Dietary oleacein, a secoiridoid from extra virgin olive oil, prevents collagen-induced arthritis in mice.

Olacein (OLA), one of the main secoiridoids derived from extra virgin olive oil (EVOO), has been shown to modulate oxidative and inflammatory responses in various pathological conditions; however, its potential benefit in joint disorders such as rheumatoid arthritis (RA) is unknown. Therefore, this study was designed to evaluate the preventive role of the effects of an OLA-supplemented diet in the murine model of collagen-induced arthritis (CIA), delving into the possible mechanisms and signaling pathways involved. Animals were fed an OLA-enriched preventive diet for 6 weeks prior to CIA induction and until the end of the experimental time course. On day 43 after the first immunization, mice were sacrificed: blood was collected, and paws were histologically and biochemically processed. Dietary OLA prevented collagen-induced rheumatic bone, joint and cartilage conditions. Circulating matrix metalloproteinase (MMP)-3 and proinflammatory cytokine (IL-6, IL-1ß, TNF-α, IL-17) levels were significantly decreased in the joint, as well as MMP-9 and cathepsin-K (CatK) expression in secoiridoid-fed animals. In addition, dietary OLA was able to decrease COX-2, mPGES-1 and iNOS protein expressions and, also, PGE2 levels. The mechanisms possibly involved in these protective effects could be related to the activation of the Nrf-2/HO-1 axis and the inhibition of proinflammatory signaling pathways, including JAK-STAT, MAPKs and NF-κB, involved in the production of inflammatory and oxidative mediators. These results support the interest of OLA, as a nutraceutical intervention, in the management of RA.

Wild Fruits of Crataegus monogyna Jacq. and Sorbus aria (L.) Crantz: From Traditional Foods to Innovative Sources of Pigments and Antioxidant Ingredients for Food Products.

Hawthorn (Crataegus monogyna Jacq.) and whitebeam (Sorbus aria (L.) Crantz) are wild species traditionally used as ethnic foods in the Mediterranean area. Their red berries, and mainly the peels, may be used as ingredients due to their color (replacing other synthetic colorants) or functional properties. Some previous studies analyze all edible fruits, but there is very little literature on the composition and properties of the pulpless epidermis of the fruits of C. monogyna and no literature concerning the fruits of S. aria. Total phenolic compounds (TPC) and families of hydroxybenzoic acids, hydroxycinnamic acids, flavonols, and total monomeric anthocyanins were determined in the epidermis of C. monogyna and S. aria fruits. The in vitro antioxidant capacity was also determined using QUENCHER (Quick-Easy-New-CHEap-Reproducible) methodology. Anthocyanins profiles were analyzed in hydroalcoholic extracts through HPLC/MS. C. monogyna fruits presented higher content of TPC than S. aria, with hydroxybenzoic acids (2870.6 mg GAE/100g dw) as the major family, followed by flavonols (771.4 mg QE/100 g dw) and hydroxycinnamic acids (610.3 FAE/100 g dw). Anthocyanins were found in 251.7 mg cyanidin-3-glucoside/100 g dw, characterized by the content of cyanidin-O-hexoxide and peonidin-O-hexoxide. The levels of these compounds correlated with higher values of a* parameter (higher intensity of reddish color). These fruits also showed higher antioxidant capacity by Q-Folin-Ciocalteu and Q-FRAP. S. aria peels had fewer phenolic compounds, particularly anthocyanins (33.7 mg cyanidin-3-glucoside/100 g dw), containing different cyanidin derivatives. From these results, new insights about the composition of the epidermis of these wild fruits are provided, and their potential as ingredients for the food industry is corroborated.

Dwarf Kiwi (Actinidia arguta Miq.), a Source of Antioxidants for a Healthy and Sustainable Diet.

The feasibility of using dwarf kiwi fruits (Actinia arguta Miq.) as a healthy and sustainable food, compared to other types of commercial kiwi fruits, was evaluated in the present study. The overall antioxidant capacity of these fruits was assessed by either extraction-dependent methods (ABTS, ORAC) or the direct method called Quick, Easy, New, CHEap, Reproducible (QUENCHER) (DPPH, FRAP, Folin-Ciocalteu), applied for the first time to analyze kiwi fruits. With this methodology, all the molecules with antioxidant capacity are measured together in a single step, even those with high molecular weight or poor solubility in aqueous extraction systems, such as antioxidant dietary fiber. The effect of kiwi extracts on physiological and induced intracellular reactive oxygen species (ROS) production on IEC-6 cells was also analyzed, as well as total phenolic content (TPC) by Fast Blue BB, flavonols, hydroxycinnamic acids, and hydroxybenzoic acids. A. arguta fruits showed the highest values in all the antioxidant assays, being remarkably higher than the other kiwi species for Q-FRAP and Q-DPPH. Dwarf kiwi showed the highest potential in reducing physiological ROS and the highest values of TPC (54.57 mgGAE/g), being hydroxybenzoic acids the main phenolic family found (2.40 mgGAE/g). Therefore, dwarf kiwi fruits are a natural source of antioxidants compared to conventional kiwi fruits, being a sustainable and healthy alternative to diversify fruits in the diet.

pH-temperature dual-sensitive nucleolipid-containing stealth liposomes anchored with PEGylated AuNPs for triggering delivery of doxorubicin.

Liposomes (Lip) are useful nanocarriers for drug delivery and cancer nanomedicine because of their ability to efficiently encapsulate drugs with different physical and chemical properties. The pH gradient between normal and tumoral tissues, and their rapid metabolism that induces hyperthermia encourage the development of pH- and thermo-sensitive Lip for delivering anticancer drugs. Nucleolipids have been studied as scaffolding material to prepare Lip, mainly for cancer therapy. Herein, we report for the first time the use of 1,2-dipalmitoyl-sn-glycero-3-(cytidine diphosphate) (DG-CDP) to develop pH/thermo-sensitive nucleolipid-containing stealth Lip stabilized by combination with 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) and cholesterol, anchored with NH2-PEGylated gold nanoparticles (PEG-AuNPs, 15 nm) for triggering delivery of doxorubicin (Dox). The optimal composition of DPPC, DG-CDP and cholesterol (94:3:3) was established by Langmuir isotherms. Unloaded and Dox-loaded Lip and AuNPs-Lip exhibited nano-scale sizes (415-650 nm), acceptable polydispersity indexes (<0.33), spherical shapes, and negative Z-potential (-23 to -6.6 mV) due to the phosphate groups of DG-CDP, which allowed the anchoring with positively charged AuNPs. High EE% were achieved (>78%) and although efficient control in the Dox release towards different receptor media was observed, the release of Dox from PEG-AuNPs-Lip-Dox was significantly triggered at acidic pH and hyperthermia conditions, demonstrating its responsiveness to both stimuli. Dox-loaded Lip showed high cytotoxic activity against MDA-MB-231 breast cancer cells and SK-OV-3 ovarian cancer cells, suggesting that Dox was released from these nanocarriers over time. Overall, the liposomal formulations showed promising properties as stimuli-responsive nanocarriers for cancer nanomedicine, with prospects for hyperthermia therapy.

Preparation, Characterization and Evaluation of the Anti-Inflammatory Activity of Epichlorohydrin-ß-Cyclodextrin/Curcumin Binary Systems Embedded in a Pluronic®/Hyaluronate Hydrogel.

Curcumin (Cur) is an anti-inflammatory polyphenol that can be complexed with polymeric cyclodextrin (CD) to improve solubility and bioavailability. The aim of the present work was to prepare a CurCD hydrogel to treat inflammatory skin conditions. Epichlorohydrin-ß-CD (EpißCD) was used as polymeric CD. To characterize the binary system, solid-state and in-solution studies were performed. Afterwards, an experimental design was performed to optimize the hydrogel system. Finally, the CurEpißCD hydrogel system was tested for anti-inflammatory activity using a HaCat psoriasis cell model. Co-grinded Cur/EpißCD binary system showed a strong interaction and Curcumin solubility was much improved. Its combination with Pluronic® F-127/hyaluronate hydrogel demonstrated an improvement in release rate and Curcumin permeation. After testing its anti-inflammatory activity, the system showed a significant reduction in IL-6 levels. Hydrogel-containing CurEpißCD complex is a great alternative to treat topical inflammatory diseases.

Synergistic Effect of Acetazolamide-(2-hydroxy)propyl ß-Cyclodextrin in Timolol Liposomes for Decreasing and Prolonging Intraocular Pressure Levels.

The purpose of this study was to design, for the first time, a co-loaded liposomal formulation (CLL) for treatment of glaucoma including timolol maleate (TM) in the lipid bilayer and acetazolamide (Acz)-(2-hydroxy)propyl ß-cyclodextrin (HPßCD) complexes (AczHP) solubilized in the aqueous core of liposomes. Formulations with TM (TM-L) and AczHP (AczHP-L), separately, were also prepared and characterized. A preliminary study comprising the Acz/HPßCD complexes and their interaction with cholesterol (a component of the lipid bilayer) was realized. Then, a screening study on formulation factors affecting the quality of the product was carried out following the design of the experiment methodology. In addition, in vitro release and permeation studies and in vivo lowering intraocular pressure (IOP) studies were performed. The results of the inclusion complexation behavior, characterization, and binding ability of Acz with HPßCD showed that HPßCD could enhance the water solubility of Acz despite the weak binding ability of the complex. Ch disturbed the stability and solubility parameters of Acz due to the fact of its competence by CD; thus, Chems (steroid derivative) was selected for further liposome formulation studies. The optimization of the lipid bilayer composition (DDAB, 0.0173 mmol and no double loading) and the extrusion as methods to reduce vesicle size were crucial for improving the physico-chemical properties and encapsulation efficiency of both drugs. In vitro release and permeation studies demonstrated that the CLL formulation showed improvement in in vitro drug release and permeation compared to the liposomal formulations with a single drug (TM-L and AczHP-L) and the standard solutions (TM-S and AczHP-S). CLL showed high efficacy in reducing and prolonging IOP, suggesting that the synergistic effect of TM and Acz on aqueous humor retention and the presence of this cyclodextrin and liposomes as permeation enhancers are responsible for the success of this strategy of co-loading for glaucoma therapy.

Cholesterol Levels Affect the Performance of AuNPs-Decorated Thermo-Sensitive Liposomes as Nanocarriers for Controlled Doxorubicin Delivery.

Stimulus-responsive liposomes (L) for triggering drug release to the target site are particularly useful in cancer therapy. This research was focused on the evaluation of the effects of cholesterol levels in the performance of gold nanoparticles (AuNPs)-functionalized L for controlled doxorubicin (D) delivery. Their interfacial and morphological properties, drug release behavior against temperature changes and cytotoxic activity against breast and ovarian cancer cells were studied. Langmuir isotherms were performed to identify the most stable combination of lipid components. Two mole fractions of cholesterol (3.35 mol% and 40 mol%, L1 and L2 series, respectively) were evaluated. Thin-film hydration and transmembrane pH-gradient methods were used for preparing the L and for D loading, respectively. The cationic surface of L allowed the anchoring of negatively charged AuNPs by electrostatic interactions, even inducing a shift in the zeta potential of the L2 series. L exhibited nanometric sizes and spherical shape. The higher the proportion of cholesterol, the higher the drug loading. D was released in a controlled manner by diffusion-controlled mechanisms, and the proportions of cholesterol and temperature of release media influenced its release profiles. D-encapsulated L preserved its antiproliferative activity against cancer cells. The developed liposomal formulations exhibit promising properties for cancer treatment and potential for hyperthermia therapy.

Infective endocarditis in patients with solid organ transplantation. A nationwide descriptive study.

BACKGROUND: Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT. METHODS: We used data from the Spanish Collaboration on Endocarditis during the period 2008-2018. RESULTS: We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p<0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p<0.001) and staphylococcal etiology (57.7% vs. 39.7%, p=0.001). Patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1 %, p<0.001), sepsis (27.1% vs. 17.2%, p=0.02), and less surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) than patients without SOT. There were no significant differences in mortality: inhospital (30.6% SOT vs. 25.6% without SOT, p=0.31), 1-year (38.8% SOT vs. 31.9% without SOT, p=0.18). CONCLUSIONS: Most IE in SOT recipients are nosocomial and over 70% are health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus spp. infections. Mortality seems to be similar to non-SOT counterparts.

Study of Xoconostle (Opuntia spp.) Powder as Source of Dietary Fiber and Antioxidants.

The objective of this study is to evaluate the nutritional composition, antioxidant properties, and functional characteristics of two cultivars of xoconostle Opuntia xoconostle F.A.C. Weber in Diguet cv. Cuaresmeño (XC) and Opuntia matudae Scheinvar cv. Rosa (XR). The samples were frozen (-32 °C, 48 h), lyophilized (96 h, -55 ± 1 °C, vacuum of 0.040 Mbar), and homogenized (size particle 500 µm) to get the xoconostle powder. Both cultivars (XC and XR) had a high content of carbohydrates characterized by soluble sugars (9.8 ± 0.7 and 29.9 ± 0.5 g/100 g dm) and dietary fiber (30.8 ± 0.7 and 36.8 ± 0.9 g/100 g dm), as well as lower proportions of organic acids, mainly citric acid (18.8 ± 0.0 and 13.6 ± 0.0 mg/100 g dm). These samples also had a high content of phenolic compounds (1580.3 ± 33.1 and 1068.5 ± 70.8 mg GAE/100 g dm), vitamin C (723.1 ± 16 and 320.2 ± 7.5 mg/100 g dm), and antioxidant activity ABTS·+ and DPPH· (between 1348.1 ± 74.0 and 3318.7 ± 178.8 µmol TE/100 g dm). Since xoconostle samples had a high content of dietary fiber, they were characterized by the capacity of water retention (water holding capacity 6.00 ± 0.1 and 5.5 ± 0.2 g H2O/g dm) and gel formation (swelling 5.2 ± 0.0 and 5.5 ± 0.0 g H2O/g dm), related with the retention of lipids and glucose in the food matrix similar to other foods. XR was characterized by a higher amount of dietary fiber, sugars and organic acids, while XC had higher phenols content and antioxidant properties, with higher values of functional properties. Then, our data suggest that both xoconostle cultivars in powder can be used as a functional ingredient for its fiber content and antioxidant properties, contributing with sensorial aspects as flavor and color. Therefore, these highly valued products can be used in the pharmaceutical and food industries.

Didodecyldimethylammonium Bromide Role in Anchoring Gold Nanoparticles onto Liposome Surface for Triggering the Drug Release.

Liposomes with their capacity to anchor gold nanoparticles (AuNPs) onto their surface are used in the treatment of several pathologies such as cancer. The objective of this work was the optimization of the vesicle composition by using cationic agents in order to reinforce the anchoring process of AuNPs, and for the study of the influence of local temperature and vesicle size on drug release. A Plackett-Burman design was conducted to determine the optimal composition for the anchoring of AuNPs. A comprehensive study of the influence of lipid bilayer composition on the surface charge, size, and polydispersity index (PdI) of liposomes was carried out. Afterwards, in vitro release studies by dialysis were performed and several release parameters were evaluated as a function of temperature. Cholesterol was fixed as the rigid agent and Didodecyldimethylammonium bromide (DDAB) was selected as the cationic lipid into the liposome bilayer. Photomicrographs revealed that DDAB facilitated the anchoring of AuNPs onto the liposomal surface. The anchoring of AuNPs also enhanced the amount and rate of calcein released, especially in extruded samples, at several incubating temperatures. In addition, it was observed that both the anchoring of AuNPs and the calcein release were improved by increasing the surface of the vesicles. The contributions of liposome composition (DDAB inclusion, incubation temperature, anchoring of AuNPs) and size and surface availability of the vesicles on calcein release could be used to design improved lipid nanostructures for the controlled release of anticancer drugs.

Fucoxanthin-Containing Cream Prevents Epidermal Hyperplasia and UVB-Induced Skin Erythema in Mice.

Microalgae represent a source of bio-active compounds such as carotenoids with potent anti-inflammatory and antioxidant properties. We aimed to investigate the effects of fucoxanthin (FX) in both in vitro and in vivo skin models. Firstly, its anti-inflammatory activity was evaluated in LPS-stimulated THP-1 macrophages and TNF-α-stimulated HaCaT keratinocytes, and its antioxidant activity in UVB-irradiated HaCaT cells. Next, in vitro and ex vivo permeation studies were developed to determine the most suitable formulation for in vivo FX topical application. Then, we evaluated the effects of a FX-containing cream on TPA-induced epidermal hyperplasia in mice, as well as on UVB-induced acute erythema in hairless mice. Our results confirmed the in vitro reduction of TNF-α, IL-6, ROS and LDH production. Since the permeation results showed that cream was the most favourable vehicle, FX-cream was elaborated. This formulation effectively ameliorated TPA-induced hyperplasia, by reducing skin edema, epidermal thickness, MPO activity and COX-2 expression. Moreover, FX-cream reduced UVB-induced erythema through down-regulation of COX-2 and iNOS as well as up-regulation of HO-1 protein via Nrf-2 pathway. In conclusion, FX, administered in a topical formulation, could be a novel natural adjuvant for preventing exacerbations associated with skin inflammatory pathologies as well as protecting skin against UV radiation.

Síndrome PAGOD y anomalías vasculares: ¿es un defecto de la angiogénesis embrionaria? Un nuevo caso y revisión / PAGOD syndrome and vascular anomalies: is a defect embryonic angiogenesis? A case report and review

El Síndrome PAGOD es un acrónimo de hipoplasia de pulmón y arterias pulmonares, agonadismo, onfalocele / defecto diafragmático y dextrocardia. Se describe una serie de 21 pacientes, en la cual, 90,5 % presentó un cariotipo 46,XY y solo dos casos 46,XX; el 66,6 % exhibió un fenotipo femenino y 28,6 % genitales ambiguos. La ocurrencia de dos paciente 46,XX excluye al cromosoma Y como portador del defecto genético y plantea la posibilidad de una herencia recesiva ligada al cromosoma X, sin descartar que los casos observados en hermanos puedan deberse a mutaciones en otros genes como STRA6, VEGFA, VEGFB, VEGFC, transcritos de empalmes alternativos de VEGFA, HIF1, HIF2, entre otros. Las malformaciones congénitas observadas en los pacientes fueron: genitales y gónadas 85,7 %, diafragma y pared 66,6 %, cardíaco 80,9 %, pulmonar 71,4 %, vascular 80,9 % y abdomen 42,8 %. La revisión de los pacientes ha demostrado un alto grado de variabilidad en la expresividad de malformaciones de órganos, aparatos o sistemas. Las malformaciones vasculares representan un componente importante y característico del síndrome PAGOD y cuya base morfogenética del síndrome pueda deberse a un defecto de la angiogénesis embrionaria temprana con repercusión en la organogénesis de aparatos y sistemas. Dentro de los genes relacionados con el remodelamiento vascular durante la embriogénesis, regeneración tisular y carcinogénesis está el Factor de Crecimiento del Endotelio Vascular D (VEGFD), localizado en Xp22.31, con expresión en pulmón, corazón, intestino delgado, pulmón fetal, útero, mamas, tejido neural y neuroblastoma, el cual representa un fuerte candidato para su análisis molecular como una de las posibles causa del síndrome.

PAGOD Syndrome is an acronym for lung and pulmonary arteries hypoplasia, agonadism, omphalocele / diaphragmatic defect and dextrocardia. A series of 21 patients is described, where 90.5% had a 46,XY karyotype and only two cases 46,XX; 66.6% exhibited a female phenotype and 28.6% ambiguous genitalia. The occurrence of two patients 46,XX excludes the Y chromosome as a carrier of the genetic defect and raises the possibility of a recessive X-linked inheritance, without ruling out that the observed cases in siblings may be due to mutations in other genes as Stra6, VEGFA, VEGFB, VEGFC, and alternative splicing of transcripts VEGFA, HIF1, HIF2, among others. Congenital malformations were observed in patients’ genitals and gonads 85.7%, 66.6% in diaphragm and abdominal wall , heart 80.9%, 71.4% lungs, blood vessels 80.9% and 42.8% in abdomen. The review of patients has demonstrated a high degree of variability in the expression of malformations of organs and organ systems. Vascular malformations represent an important and characteristic component of PAGOD syndrome and whose base morphogenetic syndrome may be due to a defect in early embryonic angiogenesis with impact on organogenesis and system development. Among genes related to vascular remodeling during embryogenesis, tissue regeneration and carcinogenesis, the Endothelial Growth Factor D Vascular (VEGFD), located in the Xp22.31 region, with expression in lung, heart, small intestine, uterus, breast, neuroblastoma and neural tissue, represents a strong candidate for molecular analysis as a cause of the syndrome.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

Complicaciones feto-neonatales del embarazo múltiple. Análisis embriológico

Objetivo: Analizar las características epidemiológicas y complicaciones feto/neonatales del embarazo múltiple en el Hospital Militar de Maracaibo. Métodos: Estudio descriptivo y retrospectivo en pacientes ingresadas con embarazo múltiple desde el 01 de enero de 1998 al 30 de mayo de 2013. Se registró edad materna, presentación, tipo de parto, motivo de interrupción del embarazo, corionicidad, complicaciones feto/neonatales, peso y anomalías congénitas. Resultados: De 2 469 embarazadas ingresadas para parto, 31 (1,26 %) fueron múltiples o 1/80 nacimientos. Edad materna promedio 28 años, presentación fetal más frecuente cefálica-podálica en 12 (38,7 %) y se realizó cesárea en 27 (87,1 %) pacientes. La indicación de interrupción del embarazo más frecuente fue la electiva en 12 (38,7 %) y prematuridad en 11 (35,5 %). Se obtuvieron 62 productos y la mortalidad fue 17,7%, con 11 muertes fetales y/o perinatales, de estas 8 (72,7 %) fueron por causa de la monocorionicidad (P < 0,05) y sus consecuencias, en 5 (45,46 %) fetos fue por síndrome de transfusión intergemelar. Se diagnosticó restricción del crecimiento intrauterino en 13 (20,9 %) y en 26 (42 %) crecimiento fetal discordante moderado o severo. En 8 (8,1 %) neonatos se observaron anomalías congénitas predominantemente osteomusculares Conclusión: El embarazo múltiple tiene una elevada morbimortalidad fetal y neonatal dependiente principalmente de las complicaciones derivadas de la corionicidad, amniocidad, prematuridad y de la posibilidad de anomalías congénitas. Realizar el diagnóstico temprano de la corionicidad permite planificar medidas de vigilancia prenatal y garantizar la mejor calidad de vida materno feto/neonatal.

Objective: To analyze epidemiological characteristics and fetal/neonatal complications of twin pregnancy at the Military Hospital of Maracaibo. Methods: A descriptive and retrospective study of patients admitted with twin pregnancies, from January 1st, 1998 to May 30th, 2013. Maternal age, fetal presentations, mode of delivery, reason for interruption of the pregnancy, chorionicity, fetal/neonatal complications, weight and congenital anomalies were registered. Results: There were 31 (1.26 %) twin deliveries (or 1/80) in 2 469 pregnant woman admitted for delivery. Average maternal age was 28. The most common fetal presentation was vertex-breech in 12 (38.7 %) and in 27 (87.1 %) patients cesarean section was performed. The most common indication of pregnancy interruption were the elective delivery in 12 (38.7 %) and prematurity in 11 (35.5 %). 62 fetuses were obtained and mortality was 17.7 % with 11 stillbirth and/or perinatal death, in 8 (72.7 %) were due to monochorionicity (P< 0.05) and its consequences, of these 5 (45.46 %) were for twin-twin transfusion syndrome. Intrauterine growth restriction in 13 babies (20,9 %) and mild or severe discordant fetal growth in 26 (42 %). Congenital anomalies were observed in 8 fetuses (8.1 %) with a musculoskeletal predominance. Conclusion: Multiple pregnancy has high fetal/neonatal morbimortality which is principally dependent of the complications derived from the chorionicity, amnionicity, prematurity and the possibility of congenital anomalies. An early diagnose of the chorionicity allows the planning of antenatal care and guaranteeing the improvement of the mother and fetal/neonatal life and health.

Tomografía computarizada cardiaca: Nuevas aplicaciones de una técnica en evolución / Cardiac computed tomography: New applications of an evolving technique

En los últimos años hemos sido testigos del continuo desarrollo de las técnicas de imagen en cardiología. Entre ellas, la tomografía computarizada cardiaca, técnica emergente y en continua evolución. Con la posibilidad actual de realizar estudios con muy baja radiación se han ampliado sus indicaciones más allá de la coronariografía no invasiva. En el presente trabajo de revisión repasamos las novedades técnicas de la tomografía computarizada cardiaca así como sus nuevas aplicaciones.

During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications.

Valoración de la capacidad funcional del adulto mayor residente en casa hogar / Assessment of functional capacity of older adults living in nursing homes

Resumen:

Introducción: el envejecimiento es un proceso de cambios progresivos que repercuten en la funcionalidad física y esta, a su vez, es el mejor indicador de salud en la población adulta mayor. Objetivo: realizar un diagnóstico de la capacidad funcional del adulto mayor residente de casas hogar del sur de Jalisco.

Metodología: se llevó a cabo un estudio transversal descriptivo prospectivo en adultos mayores, en quienes se aplicó la Escala de Barthel para evaluar su capacidad para realizar 10 actividades básicas de la vida diaria. La muestra fue no aleatoria por conveniencia. Se obtuvo el consentimiento informado. Se utilizó estadística descriptiva, X2 para comparaciones entre los sexos. Las diferencias se consideraron estadísticamente significativas con una p < 0.05.

Resultados: la muestra estuvo conformada por 111 adultos mayores. El promedio de edad fue de 81 años, 27.9 % mostró independencia total, 28.8 % dependencia leve, 14.4 % moderada, 18 % severa y 10.8 % total. Estadísticamente no hubo diferencia significativa según el sexo (p = 0.36). Las actividades básicas con mayor número de sujetos independientes totales fueron comer, arreglarse, vestirse, control en la micción y evacuación, trasladarse y deambulación; subir y bajar escaleras y lavarse fueron actividades en las que más sujetos mostraron dependencia total.

Conclusiones: 72.1 % de los adultos mayores presentó algún grado de dependencia funcional, lo que representa una oportunidad para el cuidado de enfermería.

Abstract:

Introduction: Aging is a process of progressive changes that affect physical functioning, and this is the best health indicator of the adult population.

Objective: To make a diagnosis of the functional capacity of elderly residents of nursing homes in southern Jalisco.

Methodology: A cross sectional, descriptive, prospective study in older adults was conducted, in whom Barthel scale was used to assess their ability to perform ten basic activities of daily living. The sample was not random for convenience. Informed consent was obtained. Descriptive statistics were used, X2 for comparisons between sexes. Differences were considered statistically significant at p < 0.05.

Results: The sample consisted of 111 elderly. The mean age was 81 years, 27.9 % showed complete independence, 28.8 % mild dependence, 14.4 % moderate, 18 % severe and 10.8 % total dependence. There was no statistically significant sex differences (p = 0.36). The basic activities with the highest number of total independent subjects were eating, grooming, dressing, micturition and defecation continence, moving and walking; going up and down stairs and bathing were activities in which subjects showed more total dependence.

Conclusions: 72.1 % of elderly had some degree of functional dependence, which represents an opportunity for nursing care.

Infective endocarditis and caseous calcification of the mitral annulus: The odd couple / La endocarditis infecciosa y la calcificación caseosa del anillo mitral: la extraña pareja

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.

La calcificación caseosa del anillo mitral es un hallazgo ecocardiográfico poco frecuente. Debe hacerse el diagnóstico diferencial con otras entidades tales como tumores, abscesos o trombos. Para su diagnóstico definitivo además del ecocardiograma tanto el TC cardiaco como la Cardio RM pueden ser de utilidad.

Infective endocarditis and caseous calcification of the mitral annulus: the odd couple.

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.