Interferon subverts an AHR-JUN axis to promote CXCL13+ T cells in lupus.

Systemic lupus erythematosus (SLE) is prototypical autoimmune disease driven by pathological T cell-B cell interactions1,2. Expansion of T follicular helper (TFH) and T peripheral helper (TPH) cells, two T cell populations that provide help to B cells, is a prominent feature of SLE3,4. Human TFH and TPH cells characteristically produce high levels of the B cell chemoattractant CXCL13 (refs. 5,6), yet regulation of T cell CXCL13 production and the relationship between CXCL13+ T cells and other T cell states remains unclear. Here, we identify an imbalance in CD4+ T cell phenotypes in patients with SLE, with expansion of PD-1+/ICOS+ CXCL13+ T cells and reduction of CD96hi IL-22+ T cells. Using CRISPR screens, we identify the aryl hydrocarbon receptor (AHR) as a potent negative regulator of CXCL13 production by human CD4+ T cells. Transcriptomic, epigenetic and functional studies demonstrate that AHR coordinates with AP-1 family member JUN to prevent CXCL13+ TPH/TFH cell differentiation and promote an IL-22+ phenotype. Type I interferon, a pathogenic driver of SLE7, opposes AHR and JUN to promote T cell production of CXCL13. These results place CXCL13+ TPH/TFH cells on a polarization axis opposite from T helper 22 (TH22) cells and reveal AHR, JUN and interferon as key regulators of these divergent T cell states.

Systematic exploration of a decade of publications on psychiatric genetics in Latin America.

Psychiatric disorders have a great impact in terms of mortality, morbidity, and disability across the lifespan. Considerable effort has been devoted to understanding their complex and heterogeneous genetic architecture, including diverse ancestry populations. Our aim was to review the psychiatric genetics research published with Latin American populations from 2010 to 2019, and classify it according to country of origin, type of analysis, source of funding, and other variables. We found that most publications came from Brazil, Mexico, and Colombia. Also, local funds are generally not large enough for genome-wide studies in Latin America, with the exception of Brazil and Mexico; larger studies are often done in collaboration with international partners, mostly funded by US agencies. In most of the larger studies, the participants are individuals of Latin American ancestry living in the United States, which limits the potential for exploring the complex gene-environment interaction. Family studies, traditionally strong in Latin America, represent about 30% of the total research publications. Scarce local resources for research in Latin America have probably been an important limitation for conducting bigger and more complex studies, contributing to the reduced representation of these populations in global psychiatric genetics studies. Increasing diversity must be a goal to improve generalizability and applicability in clinical settings.

IgY Antibodies as Biotherapeutics in Biomedicine.

Since the discovery of antibodies by Emil Von Behring and Shibasaburo Kitasato during the 19th century, their potential for use as biotechnological reagents has been exploited in different fields, such as basic and applied research, diagnosis, and the treatment of multiple diseases. Antibodies are relatively easy to obtain from any species with an adaptive immune system, but birds are animals characterized by relatively easy care and maintenance. In addition, the antibodies they produce can be purified from the egg yolk, allowing a system for obtaining them without performing invasive practices, which favors the three "rs" of animal care in experimentation, i.e., replacing, reducing, and refining. In this work, we carry out a brief descriptive review of the most outstanding characteristics of so-called "IgY technology" and the use of IgY antibodies from birds for basic experimentation, diagnosis, and treatment of human beings and animals.

Adapting in-person diabetes group visits to a virtual setting across federally qualified health centers.

Diabetes group visits (GVs) have been shown to improve glycemic control, enrich patient self-care, and decrease healthcare utilization among patients with type 2 diabetes mellitus (T2DM). While telehealth has become routine, virtual GVs remain understudied, especially in federally qualified health centers (FQHCs). We conducted a 5-year cluster randomized trial with a waitlist control group to test the impact of diabetes GVs on patients' outcomes in Midwestern FQHCs. Due to COVID-19, the 6 waitlisted FQHCs adapted to virtual GVs. FQHC staff were provided training and support to implement virtual GVs. The GV intervention included 6 monthly 1-1.5-h long education sessions and appointments with a primary care provider. We measured staff perspectives and satisfaction via GV session logs, monthly webinars, and staff surveys and interviews. Adaptations for implementation of virtual GV included: additional staff training, video conferencing platform use, decreased session length and group size, and adjusting study materials, activities, and provider appointments. Sites enrolled a total of 48 adults with T2DM for virtual GVs. Most FQHCs were urban and all FQHCs predominantly had patients on public insurance. Patients attended 2.1 ± 2.2 GVs across sites on average. Thirty-four patients (71%) attended one or more virtual GVs. The average GV lasted 79.4 min. Barriers to virtual GVs included patient technology issues and access, patient recruitment and enrollment, and limited staff availability. Virtual GV facilitators included providing tablets, internet access from the clinic, and technical support. Staff reported spending on average 4.9 h/week planning and implementing GVs (SD = 5.9). On average, 6 staff from each FQHC participated in GV training and 1.2 staff reported past GV experience. All staff had worked at least 1 year at their FQHC and most reported multiple years of experience caring for patients with T2DM. Staff-perceived virtual GV benefits included: empowered patients to manage their diabetes, provided patients with social support and frequent contact with providers, improved relationships with patients, increased team collaboration, and better patient engagement and care-coordination. Future studies and health centers can incorporate these findings to implement virtual diabetes GVs and promote accessible diabetes care.

Plasmin-resistant PSD-95 inhibitors resolve effect-modifying drug-drug interactions between alteplase and nerinetide in acute stroke.

Neuroprotection for acute ischemic stroke is achievable with the eicosapeptide nerinetide, an inhibitor of the protein-protein interactions of the synaptic scaffolding protein PSD-95. However, nerinetide is subject to proteolytic cleavage if administered after alteplase, a standard-of-care thrombolytic agent that nullifies nerinetide's beneficial effects. Here, we showed, on the basis of pharmacokinetic data consistent between rats, primates, and humans, that in a rat model of embolic middle cerebral artery occlusion (eMCAO), nerinetide maintained its effectiveness when administered before alteplase. Because of its short plasma half-life, it can be followed by alteplase within minutes without reducing its neuroprotective effectiveness. In addition, the problem of protease sensitivity is solved by substituting cleavage-prone amino acids from their l- to their d-enantiomeric form. Treatment of rats subjected to eMCAO with such an agent, termed d-Tat-l-2B9c, eliminated protease sensitivity and maintained neuroprotective effectiveness. Our data suggest that both the clinical-stage PSD-95 inhibitor nerinetide and protease-resistant agents such as d-Tat-l-2B9c may be practically integrated into existing stroke care workflows and standards of care.

Effect of Fe-N Codoping on the Optical Properties of TiO2 for Use in Photoelectrolysis of Water.

TiO2 nanoparticles were synthesized by green chemistry where organic solvents are replaced by an aqueous extract solution of lemongrass leaves that act as a reducer and growth-stopper agent. The nanoparticles were codoped with N-Fe to modify the absorption range in the electromagnetic spectrum and were characterized by Fourier-transform infrared (FTIR), scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS), and UV-vis/diffuse reflectance spectroscopy (DRS). The modified samples with Fe and N resulted in smaller nanoparticle size values than pure TiO2. Similarly, the band-gap energy for doped nanoparticles decreased to 2.22 eV in relation to the value of 3.09 eV for pure TiO2, due to the introduction of new energy levels.

Predictive factors for omitting lymphadenectomy in patients with node-positive breast cancer treated with neo-adjuvant systemic therapy.

A pathologic complete response (pCR) in the axilla occurs in 30%-40% of patients with initially node-positive breast cancer after neo-adjuvant chemotherapy (NACT). Debate persists about whether to perform systematic axillary lymphadenectomy (ALND) in patients with initial node-positive disease and clinical complete response after NACT. We aimed to identify predictive factors of axillary pCR (ypN0) after NACT. This retrospective study analyzed data for all patients with initial biopsy-proven node-positive disease who underwent ALND after NACT between June 2008 and December 2016 at our institution. Clinical and pathologic features, recurrence and specific mortality rates were compared between patients who achieved an axillary pCR and those who did not (ypN0 vs ypN+, respectively). A total of 331 patients were included, of whom 128 (38.7%) became ypN0 after NACT. Among patients with >2 suspicious axillary lymph nodes before treatment, 54 (38%) achieved ypN0 status. The independent predictors of ypN0 were Ki-67 > 30 (OR 1.98; 95% CI, 1.146-3.381), HER2 positivity (OR 2.6; 95% CI, 1.354-5.108), nonluminal molecular-like subtype (OR 4.15; 95% CI, 2.068-5.108), and clinical complete response, defined as negative clinical and ultrasonographic findings (OR 2.8; 95% CI, 1.110-7.081). After a mean follow-up of 61 months, distant disease-free and overall survival rates were higher in patients with ypN0 disease (HR 4.14; 95% CI, 2.03-8.43) than ypN+ patients. Complete clinical response and the presence of nonluminal molecular-like subtypes independently predicted ypN0. Patients meeting these criteria might be suitable form omitting ALND and just performing targeted axillary procedures to patients meeting these criteria.

Pericardial Effusion in Systemic Sarcoidosis: A Rare Manifestation of Cardiac Sarcoid.

We present a 65-year-old African American woman who was found to have pericardial effusion secondary to cardiac sarcoid. Pericardial effusion is a rare manifestation of cardiac sarcoid. All cases of sustemic sarcoid should be evaluated for cardiac involvement which can be difficult to detect.

Estatus epiléptico. Factores asociados a una evolución desfavorable en un centro terciario / Status Epilepticus. Prognostic Variables for an Unfavorable Outcome in a tertiary center of care

Resumen Introducción: El Estatus Epiléptico (EE) es una causa frecuente de emergencia neurológica. Escasos son los estudios realizados en Suramérica para evaluar los factores pronósticos de mortalidad y discapacidad en pacientes con EE. Objetivo: Determinar las variables asociadas a una evolución desfavorable (ED) al alta hospitalaria en pacientes con EE. Método: Se realizó un estudio retrospectivo durante el periodo enero 2016-junio 2017. Un total de 26 pacientes fueron diagnosticados con EE en sus diferentes variantes. Se evaluó el efecto de las variables clínicas, radiológicas y electroencefalográficas sobre la evolución hospitalaria final acorde la escala de Rankin. Resultados: 12 (46,2%) de los pacientes tuvieron una ED al alta hospitalaria, con una mortalidad que alcanzó el 23%. Existió un predominio del sexo masculino (76,9%). Las variables asociadas de forma independiente con una ED fueron el número de comorbilidades (p=0.01, OR: 4.27-95%CI1.33-13.6), lesiones en la imagen por Resonancia Magnética (IRM) (p=0.04, OR: 3.92-95%CI1.05-14.61) y el EE refractario (p=0.01, OR: 12.52-95%CI1.85-84.44), y la edad (p=0.07 OR: 1.03-95%CI0.99-1.07). Mientras que, un buen estado clínico inicial acorde la escala de Glasgow fue un factor protector (p=0.00 OR: 0.49-IC95%0.29-0.84) de tener una ED. Conclusiones: Tener una ED se asocia a la edad, el estado clínico inicial del paciente acorde la escala de Glasgow, así como lesiones en la IRM. EE refractario y más de 4 comorbilidades también fueron predictores de una ED al alta hospitalaria.

Abstract Introduction: Status Epilepticus (SE) is a frequent neurologic emergency. Little research has been done in South America to evaluate the prognostic variables of mortality and disability in patients with SE. Objective: To determine the variables associated to an unfavorable outcome at hospital discharge in the patients who were treated for SE. Methods: A retrospective study was performed during the period of January 2016-June 2017. A total of 26 patients were diagnosed of SE and its different variants. The effects of clinical, radiological, and electroencephalographic features on hospital outcome according Rankin scale were evaluated. Results: Twelve (46.2%) patients had an unfavorable outcome at hospital discharge, while the mortality rate reached 23.1%. There was a predominance of males with a 76.9% of all the patients. The independent variables associated with an unfavorable outcome were the number of comorbidities (p=0.01, OR: 4.27-95%CI1.33-13.6), structural lesions on the Magnetic Resonance Image (MRI) (p=0.04, OR: 3.92-95%CI1.05-14.61) and refractory SE (p=0.01, OR: 12.52-95%CI1.85-84.44). There was also a trend for age (p=0.07 OR: 1.03-95%CI0.99-1.07). While an initial good clinical condition, according to the Glasgow Scale represent a protective factor (p=0.00 OR: 0.49-IC95% 0.29-0.84) of an unfavorable outcome. Conclusions: The unfavorable outcome was marginally associated with patient age, clinical status at the onset of SE according to the Glasgow Coma Scale, as well as brain lesions on brain MRI. Refractory SE and more than 4 comorbidities are predictors of an unfavorable outcome at hospital discharge.

Endothelial vascular markers in coronary surgery.

Coronary heart disease is associated with high morbidity and mortality. Endothelial dysfunction in affected patients is linked to long-term atherosclerotic disease progression and cardiovascular event rates. The present paper reports on changes in the levels of endothelial progenitor cells (VEGFR2/CD133/CD34), essential for endothelial repair, and of endothelial microvesicles (CD31/annexin V) as indicators of endothelial lesion, in patients undergoing coronary bypass surgery with respect both to baseline levels and to counts in healthy subjects. In an observational descriptive study, 31 patients scheduled for coronary revascularization surgery were compared with those of 25 healthy controls. In a subsequent longitudinal study, patients undergoing surgery were monitored at 5 timepoints up until 48 h after surgery. Endothelial progenitor cell (VEGFR2/CD133/CD34) and endothelial microvesicle (CD31/annexin V) levels were quantified by flow cytometry. Baseline endothelial progenitor cell counts in coronary patients were significantly lower than those of healthy controls (p < 0.001); however, after surgery, levels rose steadily over all 5 timepoints to 48 h  with statistically significant differences (p < 0.001) between intra-operative and 48 h after surgery (T5). Endothelial microvesicle levels were significantly higher in coronary patients prior to surgery than in healthy controls (p < 0.001), and despite declining at 48 h remained significantly higher than those of controls (p < 0.001). Coronary surgery has had a positive impact on the endothelium in the patients, prompting a decrease in signs of endothelial dysfunction and a considerable improvement in the endothelial repair mechanisms involved in angiogenesis, playing an important role in the inflammatory response and the remodelling process of ischemic myocardium in postoperative period.

Exposición al semen paterno como factor de riesgo de preeclampsia en pacientes obstétricas del Instituto Nacional Materno Perinatal, febrero - marzo 2016 / Exposure to paternal semen as a risk factor for preeclampsia in obstetric patients of the National Institute Maternal Perinatal, February - March 2016

Introducción: La preeclampsia es una de las complicaciones más frecuentes y graves del embarazo, la causa que la origina aún se desconoce por lo que se han propuesto numerosas teorías y se han establecido numerosos factores de riesgo, entre uno de ellos se encuentra la limitada exposición al semen de la pareja la cual incrementaría el riesgo de esta enfermedad. Objetivo: Determinar si la menor exposición al semen paterno es un factor de riesgo de preeclampsia en pacientes obstétricas del Instituto Nacional Materno Perinatal, febrero - marzo 2016. Diseño: Estudio analítico, observacional, tipo caso - control. Lugar: Instituto Nacional Materno Perinatal. Participantes: En el estudio participaron 75 pacientes con preeclampsia y 75 pacientes sin preeclampsia, siendo un total de 150 pacientes obstétricas provenientes del servicio de hospitalización. Intervenciones: Revisión de historias clínicas y la realización de una entrevista estructurada a la paciente. Para describir las variables se presentó medidas de tendencia central y dispersión para las variables cuantitativas, frecuencias y porcentajes para las cualitativas. Luego, se calculó OR e intervalo de confianza al 95 por ciento. Se realizó un análisis bivariado y un análisis de regresión logística multivariado. Resultados: Se encontró que el 78,7 por ciento de pacientes preeclámpticas conviven más de 10 años con su pareja, mientras que el grupo de pacientes normotensas lo presenta en un 72 por ciento. En cuanto a la frecuencia de relaciones sexuales el 54,7 por ciento del grupo casos refiere una frecuencia de 3 veces o más por semana, comparada con el 44 por ciento del grupo control. Además, el 86,7 por ciento de pacientes con preeclampsia y el 84 por ciento del grupo control tienen un tiempo de actividad sexual con su pareja por más de 10 años. En cuanto al número de exposiciones al semen paterno el OR de presentar preeclampsia en el cuartil de 104 a 312 exposiciones comparado con el más alto cuartil de...

Introduction: Preeclampsia is one of the most frequent and serious complications of pregnancy, the originating cause is still unknown so have been proposed numerous theories and established numerous risk factors, among one of them is limited exposure the partner's sperm which increase the risk of this disease. Objective: To determine whether parental less exposure to semen is a risk factor for preeclampsia in obstetric patients the National Maternal Perinatal Institute, February-March 2016. Design: Analytical, observational, case - control. Location: National Institute Maternal Perinatal. Participants: The study involved 75 patients with preeclampsia and 75 patients without preeclampsia, with a total of 150 obstetric patients from the inpatient service. Interventions: Review of medical records and conducting a structured interview with the patient. To describe the variables measures of central tendency and dispersion for quantitative variables, frequencies and percentages for qualitative presented. Then, OR and confidence interval was calculated at 95 per cent. A bivariate analysis and multivariate logistic regression analysis was performed. Results: We found that 78.7 per cent of preeclamptic patients live more than 10 years with his partner, while the group of normotensive patients presents by 72 per cent. As for the frequency of sexual intercourse 54.7 per cent of the cases group refers a frequency of 3 times or more per week, compared with 44 per cent in the control group. In addition, 86.7 per cent of patients with preeclampsia and 84 per cent in the control group with a time of sexual activity with your partner for over 10 years. As for the number of exposures paternal sperm the OR of preeclampsia in the quartile of 104-312 exposures compared with the highest quartile of exposure to paternal semen was 0.37 with a confidence interval of 0.15 to 95 per cent - 0.93, which shows a statistically significant relationship. By multivariate analysis, adjusting...

[Vaginal birth after cesarean. A safe option?]. / Parto después de cesárea una opción segura?

OBJECTIVE: To compare the beginning and evolution of labor variables such as demographic characteristics, obstetric and perinatal outcomes of patients with vaginal birth after cesarean (VBAC). MATERIAL AND METHODS: Observational, retrospective and retro elective trial purposes of comparative analysis, were divided into groups by the onset of labor; spontaneously versus induction and by the labor evolution; spontaneously versus conduction. Being analyzing by Student's T and Fisher test. RESULTS: According the ACOG criteria. 136 patients with prior cesarean section were eligible to labor. The indications of previous cesarean have a trend of a non-recurring etiology, being the elective cesarean section the most common. Regarding the onset, 78% was spontaneous and 22% had an induction. Comparing the demographic characteristics it stands a greater number of deliveries, history of vaginal delivery, a higher Bishop score, fetal weight estimated lower and higher intergenesic period. As a perinatal prognosis, the study has shown be safe with a positive outcome. Conclusions:Vaginal birth after cesarean is safe, that should be offered to all women with a low transverse incision, with an intergenesic period greater than 18 months, whit a singleton pregnancy, in a cephalic presentation, with an appropriate fetal weight, and without obstetric contraindications of vaginal delivery.

Niveles séricos de pepsinógeno y su capacidad diagnóstica de atrofia gástrica en diferentes poblaciones colombianas / Serum pepsinogen levels and gastric atrophy diagnostic capacity in different Colombian populations

Objetivo: Caracterizar los niveles de pepsinógeno y evaluar la capacidad de discriminación del PGI y la relación PGI/PGII para el diagnóstico serológico de atrofia gástrica en diferentes poblaciones colombianas. Materiales y métodos: Participaron 600 sujetos sin sintomatología gástrica y se analizaron 544 muestras de pacientes con sintomatología gástrica provenientes de diferentes poblaciones con riesgos opuestos para cáncer gástrico. A todos los participantes se les tomó muestra de sangre. En los pacientes se obtuvieron biopsias de antro y cuerpo para su diagnóstico inicial de lesiones gastroduodenales. Los niveles de pepsinógeno y la serología de Helicobacter pylori se estimaron con pruebas de ELISA. Los análisis estadísticos incluyeron pruebas de Kruskal-Wallis y Mann-Whitney, curva ROC y valores diagnósticos. Resultados: Los niveles de pepsinógeno en pacientes y sujetos asintomáticos difieren según la zona de riesgo de procedencia. Los niveles de PGI, PGII y PGI/PGII disminuyeron a medida que aumenta la severidad del diagnóstico histológico (p < 0,005), al igual que con el grado de severidad de la atrofia y la localización multifocal (p≤0,001). El PGI ≤86,68 y PGI/PGII ≤3,19 con un área bajo la curva de 0,76 identificó pacientes con atrofia severa multifocal, serología positiva para H. pylori y procedentes de la zona de riesgo alto, con sensibilidad de 77,5% y especificidad de 71,74%. Conclusión: Los resultados sugieren que los niveles de PGI, PGI/PGII conjuntamente con serología H. pylori positiva podrían ser considerados para la detección de atrofia severa en pacientes de la zona de riesgo alto. Se necesita otros estudios en poblaciones de riesgo alto.

Objective: To characterize levels of pepsinogen and evaluate the discrimination ability of pepsinogen I (PGI) and the PGI/ pepsinogen II (PGII) ratio for the serological diagnosis of gastric atrophy in different Colombian populations. Methods: A total 600 subjects without gastric symptoms participated and 544 samples from patients with gastric symptomatology were analyzed from different populations with opposing risks to gastric cancer. A blood sample was taken from all participants; a gastric antrum and body biopsy for the initial diagnosis of gastroduodenal lesions was obtained from the patients. The levels of pepsinogen and Helicobacter pylori serology were estimated with ELISA. Statistical analyses included Kruskal -Wallis and Mann -Whitney test, ROC curve and diagnostic values. Results: The levels of PGI and PGI / PGII differ by risk area of origin. Levels of PGI, PGII and PGI / PGII decreased with increasing severity of histological diagnosis (P < .005), as with the severity of atrophy and multifocal localization (P ≤.001). The PGI ≤ 86.68 and PGI / PGII ≤ 3.19 with an area under the curve of 0.76 identified patients with severe multifocal atrophy, positive serology for H. pylori, and from the high risk area, with a sensitivity of 77.5% and specificity of 71.74%. Conclusion: The results suggest that PGI levels together with PGI / PGII ratios and positive serology for H. pylori could be considered for the detection of severe atrophy in high-risk areas. Further studies are needed in high-risk populations © 2014 Instituto Nacional de Cancerología. Published by Elsevier España, S.L.U. All rights reserved.

[Atypical preeclampsia and perinatal success: a case report]. / Preeclampsia atípica y éxito perinatal: reporte de caso.

Preeclampsia is a multi systemic syndrome of variable severity, pregnancy specific, consequence of an abnormal vascular response to placentation, with increase in peripheral vascular resistance, stimulation of platelet aggregation, activation of the coagulation cascade, and endothelial dysfunction. In the majority of cases, it will present with gestational hypertension and proteinuria, after 20 weeks, nevertheless, in other cases, it has presented as an atypical form (with absence of hypertension and/or proteinuria) behaving like severe preeclampsia. We report the case of a patient, 32 year old primigravida, with a 26.6 weeks gestation, that comes to the office with postprandial projectile vomiting. At the time of admission, she presents with sudden headache, phosphenes, and tinnitus, associated to epigastric pain, with a blood pressure of 110/70 mmHg; fetal heart rate of 146 bpm, normal lower limbs and reflexes. The Complete Blood Count and liver function tests are within normal values, urinalysis with proteinuria. Normal hepatic ultrasound. Obstetric ultrasound; with fetal measurements of 2.6 weeks below, with flattening of the growth curve, Doppler flowmetry with an increase in placental resistance and oligohydramnios. Given the clinical manifestations compatible with severe preeclampsia, magnesium sulfate, and antenatal corticosteroid therapy are initiated, and abdominal termination of pregnancy is decided. A female newborn is obtained, of 595 g, Apgar 4/7. On immediate puerperium, she presents with an increase in blood pressure of 150/90 mmHg, discharged with normal blood pressure 96 hours later. The newborn girl was discharged when she reached a weight of 2000 g. Today, she is neurologically unimpaired.

[Placental acretism, a repercussion of modern obstetrics]. / Acretismo placentario, una de las repercusiones de la obstetricia moderna.

The evolution of obstetrics has led us to beneficial discoveries, and to new pathologies. The increase of cesarean section is due to elective cesarean section and cesarean section on maternal request, which have increased in popularity over the last past few years. Without condemning them, we have to take into account the benefits, as well as the complications that may arise from them, leading us to pathologies that were not frequent before, such as placental acretism, which today, is the second cause of obstetric hemorrhage worldwide. For us to be able to counteract the potential complications, it is important to have a multidisciplinary team that allows us to decrease maternal and neonatal death, starting with primary prevention, capable of identifying risk factors, so as to be able to make an early diagnosis. Today, imaging studies have described suggestive markers of acretism at early gestational age, such as 8.4 to 14.2 weeks, allowing us a wide range of time for decision making. In the majority of cases, it is required to perform an obstetrical hysterectomy as a definitive treatment, which is a real challenge for medical skills. Nevertheless, conservative treatment with limited evidence, with uterotonics, and uterine artery embolization, has proved useful. When set on a scale, the risks and benefits of an elective, or maternal request cesarean section, we can understand why we have concluded that, in absence of maternal or fetal indications, natural delivery is the best way to resolve pregnancy.

Heart transplantation in a patient with recurrent early extensive endocarditis.

Active valvular endocarditis could be considered a contraindication to heart transplantation. Nevertheless, there have been some reports of success with this form of treatment, despite the characteristics of the infection and its aggressive nature. Here, we describe the case of a patient with acute bicuspid aortic valvular endocarditis caused by Staphylococcus aureus and with a periannular abscess. Cryopreserved aortic homograft replacement of the aortic root was initially carried out, in addition to debridement and reconstruction of the interventricular septum with a pericardial patch. Early recurrence occurred, however, with extensive tissue destruction, a periaortic abscess and involvement of multiple valves, associated with severe sepsis. In view of the failure of 'conventional' surgery, an emergency heart transplantation was decided on after discussing the case with the Spanish National Transplant Organization (ONT), because of the theoretical contraindication of transplantation in this case. Transplantation was finally carried out after a waiting period of 3 days, in emergency code conditions, and the postoperative course proved uneventful, with no reinfection during the follow-up period. The present case suggests that heart transplantation may be an alternative option in patients suffering aggressive endocarditis with extensive involvement of the heart structures.

Prevalencia de anticuerpos antinucleares en un grupo de adultos sanos residentes en Santafé de Bogotá

Se analizaron 625 sueros provenientes de igual número de personas sanas residentes en Santafé de Bogotá, con el fin de establecer la prevalencia de anticuerpos antinucleares (ANAs), mediante la técnica de inmunofluorescencia indirecta sobre células HEp-2. Se encontró una positividad global de 2.9 por ciento (18/625) con una diferencia entre hombres (2.3 por ciento) y mujeres (3.5 por ciento) no significativa (p>0.05). El mayor porcentaje de positividad se observó en el grupo etáreo comprendido entre 56 y 75 años de edad (7.2 por ciento). Los patrones de inmunofluorescencia encontrados fueron nucleolar (44 por ciento), moteado (38 por ciento), mixto moteado y nucleolar (11 por ciento), citoplasmático (5.6 por ciento). En 83.4 por ciento de los casos positivos los títulos fueron iguales o menores de 1/320. El presente estudio confirma la posibilidad que una persona pueda ser portadora de ANAs sin que sufra de ninguna afección autoinmune. El potencial patogénico de estos individuos sanos es desconocido.