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Objetivo: Valorar el impacto de la implementación de un programa de medidas de prevención de la neumonía asociada a la ventilación mecánica durante 12 meses. Diseño: Estudio de implementación de estrategias de mejora cuasiexperimental, de intervención antes-después sin población de control. La intervención consistió en la aplicación de un paquete de medidas para prevenir la neumonía asociada a la ventilación mecánica. Ámbito: Unidad de Cuidados Intensivos Pediátricos del Hospital Abete, Buenos Aires, Argentina. Pacientes: Niños de entre 30 días de vida y 16 años de edad, con requerimiento de ventilación mecánica invasiva por, al menos, 48 horas. Intervenciones: Las estrategias de prevención se aplicaron desde el 1 de enero hasta el 31 de diciembre de 2014. Variable de interés: Episodio de neumonía asociada a la ventilación mecánica, según los criterios de diagnóstico consensuados. Resultados: La tasa de uso de ventilación mecánica se mantuvo estable durante el período 2013-2014 (55,9% y 55%, respectivamente). A partir de la implementación del paquete de medidas de prevención, se observó una disminución de los episodios de neumonía asociada a la ventilación mecánica en 2014 (tasa de neumonía asociada a la ventilación mecánica del 0,7‰ comparada con una tasa del 3,8‰ en 2013).Conclusiones: Todas las estrategias de prevención han tenido un efecto significativo en la disminución de los episodios de neumonía asociada a la ventilación mecánica. Su presencia se asocia a mayor morbilidad, aumento de la estadía hospitalaria, incremento de los días de ventilación mecánica y de los costos hospitalarios.(AU)

Objective: To evaluate the effect of a bundle of strategies for prevention of ventilator-associated pneumonia during a period of 12 months. Design: Implementation study of quasi experimental improvement strategies, before-after intervention with no control group. The intervention consisted in the implementation of a bundle of strategies for the prevention of ventilator-associated pneumonia. Setting: Pediatric Intensive Care Unit, Hospital Abete, Buenos Aires, Argentina. Patients: Children between 30 days of life and 16 years with mechanical ventilation requirement of at least 48 hours. Interventions: Prevention strategies were implemented from January 1st to December 31st, 2014. Variable of interest: The primary outcome measured was the development of ventilator-associated pneumonia, according to the agreed diagnostic criteria. Results: The mechanical ventilation use rate remained stable during the period 2013-2014 (55.9% and 55%, respectively). After the development of prevention strategies, a decrease in ventilator-associated pneumonia events was observed in 2014 (ventilator-associated pneumonia rate of 0.7‰ in comparison to 3.8‰ in 2013). Conclusions: All prevention strategies have shown a significant effect in reducing events of ventilator-associated pneumonia. It contributes to a higher morbidity leading to longer hospital stay, duration of mechanical ventilation and higher costs of hospitalization(AU)

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Effects of sucralose sweetener on blood constituents labelled with technetium-99m ((99m)Tc) on red blood cell (RBC) morphology, sodium pertechnetate (Na(99m)TcO(4)) and diethylenetriaminepentaacetic acid labeled with (99m)Tc ((99m)Tc-DTPA) biodistribution in rats were evaluated. Radiolabeling on blood constituents from Wistar rats was undertaken for determining the activity percentage (%ATI) on blood constituents. RBC morphology was also evaluated. Na(99m)TcO(4) and (99m)Tc-DTPA biodistribution was used to determine %ATI/g in organs. There was no alteration on RBC blood constituents and morphology %ATI. Sucralose sweetener was capable of altering %ATI/g of the radiopharmaceuticals in different organs. These findings are associated to the sucralose sweetener in specific organs.

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Effects of Cinnamomum zeylanicum (cinnamon) on the labelling of blood constituents with technetium-99m(99mTc) and on the morphology of red blood cells were studied. Blood samples from Wistar rats were incubated with cinnamon extract for 1 hour or with 0.9% NaCl, as control. Labelling of blood constituents with 99mTc was performed. Plasma (P) and blood cells (BC), soluble (SF-P and SF-BC) and insoluble (IF-P and IF-BC) fractions were separated. The radioactivity in each fraction was counted and the percentage of radioactivity incorporated (%ATI) was calculated. Blood smears were prepared, fixed, stained and the qualitative and quantitative morphological analysis of the red blood cells was evaluated. The data showed that the cinnamon extract decreased significantly (p<0.05) the %ATI on BC, IF-P and IF-BC. No modifications were verified on shape of red blood cells. Cinnamon extracts could alter the labelling of blood constituents with 99mTc, and although our results were obtained with animals, precaution is suggested in interpretations of nuclear medicine examinations involving the labelling of blood constituents in patients who are using cinnamon.

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Acetylsalicylic acid is the most widely used drug as antipyretic, analgesic, anti-inflammatory agent and for secondary prevention of thrombotic phenomena in the heart, brain and peripheral circulation. Drugs can modify the labeling of blood constituents with technetium-99m (99mTc). This work has evaluated the effect of in vivo treatment with acetylsalicylic acid on the in vitro labeling of the blood constituents with 99mTc. Wistar rats were treated with different doses (1.5, 3.0 and 6.0 mg/kg) of acetylsalicylic acid during 1 hour. At higher dose used (6.0 mg/kg) animals were treated during different period of time (0.25, 1.0 and 4.0 hours). Animals treated with physiologic saline solution were used as control. After the labeled process; plasma (P), blood cells (BC), insoluble (IF-P, IF-BC) and soluble (SF-P, SF-BC) fractions were separated. Afterwards, the percentage of radioactivity (%ATI) in each fraction was calculated. The treatment during 1 hour with acetylsalicylic acid at higher dose has significantly (p < 0.05) modified the fixation of 99mTc on blood cells. Considering the results, we suggest that acetylsalicylic acid used at therapeutic doses may interfere with the nuclear medicine procedures related to these blood constituents.

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Acetaminophen (AAP), acetylsalicylic acid (ASA) and dipyrone (DIP) are antipyretic and analgesics drugs that have wide use in health sciences. Some drugs can modify the labeling of blood elements with technetium-99m (99mTc). This work has evaluated the effect of AAP, ASA and DIP on the labeling of the blood elements with 99mTc. Blood was incubated with different concentrations of the drugs before the 99mTc-labeled process. Plasma (P), blood cells (BC), insoluble (IF-P, IF-BC) and soluble (SF-P, SF-BC) fractions were separated and percentage of radioactivity (%ATI) in each fraction was determined. Data have shown that the antipyretic drugs used in this study did not significantly modify the fixation of 99mTc on the blood elements when the experiments were carried out with the doses usually used in human beings. Although the experiments were carried out with rats, it is possible to suggest that AAP, ASA or DIP should not interfere with the procedures in nuclear medicine involving the labeling of blood elements with 99mTc.

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The induction of heme oxygenase in rat liver by cobaltous chloride (CoCl2) and Co-protoporphyrin IX is entirely prevented by the administration of alpha-tocopherol and allopurinol. CoCl2 was converted in the liver into Co-protoporphyrin IX before it induced heme oxygenase activity. Actinomycin and cycloheximide affected to a similar degree the induction of heme oxygenase by both CoCl2 and Co-protoporphyrin IX. Administration of either CoCl2 or Co-protoporphyrin strongly decreased the intrahepatic GSH pool, a decrease which was completely prevented by the administration of either alpha-tocopherol or allopurinol. The latter compounds prevented heme oxygenase induction as well as the decrease in hepatic GSH when administered 2 h before, together with, or 2 h after CoCl2. However, when given 5 h after administration of CoCl2, alpha-tocopherol and allopurinol showed no preventive effect. Similar results were obtained when Co-protoporphyrin IX was used, with the difference that when alpha-tocopherol and allopurinol were given 2 h after administration of the inducer, they showed no protective effect. Phenylhydrazine and diamide also induced heme oxygenase activity in rat liver. This inductive effect was preceded by a decrease in the intrahepatic GSH pool, which took place several hours before induction of the oxygenase. Administration of alpha-tocopherol and allopurinol prevented induction of the oxygenase but had no effect on the decrease in GSH levels. These results suggest that the induction of heme oxygenase by phenylhydrazine and the diamide is preceded by an oxidative stress which very likely originates in the depletion of GSH. The induction of heme oxygenase by hemin was not prevented by administration of alpha-tocopherol or allopurinol. Coprotoporphyrin IX did not affect the pattern of the molecular forms of hepatic biliverdin reductase, at variance with CoCl2, which is known to convert molecular form 1 of the enzyme into molecular form 3.

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Rat liver biliverdin reductase exists in two molecular forms. The major one (molecular form 1) is transformed, under conditions of oxidative stress into another molecular form (molecular form 3) which is an S-S bridged dimer of form 1. The chemical modifications of the thiol, arginine and lysine residues of molecular form 1 which resulted in an inhibition of its catalytic activity did not affect the activity of molecular form 3. Rabbit polyclonal antibodies raised against form 1 did not recognize form 3. This lack of recognition persisted even when the dimer (form 3) was denatured with SDS or urea under non-reductive conditions. Reduction of form 3 with reduced thioredoxin gave the monomeric form 1, which was fully recognized by the antibodies. The latter recognized the biliverdin reductases from rat spleen and kidney to the same extent as they did with form 1. Molecular form 1 was completely inhibited by the addition of the antibodies. This inhibition was prevented by preincubation of the enzyme with either the substrate (biliverdin) or the cosubstrate (NADPH). Preincubation with the latter or with NADP+ (but not with bilirubin) strongly impaired the recognition of form 1 by the antibodies. Modification of the lysine or arginine residues of form 1 which were involved in substrate binding, impaired the interaction of the enzyme with the antibodies. The antisera blocked the enzymatic conversion of form 1 to form 3, but alkylation of the thiol residue involved in this dimerization had no effect on the interaction of form 1 with the antibodies. The lack of recognition of form 3 by the antibodies suggest that the antigenic site of the former becomes buried upon dimerization.

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The effect of several methylputrescines on the activity of insulin-induced ornithine decarboxylase (ODC) was examined in H-35 hepatoma cells. The induction involved both protein and m-RNA synthesis. Actinomycin D inhibited ODC activity when given up to 1 h after insulin treatment. When added to the medium 2 h or 3 h after the insulin, the activity was increased 100% and 80% respectively. Insulin-induced ODC from H-35 cells had a biphasic half-life, a shorter one of 46 min and a longer one of 90 min. 1-Methylputrescine and 2-methylputrescine were found to be competitive inhibitors of the ODC from H-35 cells with Ki values of 2.8 and 0.1 mM respectively. Putrescine itself was found to have a Ki = 2.4 mM. N-Methylputrescine was a very poor inhibitor of the cell free ODC while 1,4-dimethylputrescine did not show any inhibitory effect. When cellular ODC activity was measured, the four methylputrescines assayed as well as putrescine entirely abolished its activity in the H-35 cells when given at a 1 mM concentration together with insulin. 1-Methylputrescine and 1,4-dimethylputrescine abolished 60% of the activity at a 0.1 microM concentration. All the methylputrescines given at 0.1 mM concentrations decreased the putrescine content of the stimulated cells to the levels found in quiescent cells, but only 1-methyl and 2-methylputrescines decreased spermidine and spermine content. 1,4-Dimethyl and 1-methylputrescines showed a strong inhibition of ODC synthesis, while the other diamines were less inhibitory. At concentrations that abolished ODC activity, 1,4-dimethylputrescine decreased 70% of the total immunoreactive ODC bands, while 1-methyl and 2-methylputrescine decreased them by 50%, and N-methylputrescine and putrescine decreased them by 20%. The lack of decrease in immuno-reactive ODC with the latter two compounds was mainly due to the appearance of immunoreactive degradation products of ODC of low molecular weight. Putrescine and N-methylputrescine affected protein synthesis to a small extent in stimulated cells, while 1-methylputrescine decreased it to the level of non-stimulated cells. Insulin (1 microM concentration) stimulated DNA synthesis in the cells, and this stimulation was doubled in the presence of 2-methylputrescine or putrescine. It can be concluded that, among the methylputrescines assayed, 2-methylputrescine was the best inhibitor of cell-free ODC activity, while 1,4-dimethylputrescine and 1-methylputrescine were the best inhibitors of cellular ODC activity.

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Biliverdin reductase (molecular form 1, EC 1.3.1.24, bilirubin:NAD(P)+ oxidoreductase) carries three thiol residues. Only one of them could be alkylated when a ratio N-ethylmaleimide (NEM)/mol enzyme's SH = 90 was used. The alkylation of this thiol group inhibited the conversion of molecular form 1 to its dimer, molecular form 3; however, it did not inhibit the enzymatic activity. At a ratio of NEM/enzyme's SH = 300, two thiol residues were alkylated and the activity of the enzyme was totally inhibited. The third thiol group could not be alkylated either by NEM or by iodoacetamide. Biliverdin as well as the co-substrate NADPH protected the thiol residue essential for the enzymatic activity from alkylation. Spectroscopic evidence was obtained that this thiol group binds covalently to the C-10 of biliverdin to form a rubinoid adduct. The presence of a lysine residue, which is also essential for the enzymatic activity, could be inferred from the fact that by reduction of the Schiff base formed by the enzyme with pyridoxal phosphate the catalytic activity was irreversibly abolished. The location of a lysine residue in the vicinity of the thiol group involved in the catalytic activity was evident when the enzyme was treated with o-phthalaldehyde. The inactivation of the enzymatic activity was coincident with the formation of the fluorescent isoindole derivative which originates when the thiol and epsilon-NH2 groups are located about 3 A apart. The presence of a positively charged ammonium ion in the vicinity of the NADPH binding site was inferred from the shifts in the UVmax of NADPH from 340 nm to 327 nm and of 3-acetyl NADPH from 360 nm to 348 nm when the pyridine nucleotides bind to the reductase. The involvement of arginine residues in the enzymatic activity was established by inhibition of the latter after reaction with butanedione. This inhibition was totally protected by NADPH but not by biliverdin. The similarity of the structural features of biliverdin reductase with those of several dehydrogenases is discussed.

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1,4-Dimethylputrescine (2,5-hexanediamine) was separated into its racemic and meso isomers by fractional crystallization of its dibenzoyl derivative. The racemic form was resolved into its (+)- and (-)-isomers with (+)- and (-)-dibenzoyltartaric acids. None of the three isomers (meso, +, and -) inhibited ornithine decarboxylase (ODC) activity in vitro, while all the three were strongly inhibitory of ODC when assayed in vivo in rats or in H-35 hepatoma cells. In rat liver the three isomers also decreased the putrescine pool while only the (+)-isomer decreased spermidine content. In the H-35 cells the (-)- and (+)-isomers decreased the spermidine and spermine content. When ODC was induced in the latter by insulin it was found that the (-)-isomer strongly inhibited protein and ODC synthesis, while the (+)-isomer and the meso isomer were less inhibitory. The meso isomer was a good inducer of ODC antizyme in rat liver, while the (+)- and (-)-isomers were poor inducers of the former.

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Administration of phenylhydrazine to rats converted molecular form 1 of the liver biliverdin reductase into its disulfide bridged dimer (molecular form 3). This oxidative dimerization was shown not to be mediated by the NAD(+)-dependent dehydrogenase [(1984) Biochem. Biophys. Res. Commun. 121, 249-254]. Administration of diamide produced the same conversion. Although hepatic levels of GSH also decreased, no mixed disulfides of the reductase and GSH could be detected. Administration of the antioxidants allopurinol and alpha-tocopherol together with the diamide did not affect this conversion of molecular forms produced by the latter. The diamide also oxidized molecular form 1 of biliverdin reductase in vitro and molecular form 3 was formed. The chemical oxidation took place at a high rate and was partially inhibited by GSH but not by cysteine.

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