Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases.

The relationship between events occurring during intrauterine development and later-life predisposition to long-term disease, has been described. The fetus responds to excess intrauterine exposure to high levels of corticosteroids, modifying their physiological development and stopping their growth. Fetal exposure to elevated levels of either endogenous (alterations in fetal hypothalamic-pituitary-adrenal axis) or synthetic corticosteroids, is one model of early-life adversity; to developing adult disease. At the molecular level, there are transcriptional changes in metabolic and growth pathways. Epigenetic mechanisms participate in transgenerational inheritance, not genomic. Exposures that change 11ß-hydroxysteroid dehydrogenase type 2 enzyme methylation status in the placenta can result in transcriptional repression of the gene, causing the fetus to be exposed to higher levels of cortisol. More precise diagnosis and management of antenatal corticosteroids for preterm birth, would potentially decrease the risk of long-term adverse outcomes. More studies are needed to understand the potential roles of factors to alter fetal corticosteroid exposure. Long-term infant follow-up is required to determine whether methylation changes in placenta may represent useful biomarkers of later disease risk. This review, summarize recent advances in the programming of fetal effects of corticosteroid exposure, the role of corticosteroids in epigenetic gene regulation of placental 11ß-hydroxysteroid dehydrogenase type 2 enzyme expression and transgenerational effects.

Bibliometría o altimetría: desde las métricas tradicionales a las actuales. Revisión bibliográfica / Bibliometry or altimetry: from traditional metrics to present. A review

Introducción:La forma en la que se mide la difusión de la información en la comunidad científica ha sufrido cambios en la última década. Objetivo:Esta revisión tiene como objetivo contextualizar al lector sobre las diferentes formas de medir el impacto de un artículo, tomando en cuenta el "sistema de medición tradicional" y el de "métricas alternativas". Metodología de búsqueda:Se realizó una búsqueda en las bases de datos "PubMed/MEDLINE", "Dialnet", "Scielo" y "ScienceDirect", utilizando las palabras clave: Bibliometría, alt métricas, métricas alternativas y factor de impacto. Conclusiones:El "sistema de medición tradicional", basado en el factor de impacto y que se apoya esencialmente en la opinión de expertos, con el fin asegurar la calidad de las investigaciones, es una herramienta aún vigente que en conjunto con las métricas alternativas o altmétricas, favorecen la difusión del conocimiento, sin que necesariamente midan de manera precisa la calidad del artículo y su impacto...(AU)

Femicidioy Overkill: a propósito de un caso / Femicide and Overkill: A casereport

Introducción: El femicidio es todo homicidio intencional de una mujer por razones de su género. El término overkillse utiliza en los casos donde se observa gran cantidad de heridas, excediendo lo necesario para causar la muerte. Presentamos este caso médico-legal con el objetivode ejemplificar la relación entre el overkill y los femicidios. Resultados: Los hallazgos de autopsia revelaron lesiones compatibles con estrangulación manualeinstrumentalizada y heridas por arma blanca. Esto permitiócalificarla como overkill. Conclusión: Este tipo de caso llama a la reflexión sobre los factores de riesgo y formas de cómo prevenirlos...(AU)

Hernia paraesofágica mixta con mal rotación de estómago / Mixed paraesophageal hernia with bad gastric rotation

Las hernias hiatales, son defectos anatómicos en el hiato diafragmático. Las de tipo "paraesofágicas" son frecuentes, se sabe que atentan contra la vida de una manera potencial, ya que presentan un alto riesgo de complicación de vólvulo y encarcelación lo que incrementa con la edad. Objetivo: establecer una ruta diagnóstica para mejorar el abordaje clínico de esta patología. Caso Clínico: niño de 4 años, con historia de dolor abdominal de 3 meses de evolución en región mesogástrica, que se acompaña de palidez hiporexia y estreñimiento. Laboratorio: hemoglobina 4.3g/dl, hematocrito 13.9%, diagnóstico de anemia, diagnóstico por endoscopía: hernia hiatal tipo III (mixta), mal rotación de estómago. Se trató con funduplicatura Nissen y posteriormente con dilataciones esofágicas. Conclusión: La hernia hiatal es la anormalidad más frecuente del tracto digestivo alto, las de tipo paraesofágico son infrecuentes y debe ser incluida como diagnóstico diferencial en niños con repetidos episodios de infección respiratoria o vómitos a repetición. El estudio diagnóstico de elección es el esofagograma con medio de contraste.

Infección al sistema nervioso por toxocara canis en Hospital Escuela Universitario, Honduras / Nervous system infection by Toxocara Canis in the University School Hospital, Honduras

La toxocariosis es una enfermedad provocada por nematodos; actualmente se cataloga una de las zoonosis prevalentes a nivel mundial, especialmente en áreas rurales, se presenta a cualquier edad de la vida. Se presenta el primer caso publicado de neurotoxocariosis canis en Honduras. Objetivo: orientar al lector sobre el comportamiento de esta enfermedad y su sospecha clínica en paciente con contacto canino. Caso clínico: paciente masculino con 14 meses de edad, en contacto con perros de su comunidad, con historia de fiebre y convulsiones; al examen físico hepatomegalia y signo Babinski (+). Laboratorialmente presentó hipereosinofilia y en estudio de imágenes edema cerebral difuso. Se realizó ELISA por Toxocara y resultó positivo, de acuerdo al resultado se sospechó toxocariosis no clásica. Conclusión: la presentación no típica de esta enfermedad es rara, la similitud de la sintomatología con otras enfermedades hace de la práctica clínica de difícil diagnóstico. Es importante tener presente esta forma no clásica de esta enfermedad...(AU)

Unexpected ring-closure products derived from 3-(2-allylanilino)-3-phenylacrylate esters: crystal and molecular structures of 3-acetyl-8-allyl-6-methyl-2-phenylquinolin-4-yl acetate and (2RS)-2,8-dimethyl-4-phenyl-1,2-dihydro-6H-pyrrolo[3,2,1-ij]quinolin-6-one.

The reactions of two 3-(2-allylanilino)-3-phenylacrylate esters with acetic anhydride and with strong acids has revealed a richly diverse reactivity providing a number of unexpected products. Thus, acetylation of ethyl 3-(2-allylanilino)-3-phenylacrylate, (Ia), or ethyl 3-(2-allyl-4-methylanilino)-3-phenylacrylate, (Ib), with acetic anhydride yields not only the expected acetylated esters, (II), as the major products but also the unexpected polysubstituted quinolines 3-acetyl-8-allyl-2-phenylquinolin-4-yl acetate, (IIIa), and 3-acetyl-8-allyl-6-methyl-2-phenylquinolin-4-yl acetate, (IIIb), as minor products. Subsequent reaction of the major product ethyl 2-[(2-allyl-4-methylanilino)(phenyl)methylidene]-3-oxobutanoate, (IIb), with concentrated sulfuric acid did not provide the expected 3-acetylquinoline derivative, but instead two unexpected products, namely ethyl 4-ethyl-2-phenyl-1,4-dihydroquinoline-3-carboxylate, (IV), and ethyl 3-acetyl-4-ethyl-2-phenyl-3,4-dihydroquinoline-3-carboxylate, (V), in yields of 39 and 22%, respectively. The reaction of (Ib) with Eaton's reagent gave both the quinoline (Z)-6-methyl-2-phenyl-8-(prop-1-en-1-yl)quinolin-4(1H)-one, (VI), and the unexpected tricyclic product (2RS)-2,8-dimethyl-4-phenyl-1,2-dihydro-6H-pyrrolo[3,2,1-ij]quinolin-6-one, (VII), in yields of 71 and 12%, respectively. The products (II)-(VII) have all been fully characterized spectroscopically and the crystal structures of two of the unexpected products, i.e. (IIIb) (C23H21NO3) and (VII) (C19H17NO), are reported here. The formation of compounds (IV), (V) and (VII) all require an isomerization of the initial allyl substituent, with migration of the C=C double bond from the terminal site to the internal site. In (IIIb), the two acetyl substituents are oriented such that the intramolecular distance between the two carbonyl O atoms is only 3.243 (2) Å, and in (VII), the five-membered ring adopts a twisted half-chair conformation. The molecules of compound (IIIb) are linked by two independent hydrogen bonds to form sheets built from R4(3)(20) rings and the sheets are linked by a π-π stacking interaction to form a three-dimensional framework structure. The molecules of compound (VII) are linked by a single type of C-H...O hydrogen bond to form centrosymmetric R2(2)(14) dimers. The molecules of compound (V), which crystallizes with Z' = 2, are linked by two N-H...O and two C-H...O hydrogen bonds, forming a chain of rings.

Crystal structures of five new substituted tetrahydro-1-benzazepines with potential antiparasitic activity.

Tetrahydro-1-benzazepines have been described as potential antiparasitic drugs for the treatment of chagas disease and leishmaniasis, two of the most important so-called `forgotten tropical diseases' affecting South and Central America, caused by Trypanosoma cruzi and Leishmania chagasi parasites, respectively. Continuing our extensive work describing the structural characteristics of some related compounds with interesting biological properties, the crystallographic features of three epoxy-1-benzazepines, namely (2SR,4RS)-6,8-dimethyl-2-(naphthalen-1-yl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, (1), (2SR,4RS)-6,9-dimethyl-2-(naphthalen-1-yl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, (2), and (2SR,4RS)-8,9-dimethyl-2-(naphthalen-1-yl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, (3), all C22H21NO, and two 1-benzazepin-4-ols, namely 7-fluoro-cis-2-[(E)-styryl]-2,3,4,5-tetrahydro-1H-1-benzazepin-4-ol, C18H18FNO, (4), and 7-fluoro-cis-2-[(E)-pent-1-enyl]-2,3,4,5-tetrahydro-1H-1-benzazepin-4-ol, C15H20FNO, (5), are described. Some peculiarities in the crystallization behaviour were found, involving significant variations in the crystalline structures as a result of modest changes in the peripheral substituents in (1)-(3) and the occurrence of discrete disorder due to the molecular overlay of enantiomers with more than one conformation in (5). In particular, an interesting phase change on cooling was observed for compound (5), accompanied by an approximate fourfold increase of the unit-cell volume and a change of the Z' value from 1 to 4. This transition is a consequence of the partial ordering of the pentenyl chains in half of the molecules breaking half of the -3 symmetry axes observed in the room-temperature structure of (5). The structural assembly in all the title compounds is characterized by not only (N,O)-H...(O,N) hydrogen bonds, but also by unconventional C-H...O contacts, resulting in a wide diversity of packing.

Cardiomiopatia severa secundaria a feocromocitoma: utilidad del sulfato de magnesio. Reporte de un caso / Severe cardiomyopathy secondary to pheochromocytoma: Usefulness of magnesium sulfate. Case report

The following report on the perioperative anesthetic management of severe cardiomyopathy and resection of pheochromocytoma tumors offers a clinical and pharmaceutical experience with a good outcome for a high-risk pathology with little available world literature. The female patient accesses emergency services in distress with tachycardia, labile blood pressure, dyspnea, and severe abdominal pain. Clinical studies reveal heart failure, an adrenal mass, and derivates of high levels of catecholamines in the blood, which leads to the diagnosis of severe cardiomyopathy induced by pheochromocytoma. The medical management for the acute crisis is performed with therapy in the intensive care unit, antihypertensives and magnesium sulfate. Once stabilized, a laparoscopic tumor resection followed. Her postoperative progress was adequate with a progressive resolution of symptoms. Cardiomyopathy secondary to pheochromocytoma is a pathology with high morbimortality and low frequency and is produced by the action of great quantities of catecholamines released subacutely due to hemorrhagic tumor necrosis or manipulation of the pheochromocytoma. It requires strict care in its acute crises and during surgery for its definitive resection. This report shows our experience with the usefulness of magnesium sulfate as a contributory drug in the control of this pathology throughout the perioperative period due to its mechanism of action and pharmacodynamics. Its easy availability in hospitals, the good clinical results it produces, and its scientific backing are important factors that make it a pharmacological option for pheochromocytoma.

El siguiente reporte de manejo anestésico perioperatorio de cardiomiopatía severa y resección de tumor de feocromocitoma, ofrece una experiencia clínica y farmacológica con buen resultado, de una patología de alto riesgo con poca literatura mundial. La paciente ingresa al servicio de urgencias con angustia, taquicardia, tensión arterial lábil, disnea y dolor abdominal severos. Sus estudios clínicos revelan insuficiencia cardiaca, masa suprarenal y derivados de catecolaminas elevados en sangre, que hacen diagnóstico de cardiomiopatía severa inducida por Feocromocitoma; se realiza el manejo médico de la crisis aguda con terapia en unidad de cuidado intensivo, antihipertensivos y sulfato de magnesio y una vez estabilizada se lleva a resección tumoral laparoscopica. Su evolución postoperatoria fue adecuada, con resolución progresiva de los síntomas. La cardiomiopatía secundaria a feocromocitoma es una patología de alta morbimortalidad e inusual frecuencia, producida por la acción de grandes cantidades de catecolaminas liberadas de modo subagudo por necrosis tumoral hemorrágica o manipulación de feocromocitoma, que requiere manejo estricto en su crisis aguda y en la cirugía de resección definitiva. Este reporte muestra la experiencia de la utilidad del sulfato de magnesio, como fármaco coadyuvante en el control de esta patología durante todo el periodo perioperatorio, por su mecanismo de acción y farmacodinamia. Su fácil accesibilidad hospitalaria, buen resultado clínico y soporte científico son factores importantes para ser considerado una opción farmacológica en Feocromocitoma.

Four related benzazepine derivatives in a reaction pathway leading to a benzazepine carboxylic acid: hydrogen-bonded assembly in zero, one, two and three dimensions.

(2R*,4S*)-Methyl 2,3,4,5-tetrahydro-1,4-epoxy-1H-benz[b]azepine-2-carboxylate, C12H13NO3, (I), and its reduction product (2R*,4S*)-methyl 4-hydroxy-2,3,4,5-tetrahydro-1H-benz[b]azepine-2-carboxylate, C12H15NO3, (II), both crystallize as single enantiomers in the space group P212121, while the hydrolysis product (2RS,4SR)-4-hydroxy-2,3,4,5-tetrahydro-1H-benz[b]azepine-2-carboxylic acid, C11H13NO3, (III), and the lactone (2RS,5SR)-8-(trifluoromethoxy)-5,6-dihydro-1H-2,5-methanobenz[e][1,4]oxazocin-3(2H)-one, C12H10F3NO3, (IV), both crystallize as racemic mixtures in the space group P21/c. The molecules of compound (IV) are linked into centrosymmetric R2(2)(10) dimers by N-H···O hydrogen bonds, and those of compound (I) are linked into chains by C-H···π(arene) hydrogen bonds. A combination of O-H···O and O-H···N hydrogen bonds links the molecules of compound (III) into sheets containing equal numbers of R4(4)(14) and R4(4)(26) rings, and a combination of C-H···π(arene) hydrogen bonds and three-centre O-H···(N,O) hydrogen bonds links the molecules of compound (II) into a three-dimensional framework structure. Comparisons are made with some related compounds.

Three closely related dibenzazepine carboxylic acids: hydrogen-bonded aggregation in one, two and three dimensions.

In the structure of (6R*,11R*)-5-acetyl-11-ethyl-6,11-dihydro-5H-dibenzo[b,e]azepine-6-carboxylic acid, C19H19NO3, (I), the molecules are linked into sheets by a combination of O-H...O and C-H...O hydrogen bonds; in the structure of the monomethyl analogue (6RS,11SR)-5-acetyl-11-ethyl-2-methyl-6,11-dihydro-5H-dibenzo[b,e]azepine-6-carboxylic acid, C20H21NO3, (II), the molecules are linked into simple C(7) chains by O-H...O hydrogen bonds; and in the structure of the dimethyl analogue (6RS,11SR)-5-acetyl-11-ethyl-1,3-dimethyl-6,11-dihydro-5H-dibenzo[b,e]azepine-6-carboxylic acid, C21H23NO3, (III), a combination of O-H...O, C-H...O and C-H...π(arene) hydrogen bonds links the molecules into a three-dimensional framework structure. None of these structures exhibits the R2(2)(8) dimer motif characteristic of simple carboxylic acids.

Four 1-naphthyl-substituted tetrahydro-1,4-epoxy-1-benzazepines: hydrogen-bonded structures in one, two and three dimensions.

(2S*,4R*)-2-exo-(1-Naphthyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(20)H(17)NO, (I), crystallizes with Z' = 2 in the space group P2(1); the two independent molecules have the same absolute configuration, although this configuration is indeterminate. The molecules of each type are linked by a combination of C-H...O and C-H...π(arene) hydrogen bonds to form two independent sheets, each containing only one type of molecule. (2SR,4RS)-7-Methyl-2-exo-(1-naphthyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(21)H(19)NO, (II), crystallizes as a true racemate in the space group P2(1)/c, and a combination of C-H...N, C-H...O and C-H...π(arene) hydrogen bonds links the molecules into sheets, each containing equal numbers of the two enantiomorphs. (2S*,4R*)-2-exo-(1-Naphthyl)-7-trifluoromethyl-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(21)H(16)F(3)NO(2), (III), crystallizes as a single enantiomorph, as for (I), but now with Z' = 1 in the space group P2(1)2(1)2(1); again, the absolute configuration is indeterminate. A single C-H...π(arene) hydrogen bond links the molecules of (III) into simple chains. (2S,4R)-8-Chloro-9-methyl-2-exo-(1-naphthyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(21)H(18)ClNO, (IV), crystallizes as a single enantiomorph of well defined configuration, in the space group P2(1)2(1)2(1), where two independent C-H...π(arene) hydrogen bonds link the molecules into a single three-dimensional framework structure.

Four differently substituted 2-aryl-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepines: hydrogen-bonded structures in one, two and three dimensions.

In (2RS,4SR)-7-chloro-2-exo-(2-chloro-6-fluorophenyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(16)H(12)Cl(2)FNO, (I), molecules are linked into chains by a single C-H...pi(arene) hydrogen bond. (2RS,4SR)-2-exo-(2-Chloro-6-fluorophenyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(16)H(13)ClFNO, (II), is isomorphous with compound (I) but not strictly isostructural with it, as the hydrogen-bonded chains in (II) are linked into sheets by an aromatic pi-pi stacking interaction. The molecules of (2RS,4SR)-7-methyl-2-exo-(4-methylphenyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(18)H(19)NO, (III), are linked into sheets by a combination of C-H...N and C-H...pi(arene) hydrogen bonds. (2S,4R)-2-exo-(2-Chlorophenyl)-2,3,4,5-tetrahydro-1H-1,4-epoxy-1-benzazepine, C(16)H(14)ClNO, (IV), crystallizes as a single enantiomer and the molecules are linked into a three-dimensional framework structure by a combination of one C-H...O hydrogen bond and three C-H...pi(arene) hydrogen bonds.

Histerectomía obstétrica: análisis de 15 años / Obstetric hysterectomy: analysis of 15 years

Determinar la incidencia, factores asociados y repercusiones de la histerectomía obstétrica. Estudio retrospectivo, descriptivo, analítico y transversal que incluyó 50 pacientes sometidas a histerectomía obstétrica en 64293 casos obstétricos, durante un período de 15 años (del 01 de agosto de 1993 al 31 de julio de 2008). Departamento de Obstetricia y Ginecología. Hospital Nuestra Señora de Chiquinquirá. Maracaibo, Venezuela. La incidencia de histerectomía obstétrica fue 0,07 por ciento (1 HO por 1 285 casos obstétricos). Fue más frecuente en mujeres entre 25-29 años (26 por ciento), IV gestas (34 por ciento), para 3 (26 por ciento), con control prenatal (63,33 por ciento), embarazos de 37-41semanas (56 por ciento), poscesárea (46 por ciento), histerectomía tipo total (86 por ciento), indicadas por atonía uterina (38 por ciento), complicadas con anemia (88 por ciento), ameritaron transfusión sanguínea (84 por ciento) y duraron <7 días de hospitalización (56 por ciento). Hubo 8 muertes maternas (16 por ciento) y la tasa de mortalidad materna ajustada fue 792 por 10000 nacidos vivos. Hubo 9 abortos (18 por ciento), 15 muertes fetales (30 por ciento) y la tasa de mortalidad perinatal fue 129 por 1000 nacidos vivos. En la población estudiada, la histerectomía obstétrica fue poco frecuente, más comúnmente indicada por trastornos hemorrágicos y tuvo cifras de morbilidad y mortalidad materna elevadas

To determine the incidence, associated factors and repercussions of obstetric hysterectomy. Retrospective, descriptive, analytic and transversal study that included 50 obstetric hysterectomies (OH) in 64293 obstetrics cases, during fifteen years (from August 1st, 1993 to July 31th, 2008). Department of Obstetrics and Gynecology. Our Lady of Chiquinquira Hospital. Maracaibo, Venezuela. The incidence of OH was 0.07 percent (1 OH by 1285 obstetric cases). It was more frequent in women between 25-29 years (26 percent), IV gestations (34 percent), para 3 (26 percent), prenatal care (63,33 percent), pregnancies 37-41 weeks (56 percent), after cesarean section (46 percent), total hysterectomy (86 percent), uterine atony as mean indication (38 percent), complicated with anemia (88 percent), blood transfusion (84 percent) and discharged home <7 days length of stay (56 percent). There were 8 maternal deaths (16 percent) and adjusted maternal mortality rate was 792 by 10000 live births. There were 9 abortions (18 percent), 15 fetal deaths (30 percent) and adjusted perinatal mortality rate was 129 by 1000 live births. Obstetric hysterectomy in the studied population, was not frequent, commonest indicated by hemorrhagic disorders and there were high maternal morbidity and mortality

[Vaginal leiomyoma]. / Leiomioma vaginal.

Vaginal leiomyomas are rare benign tumors. This is a case report with menstrual and urinary difficulties and vaginal mass with inner urethral meatus and hymen displacement. Miccional cystourethrography showed a posterior displaced, comprised and elongated urethra. Excretory urography and pelvic sonogram were normal. Preurethral enucleation extirpation with no complications was practiced. Current literature is reviewed.

Placenta percreta / Placenta percreta

La placenta adherida al miometrio es muy rara. Varía entre 1:500 y 1:93 000 partos. La placenta percreta es el tipo menos común. Es importante porque las complicaciones pueden ser mortales. La ruptura uterina anterior es más frecuente que la posterior. En la literatura inglesa, entre 1899 y 1999, sólo se reportaron menos de 50 casos con hemoperitoneo. En Venezuela se han descrito 6 placentas percretas. En esta nota clínica se reporta un caso de placenta percreta con rotura uterina posterior, hemoperitoneo e invasión a epiplón.

Embarazo ístmico-cervical con invasión a región vésico-uterina / Isthmic cervical ectopic pregnancy with vesical uterine invasion

El embarazo ectópico cervical es muy raro. Entre 1978 y 1994, sólo se reportaron 120 casos en la literatura inglesa. En Venezuela se han descrito 4. En esta nota clínica se reporta un caso de embarazo ísmico-cervical con invasión a región vésico-uterina