Chemical constituents and antifungal potential of Attalea geraensis Barb. Rodr. (Arecaceae) palm leaves, a species native to the Cerrado of Brazil

Fungal diseases, especially those that affect the root systems of plants, caused by Rhizoctonia and Macrophomina are limiting factors for achieving high crop yields. Alternatives to controlling fungi with chemical products drive the search for new options for bioactive compounds from plants. Attalea geraensis, a palm tree from the Brazilian Cerrado, is rich in flavonoids with antifungal actions. The objective of this work is to identify the chemical classes present in the ethanolic extract of green leaves of A. geraensis and determine the antifungal potential of the extract against isolates of Macrophomina phaseolina (Tassi) Goid. and Rhizoctonia solani JG Kühn. Phytochemical prospection, flavonoid dereplication, and antifungal activity were carried out of the ethanolic extract of the green leaves of A. geraensis harvested in the Cerrado area of Brazil. Steroids, triterpenes, saponins, and anthraquinones are described here for the first time for the leaves of A. geraensis. The flavonoids quercetin, isorhamnetin, 3,7-dimethylquercetin, quercetin 3-galactoside, 5,7-dihydroxy-2-(4-hydroxy-3-methoxyphenyl)-3-{[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy}-4H-chromen-4-one, rhamnazin 3-galactoside, keioside, and rhamnazin 3-rutinoside were identified. Of these, only quercetin and isorhamnetin had already been identified in the leaves of A. geraensis. The results show a fungistatic potential for the species. The diversity of flavonoids present in the leaves of A. geraensis may be the result of a synergistic action between fungus and plant or there could be an antagonistic effect between flavonoids and the other identified chemical classes.

Patient with adrenal insufficiency due to a de novo mutation in the NR0B1 gene

Objectives

Congenital X-linked adrenal hypoplasia is a rare disease with a known genetic basis characterized by adrenal insufficiency, hypogonadotropic hypogonadism, and a wide variety of clinical manifestations.

Case presentation

We present the case of a 26-day old male newborn with symptoms consistent with adrenal insufficiency, hyponatremia, and hyperkalemia. Following NaCl and fludrocortisone supplementation, the patient remained clinically stable. 17-OH-progesterone testing excluded congenital adrenal hyperplasia. The rest of hormones were within normal limits, except for adrenocorticotropic hormone (ACTH), which was significantly elevated, and aldosterone, which was below the reference value. Further testing included very long chain fatty acids to exclude adrenoleukodystrophy, the CYP11B2 gene (aldosterone synthase), and an MRI to screen for other morphological abnormalities. All tests yielded normal results. Finally, after cortisol deficiency was detected, expanded genetic testing revealed a mutation in the NR0B1 gene, which led to a diagnosis of congenital adrenal hypoplasia.

Conclusions

Diagnosis of congenital adrenal hypoplasia is challenging due to the heterogeneity of both clinical manifestations and laboratory abnormalities. As a result, diagnosis requires close monitoring and genetic testing.

Recommendations for the measurement of sexual steroids in clinical practice. A position statement of SEQCML/SEEN/SEEP

The proper clinical approach to a wide range of disorders relies on the availability of accurate, reproducible laboratory results for sexual steroids measured using methods with a high specificity and sensitivity. The chemiluminescent immunoassays currently available have analytical limitations with significant clinical implications. This position statement reviews the current limitations of laboratory techniques for the measurement of estradiol and testosterone and their impact on diverse clinical scenarios. A set of recommendations are provided to incorporate steroid hormone analysis by mass spectrometry in national health systems. International societies have recommended this methodology for a decade.

Executive summary of the position statement of the Spanish Societies SEQCML/SEEN/SEEP. Recommendations for the measurement of sex steroids in clinical practice

Accurate measurement of sex steroids, particularly testosterone and estradiol, is relevant for the diagnosis and treatment of a wide range of conditions. Unfortunately, current chemiluminescent immunoassays have analytical limitations with important clinical consequences. This document reviews the current state of clinical assays for estradiol and testosterone measurements and their potential impact in different clinical situations. It also includes a series of recommendations and necessary steps to introduce steroid analysis by mass spectrometry into national health systems, a methodology recommended for more than a decade by international societies.

Macroprolactin: From laboratory to clinical practice

Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.

Oncideres saga Dalman: first record damaging Stryphnodendron adstringens Mart. Coville (Fabaceae) in Brazil

Oncideres females girdle tree branches of the Fabaceae family, interrupting the sap flow and turning the wood conditions ideal for their larvae development. The bark of Stryphnodendron adstringens (Mart.) Coville, a species native to the Brazilian Cerrado, is widely used in the traditional medicine. The objectives were to report, for the first time, Oncideres saga (Dalman), using S. adstringens as a host and to describe the pattern of branch girdling and oviposition distribution by this insect on these branches. The diameter at the base and the length of the girdled branches were measured and the number of incisions made by the O. saga females to oviposit, per branch section (basal, median and apical), counted. The emerged specimens were counted and the diameter of the exit holes measured. The average diameter at the base of the girdled branches was 2.5 ± 0.16 cm and the length was 90.6 ± 4.6 cm. The average number of incisions per branch was 37.7 ± 2.7. Damage by O. saga can reduce the growth and cause losses on S. adstringens, a tree with great extractivism potential.

Macroprolactin: From laboratory to clinical practice

Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.

[50 years of the Neonatal Screening Program in Catalonia.]

The Catalonian Newborn Screening Program (CNSP) began in 1969, in Barcelona. It was promoted by Dr. Juan Sabater Tobella and supported by Barcelona Provincial Council and Juan March Foundation. That is how the Institute of Clinical Biochemistry was born, whose aims were diagnosis, research and teaching, along with the spirit of contributing to the prevention of mental retardation. The CNSP began with the detection of phenylketonuria (PKU), and, in 1982, the Program was expanded with the inclusion of congenital hypothyroidism detection. Towards 1990, the Program covered almost 100% of all newborns (NB) in Catalonia. In 1999, the CNSP was expanded with the incorporation of cystic fibrosis. It took fourteen years, until 2013, to make the largest expansion so far, with the incorporation of 19 metabolic diseases to the screening panel. The detection of sickle cell disease began in 2015 and in 2017 the detection of severe combined immunodeficiency was included. Currently, the CNSP includes 24 diseases in its main panel. Since 1969, 2,787,807 NBs have been screened, of whom 1,724 have been diagnosed with any of these diseases, and 252 of other disorders by differential diagnosis with those included in the main panel. The global prevalence is 1: 1,617 NBs affected by any of the diseases included in the CNSP and 1: 1,140 NBs if incidental findings diagnosed through the CNSP are included.

Economic selection indexes for Hereford and Braford cattle raised in southern Brazil

Economic selection indexes (EI) are considered the best way to select the most profitable animals for specific production systems. Nevertheless, in Brazil, few genetic evaluation programs deliver such indexes to their breeders. The aims of this study were to determine the breeding goals (BG) and economic values (EV, in US$) for typical beef cattle production systems in southern Brazil, to propose EI aimed to maximize profitability, and to compare the proposed EI with the currently used empirical index. Bioeconomic models were developed to characterize 3 typical production systems, identifying traits of economic impact and their respective EV. The first was called the calf-crop system and included the birth rate (BR), direct weaning weight (WWd), and mature cow weight (MCW) as selection goals. The second system was called the full-cycle system, and its breeding goals were BR, WWd, MCW, and carcass weight (CW). Finally, the third was called the stocking and finishing system, which had WWd and CW as breeding goals. To generate the EI, we adopted the selection criteria currently measured and used in the empirical index of PampaPlus, which is the genetic evaluation program of the Brazilian Hereford and Braford Association. The comparison between the EI and the current PampaPlus index was made by the aggregated genetic-economic gain per generation (Δ). Therefore, for each production system an index was developed using the derived economic weights, and it was compared with the current empirical index. The relative importance (RI) for BR, WWd, and MCW for the calf-crop system was 68.03%, 19.35%, and 12.62%, respectively. For the full-cycle system, the RI for BR, WWd, MCW, and CW were 69.63%, 7.31%, 5.01%, and 18.06%, respectively. For the stocking and finishing production system, the RI for WWd and CW was 34.20% and 65.80%, respectively. The Δ for the calf-crop system were US$6.12 and US$4.36, using the proposed economic and empirical indexes, respectively. Respective values were US$19.87 and US$18.22 for the full-cycle system and US$20.52 and US$18.52 in the stocking and finishing system. The efficiency of the proposed EI had low sensitivity to changes in the values of the economic and genetic parameters. The 3 EI generated higher Δ when using the proposed economic weight compared to the Δ provided by a PampaPlus index, suggesting the use of proposed EI to obtain greater economic profitability in relation to the current empirical PampaPlus index.

[Plasma 25-OH Vitamin D Concentrations in Cord Blood after Summer Months, Spain]

OBJECTIVE

Plasma vitamin D (25(OH)D) levels in the newborn are dependent on maternal stores. Several studies showing a high prevalence of vitamin D deficiency in pregnant women have been published last years. The aim of the study was to analyze 25(OH)D levels in cord blood after summer month, determine whether there is a relation with different variables.

METHODS

103 pregnant women were recruited between October and early December 2014, whose gestations took place during month of maximum sun exposure. Plasmatic 25(OH)D values were measured in cord blood at birth. Clinical record data were collected and a nutritional survey was made on maternal vitamin D and calcium intake and sun exposure. Statistical analysis was performed using SPSS. Comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests, and correction for multiple comparisons using Bonferroni. P value smaller than 0.05 and smaller than 0.0083 for multiple comparisons were considered sta¬tistically significant.

RESULTS

Mean 25(OH)D value in cord blood was 12.36± 7.2 ng/ml. Vitamin D deficiency was present in 83.4% of women. A statistically significant correlation was observed between lowvitamin D levels and low vitamin D intake (correlation coefficient 0.29); Ethnic group, with the highest level in caucasic group (17.9 ± 5.83 ng/ml) and the lowest in indopakistani group (6.68 ± 4.2 ng/ml); the use of traditional clothing (5.64 ± 3.09 ng/ml); low sun exposure and dark skin phototype with a correlation coefficient of 0.67 and -0.48, respectively.

CONCLUSIONS

There is a high prevalence of vitamin D deficiency in pregnant women regardless of the season and increased sun exposure. Low vitamin D levels in cord blood were significantly related to ethnicity (Indopakistan and Maghreb), low sun exposure and dark skin phototype. No statistically significant differences were found between vitamin D levels and perinatal variables studied.

Predictive value of ophthalmic artery Doppler velocimetry in relation to development of pre-eclampsia

OBJECTIVE

To test the hypothesis that ophthalmic artery Doppler velocimetry is predictive of the development of pre-eclampsia (PE).

METHODS

This was a prospective cohort study that included pregnant women in the second trimester who had risk factors for PE. Seven ophthalmic artery Doppler parameters, in addition to uterine artery (UtA) Doppler and clinical variables, were investigated for their prognostic value with respect to PE.

RESULTS

A total of 347 women were recruited, of whom 40 developed PE. A comparison of the mean ophthalmic artery Doppler parameter values between women with and those without PE showed statistically significant differences in several parameters: peak systolic velocity, end-diastolic velocity, mean velocity, peak mesodiastolic velocity (PMDV) and peak ratio. After adjusting for confounding variables, only PMDV remained statistically significant (P < 0.001), with an area under the receiver-operating characteristics curve (AUC) of 0.73. The best cut-off for predicting PE was a PMDV of > 22.11 cm/s, with sensitivity of 70%, specificity of 75%, positive likelihood ratio of 2.8, negative likelihood ratio of 0.4, positive predictive value of 28% and negative predictive value of 95%. The AUC increased from 0.72 to 0.78 when the PMDV was incorporated into a prediction model based on clinical variables, demonstrating that this marker increased the discriminatory capability of the model. The performance of ophthalmic artery Doppler was similar to that of UtA Doppler for predicting PE. Additionally, the AUC increased significantly from 0.82 to 0.88 when the PMDV was incorporated into the model containing clinical variables and UtA Doppler indices.

CONCLUSION

A high ophthalmic artery PMDV in the second trimester of pregnancy is an independent predictor of PE that increases the discriminatory ability of clinical markers, as well as of models that include clinical variables and UtA Doppler indices.

(67)Ga and (68)Ga purification studies: preliminary results

The positron emission tomography technique is very useful for diagnosis of several diseases. (68)Ga is a positron emitter with half-life of 67.7 min. As it is available from (68)Ge/(68)Ga generator systems, it is not necessary to have a nearby cyclotron. However, the eluate from commercial generators contains high levels of metallic impurities, which compete with (68)Ga in biomolecular labeling. Thus, a subsequent purification step is needed after generator elution. Here we present the results of two different methods developed for handmade purification of (68)Ga and (67)Ga for subsequent radiolabeling of biomolecules. Two purification methods were employed. The first one uses a cation exchange resin, and (68)Ga is eluted with a solution of acetone/acid. The second method of purification is performed by column chromatography solvent extraction, with (68)Ga recovery in deionized water. The best result was achieved with cationic resin AG50W-X8 (>400 mesh). However, the resin is not commercially available. The extraction chromatography column based on absorption of diisopropyl ether in XAD-16 is the most promising purification method. Although the levels of (68)Ga recovery and purification were smaller with the cationic resin method, its advantage is the (68)Ga recovery in deionized water.

Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy

The introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10% - 32%), with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2% - 20%). Recently the complications associated with these stones have been documented in the literature. We report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. During the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. Two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. After eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. We conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.