Differential cardiomyocyte transcriptomic remodeling during in vitro Trypanosoma cruzi infection using laboratory strains provides implications on pathogenic host responses.

BACKGROUND: Chagas disease can lead to life-threatening cardiac manifestations. Regional factors, including genetic characteristics of circulating Trypanosoma cruzi (T. cruzi), have attracted attention as likely determinants of Chagas disease phenotypic expression and Chagas cardiomyopathy (CCM) progression. Our objective was to elucidate the differential transcriptomic signatures of cardiomyocytes resulting from infection with genetically discrete T. cruzi strains and explore their relationships with CCM pathogenesis and progression. METHODS: HL-1 rodent cardiomyocytes were infected with T. cruzi trypomastigotes of the Colombian, Y, or Tulahuen strain. RNA was serially isolated post-infection for microarray analysis. Enrichment analyses of differentially expressed genes (fold-change ≥ 2 or ≤ 0.5) highlighted over-represented biological pathways. Intracellular levels of reactive oxygen species (ROS) were compared between T. cruzi-infected and non-infected HL-1 cardiomyocytes. RESULTS: We found that oxidative stress-related gene ontology terms (GO terms), 'Hypertrophy model', 'Apoptosis', and 'MAPK signaling' pathways (all with P < 0.01) were upregulated. 'Glutathione and one-carbon metabolism' pathway, and 'Cellular nitrogen compound metabolic process' GO term (all with P < 0.001) were upregulated exclusively in the cardiomyocytes infected with the Colombian/Y strains. Mean intracellular levels of ROS were significantly higher in the T. cruzi-infected cardiomyocytes compared to the non-infected (P < 0.0001). CONCLUSIONS: The upregulation of oxidative stress-related and hypertrophic pathways constitutes the universal hallmarks of the cardiomyocyte response elicited by T. cruzi infection. Nitrogen metabolism upregulation and glutathione metabolism imbalance may implicate a relationship between nitrosative stress and poor oxygen radicals scavenging in the unique pathophysiology of Chagas cardiomyopathy.

Diagnóstico antenatal de cardiopatías congénitas por telemedicina: experiencia en CERPO, 2017-2022 / Antenatal diagnosis of congenital heart disease by telemedicine: experience in CERPO, 2017-2022

Introducción: Las cardiopatías congénitas son las anomalías más frecuentes y la principal causa de muerte infantil y neonatal. El diagnóstico prenatal mejora el resultado perinatal determinando el lugar de nacimiento y el nivel de cuidado neonata. La telemedicina mediante videoconferencia en tiempo real permite mejorar la precisión diagnóstica y planificar el nacimiento. Objetivo: Determinar el diagnóstico y manejo perinatal de fetos con sospecha de cardiopatía congénitas, evaluadas a través de telemedicina en tiempo real atendidas en CERPO en el periodo 2017-2022. Material y métodos: Estudio retrospectivo de las evaluaciones mediante telemedicina en tiempo real realizadas en CERPO entre los años 2017 a 2022. Se revisó el resultado perinatal y se compararon los diagnósticos pre y postnatales, extraídos de la base de datos CERPO y Unidad de Neonatología del Hospital Luis Tisné Brousse. Resultados: La correlación del diagnóstico de cardiopatía congénita mediante telemedicina es de un 81,8% y de 89,8% con el diagnostico posnatal. Conclusiones: La evaluación por medio de telemedicina permite mejorar la precisión diagnostica de la cardiopatía congénita en áreas con escaso acceso a operadores experimentados en evaluación cardiaca fetal. Esto minimiza el impacto económico y social asociado al manejo perinatal de un feto con cardiopatía congénita en nuestro país.

Introduction: Congenital heart disease is the most common anomaly and the leading cause of infant and neonatal death. Prenatal diagnosis improves perinatal outcomes by choosing the right place of birth and level of neonatal care. Telemedicine by videoconferencing in real-time allows for improved diagnostic accuracy and birth planning. Objective: To determine the diagnosis and perinatal management of fetuses with suspected congenital heart disease, evaluated by telemedicine at CERPO in the period 2017-2022. Material and Methods: Retrospective study of evaluations via real-time videoconferencing performed at CERPO between 2017-2022. The perinatal outcome was reviewed, and pre and postnatal diagnoses were compared. The data was extracted from the CERPO database and the Neonatology Unit of the Luis Tisné Brousse Hospital. Results: The correlation of congenital heart disease diagnosis by telemedicine was 81.8% and 89.8% with postnatal diagnosis. Conclusions: Telemedicine assessment improves the diagnostic accuracy of congenital heart disease in areas with poor access to an experienced fetal cardiac specialist. This minimizes the economic and social impact associated with our countrys perinatal management of a fetus with congenital heart disease.

Atividades da vida diária de pacientes após transplante pulmonar / Daily life activities of patients after lung transplantation

Objetivo: conhecer as atividades da vida diária através da percepção dos pacientes sobre os cuidados após o transplante pulmonar. Metodologia: estudo descritivo, com abordagem qualitativa, através de grupo focal com 10 pacientes, no período de março a abril de 2018. Na análise dos dados foi utilizada a análise do conteúdo. Respeitaram-se os princípios éticos da pesquisa envolvendo seres humanos e o estudo foi aprovado pelo Comitê de Ética com o número 1.146.838. Resultados: emergiram três categorias temáticas: Atividades da vida diária; Cuidados após o transplante pulmonar e Nível de entendimento. Conclusão: o estudo identificou que os pacientes desenvolveram atividades de autocuidado como tomar banho sozinho e comer sem ajuda, modificaram hábitos alimentares, e aumentaram os cuidados com as medicações prescritas. (AU)

Objective: To know the activities of daily living through the perception of patients about care after lung transplantation. Methodolgy: a descriptive study with a qualitative approach through a focus group with 10 patients, from March to April 2018. In the data analysis was used the content analysis. The ethical principles of research involving human subjects were respected and the study was approved by the Ethics Committee under number 1.146.838. Results: three thematic categories emerged: instrumental activities of daily living; Care after lung transplantation and Level of understanding. Conclusion: The study found that patients developed self-care activities such as bathing alone and eating unaided, modified eating habits, and increased care with prescribed medications. (AU)

Objetivo: Conocer lãs actividades de la vida diária através de La percepción de los pacientes sobre la atención después del trasplante pulmonar. Metodología: um estúdio descriptivo com um enfoque cualitativo através de um grupo focal com 10 pacientes, de marzo a abril de 2018. En el análisis de datos se utilizo el análisis de contenido. Se respetaron los princípios éticos de la investigación en seres humanos y el estúdio fue aprobado por el Comitê de Ética con el número 1.146.838. Resultados: surgieron tres categorias temáticas: actividades de la vida diária; Atención después del trasplante de pulmón y nível de comprensión. Conclusión: el estúdio encontro que los pacientes desarrollaron actividades de autocuidado como bañarse solo y comer sin ayuda, hábitos alimentícios modificados y uma mayor atención con medicamentos recetados. (AU)

Zika virus-induced neurological critical illness in Latin America: Severe Guillain-Barre Syndrome and encephalitis.

Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection. We included 10 critically ill patients with ZIKAV infection, as diagnosed with RT-PCR, admitted to the ICU. Neurologic manifestations concordant with Guillain-Barre Syndrome (GBS) were present in all patients, although 2 evolved into an encephalitis-like picture. 2 cases died, one due to encephalitis, the other septic shock. CONCLUSIONS: Differing from what was usually reported, ZIKAV infection can result in life-threatening neurologic illness in adults, including GBS and encephalitis. Collaborative reporting to identify severe illness from an emerging pathogen can provide valuable insights into disease epidemiology and clinical presentation, and inform public health authorities about acute care priorities.

[Relationship between domestic violence during pregnancy and risk of low weight in the newborn]. / Relación entre la violencia familiar durante el embarazo y el riesgo de bajo peso en el recién nacido.

OBJECTIVES: To determine the prevalence and characteristics of domestic violence before and during pregnancy, and its impact on obstetrical and perinatal outcomes, as well as to identify the main variables associated to domestic violence during pregnancy. PATIENTS AND METHODS: From August to September 2004, 288 consecutive women in the puerperium period were screened for a cross-sectional study in the Hospital General Dr. Manuel Gea Gonz6lez. The Abuse Assessment Screen and the IPPF screening instrument were used to measure emotional and physical abuse during pregnancy. Outcome data included miscarriage, cesarean delivery, gestational age, birth weight and Apgar score. Odds ratios and 95% confidence intervals were calculated to measure the associations between maternal characteristics, perinatal outcome and violence. RESULTS: The prevalence of domestic violence during pregnancy was 39.24%. Emotional abuse was the most prevalent type before and during pregnancy (94.71 and 96.46%, respectively) whereas the frequency of physical and sexual decreased during pregnancy. Domestic violence 12 months before pregnancy increased risk of low birth weight (OR: 1.69; 95% CI: 1.01-2.81), and miscarriage (OR: 2.09; 95% CI 1.14-3.83). The exposure to domestic violence anytime before pregnancy (OR: 3.13; 95% CI 1.48-6.63) and 12 months before pregnancy (OR: 12.79; 95% CI 6.38-25.6) increased risk of domestic violence during pregnancy. CONCLUSIONS: Violence before and during pregnancy is common and is associated with adverse maternal and perinatal outcomes. There is a critical need to include a routine screening in the obstetric and gynecologic services and to provide medical and social services.

[Domestic violence: an approach from gynecology and obstetrics]. / Violencia familiar: una aproximación desde la ginecología y obstetricia.

Violence against women represents a serious violation of women's human rights and has been recognized as a clinical and public health problem, independently of nationality, ethnicity, cultural norms and socioeconomic status. One of the most common forms of violence against women is that perpetrated by an intimate male partner. The intimate partner violence has short-term and long-term negative health consequences, which provoke a poor quality of life with high use of health services, and even the suicide and homicide of women. Specifically, abuse during pregnancy is associated with sexually transmitted diseases, anemia, first and second trimester bleeding, less than optimal weight gain, deleterious perinatal outcomes (low birth weight, miscarriage, and fetal distress) and maternal or infant deaths. The purpose of this review is to emphasize the serious health consequences of the partner violence, and to compile the studies that have measured violence during pregnancy, particularly in Latin America.

[Attitudes and hierarchy of medical values in a gynecology and obstetrics department]. / Actitudes y jerarquía de valores en un servicio de ginecología y obstetricia.

BACKGROUND: The current practice of medicine is suffering a deep crisis of values due to the process of super-specialization, marketing tendencies, growing and the practice of a defensive medicine. OBJECTIVE: To examine the attitudes and hierarchy of medical values in undergraduate students, residents and faculty physicians in an obstetrics and gynecology department. MATERIAL AND METHODS: A descriptive, open, observational and transversal study was done, in which a questionnaire including a demographic data-record and 22 questions related to values and attitudes was applied to 29 individuals belonging to the medical staff of the gynecology and obstetrics service at Hospital General Dr. Manuel Gea Gonzalez. RESULTS: Medical knowledge, honesty and respect were consistently mentioned as the most emphasized characteristics across the examination. Benevolence and compassion were frequently indicated in undergraduate students, but not in third year residents and specialists. Respect for the right of individual patients to make their own choices about their health care, in some doctors, is a problematic issue. CONCLUSIONS: The teaching of professionalism is important in residency training and is expected to be an equal partner in the triad of knowledge, skills and values.

[Current concepts of venous thromboembolism and anticoagulation during pregnancy]. / Conceptos actuales en tromboembolismo venoso y anticoagulación durante el embarazo.

The pregnancy is a physiologic state with an elevated risk for thromboembolic complications. Clinical diagnosis and many diagnostic tests are less accurate in pregnant than in nonpregnant patients. The principal indications for anticoagulation during pregnancy include treatment and prophylaxis of deep vein thrombosis and pulmonary embolism, and prevention of pregnancy loss in women with antiphospholipid antibodies. However, the use of anticoagulants may produce complications in the fetus, as well as in the mother. This paper provides recommendations for the safe use of anticoagulants during pregnancy.