Aplicación de un balón de contrapulsación intraaórtico en procedimientos obstétricos. Reporte de caso / Use of an intra-aortic balloon pump in Obstetrics. Case report

Resumen ANTECEDENTES: Las anomalías en la inserción placentaria son cada vez más frecuentes en nuestro medio. En la atención de la paciente embarazada es importante la prevención de la pérdida hemática con balones de contrapulsación intraaórticos, como una opción útil. CASO CLÍNICO: Paciente de 38 años, embarazada, con antecedente de parto eutócico y sin enfermedades de interés, ni intervenciones quirúrgicas previas. El seguimiento prenatal se inició a las 17 semanas, con retraso diagnóstico debido a que continuaba en tratamiento anticonceptivo. La invasión trofoblástica estaba limitada al miometrio, sin evidencia de invasión a los órganos vecinos. Se le expusieron a la paciente las posibles complicaciones a fin de minimizar los riesgos de hemorragia masiva, potencialmente mortal en el momento del parto. Puesto que la paciente expresó no desear volver a embarazarse, se le recomendó la histerectomía poscesárea, dejando la placenta in situ. CONCLUSIONES: La oclusión endovascular con balón de contrapulsación intraaórtico es una opción segura y eficaz para minimizar la pérdida de sangre en casos de anomalías en la inserción placentaria. Además del clásico acceso por vía femoral es posible colocarlo por vía axilar, con igual efectividad. La baja tasa de complicaciones maternas y la seguridad, en términos de irradiación fetal, la convierten en una opción razonable en la atención de pacientes embarazadas en quienes se espera una alta pérdida sanguínea.

Abstract BACKGROUND: Anomalies of placental insertion are becoming increasingly common. Prevention of blood loss with intra-aortic counterpulsation balloons is a useful option in the care of pregnant patients. CLINICAL CASE: 38-year-old pregnant woman with a history of euthyroid delivery and no medical or surgical history. Prenatal follow-up was initiated at 17 weeks, with a delay in diagnosis due to the fact that she was still on contraceptive treatment. Trophoblastic invasion was limited to the myometrium with no evidence of invasion into adjacent organs. The patient was counseled on the potential complications to minimize the risk of massive, potentially fatal hemorrhage at delivery. As the patient did not wish to become pregnant again, a post-cesarean hysterectomy was recommended, leaving the placenta in situ. CONCLUSIONS: Endovascular occlusion with intra-aortic balloon counterpulsation is a safe and effective option to minimize blood loss in cases of placental insertion anomalies. In addition to the classical femoral approach, the axillary route can be used with equal efficacy. The low rate of maternal complications and the safety with respect to fetal irradiation make it a reasonable option in the management of pregnant patients in whom high blood loss is expected.

New Aromatic Bisabolane Derivatives with Lipid-Reducing Activity from the Marine Sponge Myrmekioderma sp.

The previously reported 1-(2,4-dihydroxy-5-methylphenyl)ethan-1-one (1), (1'Z)-2-(1',5'-dimethylhexa-1',4'-dieny1)-5-methylbenzene-1,4-diol (2), and 1,8-epoxy-1(6),2,4,7,10-bisaborapentaen-4-ol (5) together with four new structures of aromatic bisabolane-related compounds (3, 4, 6, 7) were isolated from the marine sponge Myrmekioderma sp. Compounds 1, 2, and 5 were identified based on spectral data available in the literature. The structures of the four new compounds were experimentally established by 1D and 2D-NMR and (-)-HRESIMS spectral analysis. Cytotoxic and lipid-reducing activities of the isolated compounds were evaluated. None of the isolated compounds were active against the tested cancer cell lines; however, lipid-reducing activity was found for compounds 2-5 and 7 in the zebrafish Nile red fat metabolism assay. This class of compounds should be further explored for their suitability as possible agents for the treatment of lipid metabolic disorders and obesity.

Unusual size and reconstructive procedure in a Phyllodes tumor / Tamaño poco usual y cirugía reconstructiva en un tumor filodes

We present the case of a 51 years-old patient, with the diagnosis of a giant borderline Phyllodes tumor. We present her clinical record, treatment and the follow-up care in the next two years and a half. We remark the importance of being conscious about health care

Presentamos el caso de un paciente de 51 años con diagnóstico de tumor gigante de Phyllodes en el límite. Presentamos su historia clínica, tratamiento y seguimiento en los próximos dos años y medio. Destacamos la importancia de ser conscientes de la atención a la salud

Demencia en pacientes adultos con síndrome de inmunodeficiencia adquirida, atendidos en el Hospital Mario Catarino Rivas / Dementia in adult patients with acquired immunodeficiency syndrome treated at Hospital Mario Catarino Rivas

Introducción: La demencia asociada al virus de inmunodeficiencia humana (D-VIH) es un tipo de demencia subcortical debido a infecciones crónicas por VIH; y combina alteraciones cognitivas, motoras y conductuales, afectando del 20 al 30% de los pacientes adultos que sufren esta enfermedad. La Escala de Demencia por VIH (EDV) es una herramienta sensible que se utiliza para tamizaje de pacientes infectados por VIH y con riesgo de desarrollar demencia. Objetivos. Aplicar la EDV en pacientes con infección avanzada por VIH que asistían al Centro de Atención Integral (CAI) del Hospital Mario Catarino Rivas (HMCR) y analizar su relación con el conteo de células TCD4 <200. Metodología. Se trata de un estudio cuantitativo, descriptivo, de corte transversal con un muestreo intencionado. En el estudio se incluyó pacientes mayores de 18 años con VIH confirmado, quienes asisten al CAI, alfabetos, con conteo reciente de linfocitos CD4 menor de 200 células y que consintieron participar en el estudio. Se les aplicó la EDV como tamizaje para evaluar su función mental. Resultados. El 81% de los pacientes entrevistados presentaron riesgo de D-VIH con un rango de edad de mayor prevalencia entre 38 y 57 años, siendo el género femenino el de mayor riesgo. Conclusión de acuerdo a los resultados obtenidos, la EDV es una herramienta costo-efectiva para determinar la función cognitiva en los pacientes...(AU)

Tanjungides A and B: new antitumoral bromoindole derived compounds from Diazona cf formosa. isolation and total synthesis.

Tanjungides A (1) (Z isomer) and B (2) (E isomer), two novel dibrominated indole enamides, have been isolated from the tunicate Diazona cf formosa. Their structures were determined by spectroscopic methods including HRMS, and extensive 1D and 2D NMR. The stereochemistry of the cyclised cystine present in both compounds was determined by Marfey's analysis after chemical degradation and hydrolysis. We also report the first total synthesis of these compounds using methyl 1H-indole-3-carboxylate as starting material and a linear sequence of 11 chemical steps. Tanjungides A and B exhibit significant cytotoxicity against human tumor cell lines.

Isolation and structures of pipecolidepsins A and B, cytotoxic cyclic depsipeptides from the Madagascan sponge Homophymia lamellosa.

Two new cyclic depsipeptides, pipecolidepsins A and B (1 and 2), have been isolated from the sponge Homophymia lamellosa collected off the coast of Madagascar. Their structures were determined by a combination of NMR experiments and by LC-MS analysis of the amino acid fragments obtained by hydrolysis and derivatization using Marfey's reagent. In addition to several common amino acids, these peptides contain unusual residues, including 2-amino-3-hydroxy-4,5-dimethylhexanoic acid, 3-ethoxyasparagine, 3,4-dimethylglutamine, 4,7-diamino-2,3-dihydroxy-7-oxoheptanoic acid, and 3-hydroxyaspartic acid as well as a terminal 3-hydroxy-2,4,6-trimethylheptanoic acid residue. Pipecolidepsins A and B displayed cytotoxic activity against a panel of different human tumor cell lines.

Isolation and first total synthesis of PM050489 and PM060184, two new marine anticancer compounds.

Microtubules continue to be one of the most successful anticancer drug targets and a favorite hit for many naturally occurring molecules. While two of the most successful representative agents in clinical use, the taxanes and the vinca alkaloids, come from terrestrial sources, the sea has also proven to be a rich source of new tubulin-binding molecules. We describe herein the first isolation, structural elucidation and total synthesis of two totally new polyketides isolated from the Madagascan sponge Lithoplocamia lithistoides . Both PM050489 and PM060184 show antimitotic properties in human tumor cells lines at subnanomolar concentrations and display a distinct inhibition mechanism on microtubules. The development of an efficient synthetic procedure has solved the supply problem and, following pharmaceutical development, has allowed PM060184 to start clinical studies as a promising new drug for cancer treatment.

1,5-diazacyclohenicosane, a new cytotoxic metabolite from the marine sponge Mycale sp.

A new cyclic diamine, 1,5-diazacyclohenicosane (1), was isolated from samples of the marine sponge Mycale sp. collected at Lamu Island (Kenya). Its structure was determined by a combination of spectroscopic techniques, including (+)-HRESIMS and 1D and 2D NMR spectroscopy. The compound displayed cytotoxicity at the muM level against three human tumor cell lines.