Anestesia neuroaxial y sedación para cierre quirúrgico de comunicación interatrial (CIA) / Atrial septal defect surgical repair under Neuroaxial anesthesia and sedation: case report

We present the case report of one of the co-authors for the closure of her atrial septal defect under neuraxial anesthesia. The influence of the Cardiovascular Anesthesiologist on the response to perioperative stress in the context of cardiac surgery with the choice and application of the best anesthetic technique adjusted to a high-risk patient, has a positive impact on the main objectives of high-value care in the critical area of medicine and in the immediate postoperative evolution after a heart surgery. The safety of neuraxial anesthesia in cardiac surgery is a subject in wide debate in Mexico, even in hospitals with high volume of cardiac surgery it is a controversial subject, we present the first clinical case in Mexico of a 21-year-old female patient under- going closure of Atrial septal defect (ASD) via median sternotomy with extracorporeal circulation under neuraxial anesthesia and sedoanalgesia without orotracheal intubation.

Presentamos el reporte de caso de una de las coautoras para el cierre de su comunicación interatrial bajo anestesia neuroaxial. La influencia del Anestesiologo Cardiovascular en la respuesta al estres perioperatorio en el contexto de cirugía cardíaca con la elección y aplicación de la mejor tecnica anestesica ajustada a un paciente de alto riesgo, tiene un impacto positivo en los principales obejtivos del cuidado de alto valor en el área de la medicina critica y en la evolución posoperatoria inmediata tras una cirugía caridaca. La seguridad de la anestesia neuroaxial en cirugía cardíaca es un tema en amplio debate en México, aun en hospitales con alto volumen de cirugía cardíaca es un tema controversial. Presentamos el primer caso clínico en México de una paciente femenino de 21 años sometida a cierre de comunicación interauricular (CIA) vía esternotomia media con circulación extracorporea bajo anestesia neuroaxial y sedoanalgesia sin intubación orotraqueal.

Oxigenación con membrana extracorpórea y COVID-19 / Extracorporeal membrane Oxygenation and COVID-19

ECMO (ExtraCorporeal Membrane Oxygenation) is still a "rescue" therapy for both hemodynamic and respiratory support. Its use is relatively low and is restricted to specialized centers. The WHO declared as pandemic the severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) causing fatal pneumonia due to coronavirus 19 disease (COVID-19). Although the new coronavirus has a low lethality compared to other epidemics, its diffusion capacity is phenomenal. When ECMO therapy is indicated, its initiation in a specialized ECMO center should not be delayed. HEALTH WORKERS ARE OF HIGH PRIORITY. VA or VAV support may be indicated. In Mexico, we have even considered activating the logistics of obtaining an ECMO team since the patient presents with PaO/FiO of 100 mmHg or when it is indicated to pronate the patient. The early use and early activation of an ECMO team will undoubtedly give better results than the late application of this therapy. Direct myocardial involvement due to this virus has been reported causing myocarditis and acute coronary events, so it may be worth leaving a femoral artery vascular introducer so that if necessary, the patient can be supported with VA ECMO or VAV ECMO. These measures may lead to improved prognosis and outcome for patients affected by COVID-19.

ECMO (ExtraCorporeal Membrane Oxygenation) es una terapia de "rescate" para soporte, tanto hemodinámico como respiratorio. Su uso es relativamente bajo y está restringido a centros especializados. La OMS declaró como pandémico el síndrome agudo respiratorio severo por coronavirus 2 (SARS-CoV-2) causante de neumonía fatal por la enfermedad del coronavirus 19 (COVID-19). Aunque el nuevo coronavirus presenta una baja letalidad en comparación con otras epidemias, su capacidad de difusión es fenomenal. Cuando la terapia con ECMO está indicada, no debe retrasarse su inicio en un centro ECMO especializado. LOS TRABAJADORES DE LA SALUD SON DE ALTA PRIORIDAD. El soporte VA o VAV puede indicarse. En México hemos considerado incluso activar la logística de conseguir en ECMO team desde encontrarnos con PaO2/FiO2 de 100 mmHg o cuando se indica pronar al paciente. El uso temprano y la activación temprana de un ECMO team, sin duda dará mejores resultados que la aplicación tardía de esta terapia. Se ha reportado afección miocárdica directa por este virus provocando miocarditis y eventos coronarios agudos, por lo que podría valer la pena dejar un introductor vascular arterial femoral para que en caso de ser necesario se pueda soportar al paciente con ECMO VA o ECMO VAV. Estas medidas pueden llevar a mejorar el pronóstico y desenlace de los pacientes afectados por COVID-19.

Arsenic-induced stress activates sulfur metabolism in different organs of garlic (Allium sativum L.) plants accompanied by a general decline of the NADPH-generating systems in roots.

Arsenic (As) contamination is a major environmental problem which affects most living organisms from plants to animals. This metalloid poses a health risk for humans through its accumulation in crops and water. Using garlic (Allium sativum L.) plants as model crop exposed to 200µM arsenate, a comparative study among their main organs (roots and shoots) was made. The analysis of arsenic, glutathione (GSH), phytochelatins (PCs) and lipid peroxidation contents with the activities of antioxidant enzymes (catalase, superoxide dismutase, ascorbate-glutathione cycle), and the main components of the NADPH-generating system, including glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconate dehydrogenase (6PGDH), NADP-malic enzyme (NADP-ME) and NADP-isocitrate dehydrogenase (NADP-ICDH) was carried out. Data showed a correlation among arsenic accumulation in the different organs, PCs content and the antioxidative response, with a general decline of the NADPH-generating systems in roots. Overall, our results demonstrate that there are clear connections between arsenic uptake, increase of their As-chelating capacity in roots and a decline of antioxidative enzyme activities (catalase and the ascorbate peroxidase) whose alteration provoked As-induced oxidative stress. Thus, the data suggest that roots act as barrier of arsenic mediated by a prominent sulfur metabolism which is characterized by the biosynthesis of high amount of PCs.

Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone.

OBJECTIVE: Bone augmentation with the titanium-mesh (Ti-mesh) technique is susceptible to a large rate of complications such as morbidity of bone graft donor site, and mesh exposure to the oral cavity. The purpose of this study was to evaluate the effectiveness of anorganic bovine bone (ABB) in alveolar bone augmentation with the Ti-mesh technique. In addition, we investigated the effect of platelet-rich plasma (PRP) in preventing mesh exposure by using it to cover the Ti-mesh. PATIENTS AND METHODS: Patients included in the clinical trial were randomly allocated by a blinded assistant into two groups. The 30 patients recruited for this study underwent 43 alveolar bone augmentation with the Ti-mesh technique using ABB as graft material in all of them. In 15 patients, the Ti-meshes were covered with PRP (PRP group) whereas in the other 15 the Ti-meshes were not (control group). After 6 months, patients were called for clinical, radiographic, and histological evaluation, and implant placement surgery. A total of 97 implants were placed in the augmented bone and their evolution was followed up for a period of 24 months. RESULTS: Significant differences were found between the two study groups in terms of complications and bone formation. In the control group, 28.5% of the cases suffered from mesh exposure, while in the PRP group, no exposures were registered. Radiographic analysis revealed that bone augmentation was higher in the PRP group than in the control group. Overall, 97.3% of implants placed in the control group and 100% of those placed in the PRP group were successful during the monitoring period. We suggest that the positive effect of PRP on the Ti-mesh technique is due to its capacity to improve soft tissue healing, thereby protecting the mesh and graft material secured beneath the gingival tissues. CONCLUSIONS: Alveolar bone augmentation using ABB alone in the Ti-mesh technique is sufficient for implant rehabilitation. Besides, covering the Ti-meshes with PRP was a determining factor in avoiding mesh exposure. Ti-mesh exposure provoked significant bone loss, but in most cases it did not affect the subsequent placement of implants.

Study of DQE dependence with beam quality on GE essential mammography flat panel.

This paper deals with the analysis of the behavior of objective image quality parameters for the new GE Senographe Essential FFDM system, in particular its dependence with beam quality. The detector consists of an indirect conversion a-Si flat panel coupled to a CsI:Tl scintillator. The system under study has gone through a series of relevant modifications in flat panel with respect to the previous model (GE Senographe DS 2000). These changes in the detector modify its performance and are intended to favor advanced applications like tomosynthesis, which uses harder beam spectra and lower doses per exposure than conventional FFDM. Although our system does not have tomosynthesis implemented, we noticed that most clinical explorations were performed by automatically selecting a harder spectrum than that of typical use in FFDM (Rh/Rh 28-30 kV instead of Mo/Mo 28 kV). Since flat-panel optimization for tomosynthesis influences the usual FFDM clinical performance, the new detector behavior needed to be investigated. Therefore, the aim of our study is evaluating the dependence of the detector performance for different beam spectra and exposure levels. In this way, we covered the clinical beam quality range (Rh/Rh 28-30 kV) and we extended the study to even harder spectra (Rh/Rh 34 kV). Detector performance is quantified by means of modulation transfer function (MTF), normalized noise power spectrum (NNPS) and detective quantum efficiency (DQE). We found that flat-panel optimization results in slightly - but statistically significant - higher DQE values as beam quality increases, which is contrary to the expected behavior. This positive correlation between beam quality and DQE is also diametrically opposite to that of the previous model by the same manufacturer. As a direct consequence, usual FFDM takes advantage of the changes in the detector, as less exposure is needed to achieve the same DQE if harder beams are used.

Effect of platelet-rich plasma on sinus lifting: a randomized-controlled clinical trial.

OBJECTIVE: The combination of anorganic bovine bone (ABB) with platelet-rich plasma (PRP) has been widely used in bone regeneration procedures although its benefits are still unclear. The purpose of this study was to evaluate whether or not PRP improves the efficacy of ABB in sinus floor augmentation. In addition, we have investigated the effect of residual bone height and tobacco on implant survival in sinus augmentation procedures. PATIENT AND METHODS: Eighty-seven patients recruited for this study underwent 144 sinus floor augmentation procedures using ABB alone or ABB plus PRP (ABB+PRP) in a randomized clinical trial. A total of 286 implants were placed in the augmented bone, and their evolution was followed up for a period of 24 months. In order to investigate on a histological level and any adjunctive effects, we performed an ancillary study in five edentulous patients with a symmetrical severely resorbed maxilla. In these patients, a bilateral sinus augmentation was randomly performed using ABB or ABB+PRP in a split-mouth design, and after 6 months, bone biopsies were taken from the implant sites for histological and histomorphometric analysis. RESULTS: Overall, 96.2% of ABB and 98.6% of ABB+PRP implant success were obtained during the monitoring period and differences were not found between sites grafted with and without PRP in the 87 patients studied. Densitometry assessments and graft resorption were similar in both experimental groups. However, the histological and histomorphometrical analysis in the five edentulous patients revealed that bone augmentation was significantly higher in sites treated with ABB+PRP (p

Glutathione and growth inhibition of Mycobacterium tuberculosis in healthy and HIV infected subjects.

Intracellular levels of glutathione are depleted in patients with acquired immunodeficiency syndrome in whom the risk of tuberculosis, particularly disseminated disease is many times that of healthy individuals. In this study, we examined the role of glutathione in immunity against tuberculosis infection in samples derived from healthy and human immunodeficiency virus infected subjects. Our studies confirm that glutathione levels are reduced in peripheral blood mononuclear cells and in red blood cells isolated from human immunodeficiency virus-infected subjects (CD4>400/cumm). Furthermore, treatment of blood cultures from human immunodeficiency virus infected subjects with N-acetyl cysteine, a glutathione precursor, caused improved control of intracellular M. tuberculosis infection. N-acetyl cysteine treatment decreased the levels of IL-1, TNF-alpha, and IL-6, and increased the levels of IFN-gamma in blood cultures derived from human immunodeficiency virus-infected subjects, promoting the host immune responses to contain M. tuberculosis infection successfully.

Characterization of a human Bid homologue protein from Gallus gallus.

Bid protein, a member of the "BH3-only" subgroup of Bcl-2 family, plays a critical role in mammalian apoptosis regulation. In this study, we have cloned the chicken Bid gene, which encodes a 193 amino acid protein and shares 40% homology with human and mouse Bid proteins. Bid sequence comparison emphasises the conservation of both the functional domain BH3 and the proteolytic cleavage sites. An induction of apoptosis by chicken Bid and the cleavage of the protein, after TNFalpha treatment, were also demonstrated. In addition, mRNA Bid expression was detected along all embryo stages and tissues examined, suggesting a role for this protein in the developmental process. This is the first report demonstrating the functionality of a "BH3-only" protein in chicken.

Developing chick embryos express a protein which shares homology with the nuclear pore complex protein Nup88 present in human tumors.

Nup88 is a nuclear pore complex protein which is overexpressed in a variety of human tumors of the stomach, colon, liver, pancreas, breast, lung, ovary, uterus, prostate and kidney. A monoclonal antibody crossreacting with the yeast Candida albicans and Nup88 was used to investigate the expression of cross-reactive antigens in chick embryos, in an attempt to identify an experimental model for studying the role played by Nup88 during cell development and differentiation. All cells in the trilaminar embryo were labeled with the antibody, but as development advanced and organogenesis was completed, expression of the corresponding antigen became more restricted. Thus, some structures continued to be intensely labeled (skin epithelium, oropharyngeal endothelium, perichondral mesenchymal tissue), whereas others ( muscular tissue, vascular endothelium, respiratory endothelium, digestive tract mucosa, peripheral nerves, medullary white matter and the retinal axons) were more moderately stained. No immunoreactivity was observed in the medullary grey matter or cartilage. A specific band of 53 kDa observed by Western blotting of chick embryo extracts suggested that the chicken antigen recognized by the monoclonal antibody is the homologue of human Nup88, which is associated with the high proliferation and low differentiation of tumor cells. The present results indicate that the role of Nup88 in cell differentiation and organ development could be fruitfully investigated using the developing chick embryo as an experimental model.