The control of dyslipidemia by using herbal products is an important subject for studies. In this study, we evaluated the effects of dry Passiflora incarnata L. extract over dyslipidemia, left ventricular hypertrophy, and hepatic oxidative stress of LDL receptor knockout mice (LDLr-/-). Forty 4-month old male LDLr-/-mice were distributed into four groups: Group standard diet; Group standard diet and 200 mg/kg of body weight of Passiflora incarnata L. leaf dry extract; Group high-fat diet; Group high-fat diet and 200 mg/kg of body weight of Passiflora incarnata L. leaf dry extract. After 30 days, Passiflora incarnata L. dry extract reduced the effects of the high-fat diet, with a decrease of total cholesterol, triglycerides, and increase of high-density lipoprotein (HDL), as well as a reduction of C-reactive protein, alkaline phosphatase and insulin. There was no effect on glucose, Homa index and enzymes aspartate aminotransferase and alanine aminotransferase. However, the prevention of left ventricular hypertrophy occurred, as well as lipid peroxidation and the production of carbonyl proteins, which are both oxidative stress markers. In conclusion, Passiflora incarnata L. dry extract acts in the prevention of dyslipidemia, consequently, hindering the occurrence of hepatic oxidative stress and the development of left ventricular hypertrophy by the increase of serum HDL, in mice that had the effects of a high-fat diet.
Background Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. Case presentation A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. Conclusion Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional “endocarditis team” is essential to achieve favorable clinical outcomes in such defiant scenarios.
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