RESUMEN
Resumen Introducción: La mucormicosis en una enfermedad infrecuente y oportunista que afecta, principalmente, a pacientes inmunocomprometidos. Pocas veces se han reportado casos de afectación periostomal. Clínicamente puede ser confundida con otras patologías, pudiendo tener una evolución fulminante, por lo que un adecuado y pronto diagnóstico son necesarios para una instauración precoz del tratamiento. Caso Clínico: Se presenta el caso de una paciente de 62 años inmunocomprometida, que tras complicaciones quirúrgicas evoluciona con mucormicosis periostomal de la pared abdominal. A pesar de un tratamiento quirúrgico con múltiples resecciones de tejido asociado a antifúngico local y sistémico, la paciente fallece, concordante a la letalidad expresada en la literatura.
Introduction: Mucormycosis is a rare and opportunistic disease that mainly affects immunocompromised patients. Few cases of peristomal involvement have been reported. Clinically it can be confused with other pathologies and may have a fulminant evolution, so an adequate and prompt diagnosis is necessary for an early establishment of treatment. Clinical Case: We present the case of a 62-year-old immunocompromised patient who, after surgical complications, evolves with periostomal mucormycosis of the abdominal wall. Despite surgical treatment with multiple tissue resections, associated with local and systemic antifungal agents, the patient died, consistent with the lethality expressed in the literature.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Músculos Abdominales/patología , Mucormicosis/patología , Mucormicosis/tratamiento farmacológico , Combinación de Medicamentos , Mucormicosis/complicaciones , Mucormicosis/microbiologíaRESUMEN
INTRODUCCIÓN Y OBJETIVOS: El embarazo en cicatriz de cesárea previa (ECC) es una entidad poco frecuente que puede tener graves consecuencias. Hasta la fecha no existen esquemas estandarizados de tratamiento y su manejo óptimo sigue siendo controvertido. Nuestro objetivo es realizar una revisión de la literatura publicada sobre el manejo del ECC y proponer un algoritmo. También exponemos tres casos de ECC resueltos con diferentes tratamientos en el Hospital Universitario Infanta Elena MÉTODOS: Búsqueda de la literatura en bases de datos utilizando las palabras clave: "embarazo en cicatriz cesárea"," gestación ectópica en cicatriz cesárea", "tratamiento", "manejo". RESULTADOS: Las opciones terapéuticas pueden ser médicas, quirúrgicas o una combinación de ambas. Los tratamientos quirúrgicos tienen altas tasas de éxito, sin embargo, son más invasivos y no están exentos de riesgo. La combinación de tratamientos parece aumentar la tasa de éxito, no obstante, podría implicar un mayor riesgo de efectos secundarios y costes. CONCLUSIONES: El manejo de los ECC debe de ser individualizado, basado en la evidencia científica, en los medios disponibles y la experiencia de los profesionales en los distintos procedimientos, guiándonos por el tipo de ECC y su grado de vascularización e invasión, grosor del miometrio, niveles de beta-hCG, presencia de actividad cardiaca, clínica y estabilidad hemodinámica de la paciente. Deben tenerse en cuenta las circunstancias y patología intercurrente de la mujer, así como su deseo genésico o de preservación del útero.
INTRODUCTION AND OBJECTIVES: Cesarean scar pregnancy (CSP) is a rare entity that can cause serious consequences. Up to now, there are no standardized treatment schemes, and its optimal management remains controversial. Our objetive is to review the literature regarding CSP management and propose an algorithm. We also present three cases of CSP resolved with different treatments at Hospital Universitario Infanta Elena. METHODS: Literature search in databases using the following keywords: pregnancy with cesarean section, ectopic pregnancy with cesarean section, treatment, management. RESULTS: The therapeutic options can be medical, surgical or a combination of both. Surgical treatments have high success rates; however, they are more invasive and are not without risk. The combination of treatments seems to increase the success rate; however, it could imply a higher risk of side effects and costs. CONCLUSIONS: The management of CSP must be individualized; based on scientific evidence, on the means available, and on the experience of the professionals in the different procedures; guided by the type of CSP and its degree of vascularization and invasion, by the thickness of the myometrium, beta-hCG levels, presence of cardiac activity, and by clinical and hemodynamic stability of the patient. The circumstances and intercurrent pathology of the patient must be considered, as well as her desire for future pregnancy or preservation of the uterus.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Embarazo Ectópico/terapia , Cesárea/efectos adversos , Cicatriz/etiología , Cicatriz/terapia , Embarazo Ectópico/cirugía , Embarazo Ectópico/tratamiento farmacológico , Metotrexato/uso terapéutico , Cicatriz/cirugía , Cicatriz/tratamiento farmacológico , Embolización de la Arteria Uterina , Ultrasonido Enfocado de Alta Intensidad de Ablación , HisterectomíaRESUMEN
Cystic fibrosis (CF) is a disease characterized by bacterial chronic infection of the respiratory tract and inflammation, which leads to a progressive decrease in lung function. Pseudomonas aeruginosa is commonly isolated from the sputum of patients and their presence is associated with a predominant airway inflammation with neutrophils, causing chronic colonization and higher mortality rates. Neutrophil extracellular traps (NETs) have been observed in response against Pseudomonas, however, these cannot eliminate the pathogen from the respiratory tract, so one possibility is that the bacteria could promote their production to use them as a scaffold to colonize the lungs and as a nutrient source, however, their overproduction could also lead to increased damage to the lungs. In this work, we evaluated NETs formation by Pseudomonas clinical isolates obtained from CF patients and found that these induced NETs formation with globular or spread morphologies, of note, we found that there is a trend by which the spread forms were induced mainly by isolates obtained from patients with severe disease, whereas, the globular morphologies were observed for isolates obtained from patients with mild/moderate disease. Finally, we screened for bacterial molecules implicated in NETs formation and found that Exotoxin S, pyocin S2 and pyoverdine could participate in the process.
Asunto(s)
Fibrosis Quística , Trampas Extracelulares , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Fibrosis Quística/complicaciones , Humanos , Neutrófilos , Índice de Severidad de la EnfermedadRESUMEN
Severe COVID-19 patients develop acute respiratory distress syndrome that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that neutrophil extracellular traps (NETs) have been described as important mediators of tissue damage in inflammatory diseases, we investigated whether NETs would be involved in COVID-19 pathophysiology. A cohort of 32 hospitalized patients with a confirmed diagnosis of COVID-19 and healthy controls were enrolled. The concentration of NETs was augmented in plasma, tracheal aspirate, and lung autopsies tissues from COVID-19 patients, and their neutrophils released higher levels of NETs. Notably, we found that viable SARS-CoV-2 can directly induce the release of NETs by healthy neutrophils. Mechanistically, NETs triggered by SARS-CoV-2 depend on angiotensin-converting enzyme 2, serine protease, virus replication, and PAD-4. Finally, NETs released by SARS-CoV-2-activated neutrophils promote lung epithelial cell death in vitro. These results unravel a possible detrimental role of NETs in the pathophysiology of COVID-19. Therefore, the inhibition of NETs represents a potential therapeutic target for COVID-19.
Asunto(s)
Betacoronavirus/fisiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Trampas Extracelulares/fisiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Células A549 , Adulto , Enzima Convertidora de Angiotensina 2 , COVID-19 , Muerte Celular , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/patología , Células Epiteliales/patología , Células Epiteliales/virología , Femenino , Células HeLa , Humanos , Masculino , Activación Neutrófila , Pandemias , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/sangre , Neumonía Viral/patología , SARS-CoV-2 , Serina Proteasas/metabolismo , Succión , Tráquea/inmunologíaAsunto(s)
Ainhum/genética , Constricción Patológica/genética , Queratodermia Palmoplantar/genética , Mutación Missense/genética , Canales Catiónicos TRPV/genética , Administración Tópica , Adulto , Ainhum/diagnóstico , Ainhum/patología , Biopsia , Constricción Patológica/diagnóstico , Constricción Patológica/patología , Cuba/epidemiología , Femenino , Humanos , Queratodermia Palmoplantar/diagnóstico , Queratodermia Palmoplantar/tratamiento farmacológico , Queratodermia Palmoplantar/patología , Ácido Láctico/administración & dosificación , Ácido Láctico/uso terapéutico , Linaje , Canales Catiónicos TRPV/metabolismo , Urea/administración & dosificación , Urea/uso terapéuticoRESUMEN
Resumen Introducción El Breast-Q® módulo reconstrucción mamaria es un instrumento específico para evaluar la calidad de vida asociada a la cirugía mamaria desde el punto de vista del paciente. Objetivo Realizar la traducción y adaptación transcultural del Breast-Q® módulo reconstrucción mamaria Versión 2.0 al español chileno. Materiales y Método Se utilizaron las guías de validación lingüística del MAPI/TRUST Research Institute . El proceso consistió en traducción inglés-español, contra-traducción español-inglés, conciliación y aplicación piloto a 6 pacientes. Resultados Todas las pacientes comprendieron la encuesta y no existieron dudas sobre redacción y parámetros lingüísticos. No se requirieron más modificaciones. Conclusiones El proceso de traducción y adaptación cultural del instrumento fue completado exitosamente. El instrumento se encuentra listo para la validación lingüística.
Introduction The Breast Q Reconstruction Module is a specific instrument for assessing breast surgery related quality of life from the patient's perspective. Aim To carry out a transcultural translation and adaptation of version 2.0 to Chilean Spanish. Materials and Method Linguistic validation guides of the MAPI/TRUST Research Institute were used. The process consisted of English-Spanish translation, Spanish-English back translation, conciliation and pilot application of the scale in 6 patients. Results Patients had good understanding and no doubt about redaction and linguistic parameters. No further modifications were needed. Conclusions Traduction and cultural adaptation of the instrument was completed successfully in Chilean population. The instrument is ready for linguistic validation.
Asunto(s)
Humanos , Calidad de Vida , Encuestas y Cuestionarios , Mamoplastia/psicología , Traducción , Mamoplastia/rehabilitaciónRESUMEN
Interleukin (IL)-1ß is a potential target for treatment of several inflammatory diseases, including envenomation by the scorpion Tityus serrulatus. In this context, bioactive lipids such as prostaglandin (PG)E2 and leukotriene (LT)B4 modulate the production of IL-1ß by innate immune cells. Pattern recognition receptors (PRRs) that perceive T. serrulatus venom (TsV), and orchestrate LTB4, PGE2, and cyclic adenosine monophosphate (cAMP) production to regulate IL-1ß release are unknown. Furthermore, molecular mechanisms driving human cell responses to TsV remain uncharacterized. Here, we identified that both CD14 and CD36 control the synthesis of bioactive lipids, inflammatory cytokines, and mortality mediated by TsV. CD14 induces PGE2/cAMP/IL-1ß release and inflammation. By contrast, CD36 shunts eicosanoid metabolism toward production of LTB4, which represses the PGE2/cAMP/IL-1ß axis and mortality. Of importance, the molecular mechanisms observed in mice strongly correlate with those of human cell responses to TsV. Overall, this study provides major insights into molecular mechanisms connecting CD14 and CD36 with differential eicosanoid metabolism and inflammation mediated by IL-1ß.
Asunto(s)
Antígenos CD36/inmunología , Interleucina-1beta/inmunología , Receptores de Lipopolisacáridos/inmunología , Picaduras de Escorpión/inmunología , Venenos de Escorpión/inmunología , Adulto , Animales , Antígenos CD36/metabolismo , Modelos Animales de Enfermedad , Eicosanoides/metabolismo , Femenino , Voluntarios Sanos , Humanos , Interleucina-1beta/metabolismo , Leucocitos Mononucleares , Receptores de Lipopolisacáridos/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Persona de Mediana Edad , Cultivo Primario de Células , Picaduras de Escorpión/sangre , Picaduras de Escorpión/mortalidad , Escorpiones/inmunología , Transducción de Señal/inmunología , Adulto JovenRESUMEN
Abstract Objectives: Three decades after HIV recognition and its association with AIDS development, many advances have emerged – especially related to prevention and treatment. Undoubtedly, the development of Highly Active Antiretroviral Therapy (HAART) dramatically changed the future of the syndrome that we know today. In the present study, we evaluate the impact of Highly Active Antiretroviral Therapy on macrophage function and its relevance to HIV pathogenesis. Methods: PBMCs were isolated from blood samples and monocytes (CD14+ cells) were purified. Monocyte-Derived Macrophages (MDMs) were activated on classical (MGM-CSF+IFN-γ) or alternative (MIL-4+IL13) patterns using human recombinant cytokines for six days. After this period, Monocyte-Derived Macrophages were stimulated with TLR2/Dectin-1 or TLR4 agonists and we evaluated the influence of HIV-1 infection and Highly Active Antiretroviral Therapy on the release of cytokines/chemokines by macrophages. Results: The data were obtained using Monocyte-Derived Macrophages derived from HIV naïve or from patients on regular Highly Active Antiretroviral Therapy. Classically Monocyte-Derived Macrophages obtained from HIV-1 infected patients on Highly Active Antiretroviral Therapy released higher levels of IL-6 and IL-12 even without PAMPs stimuli when compared to control group. On the other hand, alternative Monocyte-Derived Macrophages derived from HIV-1 infected patients on Highly Active Antiretroviral Therapy released lower levels of IL-6, IL-10, TNF-α, IP-10 and RANTES after LPS stimuli when compared to control group. Furthermore, healthy individuals have a complex network of cytokines/chemokines released by Monocyte-Derived Macrophages after PAMP stimuli, which was deeply affected in MDMs obtained from naïve HIV-1 infected patients and only partially restored in MDMs derived from HIV-1 infected patients even on regular Highly Active Antiretroviral Therapy. Conclusion: Our therapy protocols were not effective in restoring the functional alterations induced by HIV, especially those found on macrophages. These findings indicate that we still need to develop new approaches and improve the current therapy protocols, focusing on the reestablishment of cellular functions and prevention/treatment of opportunistic infections.
Asunto(s)
Humanos , Adulto , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Terapia Antirretroviral Altamente Activa , Macrófagos/efectos de los fármacos , Linfocitos T CD4-Positivos/efectos de los fármacos , Estudios de Casos y Controles , Infecciones por VIH/sangre , Enfermedad Aguda , Enfermedad Crónica , Interleucinas/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Resultado del Tratamiento , Relación CD4-CD8 , Estadísticas no Paramétricas , Linfocitos T CD8-positivos/efectos de los fármacos , Quimiocina CCL5/metabolismo , Receptores de Lipopolisacáridos/efectos de los fármacos , Carga Viral/efectos de los fármacos , Quimiocina CXCL10/metabolismoRESUMEN
OBJECTIVES: Three decades after HIV recognition and its association with AIDS development, many advances have emerged - especially related to prevention and treatment. Undoubtedly, the development of Highly Active Antiretroviral Therapy (HAART) dramatically changed the future of the syndrome that we know today. In the present study, we evaluate the impact of Highly Active Antiretroviral Therapy on macrophage function and its relevance to HIV pathogenesis. METHODS: PBMCs were isolated from blood samples and monocytes (CD14+ cells) were purified. Monocyte-Derived Macrophages (MDMs) were activated on classical (MGM-CSF+IFN-γ) or alternative (MIL-4+IL13) patterns using human recombinant cytokines for six days. After this period, Monocyte-Derived Macrophages were stimulated with TLR2/Dectin-1 or TLR4 agonists and we evaluated the influence of HIV-1 infection and Highly Active Antiretroviral Therapy on the release of cytokines/chemokines by macrophages. RESULTS: The data were obtained using Monocyte-Derived Macrophages derived from HIV naïve or from patients on regular Highly Active Antiretroviral Therapy. Classically Monocyte-Derived Macrophages obtained from HIV-1 infected patients on Highly Active Antiretroviral Therapy released higher levels of IL-6 and IL-12 even without PAMPs stimuli when compared to control group. On the other hand, alternative Monocyte-Derived Macrophages derived from HIV-1 infected patients on Highly Active Antiretroviral Therapy released lower levels of IL-6, IL-10, TNF-α, IP-10 and RANTES after LPS stimuli when compared to control group. Furthermore, healthy individuals have a complex network of cytokines/chemokines released by Monocyte-Derived Macrophages after PAMP stimuli, which was deeply affected in MDMs obtained from naïve HIV-1 infected patients and only partially restored in MDMs derived from HIV-1 infected patients even on regular Highly Active Antiretroviral Therapy. CONCLUSION: Our therapy protocols were not effective in restoring the functional alterations induced by HIV, especially those found on macrophages. These findings indicate that we still need to develop new approaches and improve the current therapy protocols, focusing on the reestablishment of cellular functions and prevention/treatment of opportunistic infections.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Macrófagos/efectos de los fármacos , Enfermedad Aguda , Adulto , Relación CD4-CD8 , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD8-positivos/efectos de los fármacos , Estudios de Casos y Controles , Quimiocina CCL5/metabolismo , Quimiocina CXCL10/metabolismo , Enfermedad Crónica , Infecciones por VIH/sangre , Humanos , Interleucinas/metabolismo , Receptores de Lipopolisacáridos/efectos de los fármacos , Estadísticas no Paramétricas , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/metabolismo , Carga Viral/efectos de los fármacosRESUMEN
Determinar factores de riesgo de parto prematuro espontáneo < 34 semanas.Determinar las medidas de prevención de parto prematuro espontáneo < 34 semanas.Conocer la alta tasa de falsos positivos del diagnóstico clínico de parto prematuro y el papel de la evaluación ecográfica del cérvix.Conocer el concepto del uso de tocolisis en parto prematuro.Valorar el papel de los corticoides y sulfato de magnesio en la reducción de morbi-mortalidad perinatal en el parto prematuro.Evaluar el papel de los antibióticos en el parto prematuro con membranas íntegras.
Asunto(s)
Humanos , Adolescente , Adulto , Femenino , Adulto Joven , Trabajo de Parto Prematuro/diagnóstico , Trabajo de Parto Prematuro/fisiopatología , Trabajo de Parto Prematuro/terapiaRESUMEN
Although much research has been done related to biomarker discovery for tuberculosis infection, a set of biomarkers that can discriminate between active and latent TB diseases remains elusive. In the current study we correlate clinical aspects of TB disease with changes in the immune response as determined by biomarkers detected in plasma. Our study measured 18 molecules in human plasma in 17 patients with active disease (APTB), 14 individuals with latent tuberculosis infection (LTBI) and 16 uninfected controls (CTRL). We found that active tuberculosis patients have increased plasma levels of IL-6, IP-10, TNF-α, sCD163 and sCD14. Statistical analysis of these biomarkers indicated that simultaneous measurement of sCD14 and IL-6 was able to diagnose active tuberculosis infection with 83% accuracy. We also demonstrated that TNF-α and sCD163 were correlated with tuberculosis severity. We showed that the simultaneous detection of both plasma sCD14 and IL-6 is a promising diagnostic approach to identify APTB, and further, measurement of TNF-α and sCD163 can identify the most severe cases of tuberculosis.
Asunto(s)
Citocinas/sangre , Receptores de Lipopolisacáridos/sangre , Tetraspanina 30/sangre , Tuberculosis Pulmonar/sangre , Adulto , Biomarcadores/sangre , Femenino , Humanos , MasculinoRESUMEN
Explicar el diagnóstico y clasificación de los embarazos gemelares.Explicar el modelo de control prenatal de los embarazos gemelares que se aplica en el Hospital Clínico Universidad de Chile. Definir el momento y la vía de interrupción de los distintos tipos de embarazos gemelares nocomplicados. Referirse al parto prematuro en el embarazo gemelar.
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Femenino , Humanos , Embarazo , Embarazo Múltiple , Embarazo GemelarRESUMEN
As diferentes formas de avaliação são elementos centrais do processo de ensino-aprendizagem de qualquer programa educacional, e devem ser bem planejadas e implementadas em todas as propostas curriculares,especialmente na formação de profissionais na área da saúde. Uma avaliação do estudante adequada e de qualidade guarda estreita relação com a competência e capacitação do profissional que será entregue à sociedade. Neste contexto, a avaliação formativa e a capacitação dos professores para prover feedback efetivo, frequente, e de qualidade são fundamentais na formação dos futuros profissionais da saúde. Este artigo faz uma revisão sobre avaliação formativa, feedback e debriefing.
The different assessment forms are major elements of any teaching and learning process in educational programs, and should be considered as a core component to be planned and implemented in all curriculums, especially in the health professions education. A regular and qualified students assessment is closely related to competence and skills of the professionals that will be delivered to society. In this context, formative assessment and well-trained staff to provide effective and regular feedback are essentials in the formation of the future generation of health professionals. This article focuses primarily on formative assessment, feedback and debriefing.