Atypical hemolytic uremic syndrome in a patient with HIV treated with eculizumab: A case report.

Thrombotic microangiopathy defines a group of pathologies characterized by microvascular dysfunction with the concurrence of microangiopathic hemolytic anemia, thrombocytopenia, and organ damage. It represents the most frequent microvascular manifestation of human immunodeficiency virus (HIV) infection. We report the case of a man in the seventh decade of life with a recent diagnosis of infection by HIV, who develops hemolytic uremic syndrome, requiring continuous renal replacement therapy and plasma replacement therapy, without response, ADAMTS13 with preserved activity, ruling out other etiologies (infectious, metabolic, and genetic) with successful response to eculizumab.

Development of a Highly Potent Transthyretin Amyloidogenesis Inhibitor: Design, Synthesis, and Evaluation.

Transthyretin amyloidosis (ATTR) is a group of fatal diseases described by the misfolding and amyloid deposition of transthyretin (TTR). Discovering small molecules that bind and stabilize the TTR tetramer, preventing its dissociation and subsequent aggregation, is a therapeutic strategy for these pathologies. Departing from the crystal structure of TTR in complex with tolcapone, a potent binder in clinical trials for ATTR, we combined rational design and molecular dynamics (MD) simulations to generate a series of novel halogenated kinetic stabilizers. Among them, M-23 displays one of the highest affinities for TTR described so far. The TTR/M-23 crystal structure confirmed the formation of unprecedented protein-ligand contacts, as predicted by MD simulations, leading to an enhanced tetramer stability both in vitro and in whole serum. We demonstrate that MD-assisted design of TTR ligands constitutes a new avenue for discovering molecules that, like M-23, hold the potential to become highly potent drugs to treat ATTR.

Estrés emocional relacionado con un terremoto como factor causante de un síndrome de takotsubo / Takotsubo syndrome associated with an earthquake. report of two cases

Takotsubo syndrome is an acute heart disease usually triggered by significant emotional or physical stress, very occasionally described in association with natural disasters such as earthquakes. Clinically, it simulates an acute myocardial infarction with similar symptoms, laboratory tests, and electrocardiographic changes. Coronary angiography shows the absence of significant coronary disease. We report two women, aged 71 and 80 years, and who developed a Takotsubo syndrome after an earthquake. In both, the syndrome was diagnosed with cardiac magnetic resonance imaging.

El rol de la resonancia magnética cardíaca en el diagnóstico diferencial entre miocarditis aguda e infarto agudo de miocardio con elevación del segmento ST / Cardiac magnetic resonance imaging for the diagnosis of acute myocarditis mimicking a myocardial infarction

BACKGROUND: Acute myocarditis frequently mimics an acute myocardial infarction, and its diagnosis is a clinical challenge. AIM: To describe the characteristics of cardiac magnetic resonance imaging in patients with acute myocarditis hospitalized with a diagnosis of ST-segment elevation myocardial infarction. PATIENTS AND METHODS: Twenty-four patients aged 33 ± 11 years (21 men) with a definitive diagnosis of acute myocarditis hospitalized with a presumptive diagnosis of ST-segment elevation myocardial infarction, in whom a coronary angiogram excluded significant atherosclerotic coronary lesions, were included. Cardiac magnetic resonance imaging with cine-resonance images was performed to assess global and regional ventricular function, and to study myocardial tissue characteristics. T2-STIR sequences were used for the assessment of oedema and late gadolinium enhancement for necrosis/fibrosis. RESULTS: Patients had high levels of total CK, CK-MB, troponin I, brain natriuretic peptide and C-reactive protein. Cardiac magnetic resonance imaging revealed myocardial edema and late gadolinium enhancement was identified in all patients. The edema was transmural in 86% and subepicardial in 14%. Enhancement was subepicardial in 74% of patients and intramural in 26%. It was located in the inferior and lateral walls of the left ventricle in 93%, without affecting the endocardium. In all patients, two of three Lake Louise criteria were met, and an acute myocarditis was diagnosed. CONCLUSIONS: Cardiac magnetic resonance imaging is the diagnostic method of choice for diagnosing acute myocarditis when it mimics an acute myocardial infarction.

Surface morphology controls water dissociation on hydrated IrO2 nanoparticles.

Iridium oxide is a highly efficient catalyst for the oxygen evolution reaction, whose large-scale application requires decreasing the metal content. This is achieved using small nanoparticles. The knowledge of the water-IrO2 nanoparticle interface is of high importance to understand the IrO2 behavior as electrocatalyst in aqueous solutions. In this contribution, DFT (PBE-D2) calculations and AIMD simulations on IrO2 nanoparticle models of different sizes ((IrO2)33 and (IrO2)115) are performed. Results show that two key factors determine the H2O adsorption energy and the preferred adsorption structure (molecular or dissociated water): metal coordination and hydrogen bonding with oxygen bridge atoms of the IrO2 surface. Regarding metal coordination, and since the tetragonal distortion existing in IrO2 is retained on the nanoparticle models, the adsorption at iridium axial vacant sites implies stronger Ir-H2O interactions, which favors water dissociation. In contrast, Ir-H2O interaction at equatorial vacant sites is weaker and thus the relative stability of molecular and dissociated forms becomes similar. Hydrogen bonding increases adsorption energy and favors water dissociation. Thus, tip and corner sites of the nanoparticle, with no oxygen bridge atoms nearby, exhibit the smallest adsorption energies and a preference for the molecular form. Overall, the presence of rather isolated tip and corner sites in the nanoparticle leads to lower adsorption energies and a smaller degree of water dissociation when compared with extended surfaces.

[Takotsubo syndrome associated with an earthquake. report of two cases]. / Estrés emocional relacionado con un terremoto como factor causante de un síndrome de takotsubo.

Takotsubo syndrome is an acute heart disease usually triggered by significant emotional or physical stress, very occasionally described in association with natural disasters such as earthquakes. Clinically, it simulates an acute myocardial infarction with similar symptoms, laboratory tests, and electrocardiographic changes. Coronary angiography shows the absence of significant coronary disease. We report two women, aged 71 and 80 years, and who developed a Takotsubo syndrome after an earthquake. In both, the syndrome was diagnosed with cardiac magnetic resonance imaging.

[Cardiac magnetic resonance imaging for the diagnosis of acute myocarditis mimicking a myocardial infarction]. / El rol de la resonancia magnética cardíaca en el diagnóstico diferencial entre miocarditis aguda e infarto agudo de miocardio con elevación del segmento ST.

BACKGROUND: Acute myocarditis frequently mimics an acute myocardial infarction, and its diagnosis is a clinical challenge. AIM: To describe the characteristics of cardiac magnetic resonance imaging in patients with acute myocarditis hospitalized with a diagnosis of ST-segment elevation myocardial infarction. PATIENTS AND METHODS: Twenty-four patients aged 33 ± 11 years (21 men) with a definitive diagnosis of acute myocarditis hospitalized with a presumptive diagnosis of ST-segment elevation myocardial infarction, in whom a coronary angiogram excluded significant atherosclerotic coronary lesions, were included. Cardiac magnetic resonance imaging with cine-resonance images was performed to assess global and regional ventricular function, and to study myocardial tissue characteristics. T2-STIR sequences were used for the assessment of oedema and late gadolinium enhancement for necrosis/fibrosis. RESULTS: Patients had high levels of total CK, CK-MB, troponin I, brain natriuretic peptide and C-reactive protein. Cardiac magnetic resonance imaging revealed myocardial edema and late gadolinium enhancement was identified in all patients. The edema was transmural in 86% and subepicardial in 14%. Enhancement was subepicardial in 74% of patients and intramural in 26%. It was located in the inferior and lateral walls of the left ventricle in 93%, without affecting the endocardium. In all patients, two of three Lake Louise criteria were met, and an acute myocarditis was diagnosed. CONCLUSIONS: Cardiac magnetic resonance imaging is the diagnostic method of choice for diagnosing acute myocarditis when it mimics an acute myocardial infarction.

Valor de la resonancia magnética cardíaca para el diagnóstico diferencial en pacientes con sospecha de infarto agudo de miocardio con elevación del segmento ST y arterias coronarias normales

Background: Patients hospitalized with suspected ST-segment elevation myocardial infarction (STEMI) who have normal coronary arteries (CAs) on invasive coronary angiography (ICA) may have an AMI or another acute cardiac disease that mimics it. Aim: To evaluate the usefulness of cardiac magnetic resonance imaging (CMRI) for diagnosing conditions resembling AMI with normal CAs. Material and Methods: We studied 424 consecutive patients admitted with suspected STEMI who underwent ICA. Those with normal CAs underwent CMRI involving cine-CMRI sequences to evaluate segmental wall motion, T2-weighted short-tau inversion-recovery imaging to detect oedema and delayed contrast enhancement (DCE) after gadolinium administration to identify necrosis/fibrosis. Patients with previous myocardial infarction were excluded. Results: Twenty-six patients (6.1%) had normal CAs. Definitive diagnosis after CMRI was acute myocarditis in 11 patients (42.3%) whose DCE was localized in the subepicardium or intramyocardially but not in the endocardium, AMI in nine patients (34.6%) who had subendocardial or transmural DCE, and Takotsubo cardiomyopathy (TCM) in six patients (23.1%), whose CMRI showed regional contractility abnormalities of the left ventricle and myocardial oedema but not DCE. Conclusions: Cardiac magnetic resonance imaging allows a precise diagnosis of acute myocardial infarction in patients with angiographically normal coronary arteries.

[Cardiac magnetic resonance imaging in patients with a suspected myocardial infarction and normal coronary arteries]. / Valor de la resonancia magnética cardíaca para el diagnóstico diferencial en pacientes con sospecha de infarto agudo de miocardio con elevación del segmento ST y arterias coronarias normales.

BACKGROUND: Patients hospitalized with suspected ST-segment elevation myocardial infarction (STEMI) who have normal coronary arteries (CAs) on invasive coronary angiography (ICA) may have an AMI or another acute cardiac disease that mimics it. AIM: To evaluate the usefulness of cardiac magnetic resonance imaging (CMRI) for diagnosing conditions resembling AMI with normal CAs. MATERIAL AND METHODS: We studied 424 consecutive patients admitted with suspected STEMI who underwent ICA. Those with normal CAs underwent CMRI involving cine-CMRI sequences to evaluate segmental wall motion, T2-weighted short-tau inversion-recovery imaging to detect oedema and delayed contrast enhancement (DCE) after gadolinium administration to identify necrosis/fibrosis. Patients with previous myocardial infarction were excluded. RESULTS: Twenty-six patients (6.1%) had normal CAs. Definitive diagnosis after CMRI was acute myocarditis in 11 patients (42.3%) whose DCE was localized in the subepicardium or intramyocardially but not in the endocardium, AMI in nine patients (34.6%) who had subendocardial or transmural DCE, and Takotsubo cardiomyopathy (TCM) in six patients (23.1%), whose CMRI showed regional contractility abnormalities of the left ventricle and myocardial oedema but not DCE. CONCLUSIONS: Cardiac magnetic resonance imaging allows a precise diagnosis of acute myocardial infarction in patients with angiographically normal coronary arteries.

Water Adsorption on MO2 (M = Ti, Ru, and Ir) Surfaces. Importance of Octahedral Distortion and Cooperative Effects.

Understanding metal oxide MO2 (M = Ti, Ru, and Ir)-water interfaces is essential to assess the catalytic behavior of these materials. The present study analyzes the H2O-MO2 interactions at the most abundant (110) and (011) surfaces, at two different water coverages: isolated water molecules and full monolayer, by means of Perdew-Burke-Ernzerhof-D2 static calculations and ab initio molecular dynamics (AIMD) simulations. Results indicate that adsorption preferably occurs in its molecular form on (110)-TiO2 and in its dissociative form on (110)-RuO2 and (110)-IrO2. The opposite trend is observed at the (011) facet. This different behavior is related to the kind of octahedral distortion observed in the bulk of these materials (tetragonal elongation for TiO2 and tetragonal compression for RuO2 and IrO2) and to the different nature of the vacant sites created, axial on (110) and equatorial on (011). For the monolayer, additional effects such as cooperative H-bond interactions and cooperative adsorption come into play in determining the degree of deprotonation. For TiO2, AIMD indicates that the water monolayer is fully undissociated at both (110) and (011) surfaces, whereas for RuO2, water monolayer exhibits a 50% dissociation, the formation of H3O2 - motifs being essential. Finally, on (110)-IrO2, the main monolayer configuration is the fully dissociated one, whereas on (011)-IrO2, it exhibits a degree of dissociation that ranges between 50 and 75%. Overall, the present study shows that the degree of water dissociation results from a delicate balance between the H2O-MO2 intrinsic interaction and cooperative hydrogen bonding and adsorption effects.

Small molecule inhibits α-synuclein aggregation, disrupts amyloid fibrils, and prevents degeneration of dopaminergic neurons.

Parkinson's disease (PD) is characterized by a progressive loss of dopaminergic neurons, a process that current therapeutic approaches cannot prevent. In PD, the typical pathological hallmark is the accumulation of intracellular protein inclusions, known as Lewy bodies and Lewy neurites, which are mainly composed of α-synuclein. Here, we exploited a high-throughput screening methodology to identify a small molecule (SynuClean-D) able to inhibit α-synuclein aggregation. SynuClean-D significantly reduces the in vitro aggregation of wild-type α-synuclein and the familiar A30P and H50Q variants in a substoichiometric molar ratio. This compound prevents fibril propagation in protein-misfolding cyclic amplification assays and decreases the number of α-synuclein inclusions in human neuroglioma cells. Computational analysis suggests that SynuClean-D can bind to cavities in mature α-synuclein fibrils and, indeed, it displays a strong fibril disaggregation activity. The treatment with SynuClean-D of two PD Caenorhabditis elegans models, expressing α-synuclein either in muscle or in dopaminergic neurons, significantly reduces the toxicity exerted by α-synuclein. SynuClean-D-treated worms show decreased α-synuclein aggregation in muscle and a concomitant motility recovery. More importantly, this compound is able to rescue dopaminergic neurons from α-synuclein-induced degeneration. Overall, SynuClean-D appears to be a promising molecule for therapeutic intervention in Parkinson's disease.

Taponamiento cardiaco secundario a pericarditis tuberculosa aguda en un paciente joven, no asociado a inmunosupresión / Cardiac tamponade secondary to acute tuberculous pericarditis in a young patient, not associated to immunosuppresion

Resumen La pericarditis tuberculosa representa un pequeño porcentaje de la tuberculosis extrapulmonar, cuyo diagnóstico aún constituye un reto por la variabilidad en su presentación. La terapia antimicrobiana dirigida es el pilar del tratamiento, el cual debe seguirse de manera cercana para evaluar las complicaciones asociadas. A continuación presentamos el caso de un hombre de 25 años de edad, previamente sano, quien cursó con el taponamiento cardiaco y la falla cardiaca aguda secundaria a la pericarditis tuberculosa, cuyo diagnóstico y factores de confusión jugaron un papel importante en el desarrollo del caso.

Tuberculous pericarditis represents a small percentage of extrapulmonary tuberculosis; its diagnosis still represents a challenge because of the variability of its presentation. Empirical antimicrobial therapy is the mainstay of treatment, which must be followed closely to assess any associated complications. The case of a 25-year old male, previously healthy, who developed cardiac tamponade and acute heart failure secondary to tuberculous pericarditis, whose diagnosis and confusion factors played an important role as the case progressed, is presented.

Historia clínica para trauma: registro hospitalario específico para pacientes traumatizados: un recurso para países en desarrollo / Trauma clinical record: specfic hospital record for traumatized patients: a resource for developing countries

Introducción: el trauma constituye en nuestro país la primera causa de muerte en la población menor de 40 años. La vigilancia epidemiológica es un elemento fundamental en lacomprensión de la enfermedad traumática y para ello la utilidad de los registros depende básicamente de la calidad de los datos recogidos. Objetivo: diseñar y comparar la historia clínica para traumatizados con la historia clínica general en cuanto a su eficacia cuantitativa y cualitativa para la recolección de datos específicos de los pacientes traumatizados. Material y método: se diseñó una historia clínica específica para la atención de los pacientes traumatizados. Se realizó a través del análisis retrospectivo su comparación con los datos de un número similar de historias clínicas generales (HCG) realizadas con anterioridad alcambio de formato. Resultados: se recogieron los datos de 86 historias clínicas de trauma (HCT) entre el 22 dejunio de 2006 y el 21 de marzo de 2007 y 87 HCG que se recolectaron en el período comprendido entre el 18 de octubre de 2005 y el 21 de junio de 2006. Para el análisis estadístico de los datos se utilizó la comparación de proporciones. Se estableció como erroralfa 5% (p< 0,05) y se calculó Z para cada comparación (Z calculado). Conclusiones: la HCT es claramente superior a la HCG desde el punto de vista cuantitativo y cualitativo para la recolección de datos del paciente traumatizado. Mediante una intervención de bajo costo económico permite acceder a una fuente de datosespecíficos que permiten el análisis de la enfermedad traumática en la llamada hora de oro.

Introduction: trauma constitutes the first cause of death in the population under 40 years old. Epidemiological vigilanceis essential for understanding trauma as a disease, and for this purpose usefulness of records basically dependson the quality of the data collected.Objective: to design and compare the clinical records of traumatized patients with general clinical records in terms of their quantitative and qualitative effectiveness for the collection of specific data of traumatized patients.Method: we designed a specific clinical record for traumatized patients. Subsequently through a retrospectiveanalysis, we compared it to the data in a similar number of general clinical records conducted prior to the formatchange. We collected the data of 86 trauma clinical records between June 22, 2006 and May 21, 2007, and 87 general clinical records that were collected between October 18, 2005 and June 21, 2006. The proportion comparison was used for the statistical analysis. Alpha error was set in 5%(p< 0,05) and we calculated Z for each comparison. (calculated Z).Conclusions: trauma medical records are clearly better than general clinical records form the quantitative andqualitative point of view for the collection of traumatized patientsÆ data. A low cost intervention enables the analysis of the trauma disease in the so called golden hour.

Introdução: o trauma é a primeira causa de norte em menores de 40 anos no Uruguai. A vigilância epidemiológica é um elemento fundamental para a compreensão da doença traumática e para isso a utilidade dos registros depende basicamente da qualidade dos dados coletados. Objetivo: planejar e comparar o prontuário médico para traumatizados tanto quali como quantitativo para a coleta de dados específicos dos pacientes traumatizados.Material e método: planejou-se um registro médico específico para a atenção de pacientes traumatizados. Fez se uma comparação com os dados obtidos de um número similar de prontuários médicos gerais realizados antes da adoção do novo formato. Foram coletados dados de 86 prontuários clínicos de trauma (HCT) do período 22 de junho de 2006-21 de maio de 2007, e de 87 prontuários médicos (HCG). A comparação de proporções foi o método utilizado para a análise estatística; se utilizou como erro alfa 5% (p<0,05) e Z foi calculado para cada comparação.Conclusões: a HCT é evidentemente superior a HCG tanto quanti como qualitativo para a coleta de dados do paciente traumatizado. A adoção de uma intervenção de baixo custo econômico permite ter acesso a uma fonte dedados específica que favorece a análise da patologia traumática na chamada hora de ouro.

Apropiación de los derechos sexuales y reproductivos en los adolescentes: una experiencia desde la teoría de la acción razonada / Appropiation of the reproductive and sex rights in adolescents: an experience since razoned action theory

Objetivo: Se realizó un estudio para evaluar la influencia que tienen las creencias, actitudes y normas subjetivas en el ejercicio de los derechos sexuales y reproductivos, en adolescentes escolarizados de Jamundí, Departamento del Valle del Cauca. Metodología: El diseño fue series de tiempo con muestras pareadas. Se aplicó una escala psicométrica a 128 adolescentes, antes de una intervención educativa, tres y seis meses después de la misma, y se obtuvieron resultados que demuestran que los(as) adolescentes lograron modificar positivamente la mayoría de las intenciones, actitudes y normas subjetivas relacionadas con los derechos sexuales y reproductivos.Resultados: Se encontraron cambios significativos con relación a: consultar a los profesionales de salud sobre los métodos anticonceptivos y sus usos; utilizar los métodos anticonceptivos en caso de tener relaciones sexuales, disminuir cualquier forma de abuso o violencia sexual y no tener pareja porque desea abstenerse de relaciones sexuales. Conclusiones: Estos resultados pueden configurarse como factores protectores frente a los riesgos derivados del ejercicio de la sexualidad sin responsabilidad, para concluir que la ejecución de una estrategia de educación en salud sexual y reproductiva integral enfocada hacia el apoderamiento de los(as) adolescentes frente a sus derechos sexuales y reproductivos puede modificar positivamente las intenciones, actitudes, y percepciones ante la sexualidad. Esta experiencia se convierte en un ejemplo útil para ejecutar en las instituciones educativas de educación media y así apoyar la Política Nacional de Educación Sexual en Colombia

Correlación entre los niveles séricos de IGF-1 y la longitud al nacer en neonatos con retardo del crecimiento intrauterino / Serum levels of insuline-like growth factor IGF-1 in newborns and correlate it with birth lengh

Objetivo. Determinar los niveles séricos de factor de crecimiento similar a la insulina 1 (IGF-1), en neonatos con crecimiento intrauterino retardado y su correlación con la longitud al nacer.Diseño. Estudio clínico de casos y controles. Población. Cuarenta neonatos. Metodología. Se midió por medio de ensayo radioinmunométrico los niveles de IGF-1 (ng/ml)en el suero de cuarenta neonatos de término, 20 con diagnóstico de retardo del crecimiento y 20 adecuados para su edad gestacional. Además se midió el peso y la longitud al nacer. Resultados. Los niveles séricos de IGF-1 medidos en sangre de cordón umbilical al momento del nacimiento están significativamente disminuidos en neonatos con retardo del crecimiento (media:25.36 ñ 6.3 ng/ml) en relación a los neonatos adecuados para su edad gestacional (media:59.95ñ11.4 ng/ml) (p<0.001). Exite además, una correlación directa entre los niveles IGF-1 y la longitud al nacer en los neonatos con crecimiento intrauterino retardado (r=0.45, n=20, p<0.05) No se encontró correlación entre los niveles séricos del IGF-1 y la longitud al nacer en los neonatos adecuados para su edad gestacional (r=0.30, n=20, p NS). Conclusiones: Los niveles séricos del IGF-1 se correlacionan adecuamente con la longitud al nacer en recién nacidos con retardo del crecimiento intrauterino