Detection of Asymptomatic Sickle Cell Hemoglobin Carriers and Fetal Hemoglobin Regulating Genetic Variants in African Descendants from Oaxaca, Mexico.

Sickle cell anemia has been classified as a noninfectious neglected tropical disease and, although not exclusively, affects African descendants more frequently. This study aimed to detect asymptomatic sickle cell hemoglobin carriers (HbAS) in marginalized and vulnerable populations during a public health screening in African descendants from Oaxaca, Mexico, and to validate an amplification refractory mutation system (ARMS)-PCR methodology to detect fetal-hemoglobin (HbF)-regulating genetic variants in BCL11A toward affordable routine association of single nucleotide variants (SNVs) with HbF concentrations. To this aim, hemoglobin variants were detected by acidic citrate agar and alkaline cellulose acetate electrophoreses. SNVs in the hemoglobin subunit beta gene (HBB) were identified by the ß-globin mutation detection assay (ß-GMDA) and ARMS-PCR, respectively, and validated by Sanger sequencing. The association between genotypes and HbF concentrations was evaluated using Spearman's correlation coefficient. The results obtained during a directed screening in 140 self-identified African descendants revealed 42 HbS-carriers (30%), of which 39 showed normal total hemoglobin concentrations (92.8%), only 3 presented anemia (7.2%), and 9 showed quantifiable HbF concentration (21.4%). As validated by Sanger sequencing, the designed ARMS-PCR efficiently detected homozygous and heterozygous variants in BCL11A. In a cohort of 42 heterozygous (HbAS) and 27 healthy (HbAA) individuals from the same population, only one SNV (rs766432) showed statistically significant association with increasing HbF concentration, and two new unrelated homozygous silent variants were identified. This study reveals the need to raise coverage of HbS screening in vulnerable populations and shows a feasible low-cost ARMS-PCR methodology to determine the presence of SNVs in quantitative trait loci affecting HbF.

Transcription factor Tox2 is required for metabolic adaptation and tissue residency of ILC3 in the gut.

Group 3 innate lymphoid cells (ILC3) are the major subset of gut-resident ILC with essential roles in infections and tissue repair, but how they adapt to the gut environment to maintain tissue residency is unclear. We report that Tox2 is critical for gut ILC3 maintenance and function. Gut ILC3 highly expressed Tox2, and depletion of Tox2 markedly decreased ILC3 in gut but not at central sites, resulting in defective control of Citrobacter rodentium infection. Single-cell transcriptional profiling revealed decreased expression of Hexokinase-2 in Tox2-deficient gut ILC3. Consistent with the requirement for hexokinases in glycolysis, Tox2-/- ILC3 displayed decreased ability to utilize glycolysis for protein translation. Ectopic expression of Hexokinase-2 rescued Tox2-/- gut ILC3 defects. Hypoxia and interleukin (IL)-17A each induced Tox2 expression in ILC3, suggesting a mechanism by which ILC3 adjusts to fluctuating environments by programming glycolytic metabolism. Our results reveal the requirement for Tox2 to support the metabolic adaptation of ILC3 within the gastrointestinal tract.

Nucleus segmentation of white blood cells in blood smear images by modeling the pixels' intensities as a set of three Gaussian distributions.

The precise segmentation of white blood cells (WBCs) within blood smear images is a significant challenge with implications for both medical research and image processing. Of particular importance is the often neglected task of accurately segmenting WBC nuclei, an aspect that currently lacks dedicated methodologies. This paper introduces a straightforward and efficient method designed to fill this critical gap, providing an effective solution for the efficient segmentation of WBC nuclei. In blood smear imagery, the distinctive coloration of WBCs contrasts with the hues of other blood components. The inherent obscurity of WBCs prompts their segmentation by isolating pixels with minimal intensities. To streamline this process, our proposed method employs the Laplacian pyramid technique to decorrelate pixels in blood smear images, thereby amplifying the contrast. Subsequently, the intensities of pixels constituting blood cells, encompassing WBCs and the background, are modeled using three Gaussian random variables. Capitalizing on this feature, we implement the Gaussian mixture model (GMM) clustering method to determine the optimal threshold value, facilitating a highly precise segmentation of WBC nuclei. The proposed method demonstrates the capability to process images containing a single WBC as well as effectively functioning with images containing multiple cells of this type. Evaluation of the method on the ALL-IDB, ALL-IDB2, CellaVision, and JTSC datasets yielded accuracy values of 0.9802, 0.9725, 0.9772, and 0.9730, respectively. Comparative analysis with state-of-the-art methods revealed a notably comparable performance, underscoring the effectiveness of the proposed approach. The method presented in this article is highly competitive for segmenting the nuclei of WBCs compared to state-of-the-art methods. The three main advantages of our method are its ability to process images containing one or more WBCs, the automatic calculation of threshold values for each processed image, eliminating the need for manual parameter adjustments. Lastly, the method is efficient, as its algorithmic complexity is approximately O ( n m ) .

The homeobox transcription factor DUXBL controls exit from totipotency.

In mice, exit from the totipotent two-cell (2C) stage embryo requires silencing of the 2C-associated transcriptional program. However, the molecular mechanisms involved in this process remain poorly understood. Here we demonstrate that the 2C-specific transcription factor double homeobox protein (DUX) mediates an essential negative feedback loop by inducing the expression of DUXBL to promote this silencing. We show that DUXBL gains accessibility to DUX-bound regions specifically upon DUX expression. Furthermore, we determine that DUXBL interacts with TRIM24 and TRIM33, members of the TRIM superfamily involved in gene silencing, and colocalizes with them in nuclear foci upon DUX expression. Importantly, DUXBL overexpression impairs 2C-associated transcription, whereas Duxbl inactivation in mouse embryonic stem cells increases DUX-dependent induction of the 2C-transcriptional program. Consequently, DUXBL deficiency in embryos results in sustained expression of 2C-associated transcripts leading to early developmental arrest. Our study identifies DUXBL as an essential regulator of totipotency exit enabling the first divergence of cell fates.

Transition from totipotency to pluripotency in mice: insights into molecular mechanisms.

Totipotency is the ability of a single cell to develop into a full organism and, in mammals, is strictly associated with the early stages of development following fertilization. This unlimited developmental potential becomes quickly restricted as embryonic cells transition into a pluripotent state. The loss of totipotency seems a consequence of the zygotic genome activation (ZGA), a process that determines the switch from maternal to embryonic transcription, which in mice takes place following the first cleavage. ZGA confers to the totipotent cell a transient transcriptional profile characterized by the expression of stage-specific genes and a set of transposable elements that prepares the embryo for subsequent development. The timely silencing of this transcriptional program during the exit from totipotency is required to ensure proper development. Importantly, the molecular mechanisms regulating the transition from totipotency to pluripotency have remained elusive due to the scarcity of embryonic material. However, the development of new in vitro totipotent-like models together with advances in low-input genome-wide technologies, are providing a better mechanistic understanding of how this important transition is achieved. This review summarizes the current knowledge on the molecular determinants that regulate the exit from totipotency.

Three Years of the Coronavirus Disease 2019 Pandemic in a European Region: A Population-Based Longitudinal Assessment in Madrid Between 2020 and 2022.

Background: Our objective was to assess the health impact of coronavirus disease 2019 (COVID-19) during 2020-2022 in the Madrid region. Methods: We included all individuals registered in the Madrid Health System Registry as of 31 December 2019, and followed them until 31 December 2022. Using a unique personal identifier, we linked the databases of primary care, hospitals, pharmacies, certified laboratories performing diagnostic tests, vaccines, and mortality. Results: Of 6 833 423 individuals, 21.4% had a confirmed COVID-19 diagnosis, and 1.5% had a COVID-19 hospitalization (primary diagnosis). Thirty-day mortality was 1.6% for confirmed COVID-19 (from 11.4% in first semester 2020 to 0.4% in first semester 2022). Thirty-day mortality was 10.8% for COVID-19 hospitalizations (from 14.0% in first semester 2020 to 6.0% in second semester 2022). There were 24 073 deaths within 30 days of a confirmed COVID-19 diagnosis. Advanced age, male sex, higher socioeconomic deprivation, and comorbidities were associated with higher mortality. Conclusions: By linking administrative and clinical databases, we characterized the burden of the COVID-19 pandemic in Madrid over 3 years. Our analysis proposes a high-level framework for comparisons of the burden of COVID-19 across areas worldwide.

Microbiota-Derived Extracellular Vesicles as a Postbiotic Strategy to Alleviate Diarrhea and Enhance Immunity in Rotavirus-Infected Neonatal Rats.

Rotavirus (RV) infection is a major cause of acute gastroenteritis in children under 5 years old, resulting in elevated mortality rates in low-income countries. The efficacy of anti-RV vaccines is limited in underdeveloped countries, emphasizing the need for novel strategies to boost immunity and alleviate RV-induced diarrhea. This study explores the effectiveness of interventions involving extracellular vesicles (EVs) from probiotic and commensal E. coli in mitigating diarrhea and enhancing immunity in a preclinical model of RV infection in suckling rats. On days 8 and 16 of life, variables related to humoral and cellular immunity and intestinal function/architecture were assessed. Both interventions enhanced humoral (serum immunoglobulins) and cellular (splenic natural killer (NK), cytotoxic T (Tc) and positive T-cell receptor γδ (TCRγδ) cells) immunity against viral infections and downregulated the intestinal serotonin receptor-3 (HTR3). However, certain effects were strain-specific. EcoR12 EVs activated intestinal CD68, TLR2 and IL-12 expression, whereas EcN EVs improved intestinal maturation, barrier properties (goblet cell numbers/mucin 2 expression) and absorptive function (villus length). In conclusion, interventions involving probiotic/microbiota EVs may serve as a safe postbiotic strategy to improve clinical symptoms and immune responses during RV infection in the neonatal period. Furthermore, they could be used as adjuvants to enhance the immunogenicity and efficacy of anti-RV vaccines.

Pain Prevalence and Satisfaction with Pain Management in Inpatients: A Cross-Sectional Study.

BACKGROUND: Pain in hospitalized adults is underestimated and undervalued. The aim of this study was to evaluate pain prevalence and satisfaction with the hospital's pain management among patients attending a tertiary university hospital. Predictor factors of pain were also studied. METHODS: A prospective, cross-sectional study was carried out through a structured questionnaire given on one day to all hospitalized patients in a university hospital. Clinical data, such as personal history and analgesic treatment, were collected from medical records. Other variables related to pain (including intensity rated by the visual analogue scale as well as location and patient satisfaction measured by the numerical rating scale) were also obtained. RESULTS: Of the 274 surveyed patients, pain prevalence was 52.9%, with an average intensity of 5.3 ± 2.8 according to VAS. The overall satisfaction was 87.2%, and 72.6% had already been prescribed at least one analgesic. Patients receiving analgesics showed higher pain intensity (VAS 3.6 ± 3.4) than those without treatment (VAS 1.1 ± 2.1) (p < 0.001). However, patients with treatment showed more satisfaction (NRS 7.8 ± 2 vs. 5.3 ± 1.4, p < 0.001). CONCLUSIONS: The prevalence of pain in hospitalized patients was high, despite the fact that patient satisfaction was also very high.

PLGA Nanoparticles Containing Natural Flavanones for Ocular Inflammation.

Flavanones are natural compounds that display anti-inflammatory activity. The aim of this work was to prepare PLGA nanoparticles (NPs) containing natural flavanones I ((2S)-5,7-dihydroxy-6-methyl-8-(3-methyl-2-buten-1-il)-2-phenyl-2,3-dihydro-4H-1-Benzopyran-4-one) and II (2S)-5,7-dihydroxy-2-(4'-methoxyphenyl)-6-methyl-8-(3-methyl-2-buten-1-yl)-2,3-dihydro-4H-1-Benzopyran-4-one) (NP I and NP II, respectively) so as to evaluate their potential for topical anti-inflammatory ocular therapy. An in silico study was carried out using the Molinspiration® and PASS Online web platforms before evaluating the in vitro release study and the ex vivo porcine cornea and sclera permeation. The HPLC analytical method was also established and validated. Finally, the in vitro anti-inflammatory efficacy of NPs was studied in the HCE-2 model. The flavanones I and II could be released following a kinetic hyperbolic model. Neither of the two NPs was able to permeate through the tissues. NP I and NP II were found to be respectful of any changes in the tissues' morphology, as evidenced by histological studies. In HCE-2 cells, NP I and NP II were not cytotoxic at concentrations up to 25 µM. NP I showed higher anti-inflammatory activity than NP II, being able to significantly reduce IL-8 production in LPS-treated HCE-2 cells. In summary, ocular treatment with NP I and NP II could be used as a promising therapy for the inhibition of ocular inflammation.

Microbiota-Derived Extracellular Vesicles Promote Immunity and Intestinal Maturation in Suckling Rats.

Microbiota-host communication is primarily achieved by secreted factors that can penetrate the mucosal surface, such as extracellular membrane vesicles (EVs). The EVs released by the gut microbiota have been extensively studied in cellular and experimental models of human diseases. However, little is known about their in vivo effects in early life, specifically regarding immune and intestinal maturation. This study aimed to investigate the effects of daily administration of EVs from probiotic and commensal E. coli strains in healthy suckling rats during the first 16 days of life. On days 8 and 16, we assessed various intestinal and systemic variables in relation to animal growth, humoral and cellular immunity, epithelial barrier maturation, and intestinal architecture. On day 16, animals given probiotic/microbiota EVs exhibited higher levels of plasma IgG, IgA, and IgM and a greater proportion of Tc, NK, and NKT cells in the spleen. In the small intestine, EVs increased the villi area and modulated the expression of genes related to immune function, inflammation, and intestinal permeability, shifting towards an anti-inflammatory and barrier protective profile from day 8. In conclusion, interventions involving probiotic/microbiota EVs may represent a safe postbiotic strategy to stimulate immunity and intestinal maturation in early life.

Trasplante cardíaco por hemocromatosis. Caso pediátrico / Cardiac transplantation due to hemochromatosis. A pediatric case report

La hemocromatosis es una enfermedad caracterizada por el excesivo depósito de hierro en múltiples órganos, entre ellos hígado, páncreas, piel y corazón. La infiltración de este último es un importante factor en morbilidad y mortalidad. Presentamos un caso de un paciente pediátrico con insuficiencia cardíaca terminal que ameritó trasplante cardíaco, que resultó sin complicaciones. Posterior a la cirugía, mostró mejoría bioquímica y clínica, lo que influyó positivamente en su calidad de vida y prolongó su supervivencia.

Hemochromatosis is a disease characterized by excess iron stores in multiple organs, including the liver, pancreas, skin, and heart. The infiltration of the heart is an important factor in morbidity and mortality. Here we describe the case of a pediatric patient with end-stage heart failure who required a heart transplantation, with no complications. After the surgery, she showed biochemical and clinical improvement, with a positive impact on her quality of life and a prolonged survival.

Corrigendum: Impact of a TAK-1 inhibitor as a single or as an add-on therapy to riociguat on the metabolic reprograming and pulmonary hypertension in the SUGEN5416/hypoxia rat model.

[This corrects the article DOI: 10.3389/fphar.2023.1021535.].

Impact of a TAK-1 inhibitor as a single or as an add-on therapy to riociguat on the metabolic reprograming and pulmonary hypertension in the SUGEN5416/hypoxia rat model.

Background: Despite increasing evidence suggesting that pulmonary arterial hypertension (PAH) is a complex disease involving vasoconstriction, thrombosis, inflammation, metabolic dysregulation and vascular proliferation, all the drugs approved for PAH mainly act as vasodilating agents. Since excessive TGF-ß signaling is believed to be a critical factor in pulmonary vascular remodeling, we hypothesized that blocking TGFß-activated kinase 1 (TAK-1), alone or in combination with a vasodilator therapy (i.e., riociguat) could achieve a greater therapeutic benefit. Methods: PAH was induced in male Wistar rats by a single injection of the VEGF receptor antagonist SU5416 (20 mg/kg) followed by exposure to hypoxia (10%O2) for 21 days. Two weeks after SU5416 administration, vehicle, riociguat (3 mg/kg/day), the TAK-1 inhibitor 5Z-7-oxozeaenol (OXO, 3 mg/kg/day), or both drugs combined were administered for 7 days. Metabolic profiling of right ventricle (RV), lung tissues and PA smooth muscle cells (PASMCs) extracts were performed by magnetic resonance spectroscopy, and the differences between groups analyzed by multivariate statistical methods. Results: In vitro, riociguat induced potent vasodilator effects in isolated pulmonary arteries (PA) with negligible antiproliferative effects and metabolic changes in PASMCs. In contrast, 5Z-7-oxozeaenol effectively inhibited the proliferation of PASMCs characterized by a broad metabolic reprogramming but had no acute vasodilator effects. In vivo, treatment with riociguat partially reduced the increase in pulmonary arterial pressure (PAP), RV hypertrophy (RVH), and pulmonary vascular remodeling, attenuated the dysregulation of inosine, glucose, creatine and phosphocholine (PC) in RV and fully abolished the increase in lung IL-1ß expression. By contrast, 5Z-7-oxozeaenol significantly reduced pulmonary vascular remodeling and attenuated the metabolic shifts of glucose and PC in RV but had no effects on PAP or RVH. Importantly, combined therapy had an additive effect on pulmonary vascular remodeling and induced a significant metabolic effect over taurine, amino acids, glycolysis, and TCA cycle metabolism via glycine-serine-threonine metabolism. However, it did not improve the effects induced by riociguat alone on pulmonary pressure or RV remodeling. None of the treatments attenuated pulmonary endothelial dysfunction and hyperresponsiveness to serotonin in isolated PA. Conclusion: Our results suggest that inhibition of TAK-1 induces antiproliferative effects and its addition to short-term vasodilator therapy enhances the beneficial effects on pulmonary vascular remodeling and RV metabolic reprogramming in experimental PAH.

Quantitative Proteomics for the Identification of Differentially Expressed Proteins in the Extracellular Vesicles of Cervical Cancer Cells.

The extracellular vesicles (EVs) in a tumoral microenvironment can exert different functions by transferring their content, which has been poorly described in cervical cancer. Here, we tried to clarify the proteomic content of these EVs, comparing those derived from cancerous HPV (+) keratinocytes (HeLa) versus those derived from normal HPV (-) keratinocytes (HaCaT). We performed a quantitative proteomic analysis, using LC-MS/MS, of the EVs from HeLa and HaCaT cell lines. The up- and downregulated proteins in the EVs from the HeLa cell line were established, along with the cellular component, molecular function, biological processes, and signaling pathways in which they participate. The biological processes with the highest number of upregulated proteins are cell adhesion, proteolysis, lipid metabolic process, and immune system processes. Interestingly, three of the top five signaling pathways with more up- and downregulated proteins are part of the immune response. Due to their content, we can infer that EVs can have a significant role in migration, invasion, metastasis, and the activation or suppression of immune system cells in cancer.

LL-37 Triggers Antimicrobial Activity in Human Platelets.

Platelets play a crucial role in hemostasis and the immune response, mainly by recognizing signals associated with vascular damage. However, it has recently been discovered that the antimicrobial peptide LL-37 activates platelets in functions related to thrombus formation and inflammation. Therefore, this work aims to evaluate the effect of LL-37 on the activation of antimicrobial functions of human platelets. Our results show that platelets treated with LL-37 increase the surface expression of receptors (Toll-like receptors (TLRs) 2 and -4, CD32, CD206, Dectin-1, CD35, LOX-1, CD41, CD62P, and αIIbß3 integrins) for the recognition of microorganisms, and molecules related to antigen presentation to T lymphocytes (CD80, CD86, and HLA-ABC) secrete the antimicrobial molecules: bactericidal/permeability-increasing protein (BPI), azurocidin, human neutrophil peptide (HNP) -1, and myeloperoxidase. They also translate azurocidin, and have enhanced binding to Escherichia coli, Staphylococcus aureus, and Candida albicans. Furthermore, the supernatant of LL-37-treated platelets can inhibit E. coli growth, or platelets can employ their LL-37 to inhibit microbial growth. In conclusion, these findings demonstrate that LL-37 participates in the antimicrobial function of human platelets.

Cardiac transplantation due to hemochromatosis. A pediatric case report. / Trasplante cardíaco por hemocromatosis. Caso pediátrico.

Hemochromatosis is a disease characterized by excess iron stores in multiple organs, including the liver, pancreas, skin, and heart. The infiltration of the heart is an important factor in morbidity and mortality. Here we describe the case of a pediatric patient with end-stage heart failure who required a heart transplantation, with no complications. After the surgery, she showed biochemical and clinical improvement, with a positive impact on her quality of life and a prolonged survival.

La hemocromatosis es una enfermedad caracterizada por el excesivo depósito de hierro en múltiples órganos, entre ellos hígado, páncreas, piel y corazón. La infiltración de este último es un importante factor en morbilidad y mortalidad. Presentamos un caso de un paciente pediátrico con insuficiencia cardíaca terminal que ameritó trasplante cardíaco, que resultó sin complicaciones. Posterior a la cirugía, mostró mejoría bioquímica y clínica, lo que influyó positivamente en su calidad de vida y prolongó su supervivencia.

MenPas 1.0: Plataforma online de evaluación psicosocial / MenPas 1.0: Online psychosocial Assessment Platform

El uso de instrumentos informatizados y en línea se ha incrementado notablemente en las últimas décadas. Sucesos como la COVID-19 han influido en la consolidación de su uso, siendo herramientas de trabajo muy útiles para evaluación e investigación. El objetivo del presente trabajo fue analizar una plataforma de evaluación online denominada MenPas 1.0, explorando sus áreas de trabajo y el flujo de datos de los últimos años. Se ha seguido una estrategia descriptiva para analizar las posibilidades que ofrece la plataforma, así como el tráfico de datos que posee y número de usuarios. Los resultados muestran que esta plataforma ofrece herramientas vinculadas a las siguientes áreas: ansiedad, atención, autoconcepto, autorregistros, burnout, búsqueda de talentos, calidad de vida, dinámica grupal, entrenamiento mental, inteligencia emocional, estrés, generalizabilidad, hipnosis, liderazgo, motivación, observación, organizaciones/calidad, socialización, toma de decisiones o visualización. Actualmente, tiene más de 16 mil usuarios registrados y acumula más de un millón trescientos mil sucesos. Algunos de los cuestionarios alojados han sido respondidos más de 60.000 veces. Además, sus usuarios proceden de múltiples países europeos y asiáticos, americanos o de Oceanía. Los resultados ponen de relieve el amplio espectro de uso que tiene la plataforma, las posibilidades de almacenamiento y procesamiento de datos que permite y la universalización de los recursos informatizados. (AU)

Computerized online instruments use has been increased significantly in recent decades. Influenced by events as COVID-19, consolidating its use in assessment and research. Present work main goal is to analyze the online assessment platform named MenPas 1.0, by exploring its working areas as well as the traffic communication data in the last years. A descriptive strategy has been followed in order to analyze the several possibilities offered by the platform as well as its data traffic and number of users. The results show that this platform offers a set of for the following areas: anxiety, attention, self-concept, self-registers, burnout, talent search, quality of life, group dynamics, mental training, emotional intelligence, stress, generalizability, hypnosis, leadership, motivation, observation, organizations/quality, socialization, decision making or visualization. Currently, it has more than 16 thousand registered users and accumulates more than 1.3 million events. Some of the hosted questionnaires have been run more than 60,000 times. In addition, users come from many European, Asian, American, and Oceanian countries. The results highlight the wide using spectrum of the platform joined to the data storing and processing possibilities what allows the computerized resources universalization. (AU)

Prevalence of gestational diabetes and gestational hypertension in pregnant women with pregestational obesity / Prevalencia de diabetes e hipertensión gestacional en embarazadas con obesidad pregestacional

Resumen OBJETIVO: Describir la prevalencia de diabetes gestacional e hipertensión arterial en pacientes embarazadas con obesidad pregestacional. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo llevado a cabo en mujeres embarazadas con diagnóstico previo de obesidad (índice de masa corporal superior a 29.99) y con control prenatal. Parámetros evaluados: estilo de vida (alimentación, actividad física, consumo de alcohol, tabaco o alguna toxicomanía) y características físicas, clínicas y bioquímicas durante el embarazo actual por trimestre (índice de masa corporal, glucosa, presión arterial sistólica y diastólica). El diagnóstico de diabetes gestacional se estableció mediante una prueba de tolerancia a la glucosa entre las semanas 24 y 28 de embarazo. La hipertensión gestacional se diagnosticó por cifras de presión arterial mayores e iguales a 140-90 mmHg a partir de la semana 20 de embarazo y en ausencia de proteinuria. El análisis estadístico incluyó porcentajes, promedios e intervalos de confianza. RESULTADOS: La prevalencia de diabetes gestacional en embarazadas con obesidad fue 13.7% (IC95%: 9.6 a 17.9) y la de hipertensión gestacional en embarazadas con obesidad 7.4% (IC95%: 4.3 a 10.6). CONCLUSIÓN: La obesidad es un factor conocido de riesgos, en particular de diabetes e hipertensión en el embarazo. Su alta prevalencia hace necesario implementar campañas de prevención que favorezcan su reducción.

Abstract OBJECTIVE: To describe the prevalence of gestational diabetes and arterial hypertension in pregnant patients with pre-pregnancy obesity. MATERIALS AND METHODS: Retrospective, cross-sectional and descriptive study in pregnant women with a diagnosis of obesity prior to pregnancy (body mass index greater than 29.99) and with prenatal care. The sample size was 269 pregnant women. Lifestyle (diet, physical activity, alcohol, tobacco or drug addiction) and physical, clinical and biochemical characteristics during the current pregnancy were evaluated by gestational trimester (body mass index, glucose, systolic and diastolic blood pressure). The diagnosis of gestational diabetes was established by a glucose tolerance test between the 24th and 28th week of gestation and gestational hypertension was diagnosed by blood pressure figures greater than or equal to 140/90 mmHg from the 20th week of gestation and in the absence of proteinuria. Statistical analysis included percentages, means, and confidence intervals. RESULTS: The prevalence of gestational diabetes in obese pregnant women was 13.7% (95%CI: 9.6-17.9) and the prevalence of gestational hypertension in obese pregnant women was 7.4% (95%CI: 4.3-10.6). CONCLUSION: Obesity is a known risk factor, particularly for diabetes and hypertension in pregnancy. Its high prevalence makes it necessary to implement prevention campaigns to reduce it.

Tratamiento de pseudoartrosis postquirúrgica en la base del segundo metatarsiano mediante autoinjerto de calcáneo: caso clínico / Treatment of postsurgical pseudoarthrosis in the base of the second metatarsal with calcaneus autograft: a case report

Los procesos de no-unión postquirúrgicos en pie y tobillo no son infrecuentes debido a la gran cantidad de procedimientos quirúrgicos mediante osteotomías o artrodesis que se realizan anualmente. Ocasionalmente, estos procedimientos no tienen una estabilización óptima del foco de fractura y pueden acabar degenerando en un proceso de no-unión. Presentamos el caso de una paciente a la que se le realizaron osteotomías en la base de los metatarsianos menores por cirugía mínimamente invasiva para el tratamiento de metatarsalgia, que derivó en el desarrollo de pseudoartrosis dolorosa en la base del segundo metatarsiano y de no-unión en el 4.º metatarsiano. Se realizó tratamiento quirúrgico consistente en la utilización de autoinjerto corticoesponjoso de calcáneo y estabilización con placa de bloqueo dorsal para 2.º metatarsiano y estabilización con placa dorsal de bloqueo para el 4.º metatarsiano. La radiología mostró integración del injerto a las 8 semanas y los resultados clínicos fueron muy satisfactorios tras 5 años de seguimiento. El autoinjerto de calcáneo con estabilización rígida por medio de placa de bloqueo dorsal puede ser un tratamiento efectivo para el tratamiento de la no unión y pseudoartrosis en la base de los metatarsianos.(AU)

Postsurgical nonunions of the foot and ankle are not uncommon because of the large number of procedures by means of osteotomies and arthrodesis that are performed annually. We present a clinical case of a patient who developed a painful nonunion in the base of the second metatarsal after a minimally invasive surgical procedure for metatarsalgia within a base osteotomy that developed a painful pseudoartrhosis of the 2nd metatarsal and also a nonunion of the 4th metatarsal. The patient was treated with the use of an autograft of corticocancellous bone from ipsilateral calcaneus that was fixated with a dorsal locking plate for the 3rd metatarsal and also with stabilization by means of a dorsal locking plate of the 4th metatarsal. Radiology showed good integration of the graft at 8 weeks and clinical results were excellent after 5 years of followup. Autograft from calcaneus fixed with a locking dorsal plate can be an effective treatment of nonunions in the base of the metatarsals.(AU)