causa desconocida se vincularon a un mercado de mariscos en Wuhan, China, descubriéndose así un nuevo tipo de coronavirus que dio inicio a la pandemia por COVID-19. La sintomatología más común que manifiestan los pacientes consiste en un síndrome gripal, la enfermedad severa ocurre generalmente una semana después del inicio de los síntomas. La severidad del cuadro se caracteriza por disnea, taquipnea, saturación de oxígeno disminuida. En México se ha presentado aproximadamente un total de 3'684,242 casos y 279,104 defunciones por COVID-19 hasta la semana epidemiológica número 40, siendo uno de los países a nivel internacional con más mortalidad. De 5 a 10% de los pacientes infectados por el virus SARS-CoV-2 requerirán manejo en la unidad de cuidados intensivos con necesidad de oxígeno suplementario. La mortalidad hospitalaria en México ha llegado hasta 73.7%. Los límites de la hipoxemia que indican la necesidad de oxigenoterapia son una presión parcial arterial de oxígeno (PaO2) inferior a 60 mmHg. Es preciso para el especialista en pacientes críticos conocer las diferentes interfaces y modos de administración de oxígeno, la administración de oxígeno en los pacientes con COVID-19 e insuficiencia respiratoria hipoxémica debe ser apropiada y pertinente.

Abstract: In December 2019, several people with pneumonia of unknown cause were linked to a seafood market in Wuhan, China. With the discovery of a new type of coronavirus and the initiation of the COVID-19 pandemic, the most common symptoms manifested by patients consists of a flu syndrome, the severe illness generally occurs one week after the onset of symptoms. The severity of the picture is characterized by dyspnea, tachypnea and decreased oxygen saturation. In Mexico there have been approximately 3'684,242 total cases and 279,104 total deaths from COVID-19, up to epidemiological week number 40, being one of the countries with the highest mortality at the international level, 5-10% of patients infected by SARS-CoV-2 virus will require management in the intensive care unit, with the need for supplemental oxygen, hospital mortality in Mexico has reached 73.7%. The limits of hypoxemia that indicate the need for oxygen therapy are an arterial partial pressure of oxygen (PaO2) less than 60 mmHg. It is necessary for the specialist in critical patients to know the different interfaces and modes of oxygen administration, the administration of oxygen in patients with COVID-19 and hypoxemic respiratory failure must be appropriate and pertinent.

Resumo: Em dezembro de 2019, várias pessoas com pneumonia de causa desconhecida foram ligadas a um mercado de frutos do mar em Wuhan, China. Com a descoberta de um novo tipo de coronavírus e o início da pandemia de COVID-19, a sintomatologia mais comum manifestada pelos pacientes consiste em uma síndrome gripal, com doença grave geralmente ocorrendo uma semana após o início dos sintomas. A gravidade da condição é caracterizada por dispnéia, taquipnéia, diminuição da saturação de oxigênio. No México, houve aproximadamente 3'684.242 casos totais e 279,104 mortes totais por COVID-19, até a semana epidemiológica número 40, sendo um dos países com maior mortalidade internacional, 5-10% dos pacientes infectados com o vírus SARS-CoV-2 exigirá manejo na unidade de terapia intensiva, com a necessidade de oxigênio suplementar, a mortalidade hospitalar no México atingiu 73.7%. Os limites de hipoxemia que indicam a necessidade de oxigenoterapia são uma pressão parcial arterial de oxigênio (PaO2) inferior a 60 mmHg. É necessário que o especialista em pacientes críticos conheça as diferentes interfaces e modos de administração de oxigênio, a administração de oxigênio em pacientes com COVID-19 e insuficiência respiratória hipoxêmica deve ser adequada e pertinente.

Streptococcus pneumoniae Serotype 3 in Mexico (1994 to 2017): Decrease of the Unusual Clonal Complex 4909 Lineage following PCV13 Introduction.

Streptococcus pneumoniae expressing serotype 3 has a high virulence and a high case fatality ratio. Most studies of serotype 3 pneumococci have focused on a single lineage, the widespread sequence type 180 (ST180). To evaluate the serotype 3 lineages causing infections in Mexico, we characterized 196 isolates recovered from 1994 to 2017. The isolates were mostly susceptible to all antimicrobials tested. A single meningitis isolate was resistant to penicillin, and the resistance to erythromycin was 5.2%. The isolates represented the widely disseminated clonal complex 180 (CC180; n = 140), the unusual CC4909 (n = 42), CC260 (n = 11), and a few singletons (n = 3). CC260 was less frequent among pneumococcal invasive disease isolates than CC180 and CC4909 (P = 0.015). There was a decrease of CC4909 (P < 0.001) following PCV13 introduction (2012 to 2017). The CC4909 isolates were represented mostly by ST1119 (n = 40), seemingly having a restricted geographic origin, with isolates in the PubMLST database having been recovered only in Mexico, the United States, and Germany. A genomic analysis of publicly available genomes showed that ST1119 isolates have less than 32% similarity with ST180 isolates, indicating that these lineages are more separated than revealed by traditional multilocus sequence typing. Considering the suggestions of a lower efficacy of the 13-valent pneumococcal conjugate vaccine against serotype 3, the different dynamics of the two major serotype 3 lineages in Mexico following the introduction of PCV13 should be closely monitored.

What are we looking for? Systemic lupus erythematosus vs. dengue infection: A case series report / ¿Qué estamos buscando? Lupus eritematoso sistémico vs. infección por dengue: reporte de casos

Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoantibodies and multisystemic disease. Viruses are widely associated with autoimmunity, and are also implicated in the pathogenesis of systemic lupus erythematosus. Two cases are described that have an autoimmune response related to dengue infection. The clinical presentation of systemic lupus erythematosus is very diverse, and in these cases it was important to consider SLE as a diagnosis.

Resumen El lupus eritematoso sistémico (LES) es una enfermedad autoinmune, caracterizada por la presencia de autoanticuerpos y afección multisistémica. Los virus se encuentran ampliamente asociados a autoinmunidad y también se han encontrado implicados en la patogénesis del LES. A continuación se presentan 2 casos con respuesta autoinmune relacionada con infección por el virus del dengue. La presentación clínica del LES es muy diversa, en estos casos fue importante tener la sospecha diagnóstica.

Neisseria meningitidis and Streptococcus pneumoniae as leading causes of pediatric bacterial meningitis in nine Mexican hospitals following 3 years of active surveillance.

OBJECTIVES: Meningococcal meningitis is reported as a rare condition in Mexico. There are no internationally published studies on bacterial causes of meningitis in the country based on active surveillance. This study focuses on finding the etiology of bacterial meningitis in children from nine Mexican Hospitals. METHODS: From January 2010 to February 2013, we conducted a three years of active surveillance for meningitis in nine hospitals throughout Mexico. Active surveillance started at the emergency department for every suspected case, and microbiological studies confirmed/ruled out all potentially bacterial pathogens. We diagnosed based on routine cultures from blood and cerebrospinal fluid (not polymerase chain reaction or other molecular diagnostic tests), and both pneumococcal serotyping and meningococcal serogrouping by using standard methods. RESULTS: Neisseria meningitidis was the leading cause, although 75% of cases occurred in the northwest of the country in Tijuana on the US border. Serogroup C was predominant. Streptococcus pneumoniae followed Neisseria meningitides, but was uniformly distributed throughout the country. Serotype 19A was the most incident but before universal implementation of the 13-valent pneumococcal conjugate vaccine. Other bacteria were much less common, including Enterobacteriaceae and Streptococcus agalactiae (these two affecting mostly young infants). CONCLUSIONS: Meningococcal meningitis is endemic in Tijuana, Mexico, and vaccination should be seriously considered in that region. Continuous universal vaccination with the 13-valent pneumococcal conjugate vaccine should be nationally performed, and polymerase chain reaction should be included for bacterial detection in all cultures - negative but presumably bacterial meningitis cases.

Widespread microglial activation in patients deceased from traumatic brain injury.

PRIMARY OBJECTIVE: The role of microglial activation in traumatic brain injury (TBI) has been extensively described in established animal models. In contrast, very few studies have analysed this process in human patients, the majority being focused on the local reaction in the contused parenchyma. In this work, the main objective was the analysis of microglial activation in brain regions distant from the primary lesion. RESEARCH DESIGN: Morphological changes of microglia were evaluated in the cerebral cortex of patients deceased from TBI in comparison with control subjects. METHODS AND PROCEDURES: Cortical samples from five cases with TBI and 10 controls were evaluated using Ricinus communis lectin histochemistry and conventional Hematoxylin-eosin staining. MAIN OUTCOMES AND RESULTS: It was observed that microglial cells from patients with TBI presented shorter and thicker cellular projections compared with controls. Moreover, the percentage of histological area reactive to lectin was statistically higher in samples from subjects with TBI. These signs of microglial activation were observed in all of the analysed cortical areas, thus indicating a generalized effect on the whole cerebral cortex. The results are consistent with previous imaging PET studies performed in living patients with the 11C-PK11195 radiotracer. CONCLUSIONS: The findings indicate that TBI induces a widespread activation of brain microglia which affects all cortical areas, including those distant from the contusion site.

Short-term glutamate administration positively affects the number of antral follicles and the ovulation rate in cyclic adult goats.

The acute effects of short-term glutamate administration on the number of antral follicles and ovulation rate were examined in adult goats. Neither live weight (44.5±1.3 kg) nor body condition (3.3±0.8 units) differed between the control (untreated) and glutamate-treated (0.175 mg/kg) animals (p>0.05). However, the number of antral follicles (3.4 vs. 2.1, p=0.05) and ovulation rate (2.5 vs. 1.5, p=0.05) was higher in the glutamate-administered group than in the controls.

Cuba's strategy for childhood tuberculosis control, 1995-2005.

INTRODUCTION: Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem. OBJECTIVE: Assess the impact of Cuba's new strategy for TB control in children aged <15 years during the period 1995-2005. METHODS: A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995-2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses. RESULTS: During the period 1995-2005, TB rates in children aged <15 years fell by 50% (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9%); there were four deaths (2.5%), none after 2000. Only seven children (4.5%) had serious forms, none after 2002. Except for cases diagnosed post-mortem, all children received treatment directly supervised by health personnel. Cure rate was 99.4%; there were no treatment drop-outs or chronic cases; one relapse was reported (0.6%). Knowledge of infection source increased to 90% over the selected years. Microbiological tests were conducted in 90% of cases, with isolation in 30.9%. No isolate was drug-resistant, nor were there reports of infectious contacts with resistance. We found no HIV coinfection. At the end of the study, time to diagnosis of ≥60 days persisted in 40% of cases. CONCLUSIONS: Creation of a National Reference Center for Childhood TB and Provincial Childhood TB Commissions has contributed to improved TB diagnosis and control in children aged <15 years, achieving incidence similar to that during the period prior to TB re-emergence and to those of some developed countries. Improvements are needed in the work and systematic training of health personnel, especially at the primary health care level, in order to eliminate TB as a national health problem by 2015.

Association between body mass index and migraine.

OBJECTIVE: To explore the prevalence of overweight and obesity in patients with migraine. BACKGROUND: Previous studies support the concept that obesity is an exacerbating factor for migraine. Also, some studies have found an increased frequency of obesity and overweight in migraine patients compared to the normal population. METHODS: We studied 1,371 patients with migraine and 612 controls. The migraine population was matched by gender with a healthy control group. RESULTS: Mean age of patients with migraine was 38.0 +/- 13.3 years and in the controls it was 34.8 +/- 12.1 years. The percentage of females in both groups was similar (migraine 81.6% vs. control 83.3%, p = 0.40). The distribution of body mass index (BMI) in migraine patients and controls was as follows: underweight patients (BMI <18.5) 3.1% migraine versus controls 1.5%; normal (BMI 18.5-24.9) 44.8% migraine versus controls 47.1%; overweight (BMI 25-29.9) 38.3% migraine versus controls 33.7%; obese (BMI 30-34.5) 10.3% migraine versus controls 13.6%; morbidly obese (BMI 35) 3.4% migraine versus controls 4.2%. Overweight and obesity in migraine patients versus controls were statistically significant. No association was found between the disability and severity of migraine and BMI. CONCLUSIONS: This study did not find associations between severity or disability of migraine and BMI.

Starch and albumin mixture as replacement fluid in therapeutic plasma exchange is safe and effective.

UNLABELLED: Therapeutic plasma exchange (TPE) is an effective treatment in Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) and 5% human albumin is the replacement fluid of choice; however, it is expensive. More recently, it has been suggested that starch is a safe and cheaper choice to human albumin. OBJECTIVE: To evaluate our 5-year experience using 3% hydroxyethyl starch (HES) and 5% human albumin mixture, as replacement fluid in TPE for these diseases. MATERIALS AND METHODS: Retrospective study carried out from January 2001 through September 2006. We included those patients with MG and GBS undergoing TPE. We analyzed clinical outcome (CO) and adverse events (AE) and our results were compared with a previous study which included similar patients undergoing TPE using just 5% human albumin. RESULTS: Thirty-one procedures were carried out in 26 patients, a total of 147 TPE sessions. In the group of MG we had 57% complete responses (CR) and 86% overall response (OR) while in the group of GBS we had 40% CR and 60% OR. When we analyzed our CO with the previous study no statistical differences were found. Mean processed plasma volume (PPV) was 4.2 in MG and 5.5 in GBS. Twenty patients had AE, being hypotension and catheter dysfunction the most frequent ones, while tachycardia, hypertension and paresthesias were statistically more frequent in the HES/albumin group. CONCLUSIONS: TPE with a mixture of 3% HES and 5% human albumin is as effective and safe as 5% human albumin alone for patients with these diseases.

Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors.

INTRODUCTION/AIM: In North America and Europe, the prevalence of celiac disease (CD) might be much greater than expected in previous estimates. Until recently, the prevalence of CD in Latin America remained largely unknown. So far, information regarding CD in Mexico is limited, and it is still considered a rare disease. Our aim was to determine the prevalence of tTGA in a large group of apparently healthy blood donors. SUBJECTS AND METHODS: Serum samples from 1009 consecutive blood donors, who attended a third level referral center in Mexico City, were collected between June 2004 and December 2004. Only Mexican Mestizo individuals were included. All sera were tested with a new generation human recombinant protein based tTGA-IgA ELISA commercial kit (Aeskulisa tTG-IgA, Wendelsheim, Germany). The cut-off value provided by the manufacturer was 15 U/mL. RESULTS: The mean age of the blood donors was 34+/-10 years and 68% (n=683) were men. Six hundred fifty two subjects (65%) were born in Mexico City; and from the remaining 357 subjects, at least one was born in each of the 31 different states in our country. Twenty-seven (2.7%) blood donors were positive for tTGA-IgA; all of them with tTGA-IgA values above 30 U/mL (range 36 to 1639). Overall prevalence was 1:37 [27/1009, 95% confidence interval (CI)=1.6-3.7]. The prevalence among women was 1:33 (10/326, 95% CI=1.04-5.09) and for men 1:40 (17/683, 95% CI=1.24-3.73). CONCLUSIONS: On the basis of a well-recognized serologic screening method performed to blood donor samples, we demonstrated an unexpectedly high prevalence of tTGA positivity (2.6%) in the adult Mexican Mestizo population. Thus, the prevalence of CD in Mexico could be higher or similar to that observed in other countries. This observation contributes to increase the awareness for this under diagnosed disease in clinical practice and to consider CD as a global health problem.

Demographic, clinical and comorbidity data in a large sample of 1,147 patients with migraine in Mexico City.

The objective was to identify the sociodemographic and clinical characteristics of a large sample of patients with migraine in Mexico City. This cross-sectional study was performed in two tertiary centers in Mexico City and affiliated hospitals. We evaluated the presence of migraine through a standardised interview according to the criteria of the International Headache Society. We studied 1,147 patients. The mean age was 37.1+/-13.6 (6-77) years. Nine hundred and twenty one patients were female (80%). The age of onset of migraine was 19.4+/-10.3 (1-69) years. Six hundred and four patients had migraine with aura (53%) and 543 without aura (47%). The female/male ratio was 4:1. One hundred and forty-seven patients had cardiovascular problems (13%), 72 had neurological problems (6%), 233 had gastrointestinal problems (20%) and 323 had psychiatric problems (28%). In this study we described the clinical characteristics of a large sample of patients with migraine in Mexico City. Our sample has similar characteristics to other countries.

Nutritional therapy improves growth and protein status of children with a urea cycle enzyme defect.

BACKGROUND: Poor growth has been described in patients with urea cycle enzyme defects treated with protein-restricted diets, while protein status is seldom reported. OBJECTIVE: To assess the effects of nutritional therapy with a medical food on growth and protein status of patients with a urea cycle enzyme defect. METHODS: A 6-mo multicenter outpatient study was conducted with infants and toddlers managed by nutrition therapy with Cyclinex-1 Amino Acid-Modified Medical Food with Iron (Ross Products Division, Abbott Laboratories, Columbus, OH). Main outcome variables were anthropometrics and plasma amino acids (selected), albumin, and transthyretin concentrations. RESULTS: Seventeen patients completed the study. Mean (+/-SE) baseline age was 11.30+/-3.20 months (median 4.40 months; range 0.22-38.84 months). Length and weight z-scores increased significantly during the 6-month study. Head circumference increased, but not significantly. Three patients were stunted and two were wasted (-2.0 z-score) at baseline while at study end, only one patient was both stunted and wasted. The majority of patients increased in length, head circumference, and weight z-scores during study. Mean (+/-SE) plasma albumin concentration increased from 34+/-2g/L at baseline to 38+/-1g/L at study end. Plasma transthyretin increased from a mean (+/-SE) of 177+/-13 mg/L at baseline to 231+/-15 mg/L at study end. No correlation was found between plasma NH(3) concentrations and medical food intake. Plasma NH(3) concentration was positively correlated with the percentage of Food and Agriculture Organization/World Health Organization/United Nations recommended protein ingested. CONCLUSIONS: Intakes of adequate protein and energy for age result in anabolism and linear growth without increasing plasma NH(3) concentrations. Medical food intakes did not correlate with plasma NH(3) concentrations.

Extracción y uso de pigmentos del grano de maíz (zea mays L) como colorantes en yogur / Extraction and use of pigments from maize grains (zea mays L) as colorants in yogur

El objetivo del presente trabajo fue determinar el uso potencial de las antocianinas extraídas de granos de maíz, como colorantes en yogur. Se emplearon cuatro variedades nativas de maíz (Arrocillo, Peruano, Purepecha y Cónico), que posee alta concentración de antocianinas en el pericarpio y en la capa de aleurona. Estas estructuras del grano se separaron mecánicamente con ayuda de una perladora de cebada Strong-Scott, obteniendo la fracción pericarpio-capa de aleurona (FPCA), que se caracterizó en términos del contenido total de antocianinas, y se obtuvo su perfil de antocianinas mediante HPLC. Las antocianinas extraídas de la FPCA fueron añadidas a un yogur natural comercial, en concentración de 1 mg/100 g de yogur. Las muestras de yogur coloreadas se almacenaron bajo condiciones de refrigeración (4°C ±1) durante 25 días y se les midió color y pH cada 5 días. El más alto contenido de antocianinas se obtuvo en la FPCA del maíz Peruano y fue de 259.4 mg/100 g de muestra. El color del yogur obtenido con los cuatro extractos fue diferente. Los coloreados con los extractos de los maíces Peruano y Arrocillo mostraron un tono rojizo más intenso que los obtenidos con los de Cónico y Purepecha. El color de los yogures se mantuvo sin cambios durante los primeros cuatro días, pero entre los días 5 y 10 de almacenamiento, cambió a una tonalidad más amarillenta, al incrementarse los valores de Hue. Sin embargo, estos cambios no fueron visualmente evidentes, por lo que es posible el uso de los pigmentos del grano de maíz para teñir alimentos de acidez intermedia como el yogur

[Extraction and use of pigments from maize grains (Zea mays L) as colorants in yogur]. / Extracción y uso de pigmentos del grano de maíz (Zea mays L.) como colorantes en yogur.

The aim of the present work was to determine the potential use of anthocyanins from maize grains as colorants in yogurt. Pigments were extracted from four native maize varieties (Arrocillo, Peruano, Purepecha and Cónico), which possess a high anthocyanin concentration in the pericarp. Pericarp and aleurone layer were mechanicallly removed from grain using a Strong-Scott barley pearled. Yields of pericarp and aleurone layer fraction (PALF) were evaluated. Total anthocyanin content in this fraction was determined by a conventional spectrophotometric method and the anthocyanin profile was obtained by HPLC. One mg of anthocyanin extracts from the PALF was added to 100 g of a commercial plain yogurt. Yogurt samples were kept under refrigerated conditions and color and pH were monitored every 5 days interval, during three weeks. The yields of PALF were 48.4%, 55.1%, 40.2%, and 40.0% for Arrocillo, Peruano, Cónico and Purepecha varieties, respectivelly. The highest total anthocyanin content (259.4 mg of anthocyanins/100 g sample) was observed in Peruano PALF. The color of yogurts dyed with each of the four extracts was different. Yogurts dyed with Peruano and Arrocillo extracts showed a more intense reddish tone than those dyed with Cónico and Purepecha. After 5 to 10 days under refrigerated storage, the color of all yogurt samples changed to a slight yellowish tone according to the Hue values, Nevertheless, these changes were not visually evident.

Paradoxical regulation of biotin utilization in brain and liver and implications for inherited multiple carboxylase deficiency.

Holocarboxylase synthetase (HCS) catalyzes the biotinylation of five carboxylases in human cells, and mutations of HCS cause multiple carboxylase deficiency (MCD). Although HCS also participates in the regulation of its own mRNA levels, the relevance of this mechanism to normal metabolism or to the MCD phenotype is not known. In this study, we show that mRNA levels of enzymes involved in biotin utilization, including HCS, are down-regulated during biotin deficiency in liver while remaining constitutively expressed in brain. We propose that this mechanism of regulation is aimed at sparing the essential function of biotin in the brain at the expense of organs such as liver and kidney during biotin deprivation. In MCD, it is possible that some of the manifestations of the disease may be associated with down-regulation of biotin utilization in liver because of the impaired activity of HCS and that high dose biotin therapy may in part be important to overcoming the adverse regulatory impact in such organs.

Improved growth and nutrition status in children with methylmalonic or propionic acidemia fed an elemental medical food.

BACKGROUND: Failure-to-thrive (FTT) has been described in patients with organic acidemias treated with low protein diets. OBJECTIVE: To determine if patients with methylmalonic (MMA) or propionic acidemia (PA) can achieve normal growth and nutrition status. METHODS: A 6-month multicenter outpatient study was conducted with infants and toddlers treated with Propimex-1 Amino Acid-Modified Medical Food With Iron (Ross Products Division, Abbott Laboratories, Columbus, OH). Main outcome measures were anthropometrics, protein status indices, plasma retinol, and alpha-tocopherol. RESULTS: Sixteen patients completed the study. Mean baseline age was 0.54 +/- 0.02 years (range 0.03-3.00 years). By study end, mean National Center for Health Statistics (NCHS) weight centile increased from 26 to 49%; mean crown-heel length centile from 25 to 33%; and mean head circumference centile from 43 to 54%. Mean (+/- SE) protein and energy intakes by <6-month-old, 6<12-month-old, and 1<4-year-old patients were 15.3 +/- 0.9 g and 645 +/- 10 kcal; 18.3 +/- 1.1 g and 741 +/- 92 kcal; and 25.1 +/- 2.46 g and 1062 +/- 100 kcal, respectively. Plasma glycine concentrations were significantly and negatively correlated with energy intake (r=-0.77, p<0.0005). No correlation was found between dietary protein intakes and plasma ammonia concentrations. Protein status indices, retinol and alpha-tocopherol concentrations were within reference ranges at study end. CONCLUSIONS: Propimex-1 improved growth and nutrition status in patients with MMA or PA in just 6 months when fed in sufficient amounts. Providing energy and protein for patients with FTT at intakes recommended for catch-up growth may have resulted in even better growth.