The Role of Echocardiogram and Cardiac Rhythm Analysis for Early Detection of Cardiac Amyloidosis.

Purpose: The purpose of this integrative review was to establish the role of cardiac rhythm analysis (electrocardiogram; EKG) and echocardiogram in increasing clinical suspicion for and earlier diagnosis of cardiac amyloidosis. Methods: A literature review was conducted using PubMed and Scopus databases. Dates searched were from January 2017 to May 2021. Inclusion criteria included a diagnosis of cardiac amyloidosis, use of EKG, and echocardiogram participants 18 years and older. Articles were excluded if they were duplicates, had an irrelevant title, or were incomplete. Results: Results indicated neither EKG nor echocardiogram alone or in combination are sufficient for diagnosing cardiac amyloidosis. There is, however, a combination of findings that could potentially prove useful in "ruling in" cardiac amyloidosis and prompt further evaluation. Predominant findings in cardiac amyloidosis cohorts found on EKG showed low-voltage QRS complexes, a pseudo-infarct pattern in precordial leads, and an absence of left ventricular hypertrophy on EKG. There is no single echocardiogram finding specific to cardiac amyloidosis. Patients will generally present with thickened ventricular walls, and nearly all patients will display a preserved left ventricular ejection fraction until later stages of disease. Strain imaging, either via 2D or 3D transthoracic echocardiogram, is more useful in screening for or detecting cardiac amyloidosis and should be utilized in this instance. Findings in cardiac amyloidosis include decreased global longitudinal strain and relative apical sparing. Conclusion: Overall, EKG and echocardiogram are effective, feasible, and practical tools to increase clinical suspicion for cardiac amyloidosis for the purposes of early recognition and evaluation. These are useful only to "rule in" a diagnosis. Future studies are needed to validate these findings.

[Correlation index amylase-creatinine clearance to endogenous creatinine clearance in severe preeclampsia]. / Correlación del indice de aclaramiento amilasa-creatinina con la depuración de creatinina endógena en la preeclampsia severa.

INTRODUCTION: Tubular lesion may cause acute renal insufficiency in pregnant patients with severe preeclampsia. OBJECTIVE: To describe the correlation between the amylase/creatinine clearance ratio and endogenous creatinine depuration in pregnant patients with severe preeclampsia. MATERIAL AND METHOD: Transversal study (pilot study) twenty eight women with pregnancies of 20 to 40 weeks complicated by severe preeclampsia were studied. Subjects had serum and urine creatinine and amylase determinations to calculate the amylase/creatinine clearance ratio (%). According to the results, two groups were formed: group A (> 3%) and group B (< or = 3%). The correlation between amylase/creatinine clearance ratio and endogenous creatinine depuration was evaluated. STATISTICAL ANALYSIS: measures of central tendency and dispersion, Student's t-test, Pearson correlation coefficient (r) and linear regression were used. RESULTS: Group A included 23 cases (82%) and group B included 5 cases (18%). Amylase/creatinine clearance ratio (%) for group A was 5.22 +/- 1.6 and for group B was 2.41 +/- 0.41 (p = 0.001). The endogenous creatinine depuration (mL /min. /1.73 m2 SC) for group A was 105.6 +/- 9.71 and for group B was 132.10 +/- 7.95 (p = 0.54). The r between amylase/creatinine clearance ratio and endogenous creatinine depuration for group A was -0.43 and for group B was -0.25. CONCLUSIONS: A moderately significant negative correlation exists between amylase/creatinine clearance ratio and endogenous creatinine depuration.

Shigella flexneri strains produce bacteriocins active against members of the human microbial intestinal flora.

The principal aim of this work was to detect the bacteriocinogenic capacity of S. flexneri strains on members of the human intestinal flora. A total of 49 bacteriocinogenic S. flexneri strains were isolated from individuals of both sexes and different ages. The bacteriocins were detected by means of the drop method using E. coli and B. fragilis as target strains. The serotypes of the S. flexneri were determined. The producer capacity of bacteriocins was analysed in 10 different colonies of the same cellular clone and also the arbitrary units were determined. The highest number of bacteriocinogenic S. flexneri strains were obtained from diarrhoeal individuals from 0-10 years old and the S. flexneri serotype 2a was the most abundant. It was demonstrated that E. coli and B. fragilis isolated from the normal intestinal flora of healthy individuals were susceptible to the bacteriocinogenic S. flexneri strains. By means of the determination of arbitrary units per ml of the bacteriocin, it was demonstrated that colonies from a single colony isolate of a same clone of bacteriocinogenic S. flexneri produce different quantities of bacteriocin.

Effects of the bacteriocin PsVP-10 produced by Pseudomonas sp. on sensitive bacterial strains.

The bacteriocin PsVP-10 is a 2.6 Kda peptide which was isolated and purified from Pseudomonas sp. This bacteriocin possesses lethal activity over Enterococcus faecalis, Salmonella typhimurium and Shigella flexneri. The experimental assays showed that the bacteriocin is able to be adsorbed by all cells of these bacterial species and also by their isolated cell walls. It was observed that the resistant mutants and their respective cell walls are unable to adsorb the bacteriocin. Assays performed with spheroplasts obtained from sensitive bacterial species and their resistant mutants show a rapid lethal effect of the bacteriocin PsVP-10. This results indicated furthermore, it is also shown that the optimal pH and temperature for the adsorption were 7.2 and 37 degrees C, respectively. The study carried out with organic solvents like methanol, ethanol, isopropanol and the detergents sodium dodecyl sulfate and triton X-100 showed a moderate inhibition of the bacteriocin lethal action for the Gram negative cells. The enzymes lysozime, protease XIV and trypsine type III-S did not present any effect over the adsorption capacity of the bacteriocin with any of the bacterial species studied.