Diagnóstico prenatal, síndrome Freeman-Sheldon mediante ultrasonido y estudio genético. Reporte de caso / Prenatal diagnosis of Freeman-Sheldon syndrome using ultrasound and genetic testing. Case report

Objetivos: Describir un caso de diagnóstico prenatal de síndrome de Freeman-Sheldon mediante hallazgos ecográficos y secuenciación completa del exoma fetal. Materiales y métodos: Mujer de 33 años, con antecedentes de hipotiroidismo en tratamiento, a quien en semana 19 se realizó ecografía de detalle anatómico, en la cual se observaron deformidades en el feto en más de dos áreas corporales (extremidades superiores e inferiores), sugiriendo el diagnóstico de artrogriposis. Posteriormente, se brindó asesoría genética y se realizó amniocentesis en semana 20 de gestación, con análisis de la hibridación in situ por fluorescencia, seguido de secuenciación completa del exoma fetal. Este último examen permitió identificar una variante patogénica heterocigota en el gen MYH3, la cual se asocia con la artrogriposis distal tipo 2A. Conclusiones: La realización de la secuenciación completa de exoma fetal es un factor clave para identificar la mutación del gen MYH3, y confirma que las deformidades evidenciadas por ultrasonido estaban relacionadas con la artrogriposis distal tipo 2A. Es importante hacer la secuenciación de exoma fetal en fetos que muestren hallazgos de malformaciones articulares en el ultrasonido prenatal.

Objectives: To describe a case of prenatal diagnosis of Freeman-Sheldon syndrome based on ultrasound findings and complete fetal exome sequencing. Materials and methods: A 33-year-old woman currently on treatment for hypothyroidism in whom a 19-week detailed anatomical ultrasound scan showed fetal deformities in more than two body areas (upper and lower limbs), suggesting a diagnosis of arthrogryposis. Genetic counseling was provided and amniocentesis was performed at 20 weeks for fluorescence in situ hybridization (FISH) analysis and complete fetal exome sequencing, with the latter allowing the identification of a heterozygous pathogenic variant of the MYH3 gene which is associated with type 2A distal arthrogryposis. Conclusions: Complete fetal exome sequencing was a key factor in identifying the MYH3 gene mutation and confirmed that the deformities seen on ultrasound were associated with type 2A distal arthrogryposis. It is important to perform complete fetal exome sequencing in cases of joint malformations seen on prenatal ultrasound.

Fast Parabolic Fitting: An R-Peak Detection Algorithm for Wearable ECG Devices.

Heart diseases rank among the most fatal health concerns globally, with the majority being preventable through early diagnosis and effective treatment. Electrocardiogram (ECG) analysis is critical in detecting heart diseases, as it captures the heart's electrical activities. For continuous monitoring, wearable electrocardiographic devices must ensure user comfort over extended periods, typically 24 to 48 h. These devices demand specialized algorithms with low computational complexity to accommodate memory and power consumption constraints. One of the most crucial aspects of ECG signals is accurately detecting heartbeat intervals, specifically the R peaks. In this study, we introduce a novel algorithm designed for wearable devices, offering two primary attributes: robustness against noise and low computational complexity. Our algorithm entails fitting a least-squares parabola to the ECG signal and adaptively shaping it as it sweeps through the signal. Notably, our proposed algorithm eliminates the need for band-pass filters, which can inadvertently smooth the R peaks, making them more challenging to identify. We compared the algorithm's performance using two extensive databases: the meta-database QT database and the BIH-MIT database. Importantly, our method does not necessitate the precise localization of the ECG signal's isoelectric line, contributing to its low computational complexity. In the analysis of the QT database, our algorithm demonstrated a substantial advantage over the classical Pan-Tompkins algorithm and maintained competitiveness with state-of-the-art approaches. In the case of the BIH-MIT database, the performance results were more conservative; they continued to underscore the real-world utility of our algorithm in clinical contexts.

Modeling potential risk areas of Orthohantavirus transmission in Northwestern Argentina using an ecological niche approach.

BACKGROUND: Hantavirus Pulmonary Syndrome (HPS) is a rodent-borne zoonosis in the Americas, with up to 50% mortality rates. In Argentina, the Northwestern endemic area presents half of the annually notified HPS cases in the country, transmitted by at least three rodent species recognized as reservoirs of Orthohantavirus. The potential distribution of reservoir species based on ecological niche models (ENM) can be a useful tool to establish risk areas for zoonotic diseases. Our main aim was to generate an Orthohantavirus risk transmission map based on ENM of the reservoir species in northwest Argentina (NWA), to compare this map with the distribution of HPS cases; and to explore the possible effect of climatic and environmental variables on the spatial variation of the infection risk. METHODS: Using the reservoir geographic occurrence data, climatic/environmental variables, and the maximum entropy method, we created models of potential geographic distribution for each reservoir in NWA. We explored the overlap of the HPS cases with the reservoir-based risk map and a deforestation map. Then, we calculated the human population at risk using a census radius layer and a comparison of the environmental variables' latitudinal variation with the distribution of HPS risk. RESULTS: We obtained a single best model for each reservoir. The temperature, rainfall, and vegetation cover contributed the most to the models. In total, 945 HPS cases were recorded, of which 97,85% were in the highest risk areas. We estimated that 18% of the NWA population was at risk and 78% of the cases occurred less than 10 km from deforestation. The highest niche overlap was between Calomys fecundus and Oligoryzomys chacoensis. CONCLUSIONS: This study identifies potential risk areas for HPS transmission based on climatic and environmental factors that determine the distribution of the reservoirs and Orthohantavirus transmission in NWA. This can be used by public health authorities as a tool to generate preventive and control measures for HPS in NWA.

Prenatal diagnosis of Freeman-Sheldon syndrome using ultrasound and genetic testing. Case report / Diagnóstico prenatal, síndrome Freeman-Sheldon mediante ultrasonido y estudio genético. Reporte de caso

Objectives: To describe a case of prenatal diagnosis of Freeman-Sheldon syndrome based on ultrasound findings and complete fetal exome sequencing. Materials and methods: A 33-year-old patient currently on treatment for hypothyroidism in whom a 19-week detailed anatomical ultrasound scan showed fetal deformities in more than two body areas (upper and lower limbs), suggesting a diagnosis of arthrogryposis. Genetic counseling was provided and amniocentesis was performed at 20 weeks for fluorescence in situ hybridization (FISH) analysis and complete fetal exome sequencing, with the latter allowing the identification of a heterozygous pathogenic variant of the MYH3 gene which is associated with type 2A distal arthrogryposis. Conclusions: Complete fetal exome sequencing was a key factor in identifying the MYH3 gene mutation and confirmed that the deformities seen on ultrasound were associated with type 2A distal arthrogryposis. It is important to perform complete fetal exome sequencing in cases of joint malformations seen on prenatal ultrasound.

Objetivos: describir un caso de diagnóstico prenatal de síndrome de Freeman-Sheldon mediante hallazgos ecográficos y secuenciación completa del exoma fetal. Materiales y métodos: mujer de 33 años, con antecedentes de hipotiroidismo en tratamiento, a quien en semana 19 se realizó ecografía de detalle anatómico, en la cual se observaron deformidades en el feto en más de dos áreas corporales (extremidades superiores e inferiores), sugiriendo el diagnóstico de artrogriposis. Posteriormente, se brindó asesoría genética y se realizó amniocentesis en semana 20 de gestación, con análisis de la hibridación in situ por fluorescencia, seguido de secuenciación completa del exoma fetal. Este último examen permitió identificar una variante patogénica heterocigota en el gen MYH3, la cual se asocia con la artrogriposis distal tipo 2A. Conclusiones: la realización de la secuenciación completa de exoma fetal es un factor clave para identificar la mutación del gen MYH3, y confirma que las deformidades evidenciadas por ultrasonido estaban relacionadas con la artrogriposis distal tipo 2A. Es importante hacer la secuenciación de exoma fetal en fetos que muestren hallazgos de malformaciones articulares en el ultrasonido prenatal.

Mapping the global distribution of Strongyloides stercoralis and hookworms by ecological niche modeling.

BACKGROUND: The WHO has established a control strategy for Strongyloides stercoralis in school-aged children as well as targets and to maintain control programs for Ascaris lumbricoides, Trichuris trichiura and hookworms. For an efficient development of control programs, it is necessary to know the target countries around the world, as well as the areas within each country where efforts should be focused. Therefore, maps that provide information on the areas at risk for soil-transmitted helminth (STH) infections on a national and sub-national scale would allow for a better allocation of resources. METHODS: We used the ecological niche models MaxEnt and Kuenm R library to estimate the global distribution of S. stercoralis and hookworms. We used occurrence points of both species extracted from surveys of two literature reviews and from the Global Atlas of Helminth Infection database, together with 14 raster maps of environmental variables. RESULTS: We obtained two raster maps with the presence probability of S. stercoralis and hookworm infections at a global level and then estimated the global population at risk to be 2.6 and 3.4 billion, respectively. The population at risk was also estimated at the country level using estimations for areas as small as 25 km2. A relationship was found between the probability of the presence of S. stercoralis and its prevalence, and a raster map was generated. Annual precipitation, annual temperature, soil carbon content and land cover were the main associated environmental variables. The ecological niches of Strongyloides stercoralis and hookworms had an overlap of 68%. CONCLUSIONS: Here we provide information that can be used for developing more efficient and integrated control strategies for S. stercoralis and hookworm infections. This information can be annexed to the study of other risk factors or even other diseases to assess the health status of a community. GRAPHICAL ABSTARCT.

Strongyloides stercoralis and Trypanosoma cruzi coinfections in a highly endemic area in Argentina.

BACKGROUND: Strongyloidiasis and Chagas disease are endemic in northern Argentina. In this study we evaluate the association between S. stercoralis and T. cruzi infections in villages with diverse prevalence levels for these parasites. Further understanding in the relationship between these Neglected Tropical Diseases of South America is relevant for the design of integrated control measures as well as exploring potential biologic interactions. METHODOLOGY: Community based cross-sectional studies were carried in different villages of the Chaco and Yungas regions in Argentina. Individuals were diagnosed by serology for S. stercoralis and T. cruzi. The association between S. stercoralis and T. cruzi, and between anemia and the two parasites was evaluated using two approaches: marginal (Ma) and multilevel regression (Mu). RESULTS: A total of 706 individuals from six villages of northern Argentina were included. A total of 37% were positive for S. stercoralis, 14% were positive for T. cruzi and 5% were positive for both. No association was found between infection with S. stercoralis and T. cruzi in any of the models, but we found a negative correlation between the prevalence of these species in the different villages (r = -0.91). Adults (> 15 years) presented association with S. stercoralis (Ma OR = 2.72; Mu OR = 2.84) and T. cruzi (Ma OR = 5.12; Mu OR = 5.48). Also, 12% and 2% of the variance of infection with S. stercoralis and T. cruzi, respectively, could be explained by differences among villages. On the other hand, anemia was associated with infection with S. stercoralis (Ma OR = 1.73; Mu OR = 1.78) and was more prevalent in adults (Ma OR = 2.59; Mu OR = 2.69). CONCLUSION: We found that coinfection between S. stercoralis and T. cruzi is not more frequent than chance in endemic areas. However, the high prevalence for both parasites, raises the need for an integrated strategy for the control of STH and Chagas disease.

Transcriptional responses to Fusarium oxysporum f. sp. lycopersici (Sacc.) Snyder & Hansen infection in three Colombian tomato cultivars.

BACKGROUND: Fusarium oxysporum f. sp. lycopersici (Fol) is a compendium of pathogenic and non-pathogenic fungal strains. Pathogenic strains may cause vascular wilt disease and produce considerable losses in commercial tomato plots. To gain insight into the molecular mechanisms mediating resistance to Fol in tomato, the aim of our study was to characterize the transcriptional response of three cultivars (CT1, CT2 and IAC391) to a pathogenic (Fol-pt) and a non-pathogenic (Fo-npt) strain of Fo. RESULTS: All cultivars exhibited differentially expressed genes in response to each strain of the fungus at 36 h post-inoculation. For the pathogenic strain, CT1 deployed an apparent active defense response that included upregulation of WRKY transcription factors, an extracellular chitinase, and terpenoid-related genes, among others. In IAC391, differentially expressed genes included upregulated but mostly downregulated genes. Upregulated genes mapped to ethylene regulation, pathogenesis regulation and transcription regulation, while downregulated genes potentially impacted defense responses, lipid transport and metal ion binding. Finally, CT2 exhibited mostly downregulated genes upon Fol-pt infection. This included genes involved in transcription regulation, defense responses, and metal ion binding. CONCLUSIONS: Results suggest that CT1 mounts a defense response against Fol-pt. IAC391 exhibits an intermediate phenotype whereby some defense response genes are activated, and others are suppressed. Finally, the transcriptional profile in the CT2 hints towards lower levels of resistance. Fo-npt also induced transcriptional changes in all cultivars, but to a lesser extent. Results of this study will support genetic breeding programs currently underway in the zone.

Hantavirus pulmonary syndrome outbreaks associated with climate variability in Northwestern Argentina, 1997-2017.

BACKGROUND: Rodent-borne hantaviruses (genus Orthohantavirus) are the etiologic agents causing two human diseases: hemorrhagic fever with renal syndrome (HFRS) in Euroasia; and hantavirus pulmonary syndrome (HPS) in North and South America. In South America fatality rates of HPS can reach up to 35%-50%. The transmission of pathogenic hantaviruses to humans occurs mainly via inhalation of aerosolized excreta from infected rodents. Thus, the epidemiology of HPS is necessarily linked to the ecology of their rodent hosts and the contact with a human, which in turn may be influenced by climatic variability. Here we examined the relationship between climatic variables and hantavirus transmission aim to develop an early warning system of potential hantavirus outbreaks based on ecologically relevant climatic factors. METHODOLOGY AND MAIN FINDINGS: We compiled reported HPS cases in northwestern Argentina during the 1997-2017 period and divided our data into biannual, quarterly, and bimestrial time periods to allow annual and shorter time delays to be observed. To evaluate the relationship of hantavirus transmission with mean temperature and precipitation we used dynamic regression analysis. We found a significant association between HPS incidence and lagged rainfall and temperature with a delay of 2 to 6 months. For the biannual and quarterly models, hantavirus transmission was positively associated with lagged rainfall and temperature; whereas the bimestrial models indicate a direct relationship with the rainfall but inverse for temperature in the second lagged period. CONCLUSIONS/SIGNIFICANCE: This work demonstrates that climate variability plays a significant role in the transmission of hantavirus in northwestern Argentina. The model developed in this study provides a basis for the forecast of potential HPS outbreaks based on climatic parameters. Our findings are valuable for the development of public health policies and prevention strategies to mitigate possible outbreaks. Nonetheless, a surveillance program on rodent population dynamics would lead to a more accurate forecast of HPS outbreaks.

Memory in repeat sports-related concussive injury and single-impact traumatic brain injury.

Background: Repeat sports-related concussive/subconcussive injury (RC/SCI) is related to memory impairment. Objective & Methods: We sought to determine memory differences between persons with RC/SCI, moderate-to-severe single-impact traumatic brain injury (SI-TBI), and healthy controls. MRI scans from a subsample of participants with SI-TBI were used to identify the neuroanatomical correlates of observed memory process differences between the brain injury groups. Results: Both brain injury groups evidenced worse learning and recall in contrast to controls, although SI-TBI group had poorer memory than the RC/SCI group. Regarding memory process differences, in contrast to controls, the SI-TBI group evidenced difficulties with encoding, consolidation, and retrieval, while the RC/SCI group showed deficits in consolidation and retrieval. Delayed recall was predicted by encoding, with consolidation as a secondary predictor in the SI-TBI group. In the RC/SCI group, delayed recall was only predicted by consolidation. MRI data showed that the consolidation index we used mapped onto hippocampal atrophy. Conclusions: RC/SCI is primarily associated with consolidation deficits, which differs from SI-TBI. Given the role of the hippocampus in memory consolidation and the fact that hyperphosphorylated tau tends to accumulate in the medial temporal lobe in RC/SCI, consolidation deficits may be a cognitive marker of chronic traumatic encephalopathy in athletes.

The Strongyloides stercoralis-hookworms association as a path to the estimation of the global burden of strongyloidiasis: A systematic review.

TRIAL REGISTRATION: PROSPERO (registration code CRD42019131127).

Characterization of Pathogenic and Nonpathogenic Fusarium oxysporum Isolates Associated with Commercial Tomato Crops in the Andean Region of Colombia.

In Colombia, tomato production under protected conditions represents an important economic contribution to the agricultural sector. Fusarium wilt diseases, caused by pathogenic formae speciales of the soil-borne fungus Fusarium oxysporum Schltdl., cause significant yield losses in tomatoes throughout the world. Investigation of the F. oxysporum-tomato pathosystem in Colombia is required to develop appropriate alternative disease management. In this study, 120 fungal isolates were obtained from four different departments in the Central Andean Region in Colombia from tomato crops with symptoms of wilt disease. A molecular characterization of the fungal isolates was performed using the SIX1, SIX3, and SIX4 effector genes of Fusarium oxysporum f. sp. lycopersici W.C. Snyder & H.N. Hansen (Fol). Additionally, we developed a new specific marker to distinguish between Fusarium oxysporum f. sp. radicis-lycopersici Jarvis & Shoemaker (Forl) and Fol isolates. Furthermore, a phylogenetic analysis using the Translation Elongation Factor 1-alpha (EF1a) gene was performed with the collected isolates. Two isolates (named Fol59 and Fol-UDC10) were identified as Fol race 2, four isolates were identified as Forl, six isolates were identified as F. solani, and most of the isolates were grouped within the F. oxysporum species complex. The phylogenetic tree of EF1a showed that most of the isolates could potentially correspond to nonpathogenic strains of F. oxysporum. Additional pathogenicity assays carried out with Fol59 and Fol-UDC10 confirmed that both isolates were highly virulent strains. This study represents a contribution to the understanding of the local interaction between tomatoes and F. oxysporum in Colombia.

Segmentation of the ECG Signal by Means of a Linear Regression Algorithm.

The monitoring and processing of electrocardiogram (ECG) beats have been actively studied in recent years: new lines of research have even been developed to analyze ECG signals using mobile devices. Considering these trends, we proposed a simple and low computing cost algorithm to process and analyze an ECG signal. Our approach is based on the use of linear regression to segment the signal, with the goal of detecting the R point of the ECG wave and later, to separate the signal in periods for detecting P, Q, S, and T peaks. After pre-processing of ECG signal to reduce the noise, the algorithm was able to efficiently detect fiducial points, information that is transcendental for diagnosis of heart conditions using machine learning classifiers. When tested on 260 ECG records, the detection approach performed with a Sensitivity of 97.5% for Q-point and 100% for the rest of ECG peaks. Finally, we validated the robustness of our algorithm by developing an ECG sensor to register and transmit the acquired signals to a mobile device in real time.

Psicología del absurdo: la paradoja de la subjetividad / Psychology of the absurd: the paradox of subjectivity

El texto posibilita adentrarse y reflexionar sobre el mundo psíquico y lo subjetivo que impera en él. Además de ello aborda el objeto de estudio de la psicología, el psiquismo, desde dos conceptos específicos, lo absurdo y lo paradójico.

The text makes it possible to enter and reflect on the psychic world and the subjective that prevails in it. Besides, it addresses the object of study of psychology, the psyche, from two specific concepts, the absurd and the paradoxical.

El lenguaje, Otro(s) en sí mismo: apertura y encuentro de la psique / Language, Other (s) in itself: opening and meeting of the psyche

El lenguaje es la posibilidad posibilitante que posee el terapeuta (psicoanalista y psicólogo) de acercarse al mundo psíquico del paciente, pues este es el umbral que se abre ante su mirada analítica y observadora, y ante su oído atento y sagaz; efectuando de esta forma un encuentro con la construcción subjetiva que el paciente ha forjado de su vida en su ser histórico-lingüístico. De igual forma, el lenguaje posibilita acercarse al discurso social y a los imaginarios que este crea, como realidad intrínseca en el sujeto, puesto que es una constitución que se funda en la capacidad humana de otorgar sentido y significación a la realidad objetiva y subjetiva, vivida y experimentada en él. Por lo anterior, se permite acoger a el lenguaje como herramienta que facilita operar desde el discurso y los imaginarios insertados por y en la cultura, ya que estos otorgan una visión de la significación y del sentido que el hombre ha dado a su construcción psíquica y como este lo ha afectado, y de esta forma se facilitará la apertura y el encuentro con la psique del paciente.

The language is the possibility that enables the therapist (psychoanalyst and psychologist) approach the psychic world of the patient. This is the threshold that opens before his analytical and observing gaze, and before his attentive and canny ear; effecting in this way an encounter with the subjective construction that the patient has forged of his life in his historical-linguistic being. Language also makes it possible to approach the social and imaginary speeches that he creates, as an intrinsic reality in the subject, since it is a constitution that is based on the human capacity to give meaning to the objective and subjective reality, lived and experienced in it. For the above, it is possible to accept language as a tool that facilitates the operation of speech and the imaginaries inserted by culture. Since these give a vision of meaning that the man has given to his psychic construction and how it has affected him in a way the opening and the encounter with the patient's psyche will be facilitated.

Genomic Bayesian functional regression models with interactions for predicting wheat grain yield using hyper-spectral image data.

BACKGROUND: Modern agriculture uses hyperspectral cameras that provide hundreds of reflectance data at discrete narrow bands in many environments. These bands often cover the whole visible light spectrum and part of the infrared and ultraviolet light spectra. With the bands, vegetation indices are constructed for predicting agronomically important traits such as grain yield and biomass. However, since vegetation indices only use some wavelengths (referred to as bands), we propose using all bands simultaneously as predictor variables for the primary trait grain yield; results of several multi-environment maize (Aguate et al. in Crop Sci 57(5):1-8, 2017) and wheat (Montesinos-López et al. in Plant Methods 13(4):1-23, 2017) breeding trials indicated that using all bands produced better prediction accuracy than vegetation indices. However, until now, these prediction models have not accounted for the effects of genotype × environment (G × E) and band × environment (B × E) interactions incorporating genomic or pedigree information. RESULTS: In this study, we propose Bayesian functional regression models that take into account all available bands, genomic or pedigree information, the main effects of lines and environments, as well as G × E and B × E interaction effects. The data set used is comprised of 976 wheat lines evaluated for grain yield in three environments (Drought, Irrigated and Reduced Irrigation). The reflectance data were measured in 250 discrete narrow bands ranging from 392 to 851 nm (nm). The proposed Bayesian functional regression models were implemented using two types of basis: B-splines and Fourier. Results of the proposed Bayesian functional regression models, including all the wavelengths for predicting grain yield, were compared with results from conventional models with and without bands. CONCLUSIONS: We observed that the models with B × E interaction terms were the most accurate models, whereas the functional regression models (with B-splines and Fourier basis) and the conventional models performed similarly in terms of prediction accuracy. However, the functional regression models are more parsimonious and computationally more efficient because the number of beta coefficients to be estimated is 21 (number of basis), rather than estimating the 250 regression coefficients for all bands. In this study adding pedigree or genomic information did not increase prediction accuracy.

Relationship between HSP90a, NPC2 and L-PGDS proteins to boar semen freezability.

BACKGROUND: The purpose of this study was to determine the association of three proteins involved in sperm function on the freezability of porcine semen: the heat shock protein 90 alpha (HSP90a), the Niemann-Pick disease type C2 protein (NPC2), and lipocalin-type prostaglandin D synthase (L-PGDS). Six adult boars (each boar was ejaculated three times, 18 in total) were classified by freezability based on the percentage of functionally competent sperm. The male semen with highest freezability (MHF) and the male semen with lowest freezability (MLF) were centrifuged immediately after collection to separate seminal plasma and spermatozoa to make four possible combinations of these two components and to incubate them for 3 h, adjusting the temperature to 17 °C, to freeze them afterwards. The quantification of proteins was performed in two stages: at zero and at 3 h after incubation of the four combinations. RESULTS: The spermatozoa × incubation time (IT) interaction only had effect (P < 0.01) on HSP90a levels; this protein increased in seminal plasma, after 3 h of incubation, in larger quantity (P < 0.05) in combinations with MLF spermatozoa. In relation with the NPC2 protein, two isoforms of 16 and 19 kDa were identified. The 19 kDa isoform was affected (P < 0.01) only by the seminal plasma × IT interaction, with superior values (P < 0.01) both at zero and three hours of incubation, in the combinations with MHF seminal plasma; and 16 kDa isoform was affected (P < 0.01) only by the IT with reduction after 3 h of incubation. The levels of L-PGDS was affected (P < 0.01) only by the spermatozoa × IT interaction, which reduced (P < 0.01) in combinations with MLF spermatozoa after 3 h of incubation. CONCLUSIONS: It is possible to consider that the three proteins evaluated were associated with freezability of boar semen due, especially, to the fact that mixtures with MLF spermatozoa showed greater increase levels of the HSP90a protein and reduction of L-PGDS in plasma. In addition, the seminal plasma of MHF had higher concentration of the NPC2 of 19 kDa protein, which was reduced by incubating with MHF spermatozoa.

Grosor de segmento uterino inferior como predictor de resolución de embarazo vía vaginal en pacientes con cesárea previa / Thickness of the lower uterine segment as a predictor of pregnancy resolution vaginally in patients with previous cesarean

Objetivo El objetivo de esta investigación fue determinar siel grosor del segmento uterino, medido por ultrasonido, esun predictor de la resolución del embarazo por vía vaginal.Método Estudio observacional de prueba diagnóstica quese llevó a cabo en el Hospital General San Juan de Diosde la Ciudad de Guatemala, en la Unidad de Obstetricia. Elestudio incluyo a todas las pacientes que cumplieron conlos requisitos de una cesárea previa en el periodo de enerode 2011 a enero 2012. Resultados del grupo total (n 43), el81% (n=35) resolvieron parto por vía vaginal, y el 19% (n=8)por cesárea. El 58% tenían un grosor menor de 3.5 mm y el42% fue mayor o igual a ello. De 35 pacientes que tuvieronparto eutócico simple, el 48 %(n= 19) fue menor de 3.5 mm,mientras que 52 % (n=17) tenían una medición igual o mayor;de las 8 sometidas a cesárea, en 7 fue menor de 3.5 mm. Lamorbilidad se presentó solamente en el grupo cuyo segmentofue menor de 3.5 mm, 2.3% (n=1) ruptura uterina y 4.6% (n=2)dehiscencias uterinas, y representaron el 12.5 % de las 24pacientes. No hubo mortalidad materna. Conclusión Se puedeofrecer prueba de parto vaginal a pacientes con una cesàreaprevia independientemente del grosor del segmento uterinoinferior; sin embargo cuando el mismo es menor de 3.5mmse debe realizar un monitoreo materno fetal más estricto.

Objective The objective of this research was to determinewhether uterine segment thickness, measured by ultrasound,is a predictor of pregnancy resolution vaginally. MethodObservational study of diagnostic test that took place inHospital General San Juan de Dios in Guatemala City, atthe Obstetrics Unit. The study included all patients who metthe requirements of a previous cesarean in the period fromJanuary 2011 to January 2012. Results of the total group (n43), 81% (n = 35) resolved vaginal delivery, and 19% (n =8) by cesarean section. 58% had a thickness less than 3.5mm and 42% was greater than or equal to it. 35 patientswho had single vaginal delivery, 48% (n = 19) was less than3.5 mm, while 52% (n = 17) had a measurement equal to orgreater; from 8 subjected to caesarean section 7 was lessthan 3.5 mm. The morbidity was observed only in the groupwhose segment was less than 3.5 mm, 2.3% (n = 1) uterinerupture and 4.6% (n = 2) uterine dehiscence, and accountedfor 12.5% of the 24 patients. There were no maternal deaths.Conclusion We can offer trial of labor in patients with aprevious cesarean section regardless of the thickness of thelower uterine segment; however when it is less than 3.5mmstrict materno-fetal monitoring is mandatory.

[Synchronous bilateral gangliobasal hemorrhage in a student with sickle cell anemia: a case report]. / Hemorragia gangliobasal bilateral sincronica en una escolar con anemia de celulas falciformes: reporte de caso.

Sickle cell anemia is a common genetic condition that may have ischemic brain infarct and hemorrhagic complications, these being known as major complications. The incidence of stroke in children with sickle cell anemia is similar to that presented by the elderly in the general population. A case of a schoolchild that debuted with synchronous bilateral intracerebral hemorrhage is discussed. To our knowledge this is the first report in the literature of synchronous bilateral gangliobasal bleeding in a schoolchild with sickle cell anemia.

Pentalogía de Cantrell / Pentalogy of Cantrell

La Pentalogía de Cantrell es un raro desorden caracterizado por una combinación de defectos severos de esternón, diafragma, corazón y paredes abdominales, en ocasiones asociado a una multiciplicidad de anomalías congénitas. Afecta a 5.5 infantes por un millón de nacimientos. Son más afectados los varones en una proporción de 2:1 y suelen tener signo sintomatología mas severa que en las mujeres...