Nutraceutical Targeting of Placental Synthesis of Soluble Fms-Like Tyrosine Kinase- 1 (sFlt-1) as Strategy for Preventing and Controlling Pre-eclampsia.

The primary driving force in preeclampsia (PE) appears to be excessive secretion of fms-like tyrosine kinase-1 (sFlt-1), a truncated decoy receptor for vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) that induces systemic endotheliopathy by depriving endothelial cells of the trophic support conferred by VEGF. Factors which boost placental sFlt-1 production in PE include hypoxia - reflecting improper placentation - oxidative stress, and deficient production of hydrogen sulfide (H2S). Nutraceutical measures which may address these issues include taurine and N-acetylcysteine - which may boost placental H2S production; spirulina and phase 2 inducers of heme oxygenase-1 such as lipoic acid - which may down-regulate placental NADPH oxidase activity; and citrulline, high-dose folate, and dietary nitrate - which by supporting placental nitric oxide production may aid proper placentation and hence prevent placental hypoxia. These agents may also help to alleviate the pathogenic impact of sFlt-1 excess. If the utility of such measures can be demonstrated in rodent models of PE, functional foods incorporating these nutraceuticals can be envisioned as aids to a healthful pregnancy. Moreover, rodent studies suggest that such prenatal supplementation may reduce risk for hypertension in adult offspring of the pregnancy. And, since women who develop PE are at markedly higher risk for cardiovascular disorders in their later life, continuing use of such supplementation - promoting effective NO and H2S bioactivity while aiding control of oxidative stress - may be advisable for the mothers.

Susac syndrome: the first case report in Peru. / Síndrome de Susac: primer reporte de caso en el Perú.

Susac Syndrome is a rare entity, characterized by a triad of subacute encephalopathy, retinal artery occlusion and sensorineural hearing loss. It is more common in women and the age of onset fluctuates between 9-58 years of age. The pathogenesis is presented as microangiopathic changes at the cerebral, retinal and cochlear levels associated with an autoimmune mechanism. We present the case of a 31-year-old woman who started with a diffuse headache, puerile behavior, bradylalia and somnolence. As the disease progressed, she had auditory deficit and arterial obstruction of the right temporal retinal branch in retinal fluorescein angiography. Brain magnetic resonance showed rounded hyperintense lesions in the corpus callosum, periventricular region and cerebellum. This is the first reported case of Susac Syndrome in Peru, presented with the classic triad, which is an infrequent presentation. However, cases that show incomplete forms should be evaluated in a timely manner to initiate timely treatment and avoid irreversible consequences.

El síndrome de Susac es una entidad rara, caracterizada por la triada clásica de encefalopatía subaguda, oclusión de la arteria retiniana e hipoacusia neurosensorial. Es más frecuente en mujeres, la edad de inicio fluctúa entre los nueve y los 58 años de edad. La patogénesis se plantea como un cuadro microangiopático a nivel cerebral, retiniano y coclear asociado a un mecanismo autoinmune. Presentamos el caso de una mujer de 31 años de edad que inició con cefalea holocraneana, conducta pueril, bradilalia y somnolencia. En la angiografía con fluoresceína de retina presentó en la evolución un déficit auditivo y obstrucción arterial de la rama temporal retiniana derecha. La resonancia magnética cerebral mostró lesiones redondeadas hiperintensas en el cuerpo calloso, región periventricular y cerebelo. Se reporta el primer caso de síndrome de Susac definido en Perú, el que se manifestó con la triada clásica, que es de presentación poco frecuente. Sin embargo, también los casos que muestran formas incompletas deben ser evaluados oportunamente para iniciar un tratamiento oportuno y evitar secuelas irreversibles.

Síndrome iridocórneo-endotelial: presentación de un caso / Iridocorneal-endothelial syndrome: presentation of a case

El síndrome iridocórneo-endotelial agrupa tres síndromes que cuando se presentan en las formas puras son relativamente fáciles de distinguir; sin embargo, es más frecuente que aparezca con un solapamiento considerable dificultando así el establecer una clara definición. Es una entidad nosológica muy poco común en la consulta de Oftalmología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, lo cual motivó la presentación de este caso. Se trata de una paciente de 47 años, que acudió a consulta en el mencionado hospital, que acudió a consulta en el mes de enero de 2012, portadora de un síndrome iridocórneo-endotelial unilateral en ojo derecho, con agudeza visual de 20/20, atrofia del iris, corectopia, pseudopolicoria y glaucoma secundario con hipertensión ocular marcada, a la que se le realizó trabeculectomía como proceder quirúrgico, con evolución satisfactoria.

The iridocorneal-endothelial syndrome comprehends three syndromes that when they appear in their pure forms are relatively easy to distinguish; but more frequently it appears considerably sneaked, making it difficult to stablish a clear definition. It is a nosological entity very uncommon in the consultation of Oftalmology of the Clinica-surgical Teaching Hospital Comandante Faustino Perez Hernandez, of Matanzas. That motivated the presentation of this case. It deals with a female patient, aged 47 years, assisting the consultation of the before mentioned hospital in January 2012, carrying a unilateral iridocorneal-endothelial syndrome in the right eye, with a visual acuity of 20/20, iris atrophy, corectopia, pseudopolychoria and secondary glaucoma with remarked ocular hypertension. She was subject of a trabeculectomy as a surgical procedure, with a satisfactory evolution.