Prevalencia de la arteria umbilical única en gestantes: su relación con otras malformaciones y el bajo peso al nacer

Introducción: La arteria umbilical única tiene una incidencia del 1 % en los recién nacidos. Se le asocia frecuentemente con gemelaridad, malformaciones y crecimiento intrauterino retardado, y constituye un factor de riesgo de prematuridad, muerte fetal y neonatal. Objetivos: Determinar la prevalencia de la arteria umbilical única en gestantes, y la asociación de esta entidad con otras malformaciones y el bajo peso al nacer. Materiales y métodos: Estudio descriptivo retrospectivo, con datos obtenidos de las historias clínicas y del modelo de seguimiento lineal existente en las consultas de genética comunitaria del municipio Matanzas, de enero de 2015 a diciembre de 2019. Resultados: La prevalencia de la arteria umbilical única fue del 0,3 %. Las malformaciones más frecuentes fueron las renales; el 27,7 % de los nacimientos fueron pretérmino y el 33,3 % de los nacidos fue con un peso inferior a 2500 g. Conclusiones: La arteria umbilical única constituye un marcador para otras malformaciones. Cuando coexisten ambas existe riesgo de prematuridad y bajo peso al nacer. Se recomienda realizar examen clínico posnatal a todo recién nacido con arteria umbilical única, pesquisando defectos renales y cardíacos.

Introduction: The single umbilical artery has an incidence of 1% in newborns. It is frequently associated with twinning, malformations and delayed intrauterine growth, and is a risk factor of prematurity, fetal and neonatal death. Objective: To determine the prevalence of single umbilical artery in pregnant women and the association of this entity with other malformations and low birth weight. Materials and methods: Retrospective descriptive study, with data obtained from medical records and the linear follow-up model existing in the community genetic clinics of the municipality of Matanzas, from January 2015 to December 2019. Results: The prevalence of the single umbilical artery was 0.3%. The most frequent malformations were renal ones; 27.7% of births were pre-term and 33.3% of those born weighed less than 2500g. Conclusions: The single umbilical artery is a marker for other malformations. When both coexist there is a risk of prematurity and low birth weight. Postnatal clinical examination is recommended for all newborns with single umbilical artery, checking for renal and heart defects.

Toxicity mechanisms of graphene oxide and cadmium in Microcystis aeruginosa: evaluation of photosynthetic and oxidative responses.

The potential ecotoxicological hazard of gaphene oxide (GO) is not fully clarified for photoautotrophic organisms, especially when the interactions of GO with other environmental toxicants are considered. The objective of the current study was to better understand the mechanisms of toxicity of GO in the cyanobacteria Microcystis aeruginosa, and to identify its interactions with cadmium (Cd). The individual and combined contribution of both pollutants in cyanobacteria were evaluated after 96 hours of exposure to GO and/or Cd, using photosynthetic pigments, photosynthetic parameters, cellular indicators of peroxidative damage, viability, and intracellular ROS formation as indicators of toxicity. Interactions between GO and Cd were evaluated using Toxic Units based on the EC50 of each parameter evaluated. The results of this study indicate that single concentrations ≥ 5 µg mL-1 of GO and ≥ 0.1 µg mL-1 of Cd induced a decrease in cell biomass and a change in the photosynthetic parameters associated with primary productivity in M. aeruginosa. In the combined experiments, higher GO ratios (≥ 9.1 µg mL-1) in terms of Toxic Units decreased photochemical processes and cellular metabolism, increased oxidative stress, and ultimately affected the size of M. aeruginosa. Finally, the relationship between GO concentration, Cd concentration, and the adsorption capacity of GO with respect to the co-pollutant must be taken into account when assessing the environmental risk of GO in aquatic environments.

Mielolipoma gigante unilateral de la glándula suprarrenal. Reporte de caso

Introducción: Los tumores de la glándula suprarrenal son inusuales y por lo general son hallados de forma incidental por estudios de imágenes. Dentro de este grupo los mielolipomas son uno de los tumores más raros, considerados el 2% de los tumores suprarrenales. Caso Clínico: Presentamos una paciente femenina de 60 años de edad con antecedentes de dolor a tipo cólico de forma esporádica a nivel del hipocondrio derecho. La ecografía abdominal detectó colelitiasis y una masa sugerente de adenoma suprarrenal izquierdo. La tomografía abdominal corroboró el tumor suprarrenal gigante y la litiasis vesicular. Se realizó suprarrenalectomía y colecistectomía convencional sin complicaciones. El diagnóstico histopatológico mostró un mielolipoma suprarrenal y una colecistitis crónica. Discusión: El mielolipoma suprarrenal es infrecuente, la etiología se desconoce, por lo general es asintomático y su hallazgo es incidental, habitualmente son unilaterales, menores a 4cm y la incidencia aumenta con la edad. Conclusiones: Cuando los mielolipomas alcanzan dimensiones mayores de 10cm se recomienda realizar una suprarrenalectomía convencional.

Introduction: Adrenal gland tumors are unusual and are usually found incidentally by imaging studies. Within this group, myelolipomas are one of the rarest tumors, considered 2% of adrenal tumors. Clinical case: We present a 60-year-old female patient with a history of sporadically colicky pain at the level of the right hypochondrium. Abdominal ultrasound revealed cholelithiasis and a mass suggestive of a left adrenal adenoma. Abdominal tomography confirmed a giant adrenal tumor and gallstones. An adrenalectomy and conventional cholecystectomy were performed without complications. The histopathological diagnosis showed an adrenal myelolipoma and chronic cholecystitis. Discussion: Adrenal myelolipoma is infrequent, the etiology is unknown, it is usually asymptomatic and its finding is incidental, they are usually unilateral, smaller than 4cm and the incidence increases with age. Conclusions: When myelolipomas reach dimensions greater than 10cm, conventional adrenalectomy is recommended. In selected cases.

Intracranial Virotherapy for a Canine Hemangioma.

Intracranial hemangiomas are rare neoplastic lesions in dogs that usually appear with life-threatening symptoms. The treatment of choice is tumor resection; however, complete resection is rarely achieved. The patient's prognosis therefore usually worsens due to tumor progression, and adjuvant treatments are required to control the disease. Oncolytic viruses are an innovative approach that lyses the tumor cells and induces immune responses. Here, we report the intratumoral inoculation of ICOCAV15 (an oncolytic adenovirus) in a canine intracranial hemangioma, as adjuvant treatment for incomplete tumor resection. The canine patient showed no side effects, and the tumor volume decreased over the 12 months after the treatment, as measured by magnetic resonance imaging using volumetric criteria. When progressive disease was detected at month 18, a new dose of ICOCAV15 was administered. The patient died 31.9 months after the first inoculation of the oncolytic adenovirus. Furthermore, tumor-infiltrated immune cells increased in number after the viral administrations, suggesting tumor microenvironment activation. The increased number of infiltrated immune cells, the long survival time and the absence of side effects suggest that ICOCAV15 could be a safe and effective treatment and should be further explored as a novel therapy for canine hemangiomas.

Safety and Efficacy of an Oncolytic Adenovirus as an Immunotherapy for Canine Cancer Patients.

The use of oncolytic viruses is an innovative approach to lyse tumor cells and induce antitumor immune responses. Eight dogs diagnosed with carcinoma/adenocarcinoma were intratumorally treated with ICOCAV15, an oncolytic canine adenovirus (CAV). To evaluate the treatment's safety, a blood count, biochemistry, and coagulation test were performed before treatment and during follow-up. Immune populations were analyzed by flow cytometry. Anti-adenovirus antibodies were also determined. The immune infiltration, vascularization, and viral presence in the tumor were determined by CD3, CD4, CD20, CD31 and CAV by immunohistochemistry. All the dogs maintained a good quality of life during follow-up, and some had increased median survival time when compared with dogs treated with chemotherapy. No treatment-related adverse effects were detected. The Response Evaluation Criteria In Solid Tumors criteria were also assessed: two patients showed a partial response and the rest showed stable disease at various times during the study. ICOCAV15 was detected inside the tumor during follow-up, and antiviral antibodies were detected in all patients. Furthermore, the tumor-infiltrating immune cells increased after viral administration. Therefore, we suggest that intratumorally administered ICOCAV15 could represent as a new tool for the treatment of canine carcinoma because it is safe, well-tolerated by dogs, and shows promising results.

Tumor-Homing of Mesenchymal Stem Cells Infected with Oncolytic Virus in a Canine Patient.

Intravenous administration of oncolytic adenovirus (OAds) can be challenging, although various vehicles for the delivery of the virus to the tumor have been described. The efficacy of mesenchymal stem cells (MSCs) as a virus vehicle has been reported in mouse models and canine and human patients, but the actual action mechanism has never been described in patients. It is of importance to determine whether MSCs infected with OAds can reach the tumor and release the virus in a clinical setting. For this purpose, GFP-labeled MSCs were infected with an OAd and inoculated into a companion dog diagnosed with spontaneous lung carcinoma. Forty-eight hours later, the tumor was excised and analyzed microscopically by flow cytometry for GFP fluorescence detection, and a cellular culture was established. Peripheral blood samples were taken to quantify the oncolytic adenovirus by qRT-PCR. Green fluorescence cells detected in the cellular culture by microscopy and flow cytometry revealed 0.69% GFP-positive cells in the tumor. OAd in peripheral blood was confirmed by qRT-PCR during follow-up. For the first time, the tumoral-homing capacity of OAds infected-MSC has been confirmed in a clinical setting, helping to explain the clinical response mechanism, whose efficacy was previously reported in canine and human patients.

Detección de factores de riesgo de enfermedad renal crónica en adultos / Detection of Risk Factors for Chronic Kidney Disease in Adults

Introducción: La enfermedad renal crónica se considera una enfermedad con graves repercusiones para la sociedad y las políticas de salud, con elevada incidencia y prevalencia debido al alza de enfermedades como la hipertensión arterial y la diabetes mellitus. Objetivo: Detectar, de forma oportuna, adultos con alto riesgo de desarrollar enfermedad renal crónica para preservar su salud, y así frenar la aparición y progresión del daño renal. Métodos: Se realizó un estudio descriptivo, transversal, cuantitativo, con 404 adultos familiares de estudiantes de enfermería, Universidad Técnica de Machala, El Oro, Ecuador. Se utilizó el Cuestionario de Detección Temprana de Riesgo de la Enfermedad Renal, del grupo Da Vita. Resultados: La hipertensión arterial fue la principal enfermedad hallada con (27,2 por ciento), seguido de la diabetes mellitus tipo II (9,4 por ciento). La prueba Chi-cuadrado no apuntó diferencia en el antecedente de hipertensión arterial entre ambos sexos (p > 0,05). De la población de estudio, 55,6 por ciento presentaba obesidad/sobrepeso, 54,7 por ciento refirió sedentarismo, 120 personas (29,7 por ciento) presentaron antecedentes familiares de ERC. Un total de 137 personas (33,9 por ciento) refirió que consumía antinflamatorios no esteroideos. El total de pacientes con hipertensión arterial y diabetes mellitus (n = 17, 4.21 por ciento), eran obesos, sedentarios, y todos presentaron antecedentes familiares de enfermedad renal crónica, por lo que se consideraron alto riesgo. Fueron enviados a consulta para estudio, además de recibir las charlas educativas. Conclusiones: El profesional de la salud puede y debe incidir en la detección temprana de la enfermedad renal crónica, mediante pesquisa y programas educativos que aumenten el conocimiento de la población susceptible(AU)

Introduction: Chronic kidney disease is considered a disease with serious repercussions for the society and health policies, with high incidence and prevalence due to the rise of diseases such as arterial hypertension and diabetes mellitus. Objective: To detect, in a timely manner, adults at high risk of developing chronic kidney disease in order to preserve their health, and thus slow the onset and progression of kidney damage. Methods: A descriptive, cross-sectional and quantitative study was carried out with 404 adult relatives of nursing students from the Technical University of Machala, El Oro, Ecuador. The questionnaire for early detection of renal disease risk of the Da Vita group was used. Results: Arterial hypertension was found as the main disease (27.2 percent), followed by type II diabetes mellitus (9.4 percent). The chi-square test showed no difference in the history of hypertension between both sexes (p > 0.05). Of the study population, 55.6 percent were obese/overweight, 54.7 percent reported a sedentary lifestyle, and 120 persons (29.7 percent) had a family history of chronic kidney disease. A total of 137 persons (33.9 percent) reported consuming nonsteroidal antiinflammatory drugs. The total of patients with arterial hypertension and diabetes mellitus (n = 17; 4.21 percent) were obese, sedentary, and had a family history of chronic kidney disease, a reason why they were considered at high risk. They were referred to consultation for study, in addition to receiving educational talks. Conclusions: The health professional can and should have an impact on the early detection of chronic kidney disease through screening and educational programs that increase the knowledge of the susceptible population(AU)

Colo-umbilical enterocutaneous fistula as a rare complication of diverticulitis of the sigmoid colon / Fístula enterocutánea sigmoidea umbilical como una rara complicación de una diverticulitis del colon sigmoide

Abstract The care of patients with enterocutaneous fistula constitutes a significant challenge owing to the alterations it usually brings about. For successful treatment, it is necessary to manage fluids and electrolytes adequately, provide practical nutritional support, and control sepsis until its eradication; thus, many fistulae close spontaneously. We present the case of a 36-year-old male patient with a four-month history of fecal-like umbilical secretion. When performing the fistulogram, we confirmed a fistulous tract of 9 cm, which ended at the level of the sigmoid colon, a rare location. In cases where the enterocutaneous fistula does not close, and surgical treatment is indicated, it is imperative to maximize perioperative care, decrease surgical time, choose the correct surgical technique, and prepare the patient for surgery to avoid complications with a fatal outcome.

Resumen La atención de los pacientes con fístula enterocutánea constituye un gran reto, por las alteraciones con las que suelen acompañarse. Para lograr un tratamiento exitoso es necesario realizar un adecuado manejo de los líquidos y electrolitos, brindar un apoyo nutricional eficaz y controlar la sepsis hasta lograr su erradicación; de esta manera, muchas fístulas cierran espontáneamente. Se expone el caso de un paciente de 36 años de edad, con un cuadro de secreción umbilical de aspecto fecaloideo de 4 meses de evolución. Al realizar la fistulografía se constató un trayecto fistuloso de 9 cm, el cual terminaba a nivel del colon sigmoide, localización poco frecuente. En los casos en que la fístula enterocutánea no cierre y tenga indicación de tratamiento quirúrgico, es necesario extremar los cuidados perioperatorios, minimizar el tiempo quirúrgico, elegir la técnica quirúrgica correcta y preparar al paciente para la cirugía, de modo que se eviten complicaciones que pueden tener un desenlace fatal.

Controlling silver release from antibacterial surface coatings on stainless steel for biofouling control.

This study focuses on the in-situ nucleation of silver nanoparticles (AgNPs) on stainless steel (SS) to provide a localized antibacterial action for biofouling control during space missions. Since AgNPs rapidly dissolve in water, partial passivation of AgNPs was provided to slow down silver release and extend the lifetime of the antibacterial coating. Two different passivation approaches, based on the formation of low solubility silver sulfide (Ag2S) or silver bromide (AgBr) shells, were compared to identify the optimal passivation for biofouling control. Highest bacterial inactivation (up to 75%) occurred with sulfidized AgNPs as opposed to bromidized (up to 50%) NPs. The optimal passivation treatment for biofouling control was found at 10-5 M Na2S (for Ag2S) and 10-3 M NaBr (for AgBr) concentrations. Scanning Electron Microscopy (SEM) analyses confirmed the presence of AgNPs on AgBr and Ag2S-coated samples. Further investigation revealed that compared to pristine AgNPs, Ag release from both sulfidized and bromidized NPs was significantly lower (16% vs 6% or less). Overall, both sulfidized and bromidized AgNPs were effective at controlling biofilm formation; however, sulfidized NPs exhibited the maximum antibacterial activity, making it the preferable passivation strategy for AgNPs on SS surfaces.

Aging of microplastics increases their adsorption affinity towards organic contaminants.

When released in the environment, microplastics undergo surface weathering due to mechanical abrasion and ultraviolet exposure. In this study, the adsorption of two model contaminants, phenanthrene and methylene blue, by weathered high density polyethylene (HDPE) and polypropylene (PPE) was evaluated to understand how the microplastics' aging influences contaminant adsorption. Microplastics were aged through an accelerated weathering process using ultraviolet exposure with or without hydrogen peroxide. Adsorption isotherms were conducted for both contaminants on pristine and aged microplastics. The adsorption of organic contaminants was higher on aged microplastics than on pristine ones, with methylene blue having the highest affinity increase with aging at 4.7-fold and phenanthrene having a 1.9-fold increase compared to the pristine particles. To understand the mechanisms involved with higher adsorption of contaminants by aged microplastics, changes in the specific surface area and surface chemistry of aged microplastics were characterized by Fourier Transform Infrared Spectroscopy, X-ray Photoelectron Spectroscopy, zeta potential, X-ray tomography, and Brunauer-Emmett-Teller krypton adsorption analyses. The results of this study show that oxidation of microplastics can enhance the adsorption of organic contaminants, which may increase their role as vectors of contaminants in the aquatic food chain.

Systemic cellular viroimmunotherapy for canine high-grade gliomas.

BACKGROUND: Oncolytic viruses constitute a growing field of interest, both in human and veterinary oncology, given that they are particularly helpful for treating non-surgical tumors and disseminated cancer, such as high-grade gliomas. Companion dogs present malignant gliomas with biological, genetic, phenotypic, immunological, and clinical similarities to human gliomas. These features favor comparative approaches, leading to the treatment of canine oncological patients to achieve translational applications to the human clinic. The systemic administration of oncolytic viruses presents a challenge due to their limitations in effectively targeting tumors and metastases. Therefore, the aim of this study is to evaluate the safety and antitumor activity of a virotherapy used in spontaneous canine tumors. METHODS: Ten dogs with high-grade rostrotentorial gliomas underwent weekly systemic endovenous cellular virotherapy with dCelyvir (canine mesenchymal stem cells infected with the canine oncolytic adenovirus ICOCAV17) for 8 weeks. Efficacy was determined in seven dogs according to the Response Assessment in Veterinary Neuro-Oncology criteria considering clinical status and MRI measurements. Medical history, physical and neurological examinations, and vaccination status were evaluated prior to and during follow-up. Safety was evaluated by physical examinations and hematological and biochemical changes in peripheral blood. Immune populations were analyzed by flow cytometry in peripheral blood and by gene expression and immunohistochemistry in the tumor microenvironment. RESULTS: The treatment was well tolerated and major adverse effects were not observed. Two dogs had partial responses (76% and 86% reduction in tumor size), and 3/7 showed stable disease. ICOCAV17 was detected in peripheral blood in nine dogs, and a correlation between the ICOCAV17 particles and anti-canine adenovirus (CAV) antibodies was observed. ICOCAV17 was detected in 3/9 tumor tissues after necropsies. Regarding tumor-infiltrating lymphocytes, the dogs with disease stabilization and partial response tended to have reduced memory B-cell infiltration and increased monocyte/macrophage lineage cells. CONCLUSIONS: These findings indicate that dCelyvir is safe and presents efficacy in canine rostrotentorial high-grade gliomas. These data are relevant to the ongoing phase Ib regulated human clinical trial that is administering this virotherapy to children, adolescents, and young adults with diffuse pontine glioma. Celyvir should be further explored as a treatment in veterinary and human neuro-oncology.

El papel de la familia en la autopercepción de calidad de vida del adulto mayor / The Family Role in the Older Adult's Self-Perception of Quality of Life

Introducción: El envejecimiento de la población en la actualidad es uno de los principales problemas a nivel mundial, debido al incremento en la esperanza de vida. Sin embargo, una mayor esperanza de vida no significa una mejor calidad de vida. Objetivo: Valorar el papel que desempeña la familia en la autopercepción de calidad de vida del adulto mayor. Métodos: Estudio descriptivo, observacional y transversal en adultos mayores aplicada en sujetos de ambos sexos en la provincia ecuatoriana de El Oro entre enero del 2018 y noviembre del 2019. La muestra quedó conformada por 399 pacientes. Los cuestionarios utilizados fueron: Valoración biopsicosocial del adulto mayor desde un enfoque bioético, y la Escala de Calidad de Vida WHOQOL-BREF. Resultados: El promedio de edad fue de 73,66 años ± 7,38 con un rango entre los 65 y 98 años. El 78,9 por ciento de los adultos mayores maltratados y el 75,9 por ciento de los adultos mayores con trato familiar regular refieren una calidad de vida deficiente. Solo el 18,3 por ciento de los adultos mayores bien tratados refirieron una calidad de vida deficiente, por lo que se observa una asociación entre el trato familiar y la percepción de la calidad de vida estadísticamente significativa. Se constató maltrato familiar por negligencia en los adultos mayores que refirieron una calidad de vida deficiente. Conclusiones: La familia posee un papel preponderante en la calidad de vida del adulto mayor(AU)

Introduction: Nowadays, population aging is one of the main problems worldwide, due to the increase in life expectancy. However, higher life expectancy does not mean better quality of life. Objective: To assess the role played by the family in the older adult's self-perception of quality of life. Methods: A descriptive, observational and cross-sectional study was carried out with older adults of both sexes in the Ecuadorian province of El Oro, between January 2018 and November 2019. The sample consisted of 399 patients. The questionnaires used were the Biopsychosocial Assessment of the Older Adult from a Bioethical Approach and the WHOQoL-BREF Quality of Life Scale. Results: The average age was 73.66 years ± 7.38 years, with a range between 65 and 98 years. A poor quality of life was reported by 78.9 percent of the mistreated older adults and 75.9 percent of the older adults with regular family treatment. Only 18.3 percent of the well-treated older adults reported a poor quality of life, which shows a statistically significant association between family treatment and perception of quality of life. Family mistreatment due to neglect was found in older adults who referred poor quality of life. Conclusions: The family has a preponderant role in the quality of life of the older adult(AU)

Percepción del riesgo de infección con virus del papiloma en jóvenes universitarios / Risk Perception about Papilloma Virus Infection in University Students

Introducción: El virus del papiloma humano es considerado la enfermedad de transmisión sexual de mayor prevalencia. El 50 por ciento de la población sexualmente activa ha tenido contacto con el virus alguna vez en su vida. Objetivo: Determinar el nivel de conocimientos y la percepción de riesgo que tiene la población universitaria de Machala acerca de la infección por virus del papiloma humano, sus aspectos generales, su transmisión y consecuencias. Métodos: Estudio transversal, cuantitativo, realizado con 239 estudiantes universitarios de uno y otro sexo. Fueron utilizadas: encuesta sobre el virus de papiloma humano en adultos, modificado con el Cuestionario de Vulnerabilidad al virus del Papiloma Humano. Resultados: Refirió que no había escuchado sobre el virus el 37,2 por ciento, principalmente estudiantes masculinos, se evidenciaron diferencias significativas (p = 0,000) en el conocimiento de la enfermedad de acuerdo al género. El 67,3 por ciento refirió nunca haber recibido charla educativa sobre el virus. La mayoría respondió adecuadamente a la forma de transmisión, que afecta a hombres como mujeres, las formas de protección, que provoca verrugas genitales, y la neoplasia del cuello uterino. Sin embargo, se encontró desconocimiento sobre la vacuna, la utilidad del Papanicolau, que esta enfermedad puede ser asintomática e incurable, y su relación con otras neoplasias. Conclusiones: La percepción de riesgo de los estudiantes fue muy baja en sentido general y más deficiente en hombres que en mujeres. En las comparaciones por sexo, se evidenció que aquellos estudiantes que recibieron charlas educativas por personal de la salud se asocian con un mejor conocimiento sobre el virus del papiloma humano(AU)

Introduction: The human papilloma virus is considered the most prevalent sexually transmitted disease. 50 percent of the sexually active population has had contact with the virus at some time in their lives. Objective: To determine the level of knowledge and risk perception of the university population of Machala about human papillomavirus infection, its general aspects, its transmission and consequences. Methods: A cross-sectional and quantitative study carried out with 239 university students of both sexes. We used a survey on human papillomavirus in adults, modified with the Human Papillomavirus Vulnerability Questionnaire. Results: 37.2 percent reported that they had not heard about the virus, mainly male students. There were significant differences (P=0.000) regarding the knowledge of the disease according to gender. 67.3 percent reported that they have never received an educational talk about the virus. Most of them responded adequately to the mode of transmission, that the virus affects men as well as women, the forms of protection, that it causes genital warts and neoplasia of the cervix. However, ignorance was found about the vaccine, the usefulness of the Pap smear test, that this disease can be asymptomatic and incurable, and its relationship with other neoplasms. Conclusions: The risk perception of the students was very low in general and more deficient in men than in women. In the comparisons by sex, it was evidenced that those students who received educational talks by the health personnel are associated with better knowledge about human papillomavirus(AU)

Herida por arma de fuego con lesión pulmonar, del plexo braquial, arteria axilar e intercostal

RESUMEN Introducción: Los traumas de tórax con lesiones vasculares asociadas, empeoran el pronóstico de los pacientes debido a la hemorragia. El 80 % de todos los traumas vasculares afectan las extremidades y el 30 % se localizan en los miembros superiores. Poder utilizar los propios tejidos del paciente para su reparación, es una alternativa de tratamiento viable, y en ocasiones la única posible. Objetivo: Presentar un paciente con trauma de tórax, con lesiones vasculares, en quien se utilizó la vena safena para restaurar el daño en la arteria axilar y la técnica de tractotomía, por hemotórax masivo con lesión del parénquima pulmonar. Caso clínico: Paciente masculino de 32 años, con herida causada por arma de fuego a nivel del hombro y hemitórax derecho, que ocasionó lesión de arteria axilar derecha y hemotórax masivo. Se realizó toracotomía con tractotomía a nivel del lóbulo superior derecho y ligadura de la arteria intercostal; y se exploró la región axilar derecha para reparar el daño vascular. Conclusiones: Para tratar el traumatismo torácico penetrante con lesión pulmonar sangrante, se debe realizar una tractotomía pulmonar y hemostasia, para evitar los hematomas intraparenquimatosos. Ante una lesión de arteria axilar irreparable, la vena safena es una alternativa viable para su restauración y lograr la vitalidad de la extremidad.

ABSTRACT Introduction: Chest traumas with associated vascular lesions worsen the prognosis of patients due to hemorrhage. 80 % of all vascular traumas affect the extremities and 30 % are located in the upper limbs. Being able to use the patient's own tissues for repair is a viable treatment alternative, and sometimes the only possible one. Objective: To present a patient with chest trauma with vascular lesions, where the saphenous vein was used to restore the damage in the axillary artery and the tractotomy technique for massive hemothorax with lesion of the lung parenchyma. Clinical case: 32-year-old male patient with a gunshot wound to the shoulder and right hemithorax, which caused injury to the right axillary artery and massive hemothorax. A thoracotomy with tractotomy was performed at the level of the right upper lobe and ligation of the intercostal artery; and the right axillary region was explored to repair vascular damage. Conclusions: To treat penetrating chest trauma with bleeding lung injury, a pulmonary tractotomy and hemostasis should be performed to avoid intraparenchymal hematomas. Faced with an irreparable axillary artery injury, the saphenous vein is a viable alternative for its restoration and to achieve the vitality of the limb.

Alternativa de tratamiento quirúrgico en un caso de ingestión voluntaria de cuerpos extraños / Alternative surgical treatment in a case of voluntary ingestion of foreign bodies

Introducción: La ingesta de cuerpos extraños en el adulto de forma intencional es un evento raro que ocurre fundamentalmente en pacientes psiquiátricos o reclusos, y puede ocasionar un problema serio que llegue a comprometer la vida del paciente. Objetivo: Presentar el caso clínico de un paciente adulto, con ingestión de varios cuerpos extraños puntiformes de diferentes tamaños, y mostrar una variante para extraerlos con el menor daño posible. Caso clínico: Se expone el caso de un paciente recluso, del sexo masculino, de 25 años de edad, que ingirió varios trozos de alambre de cobre de diferentes longitudes. Por el alto riesgo de perforación, se decide realizar una laparotomía exploradora y extracción de los cuerpos extraños a través de una gastrotomía, por el orificio apendicular sin necesidad de abrir un asa intestinal. Conclusiones: Una variante para extraer los cuerpos extraños finos que logran pasar por el ángulo de Trietz, puede ser, avanzar el cuerpo extraño a través del orificio apendicular y realizar apendicectomía complementaria y lograr de esa manera su extracción sin realizar una enterotomía(AU)

Introduction: Intentional ingestion of foreign bodies in adults is a rare event that occurs mainly in psychiatric patients or inmates, and can cause a serious problem, compromising the life of the patient. Objective: To present the clinical case of an adult patient with ingestion of several pinpoint foreign bodies of different sizes, and to show a variant to extract them with the least possible damage. Clinical case: The case is a 25-year-old male incarcerate patient who ingested several pieces of copper wire of different lengths, and due to the high risk of causing perforation, it was decided to perform an exploratory laparotomy and extraction of foreign bodies through a gastrotomy, and through the appendicular orifice without the need to open an intestinal loop. Conclusions: A possible method to extract the fine foreign bodies that manage to pass through the Trietz angle is to advance the foreign body through the appendicular orifice and perform a complementary appendectomy, thus achieving its extraction without performing an enterotomy(AU)

Antioxidant Defenses in the Human Eye: A Focus on Metallothioneins.

The human eye, the highly specialized organ of vision, is greatly influenced by oxidants of endogenous and exogenous origin. Oxidative stress affects all structures of the human eye with special emphasis on the ocular surface, the lens, the retina and its retinal pigment epithelium, which are considered natural barriers of antioxidant protection, contributing to the onset and/or progression of eye diseases. These ocular structures contain a complex antioxidant defense system slightly different along the eye depending on cell tissue. In addition to widely studied enzymatic antioxidants, including superoxide dismutase, glutathione peroxidase, catalase, peroxiredoxins and selenoproteins, inter alia, metallothioneins (MTs) are considered antioxidant proteins of growing interest with further cell-mediated functions. This family of cysteine rich and low molecular mass proteins captures and neutralizes free radicals in a redox-dependent mechanism involving zinc binding and release. The state of the art of MTs, including the isoforms classification, the main functions described to date, the Zn-MT redox cycle as antioxidant defense system, and the antioxidant activity of Zn-MTs in the ocular surface, lens, retina and its retinal pigment epithelium, dependent on the number of occupied zinc-binding sites, will be comprehensively reviewed.

Neumotórax espontáneo y enfisema bulloso bilateral / Spontaneous pneumothorax and bilateral bullous emphysema

Introducción. El objetivo de este artículo fue reportar el caso de un paciente con antecedente de enfisema bulloso bilateral que le ocasionó un neumotórax persistente de difícil tratamiento. Caso clínico. Se trata de un paciente de 50 años de edad con diagnóstico de neumotórax asociado con un enfisema bulloso bilateral, en quien estaba contraindicado el tratamiento quirúrgico. El cuadro clínico comenzó con dolor en el hemitórax derecho y disnea, que se fue intensificando hasta el punto de no tolerar el decúbito. En la radiografía de tórax se observó colapso del pulmón derecho con múltiples bulas en ambos pulmones, por lo que se practicó una pleurotomía mínima alta derecha. La evolución del paciente no fue favorable por persistir el neumotórax, lo cual llevó al uso de un tratamiento alternativo. Discusión. En los pacientes con neumotórax persistente por enfisema bulloso bilateral sin indicación quirúrgica, el talco es una alternativa menos invasiva para lograr una sínfisis pleural con buenos resultados, método cuya utilidad se demuestra

Introduction. The aim of this report was to present the case of a patient with a history of bilateral bullous emphysema that causes a persistent pneumothorax that was difficult to treat. Clinical case. This is a 50-year-old patient diagnosed with pneumothorax associated with bilateral bullous emphysema, in whom surgical treatment being contraindicated. The clinical picture began with pain in the right hemithorax and dyspnea, which intensified to the point of not tolerating decubitus. In the chest X-ray, collapse of the right lung was observed with multiple bullae in both lungs, therefore a right upper minimum pleurotomy was performed. The patient's evolution was not favorable due to persisting pneumothorax, which led to the use of an alternative treatment. Discussion. In patients with persistent pneumothorax due to bilateral bullous emphysema without surgical indication, talc is a less invasive alternative to achieve a pleural symphysis with good results, a method whose utility is demonstrated

AKT and JUN are differentially activated in mesenchymal stem cells after infection with human and canine oncolytic adenoviruses.

There is increasing evidence about the use of oncolytic adenoviruses (Ads) as promising immunotherapy agents. We have previously demonstrated the clinical efficiency of mesenchymal stem cells (MSCs) infected with oncolytic Ads as an antitumoral immunotherapy (called Celyvir) in human and canine patients, using ICOVIR-5 or ICOCAV17 as human and canine oncolytic Ads, respectively. Considering the better clinical outcomes of canine patients, in this study we searched for differences in cellular responses of human and canine MSCs to Ad infection that may help understand the mechanisms leading to higher antitumor immune response. We found that infection of human and canine MSCs with ICOVIR-5 or ICOCAV17 did not activate the NF-κB pathway or the interferon regulatory factors IRF3 and IRF7. However, we observed differences in the profile of cytokines secretion, as infection of canine MSCs with ICOCAV17 resulted in lower secretion of several cytokines. Moreover, we showed that infection of human MSCs with ICOVIR-5 increased the phosphorylation of a number of proteins, including AKT and c-JUN. Finally, we demonstrated that differences in regulation of AKT and c-JUN in human and canine MSCs by ICOVIR-5 or ICOCAV17 are intrinsic to each virus. Our findings suggest that ICOCAV17 induces a more limited host response in canine MSCs, which may be related to a better clinical outcome. This result opens the possibility to develop new human oncolytic Ads with these specific properties. In addition, this improvement could be imitated by selecting specific human MSC on the basis of a limited host response after Ad infection.

Biodistribution Analysis of Oncolytic Adenoviruses in Canine Patient Necropsy Samples Treated with Cellular Virotherapy.

Oncolytic immunotherapy with competent viruses is an emerging approach in cancer treatment. The clinical safety of many types of oncolytic viruses (OVs) has been demonstrated. However, there is a lack of information about viral biodistribution in patients. The available data about oncolytic adenovirus biodistribution in human subjects treated intravenously consists of virus detection in body fluids, a few tumor biopsies, and a single report of patient necropsy samples. There is no information about adenoviral biodistribution in patients treated intravenously with cellular vehicles carrying an oncolytic adenovirus. We previously published reports regarding the efficacy and clinical safety of infusing mesenchymal stem cells (MSCs) infected with an OV in human and canine patients. In this study, we performed necropsies on 12 canine patients treated with dCelyvir, canine MSCs infected with ICOCAV17, a canine oncolytic adenovirus. The prevalence of microscopic lesions, especially chronic inflammatory responses in different organs, was higher than expected. Concomitantly, we found a positive immunoreaction to ICOCAV17 in analyzed samples. These findings support a possible role of the virus in development of histopathological alterations and ongoing systemic viral replication of ICOCAV17 in the period after therapy administration.

Cellular Virotherapy Increases Tumor-Infiltrating Lymphocytes (TIL) and Decreases their PD-1+ Subsets in Mouse Immunocompetent Models.

Oncolytic virotherapy uses viruses designed to selectively replicate in cancer cells. An alternative to intratumoral administration is to use mesenchymal stem cells (MSCs) to transport the oncolytic viruses to the tumor site. Following this strategy, our group has already applied this treatment to children and adults in a human clinical trial and a veterinary trial, with good clinical responses and excellent safety profiles. However, the development of immunocompetent cancer mouse models is still necessary for the study and improvement of oncolytic viroimmunotherapies. Here we have studied the antitumor efficacy, immune response, and mechanism of action of a complete murine version of our cellular virotherapy in mouse models of renal adenocarcinoma and melanoma. We used mouse MSCs infected with the mouse oncolytic adenovirus dlE102 (OAd-MSCs). In both models, treatment with OAd-MSCs significantly reduced tumor volumes by 50% and induced a pro-inflammatory tumor microenvironment. Furthermore, treated mice harboring renal adenocarcinoma and melanoma tumors presented increased infiltration of tumor-associated macrophages (TAMs), natural killer cells, and tumor-infiltrating lymphocytes (TILs). Treated mice also presented lower percentage of TILs expressing programmed cell death protein 1 (PD-1)-the major regulator of T cell exhaustion. In conclusion, treatment with OAd-MSCs significantly reduced tumor volume and induced changes in tumor-infiltrating populations of melanoma and renal cancer.