Use of Chitosan as a Precursor for Multiple Applications in Medicinal Chemistry: Recent Significant Contributions.

Chitosan (CS) is a polymer made up of mainly deacetylated ß-1,4 D-glucosamine units, which is part of a large group of D-glucosamine oligomers known as chitooligosaccharides, which can be obtained from chitin, most abundant natural polymer after cellulose and central component of the shrimp exoskeleton. It is known that it can be used for the development of materials, among which its use stands out in wastewater treatment (removal of metal ions, dyes, and as a membrane in purification processes), food industry (anti-cholesterol and fat, packaging material, preservative, and food additive), agriculture (seed and fertilizer coating, controlled release agrochemicals), pulp and paper industry (surface treatment, adhesive paper), cosmetics (body creams, lotions, etc.), in the engineering of tissues, wound healing, as excipients for drug administration, gels, membranes, nanofibers, beads, microparticles, nanoparticles, scaffolds, sponges, and diverse biological ones, specifically antibacterial and antifungal activities. This article reviews the main contributions published in the last ten years regarding the use and application of CS in medical chemistry. The applications exposed here involve regenerative medicine in the design of bioprocesses and tissue engineering, Pharmaceutical sciences to obtain biomaterials, polymers, biomedicine, and the use of nanomaterials and nanotechnology, toxicology, and Clinical Pharmaceuticals, emphasizing the perspectives and the direction that can take research in this area.

Adherence to treatment guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) or angiotensin receptor - neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cocotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aims to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS: Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart Failure (HF) medications prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS: Out of 2528 patients in the registry, 1384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION: Prescription rates and target dose achievement is sub-optimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.

Electrophysiological Measures of Listening-in-Noise With and Without Remote Microphone System Use in Autistic and Non-Autistic Youth.

OBJECTIVES: This study examined the neural mechanisms by which remote microphone (RM) systems might lead to improved behavioral performance on listening-in-noise tasks in autistic and non-autistic youth. DESIGN: Cortical auditory evoked potentials (CAEPs) were recorded in autistic (n = 25) and non-autistic (n = 22) youth who were matched at the group level on chronological age ( M = 14.21 ± 3.39 years) and biological sex. Potentials were recorded during an active syllable identification task completed in quiet and in multi-talker babble noise with and without the use of an RM system. The effects of noise and RM system use on speech-sound-evoked P1-N1-P2 responses and the associations between the cortical responses and behavioral performance on syllable identification were examined. RESULTS: No group differences were observed for behavioral or CAEP measures of speech processing in quiet or in noise. In the combined sample, syllable identification in noise was less accurate and slower than in the quiet condition. The addition of the RM system to the noise condition restored accuracy, but not the response speed, to the levels observed in quiet. The CAEP analyses noted amplitude reductions and latency delays in the noise compared with the quiet condition. The RM system use increased the N1 amplitude as well as reduced and delayed the P2 response relative to the quiet and noise conditions. Exploratory brain-behavior correlations revealed that larger N1 amplitudes in the RM condition were associated with greater behavioral accuracy of syllable identification. Reduced N1 amplitude and accelerated P2 response were associated with shorter syllable identification response times when listening with the RM system. CONCLUSIONS: Findings suggest that although listening-in-noise with an RM system might remain effortful, the improved signal to noise ratio facilitates attention to the sensory features of the stimuli and increases speech sound identification accuracy.

Rethinking household size and children's language environment.

The number of U.S. children living in households with extended families has greatly increased in the last 4 decades. This demographic shift calls for a reevaluation of the impact of household size on children's development. Household density (HHD), measured as the ratio of people to bedrooms in a home, has been shown to negatively relate to children's language. Here, we propose that while greater HHD may result in poorer language abilities, more adults in relation to the number of children in the home may have a positive impact on children's language. To test this hypothesis, we studied relations between HHD and adult-to-child ratio with children's vocabulary scores, as well as whether maternal education and household chaos accounted for these associations. Participants included families from a range of socioeconomic and ethnic backgrounds (N = 275; Mage = 10.85; 51% female; 51% Hispanic; annual income range less than $10,000-over $100,000). In general, higher HHD was related to lower child vocabulary scores. Conversely, higher adult-to-child ratio was related to higher child vocabulary and lower household chaos. These patterns were primarily driven by effects in Hispanic families. Our results suggest that a reevaluation of household size is needed, as more adults in the home can be protective for children's language development in larger families, an effect that may vary by culture. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Constructing bilayer and volumetric atrial models at scale.

To enable large in silico trials and personalized model predictions on clinical timescales, it is imperative that models can be constructed quickly and reproducibly. First, we aimed to overcome the challenges of constructing cardiac models at scale through developing a robust, open-source pipeline for bilayer and volumetric atrial models. Second, we aimed to investigate the effects of fibres, fibrosis and model representation on fibrillatory dynamics. To construct bilayer and volumetric models, we extended our previously developed coordinate system to incorporate transmurality, atrial regions and fibres (rule-based or data driven diffusion tensor magnetic resonance imaging (MRI)). We created a cohort of 1000 biatrial bilayer and volumetric models derived from computed tomography (CT) data, as well as models from MRI, and electroanatomical mapping. Fibrillatory dynamics diverged between bilayer and volumetric simulations across the CT cohort (correlation coefficient for phase singularity maps: left atrial (LA) 0.27 ± 0.19, right atrial (RA) 0.41 ± 0.14). Adding fibrotic remodelling stabilized re-entries and reduced the impact of model type (LA: 0.52 ± 0.20, RA: 0.36 ± 0.18). The choice of fibre field has a small effect on paced activation data (less than 12 ms), but a larger effect on fibrillatory dynamics. Overall, we developed an open-source user-friendly pipeline for generating atrial models from imaging or electroanatomical mapping data enabling in silico clinical trials at scale (https://github.com/pcmlab/atrialmtk).

Photoprotective and antigenotoxic properties of Cutibacterium acnes ecotypes native to terrestrial subsurface habitats.

Actinobacteria are known to produce a variety of secondary metabolites with skin-protective properties. This study aimed to investigate the photoprotective and antigenotoxic properties against UVB of extracts obtained from Cutibacterium acnes strains. Bacterial growth was measured spectrophotometrically and the constant maximum growth rate (µ) value to each strain, were calculated. In vitro photoprotection efficacy was evaluated using in vitro indices such as sun protection factor (SPFespectrophotometric) and critical wavelength (λc). UVB-antigenotoxicity was also evaluated using the SOS Chromotest. Correlation analysis was used to examine the relationship between SPFespectrophotometric and extract concentration and the %GI estimates. Among the studied strains, one showed low (6.0 ≤ SPFespectrophotometric ≤ 14.9) and eight showed media (15.0 ≤ SPFespectrophotometric ≤ 29.9) UVB photoprotection efficacy. All of them resulted in broad-spectrum (UVA-UVB) photoprotection (λc > 370 nm). In total, two C. acnes ecotypes with different growth rates were evidenced, but the protective metabolites in the extracts were produced without the influence of growth rate. Photoprotective efficacy depended on the extract concentration and was correlated with antigenotoxicity. We demonstrated that C. acnes extracts can be used as sunscreen ingredients that reduce UVB-induced genotoxicity.

Cultural differences in auditory ecology.

Demographic differences in acoustic environments are usually studied using geographic area monitoring. This approach, however, may miss valuable information differentiating cultures. This motivated the current study, which used wearable sound recorders to measure noise levels and speech-to-noise ratios (SNRs) in the immediate acoustic environment of Latinx and European-American college students. Latinx experienced higher noise levels (64.8 dBC) and lower SNRs (3.7 dB) compared to European-Americans (noise levels, 63 dB; SNRs, 5.4 dB). This work provides a framework for a larger study on the impact of culture on auditory ecology.

Comparative mitochondrial genomics of American nectar-feeding long-nosed bats Leptonycteris spp. with insights into the phylogeny of the family Phyllostomidae.

Among leaf-nosed bats (family Phyllostomidae), the genus Leptonycteris (subfamily Glossophaginae), contains three migratory and obligate nectar-dwelling species of great ecological and economic importance; the greater long-nosed bat L. nivalis, the lesser long-nosed bat L. yerbabuenae, and the southern long-nosed bat L. curasoae. According to the IUCN, the three species are categorized as 'vulnerable', 'endangered', and 'near threatened', respectively. In this study, we assembled and characterized in detail the mitochondrial genome of Leptonycteris spp. and examined the phylogenetic position of this genus in the family Phyllostomidae based on protein coding genes (PCGs). The mitogenomes of L. nivalis, L. curasoae, and L. yerbabuenae are 16,708, 16,758, and 16,729 bp in length and each encode 13 PCGs, 22 transfer RNA genes, 2 rRNA genes, and a putative control region (CR). Mitochondrial gene order is identical to that reported before for the family Phyllostomidae. All tRNAs exhibit a 'cloverleaf' secondary structure, except tRNA-Serine-1 that is missing the DHU arm in the three species. All PCGs are exposed to purifying selection with atp8 experiencing the most relaxed purifying selection as the ω ratio was higher for this gene compared to the other PCGs in each species. The CR of each species contains three functional domains: extended termination associated sequence (ETAS), Central, and conserved sequence block domain (CSB). A phylomitogenomic analysis revealed that Leptonycteris is monophyletic and most closely related to the genus Glossophaga. The analysis also supported the monophyly of the family Glossophaginae in the speciose family Phyllostomidae. The mitochondria characterization of these species provides relevant information to develop molecular markers for conservation purposes.

Plasticity Changes in Central Auditory Systems of School-Age Children Following a Brief Training With a Remote Microphone System.

OBJECTIVES: The objective of this study was to investigate whether a brief speech-in-noise training with a remote microphone (RM) system (favorable listening condition) would contribute to enhanced post-training plasticity changes in the auditory system of school-age children. DESIGN: Before training, event-related potentials (ERPs) were recorded from 49 typically developing children, who actively identified two syllables in quiet and in noise (+5 dB signal-to-noise ratio [SNR]). During training, children completed the same syllable identification task as in the pre-training noise condition, but received feedback on their performance. Following random assignment, half of the sample used an RM system during training (experimental group), while the other half did not (control group). That is, during training' children in the experimental group listened to a more favorable speech signal (+15 dB SNR) than children from the control group (+5 dB SNR). ERPs were collected after training at +5 dB SNR to evaluate the effects of training with and without the RM system. Electrical neuroimaging analyses quantified the effects of training in each group on ERP global field power (GFP) and topography, indexing response strength and network changes, respectively. Behavioral speech-perception-in-noise skills of children were also evaluated and compared before and after training. We hypothesized that training with the RM system (experimental group) would lead to greater enhancement of GFP and greater topographical changes post-training than training without the RM system (control group). We also expected greater behavioral improvement on the speech-perception-in-noise task when training with than without the RM system. RESULTS: GFP was enhanced after training only in the experimental group. These effects were observed on early time-windows corresponding to traditional P1-N1 (100 to 200 msec) and P2-N2 (200 to 400 msec) ERP components. No training effects were observed on response topography. Finally, both groups increased their speech-perception-in-noise skills post-training. CONCLUSIONS: Enhanced GFP after training with the RM system indicates plasticity changes in the neural representation of sound resulting from listening to an enriched auditory signal. Further investigation of longer training or auditory experiences with favorable listening conditions is needed to determine if that results in long-term speech-perception-in-noise benefits.

Caregiver Experiences With Oral Bilingualism in Children Who Are Deaf and Hard of Hearing in the United States: Impact on Child Language Proficiency.

PURPOSE: Best practices recommend promoting the use of the home language and allowing caregivers to choose the language(s) that they want to use with their child who is deaf or hard of hearing (DHH). We examined whether Spanish-speaking caregivers of children who are DHH receive professional recommendations on oral bilingualism that follow best practices. We also assessed whether professional recommendations, caregiver beliefs, and language practices had an impact on child language(s) proficiency. METHOD: Sixty caregivers completed a questionnaire on demographic questions, language(s) use and recommendations, beliefs on bilingualism, and child language proficiency measures in English, Spanish, and American Sign Language (ASL). Professional recommendations on oral bilingualism were reported descriptively, and linear regression was used to identify the predictors of child language(s) proficiency. RESULTS: We found that only 23.3% of the caregivers were actively encouraged to raise their child orally bilingual. Language practices predicted child proficiency in each language (English, Spanish, and ASL), but professional recommendations and caregiver beliefs did not. CONCLUSIONS: Our results revealed that most caregivers received recommendations that do not follow current best practices. Professional training is still needed to promote bilingualism and increase cultural competence when providing services to caregivers who speak languages different from English. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21644846.

Síndrome de takotsubo relacionado con COVID-19: primer caso reportado en Latinoamérica / Takotsubo syndrome related to COVID-19: first reported case in Latin America

Resumen Se presenta el caso de una mujer de 67 años, con antecedentes de hipertensión arterial y obesidad, que acudió a urgencias por tos, fatiga, fiebre y disnea. Durante la monitorización se documentó elevación del segmento ST anterolateral e inferior y elevación de troponina; la arteriografía coronaria no evidenció lesiones significativas; en el ventriculograma y en el ecocardiograma transtorácico se documentó acinesia apical. Se confirmó RT-PCR positiva para SARS-CoV-2; se consideró como diagnóstico síndrome de takotsubo.

Abstract A 67-years-old woman with hypertension, obesity as previous diseases, presented to the emergency department due to cough, fatigue, fever, and dyspnea. ST-segment elevation was visualized during monitoring, troponin was positive, the coronary angiography was negative; the ventriculogram and transthoracic echocardiogram documented apical akinesia. The RT-PCR was positive for SARS CoV-2; the diagnosis was takotsubo-syndrome.

Manifestaciones endocrinológicas en la enfermedad de Von Hippel-Lindau: revisión narrativa

La enfermedad de Von Hippel-Lindau es un síndrome neoplásico, autosómico dominante, caracterizado por una mutación germinal del gen VHL que codifica para la proteína VHL en el cromosoma 3. Esta mutación predispone al desarrollo de tumores benignos y malignos que afectan diferentes órganos, a causa de una ausencia de la inhibición de la vía de la tumo-rigénesis mediada por el factor inducible por hipoxia. La prevalencia de esta enfermedad es de 2 a 3 por 100 000 personas y las neoplasias se localizan con mayor frecuencia en retina, sistema nervioso central, cabeza y cuello, páncreas, riñón, glándula suprarrenal y órgano reproductor. Se clasifica en 2 tipos dependiendo de la presencia o ausencia de feocromocitoma. El feocromocitoma y las neoplasias pancreáticas constituyen las manifestaciones endocrinas más frecuentes. El feocromocitoma se presenta entre el 10-30% de los casos. Puede cursar desde una entidad asintomática hasta una sintomatología variable que incluye la triada clásica de cefalea, palpitaciones y diaforesis. El diagnóstico se realiza mediante pruebas bioquímicas o sus metabolitos que confirman niveles elevados de catecolaminas, y estudios imagenológicos. Las lesiones pancreáticas son con frecuencia asintomáticas y se detectan de forma incidental en estudios de imagen realizados en los pacientes con VHL. Aunque las características clínicas y bioquímicas de estas neoplasias no son patognomóni-cas, pueden ser útiles para sugerir la enfermedad VHL como la etiología subyacente.

Von Hippel-Lindau disease is an autosomal dominant neoplastic syndrome characterized by a germline mutation of the VHL gene encoding the VHL protein on chromosome 3. This mutation predisposes to the development of benign and malignant tumors that affect different organs, due to an absence of inhibition of the hypoxia-inducible factor-mediated tumorigenesis pathway. The prevalence of this disease is 2 to 3 per 100,000 people, and neoplasms are most frequently located in the retina, central nervous system, head and neck, pancreas, kidney, adrenal gland, and the organ. It is classified into 2 types depending on the presence or absence of pheochromocytoma. Pheochromocytoma and pancreatic neoplasms are the most frequent endocrine manifestations. Pheochromocytoma occurs in 1030% of cases. It can range from an asymptomatic entity to a variable symptomatology that includes the classic triad of headache, palpitations and diaphoresis. The diagnosis is made through biochemical tests that confirm high levels of catecholamines and imaging studies. Pancreatic lesions are frequently asymptomatic and are detected incidentally in imaging studies performed in VHL patients. Although the clinical and biochemical characteristics of these malignancies are not pathognomonic, they may be useful in suggesting VHL disease as the underlying etiology.

Evidence for a Musician Speech-Perception-in-Noise Advantage in School-Age Children.

PURPOSE: The objective of this study was to evaluate whether child musicians are better at listening to speech in noise (SPIN) than nonmusicians of the same age. In addition, we aimed to explore whether the musician SPIN advantage in children was related to general intelligence (IQ). METHOD: Fifty-one children aged 8.2-11.8 years and with different levels of music training participated in the study. A between-group design and correlational analyses were used to determine differences in SPIN skills as they relate to music training. IQ was used as a covariate to explore the relationship between intelligence and SPIN ability. RESULTS: More years of music training were associated with better SPIN skills than fewer years of music training. Furthermore, this difference in SPIN skills remained even when accounting for IQ. These results were found at the group level and also when years of instrument training was treated as a continuous variable (i.e., correlational analyses). CONCLUSIONS: We confirmed results from previous studies in which child musicians outperformed nonmusicians in SPIN skills. We also showed that this effect was not related to differences in IQ between the musicians and nonmusicians for this cohort of children. However, confirmation of this finding with a cohort of children from more diverse socioeconomic statuses and cognitive profiles is warranted.

Flower Extracts from Ornamental Plants as Sources of Sunscreen Ingredients: Determination by In Vitro Methods of Photoprotective Efficacy, Antigenotoxicity and Safety.

Plants are sources of sunscreen ingredients that prevent cellular mutations involved in skin cancer and aging. This study investigated the sunscreen properties of the extracts from some ornamental plants growing in Colombia. The UV filter capability of the flower extracts obtained from Rosa centifolia L., Posoqueria latifolia (Rudge) Schult, and Ipomoea horsfalliae Hook. was examined. Photoprotection efficacies were evaluated using in vitro indices such as sun protection factor and critical wavelength. UVB antigenotoxicity estimates measured with the SOS Chromotest were also obtained. Extract cytotoxicity and genotoxicity were studied in human fibroblasts using the trypan blue exclusion and Comet assays, respectively. Major compounds of the promising flower extracts were identified by UHPLC-ESI+-Orbitrap-MS. The studied extracts showed high photoprotection efficacy and antigenotoxicity against UVB radiation, but only the P. latifolia extract showed broad-spectrum photoprotection at non-cytotoxic concentrations. The P. latifolia extract appeared to be safer for human fibroblast cells and the R. centifolia extract was shown to be moderately cytotoxic and genotoxic at the highest assayed concentrations. The I. horsfalliae extract was unequivocally cytotoxic and genotoxic. The major constituents of the promising extracts were as follows: chlorogenic acid, ecdysterone 20E, rhamnetin-rutinoside, cis-resveratrol-diglucoside, trans-resveratrol-diglucoside in P. latifolia; quercetin, quercetin-glucoside, quercetin-3-rhamnoside, kaempferol, kaempferol-3-glucoside, and kaempferol-rhamnoside in R. centifolia. The potential of the ornamental plants as sources of sunscreen ingredients was discussed.

Mapping Tree Canopy in Urban Environments Using Point Clouds from Airborne Laser Scanning and Street Level Imagery.

Resilient cities incorporate a social, ecological, and technological systems perspective through their trees, both in urban and peri-urban forests and linear street trees, and help promote and understand the concept of ecosystem resilience. Urban tree inventories usually involve the collection of field data on the location, genus, species, crown shape and volume, diameter, height, and health status of these trees. In this work, we have developed a multi-stage methodology to update urban tree inventories in a fully automatic way, and we have applied it in the city of Pamplona (Spain). We have compared and combined two of the most common data sources for updating urban tree inventories: Airborne Laser Scanning (ALS) point clouds combined with aerial orthophotographs, and street-level imagery from Google Street View (GSV). Depending on the data source, different methodologies were used to identify the trees. In the first stage, the use of individual tree detection techniques in ALS point clouds was compared with the detection of objects (trees) on street level images using computer vision (CV) techniques. In both cases, a high success rate or recall (number of true positive with respect to all detectable trees) was obtained, where between 85.07% and 86.42% of the trees were well-identified, although many false positives (FPs) or trees that did not exist or that had been confused with other objects were always identified. In order to reduce these errors or FPs, a second stage was designed, where FP debugging was performed through two methodologies: (a) based on the automatic checking of all possible trees with street level images, and (b) through a machine learning binary classification model trained with spectral data from orthophotographs. After this second stage, the recall decreased to about 75% (between 71.43 and 78.18 depending on the procedure used) but most of the false positives were eliminated. The results obtained with both data sources were robust and accurate. We can conclude that the results obtained with the different methodologies are very similar, where the main difference resides in the access to the starting information. While the use of street-level images only allows for the detection of trees growing in trafficable streets and is a source of information that is usually paid for, the use of ALS and aerial orthophotographs allows for the location of trees anywhere in the city, including public and private parks and gardens, and in many countries, these data are freely available.

Quantum Information Entropies on Hyperbolic Single Potential Wells.

In this work, we study the quantum information entropies for two different types of hyperbolic single potential wells. We first study the behaviors of the moving particle subject to two different hyperbolic potential wells through focusing on their wave functions. The shapes of these hyperbolic potentials are similar, but we notice that their momentum entropy densities change along with the width of each potential and the magnitude of position entropy density decreases when the momentum entropy magnitude increases. On the other hand, we illustrate the behaviors of their position and momentum entropy densities. Finally, we show the variation of position and momentum entropies Sx and Sp with the change of the potential well depth u and verify that their sum still satisfies the BBM inequality relation.

Demographic and sociocultural predictors of face image satisfaction: The U.S. Body Project I.

Despite substantial literature surrounding how people process and perceive faces, there is very little research investigating how people evaluate their own faces. We examined how gender, body mass, race, age, and sexual orientation were linked to people's satisfaction with the appearance of their eyes, nose, facial shape, and face overall among 11,620 adults recruited via Mechanical Turk. Most people mostly or definitely agreed they were happy with their facial appearance. There were notable racial differences, with Asian participants tending to report greater dissatisfaction. For example, only 66% of Asian women and 60% of Asian men mostly or definitely agreed that they were happy with the appearance of their eyes, which was lower than other racial groups. BMI and age were not strongly associated with face satisfaction. Sexual minority men were less satisfied than heterosexual men. About one in four gay and bisexual men, compared to only one in seven heterosexual men, reported dissatisfaction with their overall facial appearance. Men and women with poorer face image engaged in more appearance surveillance, more strongly internalized the thin-ideal, and perceived stronger sociocultural pressures from peers, parents, and media. The current study highlights important sociocultural and demographic factors tied to poorer face image.

[Advanced heart failure due to coronary aneurysms]. / Falla cardiaca avanzada por aneurismas coronarios.

We present the case of a 61 years old man with hypothyroidism, hypertension, type 2 diabetes mellitus, and ischemic cardiopathy, who was admitted with a diagnosis of non-ST elevation myocardial infarction. The coronary angiography describes coronary ectasia with giant aneurysm and slow flow in the right coronary and aneurysm with slow flow anterior descending coronary. The echocardiogram shows contractility disorders with severely decreased left ventricular ejection fraction (20%) despite optimal medical management. This case presents a patient with ischemic heart disease and advanced heart failure secondary to coronary aneurysm, the proposed optimal treatment was a heart transplant given the disease's progression.

Función tiroidea y embarazo / Thyroid function and pregnancy

La enfermedad tiroidea, junto con la diabetes mellitus, son las dos endocrinopatías más frecuentes en el embarazo. El hipotiroidismo primario en mujeres en edad gestacional tiene una prevalencia del 2%, convirtiendo en un reto su diagnóstico, tratamiento y seguimiento en la práctica clínica

Thyroid disease, along with diabetes mellitus, are the two most common endocrinopathies in pregnancy. Primary hypothyroidism in women of gestational age has a prevalence of 2%, making its diagnosis, treatment and follow-up a challenge in clinical practice

Fisiología de la tiroides e hipotiroidismo en el embarazo. Revisión de tema / Thyroid physiology and hypothyroidism in pregnancy. A review

Durante el embarazo se generan múltiples cambios fisiológicos a nivel hormonal para llevar a cabo de manera satisfactoria la gestación. Uno de los ejes hormonales con cambios más importantes que repercuten de manera directa en el desarrollo fetal y bienestar materno es el tiroideo, el cual presenta modificaciones para lograr suplir las necesidades de hormona tiroidea tanto materna como fetal, principalmente en las primeras etapas del embarazo. Entre estas, se describen cambios en la cantidad de proteínas transportadoras de hormonas, aumento en el estímulo y producción de hormonas tiroideas, incremento del aclaramiento renal de yodo y alteración en la actividad de las desyodinasas. Estos mecanismos ofrecen suficiente hormona tiroidea al feto, el cual es dependiente del aporte materno. Un desajuste en cualquiera de estos mecanismos, puede conducir al desarrollo de hipotiroidismo con múltiples complicaciones, como la pérdida del embarazo e hipertensión gestacional, entre otras. Una tamización oportuna y un tratamiento temprano pueden evitar estos desenlaces adversos. De ahí la necesidad fundamental de conocer y comprender el comportamiento del eje tiroideo en la gestación

During pregnancy, multiple physiological changes are generated at the hormonal level to successfully carry out pregnancy. One of the hormonal axes with the most important changes that have a direct impact on fetal development and maternal well-being is the thyroid axis, which presents multiple modifications to reach the needs of thyroid hormone for both the mother and the fetus, primarily in the early stages of pregnancy. Changes in the amount of hormone transport proteins, increased stimulation and production of thyroid hormones, increased renal clearance of iodine, and alteration in deiodinase activity are included within these modifications. These mechanisms offer enough thyroid hormone to the fetus, which is dependent on the maternal supply. An imbalance in any of these can lead to the development of hypothyroidism with multiple complications, such as pregnancy loss and gestational hypertension, among others. Timely screening and early treatment can avoid these adverse outcomes, hence the importance of knowing and understanding the regulation of the thyroid axis in pregnancy