MiR-151a: a robust endogenous control for normalizing small extracellular vesicle cargo in human cancer.

Small extracellular vesicles (sEVs) in the blood of cancer patients contain higher amounts of tumor markers than those identified as free-circulating. miRNAs have significant biomedical relevance due to their high stability and feasible detection. However, there is no reliable endogenous control available to measure sEVs-miRNA content, impairing the acquisition of standardized consistent measurements in cancer liquid biopsy. In this study, we identified three miRNAs from a panel of nine potential normalizers that emerged from a comprehensive analysis comparing the sEV-miRNA profile of six lung and ovarian human cancer cell lines in the absence of or under different conditions. Their relevance as normalizers was tested in 26 additional human cancer cell lines from nine different tumor types undergoing chemotherapy or radiotherapy treatment. The validation cohorts were comprised of 242 prospective plasma and ascitic fluid samples from three different human tumor types. Variability and normalization properties were tested in comparison to miR-16, the most used control to normalize free-circulating miRNAs in plasma. Our results indicate that miR-151a is consistently represented in small extracellular vesicles with minimal variability compared to miR-16, providing a novel normalizer to measure small extracellular vesicle miRNA content that will benefit liquid biopsy in cancer patients.

Nutrient recovery and valorisation from pig slurry liquid fraction with membrane technologies.

Livestock slurry has been reported to be a potential secondary raw material as it contains macronutrients ­nitrogen, phosphorus and potassium-, which could be valorised as high-quality fertilizers if proper separation and concentration of valuable compounds is performed. In this work, pig slurry liquid fraction was assessed for nutrient recovery and valorisation as fertilizer. Some indicators were used to evaluate the performance of proposed train of technologies within the framework of circular economy. As ammonium and potassium species are highly soluble at the whole pH range, a study based on phosphate speciation at pH from 4 to 8 was assessed to improve the macronutrients recovery from the slurry, resulting in two different treatment trains at acidic and alkaline conditions. The acidic treatment system based on centrifugation, microfiltration and forward osmosis was applied to obtain a nutrient-rich liquid organic fertilizer containing 1.3 % N, 1.3 % P2O5 and 1.5 % K2O. The alkaline path of valorisation was composed by centrifugation and stripping by using membrane contactors to produce an organic solid fertilizer -7.7 % N, 8,0 % P2O5 and 2.3 % K2O-, ammonium sulphate solution -1.4 % N- and irrigation water. In terms of circularity indicators, 45.8 % of the initial water content and <50 % of contained nutrients were recovered - 28.3 % N, 43.5 % P2O5 and 46.6 % K2O - in the acidic treatment resulting in 68.68 g fertilizer per kg of treated slurry. 75.1 % of water was recovered as irrigation water and 80.6 % N, 99.9 % P2O5, 83.4 % K2O was valorised in the alkaline treatment, as 219.60 g fertilizer per kg of treated slurry. Treatment paths at acidic and alkaline conditions yield promising results for nutrients recovery and valorisation as the obtained products (nutrient rich organic fertilizer, solid soil amendment and ammonium sulphate solution) fulfil the European Regulation for fertilizers to be potentially used in crop fields.

Peptides and protein hydrolysates exhibiting anti-inflammatory activity: sources, structural features and modulation mechanisms.

Inflammation is the response of the immune system to harmful stimuli such as tissue injury, infection or toxic chemicals, which has the aim of eliminating irritants or pathogenic microorganisms and enhancing tissue repair. Uncontrolled long-lasting acute inflammation can gradually progress to chronic, causing a variety of chronic inflammatory diseases that are usually treated with anti-inflammatory drugs, but most of them are inadequate to control chronic responses and are also associated with adverse side effects. Thus, many efforts are being directed to develop alternative and more selective anti-inflammatory therapies from natural products. One main field of interest is the obtaining of bioactive peptides exhibiting anti-inflammatory activity from sustainable protein sources like edible insects or agroindustry and fishing by-products. This work highlighted the structure-activity relationship of anti-inflammatory peptides. Small peptides with molecular weight under 1 kDa and amino acid chain length between 2 to 20 residues are generally the most active because of the higher probability to be absorbed in the intestine and penetrate into cells when compared with the larger size peptides. The presence of hydrophobic (Val, Ile, Pro) and positively charged (His, Arg, Lys) amino acids is another common occurrence for anti-inflammatory peptides. Interestingly, a high percentage (77%) of these bioactive peptides can be found in alternative sustainable protein sources such as Tenebrio molitor or sunflower, apart from its original protein source. However, not all of these peptides with anti-inflammatory potential in vitro achieve good scores by the in silico bioactivity predictors studied. Therefore, it is essential to implement current bioinformatics tools, in order to complement in vitro experiments with prior prediction of potential bioactive peptides.

Factores asociados al desarrollo de la neumonía asociada al ictus isquémico / Factors related to the development of pneumonia associated with ischemic stroke

RESUMEN Fundamento la neumonía asociada al ictus está relacionada con un incremento de la mortalidad, disminución de la recuperación funcional y prolongación de la estadía hospitalaria, con el consiguiente impacto económico en los servicios de salud. Objetivo identificar los factores de riesgo para el desarrollo de la neumonía asociada al ictus isquémico. Métodos estudio observacional analítico, de cohorte prospectiva, con 725 pacientes con diagnóstico de ictus isquémico, atendidos en el hospital Carlos Manuel de Céspedes (Bayamo, provincia de Granma), desde enero de 2015 hasta el julio de 2019. La asociación de las variables sociodemográficas, antecedentes patológicos personales, hábitos tóxicos, condiciones propias del ictus, la disfagia, los marcadores bioquímicos y de inmunonutrición con el desarrollo de la neumonía asociada al ictus isquémico se determinó con el uso de la regresión logística binaria. Resultados del total de pacientes estudiados el 21,5 % desarrolló neumonía asociada al ictus. Los principales factores de riesgo fueron la disfagia (OR= 13,9), la EPOC (OR= 13,9) y una puntuación en la escala de NIHSS ≥ 12 puntos (OR= 8,31). El germen que se aisló con mayor frecuencia fue el Enterobacter aerogenes (26,3 %). Con relación a los criterios clínicos cumplidos, el 89,1 % presentó alteración leucocitaria. Conclusión el modelo de regresión logística permitió identificar los factores relacionados con el desarrollo de la neumonía asociada al ictus isquémico basado en datos disponibles de modo habitual en la práctica asistencial.

ABSTRACT Background stroke-associated pneumonia is related to increased mortality, decreased functional recovery and prolonged hospital stay, with the consequent economic impact on health services. Objective to identify the risk factors for the development of pneumonia associated with ischemic stroke. Methods analytical observational study, prospective cohort, with 725 patients diagnosed with ischemic stroke, treated at the Carlos Manuel de Céspedes Hospital (Bayamo, province of Granma), from January 2015 to July 2019. The association of the variables Sociodemographic, personal pathological history, toxic habits, stroke conditions, dysphagia, biochemical and immunonutritional markers with the development of pneumonia associated with ischemic stroke were determined using binary logistic regression. Results Of the total number of patients studied, 21.5% developed pneumonia associated with stroke. The main risk factors were dysphagia (OR= 13.9), COPD (OR= 13.9) and a score on the NIHSS scale ≥ 12 points (OR= 8.31). The most frequently isolated germ was Enterobacter aerogenes (26.3%). In relation to the fulfilled clinical criteria, 89.1% presented leukocyte alteration. Conclusion the logistic regression model made it possible to identify the factors related to the development of pneumonia associated with ischemic stroke based on data available on a regular basis in healthcare practice.

Benefit of a nurse-led telephone-based intervention prior to the first urogynecology outpatient visit: a randomized-controlled trial.

INTRODUCTION AND HYPOTHESIS: Triage has become a valid tool to reduce workload during the first consultation in a specialized clinic. A nurse-led telephone intervention prior to the first urogynecologic visit reduces visit duration and increases patients' and physicians' satisfaction. METHODS: All patients scheduled for their very first visit were recruited. They were randomized into an intervention group (prior contact by a specialized urogynecology nurse) and a control group (no contact). The intervention included a questionnaire about history and symptoms. Patients were prompted to complete a bladder diary. Primary outcome was duration of the consultation; secondary outcomes were patients' and physicians' satisfaction with the intervention. RESULTS: Fifty-five patients were allocated to the intervention group and 53 to the control group with no difference regarding age, BMI, parity, menopausal status and primary diagnosis. Mean duration of the telephone call was 10.8 min (SD 4.4). The consultation was significantly shorter in the intervention group than in the control group (mean difference: 4 min and 8 s, p = 0.017). In the intervention group, 79% of the patients found the consultation quality "excellent," 86% would return, and 77% would recommend our clinic to a relative or friend compared with 68%, 67% and 66%, respectively, in the control group. Physicians were "very satisfied" or "satisfied" with the patient preparation. CONCLUSIONS: A nurse-led intervention reduces the duration of the first uroynecologic consultation and is associated with high patient and physician satisfaction. Further research should evaluate whether it also decreases the number of follow-up visits and further referrals.

Relación entre los indicadores del estado nutricional y el desarrollo de neumonía asociada al ictus isquémico / Relationship between Indicators of Nutritional Status and the Development of Pneumonia Associated with Ischemic Stroke

RESUMEN Fundamento: la desnutrición es un problema común entre los pacientes hospitalizados. Este padecimiento provoca severas consecuencias en el curso clínico, incrementa el riesgo de infecciones entre las que se destaca la neumonía y con ello la mortalidad y la estadía hospitalaria. Objetivo: determinar la posible asociación ente los indicadores del estado nutricional al ingreso y el desarrollo de neumonía asociada al ictus isquémico. Métodos: se estudiaron 361 pacientes pertenecientes a una cohorte prospectiva de estudio con el diagnóstico de ictus isquémico agudo, admitidos de modo consecutivo en la sala de ictus, medicina interna y terapia intermedia clínica del Hospital General Universitario Carlos Manuel de Céspedes durante los primeros 7 días a partir de su ingreso, desde septiembre de 2016 hasta diciembre de 2018. Los predictores independientes de neumonía asociada al ictus isquémico se obtuvieron usando regresión logística multivariable. Resultados: del total de 361 pacientes el 21,9% desarrolló neumonía asociada al ictus, el infarto aterotrombótico resultó el subtipo etiológico más frecuente. El 39,1% de los pacientes presentó determinado grado de riesgo nutricional al ingreso, los principales factores identificados fueron el conteo global de linfocitos < 2300/mm3, seguido de cifras al ingreso de albumina < 36 g/l, urea > 7 mmol/l y deaspartato-aminotransferasa> 25 U/L. Conclusiones: el estado nutricional inicial, evaluado mediante los indicadores del estado nutricional disponibles, tiene influencia en el desarrollo de neumonía en los pacientes con ictus isquémico.

ABSTRACT Background: malnutrition is a common problem among hospitalized patients. This disease causes severe consequences in the clinical course, increases the risk of infections, among which pneumonia highlight, mortality and hospital stay. Objective: to determine the possible association between the indicators of nutritional status at admission and the development of pneumonia associated with ischemic stroke. Methods: 361 patients belonging to a prospective cohort study with the diagnosis of acute ischemic stroke, admitted consecutively to the stroke room, internal medicine and clinical intermediate therapy of the Carlos Manuel de Céspedes General University Hospital during the first 7 days were studied from their admission, since September 2016 to December 2018. Independent predictors of pneumonia associated with ischemic stroke were obtained using multivariate logistic regression. Results: out of 361 patients, the 21.9% developed stroke-associated pneumonia, atherothrombotic infarction was the most frequent etiological subtype. The 39.1% of the patients presented a certain degree of nutritional risk upon admission, the main factors identified were the global lymphocyte count <2300 / mm3, followed by figures on admission of albumin <36 g / l, urea> 7 mmol / l and aspartate- aminotransferase> 25 U / L. Conclusions: the initial nutritional status, evaluated using the available nutritional status indicators, has an influence on the development of pneumonia in patients with ischemic stroke.

Factores de riesgo de morbilidad materna extrema en la unidad de cuidados intensivos / Risk factors of extreme maternal morbidity in the intensive care unit

RESUMEN Introducción: el estudio de la morbilidad materna extrema permite reducir la mortalidad materna. Objetivo: identificar los factores de riesgo de morbilidad materna extrema en una unidad de cuidados intensivos. Método: se desarrolló un estudio de casos y controles en mujeres ingresadas en la Unidad de Cuidados Intensivos del hospital "Carlos Manuel de Céspedes" de Bayamo, Granma, desde el 1 de enero de 2016 hasta el 31 de diciembre de 2017. Se aceptaron 214 pacientes, con una distribución de 73 casos y 141 controles. Se incluyeron variables clínicas y epidemiológicas. Para el análisis estadístico de los factores de riesgo se midió la fuerza de la asociación con el Odds Ratio (OR) y sus intervalos de confianza (IC 95 %) y se realizó un análisis multivariado con un modelo de regresión logística. Resultados: la edad media de las pacientes con morbilidad materna extrema fue de 25,6 años. El 84,9 % ingresaron en el puerperio y 67,1 % por causas obstétricas. En el análisis univariado los factores de riesgo para el desarrollo de morbilidad materna extrema fueron la edad gestacional mayor de 36 semanas, el puerperio, la operación cesárea y la comorbilidad. El análisis multivariado mostró que el factor con influencia independiente más importante fue la etapa del puerperio (OR 5,8, IC 95 % 1,9-17,4, p=0,002) y la comorbilidad (OR 2,1, IC 95 % 0,9-4,5, p=0,059) Conclusiones: entre los factores de riesgo de morbilidad materna extrema se identificaron a la comorbilidad, la edad gestacional mayor de 36 semanas, el puerperio y la operación cesárea.

ABSTRACT Introduction: the study of extreme maternal morbidity reduces maternal mortality. Objective: To identify the risk factors of extreme maternal morbidity in an intensive care unit. Method: a case-control study was developed in women admitted to the Intensive Care Unit of the "Carlos Manuel de Céspedes" hospital in Bayamo, Granma, from January 1, 2016 to December 31, 2017. 214 accepted. patients, with a distribution of 73 cases and 141 controls. Clinical and epidemiological variables were included. For the statistical analysis of the risk factors, the strength of the association with the Odds Ratio (OR) and its confidence intervals (95% CI) was measured and a multivariate analysis was performed with a logistic regression model. Results: the average age of patients with extreme maternal morbidity was 25.6 years. 84.9% entered the puerperium and 67.1% due to obstetric causes. In the univariate analysis, the risk factors for the development of extreme maternal morbidity were gestational age greater than 36 weeks, the puerperium, cesarean section and comorbidity. The multivariate analysis showed that the factor with the most important independent influence was the puerperium stage (OR 5.8, 95% CI 1.9-17.4, p = 0.002) and comorbidity (OR 2.1, 95% CI 0.9-4.5, p = 0.059) Conclusions: Among the risk factors for extreme maternal morbidity, comorbidity, gestational age greater than 36 weeks, puerperium and cesarean section were identified.

Factores de riesgo de morbilidad materna extrema en la unidad de cuidados intensivos / Risk factors of extreme maternal morbidity in the intensive care unit

Introducción: el estudio de la morbilidad materna extrema permite reducir la mortalidad materna. Objetivo: identificar los factores de riesgo de morbilidad materna extrema en una unidad de cuidados intensivos. Método: se desarrolló un estudio de casos y controles en mujeres ingresadas en la Unidad de Cuidados Intensivos del hospital Carlos Manuel de Céspedes de Bayamo, Granma, desde el 1ro de enero de 2016 hasta el 31 de diciembre de 2017. Se aceptaron 214 pacientes, con una distribución de 73 casos y 141 controles. Se incluyeron variables clínicas y epidemiológicas. Para el análisis estadístico de los factores de riesgo se midió la fuerza de la asociación con el Odds Ratio (OR) y sus intervalos de confianza (IC 95 por ciento) y se realizó un análisis multivariado con un modelo de regresión logística. Resultados: la edad media de las pacientes con morbilidad materna extrema fue de 25,6 años. El 84,9 por ciento ingresaron en el puerperio y 67,1 por ciento por causas obstétricas. En el análisis univariado los factores de riesgo para el desarrollo de morbilidad materna extrema fueron la edad gestacional mayor de 36 semanas, el puerperio, la operación cesárea y la comorbilidad. El análisis multivariado mostró que el factor con influencia independiente más importante fue la etapa del puerperio (OR 5,8, IC 95 por ciento 1,9-17,4, p=0,002) y la comorbilidad (OR 2,1, IC 95 por ciento 0,9–4,5, p=0,059). Conclusiones: entre los factores de riesgo de morbilidad materna extrema se identificaron la comorbilidad, la edad gestacional mayor de 36 semanas, el puerperio y la operación cesárea(AU)

Introduction: the study of extreme maternal morbidity reduces maternal mortality. Objective: To identify the risk factors of extreme maternal morbidity in an intensive care unit. Method: a case-control study was developed in women admitted to the Intensive Care Unit of the Carlos Manuel de Céspedes hospital in Bayamo, Granma, from January 1, 2016 to December 31, 2017. 214 accepted patients, with a distribution of 73 cases and 141 controls. Clinical and epidemiological variables were included. For the statistical analysis of the risk factors, the strength of the association with the Odds Ratio (OR) and its confidence intervals (95 percent CI) was measured and a multivariate analysis was performed with a logistic regression model. Results: The average age of patients with extreme maternal morbidity was 25.6 years. 84.9 percent entered the puerperium and 67.1 percent due to obstetric causes. In the univariate analysis, the risk factors for the development of extreme maternal morbidity were gestational age greater than 36 weeks, the puerperium, cesarean section and comorbidity. The multivariate analysis showed that the factor with the most important independent influence was the puerperium stage (OR 5.8, 95 percent CI 1.9-17.4, p = 0.002) and comorbidity (OR 2.1, 95 percent CI 0.9-4.5, p = 0.059). Conclusions: Among the risk factors for extreme maternal morbidity, comorbidity, gestational age greater than 36 weeks, puerperium and cesarean section were identified(EU)

Integrative Modeling and Visualization of Exosomes.

Information from proteomics, microscopy, and structural biology are integrated to create structural models of exosomes, small vesicles released from cells. Three visualization methods are employed and compared: 2D painting of a cross section using traditional media, manual creation of a cross section using the mesoscale 2.5D digital painting software cellPAINT, and generation of a 3D atomic model using the mesoscale modeling program cellPACK.

MAFG is a potential therapeutic target to restore chemosensitivity in cisplatin-resistant cancer cells by increasing reactive oxygen species.

Adjuvant chemotherapy for solid tumors based on platinum-derived compounds such as cisplatin is the treatment of choice in most cases. Cisplatin triggers signaling pathways that lead to cell death, but it also induces changes in tumor cells that modify the therapeutic response, thereby leading to cisplatin resistance. We have recently reported that microRNA-7 is silenced by DNA methylation and is involved in the resistance to platinum in cancer cells through the action of the musculoaponeurotic fibrosarcoma oncogene family, protein G (MAFG). In the present study, we first confirm the miR-7 epigenetic regulation of MAFG in 44 normal- and/or tumor-paired samples in non-small-cell lung cancer (NSCLC). We also provide translational evidence of the role of MAFG and the clinical outcome in NSCLC by the interrogation of two extensive in silico databases of 2019 patients. Moreover, we propose that MAFG-mediated resistance could be conferred due to lower reactive oxygen species production after cisplatin exposure. We developed specifically selected aptamers against MAFG, with high sensitivity to detect the protein at a nuclear level probed by aptacytochemistry and histochemistry analyses. The inhibition of MAFG activity through the action of the specific aptamer apMAFG6F increased the levels of reactive oxygen species production and the sensitivity to cisplatin. We report first the specific nuclear identification of MAFG as a novel detection method for diagnosis in NSCLC, and then we report that MAFG modulates the redox response and confers cell protection against free radicals generated after platinum administration, thus also being a promising therapeutic target.

DNA Methylation of miR-7 is a Mechanism Involved in Platinum Response through MAFG Overexpression in Cancer Cells.

One of the major limitations associated with platinum use is the resistance that almost invariably develops in different tumor types. In the current study, we sought to identify epigenetically regulated microRNAs as novel biomarkers of platinum resistance in lung and ovarian cancers, the ones with highest ratios of associated chemo-resistance. Methods: We combined transcriptomic data from microRNA and mRNA under the influence of an epigenetic reactivation treatment in a panel of four paired cisplatin -sensitive and -resistant cell lines, followed by real-time expression and epigenetic validations for accurate candidate selection in 19 human cancer cell lines. To identify specific candidate genes under miRNA regulation, we assembled "in silico" miRNAs and mRNAs sequences by using ten different algorithms followed by qRT-PCR validation. Functional assays of site-directed mutagenesis and luciferase activity, miRNAs precursor overexpression, silencing by antago-miR and cell viability were performed to confirm their specificity in gene regulation. Results were further explored in 187 primary samples obtained from ovarian tumors and controls. Results: We identified 4 candidates, miR-7, miR-132, miR-335 and miR-148a, which deregulation seems to be a common event in the development of resistance to cisplatin in both tumor types. miR-7 presented specific methylation in resistant cell lines, and was associated with poorer prognosis in ovarian cancer patients. Our experimental results strongly support the direct regulation of MAFG through miR-7 and their involvement in the development of CDDP resistance in human tumor cells. Conclusion: The basal methylation status of miR-7 before treatment may be a potential clinical epigenetic biomarker, predictor of the chemotherapy outcome to CDDP in ovarian cancer patients. To the best of our knowledge, this is the first report linking the regulation of MAFG by miRNA-7 and its role in chemotherapy response to CDDP. Furthermore, this data highlights the possible role of MAFG as a novel therapeutic target for platinum resistant tumors.

Psychosocial Stress-Induced Analgesia: An Examination of Effects on Heat Pain Threshold and Tolerance and of Neuroendocrine Mediation.

Stress-induced analgesia (SIA) is an adaptive response of reduced nociception following demanding acute internal and external stressors. Although a psychobiological understanding of this phenomenon is of importance for stress-related psychiatric and pain conditions, comparably little is known about the psychobiological mechanisms of SIA in humans. The aim of this study was to investigate the effects of acute psychosocial stress on heat pain perception and its possible neuroendocrine mediation by salivary cortisol levels and α-amylase activity in healthy men. Employing an intra-individual assessment of heat pain parameters, acute psychosocial stress did not influence heat pain threshold but significantly, albeit slightly, increased heat pain tolerance. Using linear mixed-model analysis, this effect of psychosocial stress on heat pain tolerance was not mediated by increases of salivary cortisol and state anxiety levels or by the activity of α-amylase. These results show that while psychosocial stress is selectively analgesic for heat pain tolerance, this observed effect is not mediated by stress-induced increases of salivary cortisol and α-amylase activity, as proxies of both the hypothalamus-pituitary-adrenal axis and the autonomic nervous system activation.

Morbilidad materna extrema en una unidad de cuidados intensivos / Extreme maternal morbidity in an intensive care unit

Se realizó un estudio transversal en la Unidad de Cuidados Intensivos del Hospital General Universitario Carlos Manuel de Céspedes de Bayamo, provincia de Granma, desde enero de 2010 hasta diciembre de 2014, a fin de de caracterizar la morbilidad materna extrema según variables clinicoepidemiológicas. De 504 pacientes atendidas, 153 (30,3 por ciento) presentaron complicaciones severas. La histerectomía por infección y hemorragia, el choque circulatorio, la saturación de oxígeno menor de 90 por ciento y la frecuencia respiratoria mayor que 40 o menor que 6 por minuto constituyeron los indicadores fundamentales de morbilidad extrema en estas féminas. Las tasas de mortalidad y morbilidad materna fueron de 11,1 por 100 nacidos vivos y 5,6 por 1 000 nacidos vivos, respectivamente. Entre los factores de riesgo de morbilidad extremadamente grave sobresalieron: edad gestacional mayor de 36 semanas, operación cesárea y antecedente de esta operación(AU)

A cross-sectional study was carried out in the Intensive Care Unit of Carlos Manuel de Céspedes General University Hospital in Bayamo, Granma province from January, 2010 to December, 2014, in order to characterize the extreme maternal morbidity according to clinical and epidemiological variables. From 504 assisted patients, 153 (30.3 percent) presented severe complications. Hysterectomy due to infection and hemorrhages, circulatory shock, oxygen saturation under 90 percent and respiratory frequency higher than 40 or lower than 6 per minute constituted the fundamental indicators of extreme morbidity in these women. The maternal morbidity and mortality rates were 11.1 per 100 00 live births and 5.6 per 1 000 live births, respectively. Among the risk factors of extremely severe morbidity there were: gestacional age over 36 weeks, caesarean section and a history of this surgery(AU)

Morbilidad materna extrema en una unidad de cuidados intensivos / Extreme maternal morbidity in an intensive care unit

Se realizó un estudio transversal en la Unidad de Cuidados Intensivos del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia de Granma, desde enero de 2010 hasta diciembre de 2014, a fin de de caracterizar la morbilidad materna extrema según variables clinicoepidemiológicas. De 504 pacientes atendidas, 153 (30,3 %) presentaron complicaciones severas. La histerectomía por infección y hemorragia, el choque circulatorio, la saturación de oxígeno menor de 90 % y la frecuencia respiratoria mayor que 40 o menor que 6 por minuto constituyeron los indicadores fundamentales de morbilidad extrema en estas féminas. Las tasas de mortalidad y morbilidad materna fueron de 11,1 por 100 nacidos vivos y 5,6 por 1 000 nacidos vivos, respectivamente. Entre los factores de riesgo de morbilidad extremadamente grave sobresalieron: edad gestacional mayor de 36 semanas, operación cesárea y antecedente de esta operación.

A cross-sectional study was carried out in the Intensive Care Unit of "Carlos Manuel de Céspedes" General University Hospital in Bayamo, Granma province from January, 2010 to December, 2014, in order to characterize the extreme maternal morbidity according to clinical and epidemiological variables. From 504 assisted patients, 153 (30.3%) presented severe complications. Hysterectomy due to infection and hemorrhages, circulatory shock, oxygen saturation under 90% and respiratory frequency higher than 40 or lower than 6 per minute constituted the fundamental indicators of extreme morbidity in these women. The maternal morbidity and mortality rates were 11.1 per 100 00 live births and 5.6 per 1 000 live births, respectively. Among the risk factors of extremely severe morbidity there were: gestacional age over 36 weeks, caesarean section and a history of this surgery.

Methylation status of IGFBP-3 as a useful clinical tool for deciding on a concomitant radiotherapy.

The methylation status of the IGFBP-3 gene is strongly associated with cisplatin sensitivity in patients with non-small cell lung cancer (NSCLC). In this study, we found in vitro evidence that linked the presence of an unmethylated promoter with poor response to radiation. Our data also indicate that radiation might sensitize chemotherapy-resistant cells by reactivating IGFBP-3-expression through promoter demethylation, inactivating the PI3K/AKT pathway. We also explored the IGFBP-3 methylation effect on overall survival (OS) in a population of 40 NSCLC patients who received adjuvant therapy after R0 surgery. Our results indicate that patients harboring an unmethylated promoter could benefit more from a chemotherapy schedule alone than from a multimodality therapy involving radiotherapy and platinum-based treatments, increasing their OS by 2.5 y (p = .03). Our findings discard this epi-marker as a prognostic factor in a patient population without adjuvant therapy, indicating that radiotherapy does not improve survival for patients harboring an unmethylated IGFBP-3 promoter.

Morbilidad por causas directas obstétricas en la unidad de cuidados intensivos / Morbidity for direct obstetric causes in the intensive care unit

Introducción: para la mayoría de las mujeres, la maternidad es una experiencia positiva y satisfactoria. Sin embargo, el embarazo es de gran riesgo para la mujer si influyen factores económicos, sociales, culturales y dependientes del sistema de salud. Objetivo: describir la morbilidad materna por causas directa en la unidad de cuidados intensivos. Método: se realizó un estudio descriptivo y retrospectivo en pacientes ingresadas en la Unidad de Cuidados Intensivos (UCI) del hospital general universitario Carlos Manuel de Céspedes de Bayamo, Granma, por causas obstétricas directas, el periodo comprendido desde el 1 de enero 2010 hasta el 31 de diciembre de 2012, se seleccionaron todas las pacientes con embarazo o puerperio hasta los 42 días, ingresadas en la UCI, en total 72 pacientes. Se observó un discreto predominio de la enfermedad hipertensiva 26 pacientes (36,1 por ciento), fundamentalmente en mujeres de menor edad. Resultados: las pacientes de mayor edad tuvieron diagnóstico de enfermedad hemorrágica, y el período gestacional de que predominó fue de 15 a 25 semanas. El mayor número de maternas grave mostraron un índice de APACHE II inferior a 10. La eclampsia agravada y la atonía uterina predominaron dentro de las causas de ingresos. Conclusiones: se concluye que la enfermedad hipertensiva y la sepsis fueron las principales causas obstétricas directas de ingreso; pero sin existir en las pacientes un importante deterioro de las funciones fisiológicas de órganos y sistemas al medirse por las escalas para este fin empleadas habitualmente en la UCI. A pesar de ello, se presentaron complicaciones como el estado de choque y el fracaso renal agudo principalmente; en su mayoría en los primeros días de la estadía en la Unidad de Cuidados Intensivos(AU)

Introduction: nowadays the teenagers are affected by a disproportionate percentage of non-planned pregnancy, sexually transmitted diseases (including AIDS) and other severe problems of the reproductive health. Objective: to evaluate the efficiency of an Educational Intervention Program to avoid pregnancies in the adolescence. MFO # 3. Veguitas. December 2010-2011. Method: it was performed an intervention program to the teenagers with pregnancy risk, the sample was made by 50 patients, after the application of an initial questionnaire that explored the existence of validated risk factors. They were taught 10 educational activities with duration of 45 minutes per week. It was also applied a program to increase the knowledge about the subject and determine its influence on some modifiable factors. Results: the group of age between 14-16 years prevailed. Initially the level of unsuitable knowledge was about 72 percent, at the end of the study it increased, obtaining 96 percent, what showed the efficiency of the program. The lack of knowledge on the safer contraceptive methods was about 15 percent at the beginning of the program and it increased in 35 percent at the end of it. Conclusions: the group of age between 14-16 years with an amount of 26 participants prevailed. In the teenagers studied prevailed like a risk group the one that was not preconcepcionally controlled. After the application of the educational strategy of intervention, most of the teenagers expressed that they had increased their knowledge(EU)

[Underrecognized peripheral arterial disease in patients with acute coronary syndrome: prevalence of traditional and emergent cardiovascular risk factors]. / Enfermedad arterial periférica desconocida en pacientes con síndrome coronario agudo: prevalencia y patrón diferencial de los factores de riesgo cardiovascular tradicionales y emergentes.

INTRODUCTION AND OBJECTIVES: Peripheral arterial disease (PAD) frequently coexists with coronary artery disease. Our objective was to determine the prevalence of traditional and emergent cardiovascular risk factors in patients with acute coronary syndrome (ACS), with or without PAD. PATIENTS AND METHOD: A prospective study of 141 consecutive patients (< 70 years old) admitted to our hospital with ACS was performed. PAD was diagnosed when the ankle-brachial index (ABI) was < or = 0.9. Traditional cardiovascular risk factors were evaluated. C-reactive protein, homocysteine, amyloid A, lipoprotein (a), fibrinogen, apolipoprotein A1, and apolipoprotein B100 serum levels, and microalbuminuria were measured. Specific genotypes were also determined. RESULTS: Patients were divided into two groups according to whether PAD was present (37 patients, 26% of total, ACS-PAD group) or absent (104 patients, ACS group). In the ACS-PAD group, patients were older, and diabetes and hypertension were significantly more common. Moreover, levels of C-reactive protein (3.1 mg/L vs 2.18 mg/L; P<.05), homocysteine (11.45 mmol/L vs 9.4 mmol/L; P<.01), amyloid A (5.2 mg/mL vs 3.7 mg/mL; P<.05), and microalbuminuria (4.89 mg/L vs 3.1 mg/L; P<.05) were significantly higher in this group. Logistic regression analysis showed that poorly controlled diabetes (OR = 6.3; 95% CI, 1.1-36.7), time-dependent tobacco exposure (OR = 1.5 per decade; 95% CI, 1.2-2.0), and high pulse pressure (OR = 1.9 per 10 mmHg; 95% CI, 1.3-2.7) were independent predictors of the presence of PAD. CONCLUSIONS: Several traditional and emergent cardiovascular risk factors were more prevalent in patients with acute coronary syndrome and peripheral arterial disease. Moreover, some factors were independent predictors of peripheral arterial disease.

Enfermedad arterial periférica desconocida en pacientes con síndrome coronario agudo: prevalencia y patrón diferencial de los factores de riesgo cardiovascular tradicionales y emergentes / Underrecognized peripheral arterial disease in patients with acute coronary syndrome: prevalence of traditional and emergent cardiovascular risk factors

Introducción y objetivos. La enfermedad arterial/vascular periférica frecuentemente se asocia con enfermedad coronaria. El objetivo es evaluar la prevalencia de factores de riesgo cardiovascular tradicionales y emergentes entre pacientes con síndrome coronario agudo (SCA) con o sin enfermedad vascular periférica. Pacientes y método. Realizamos un estudio prospectivo en 141 pacientes (< 70 años) que ingresaron consecutivamente por síndrome coronario agudo. El diagnóstico de enfermedad arterial periférica (EVP) se basó en un índice tobillo-brazo ≤ 0,9. Se evaluaron los factores de riesgo cardiovascular tradicionales y se midieron las concentraciones séricas de proteína C reactiva, homocisteína, amiloide A, lipoproteína (a), fibrinógeno, apolipoproteína A1 y B100, y microalbuminuria. Además, se determinaron varios genotipos. Resultados. Los pacientes fueron estratificados en 2 grupos de acuerdo con la presencia (n = 37, el 26% del total, grupo SCA-EVP) o ausencia (n = 104, grupo SCA) de enfermedad arterial periférica. Los pacientes del grupo SCA-EVP eran más viejos y tenían una significativa mayor prevalencia de diabetes e hipertensión. Las concentraciones de proteína C reactiva, homocisteína, amiloide A y microalbuminuria fueron significativamente mayores en el grupo SCA-EVP (3,1 frente a 2,18 mg/l [p < 0,05]; 11,45 frente a 9,4 mmol/l [p < 0,01]; 5,2 frente a 3,7 mg/ml [p < 0,05], y 4,89 frente a 3,1 mg/l [p < 0,05], respectivamente). El análisis de regresión logística mostró que la diabetes mal controlada, la exposición al tabaco tiempo-dependiente y la presión de pulso fueron predictores independientes de la presencia de EVP. Conclusiones. Varios factores de riesgo cardiovascular tradicionales y emergentes son más prevalentes en pacientes con SCA y enfermedad arterial periférica, y algunos de ellos son predictores independientes de ésta

Introduction and objectives. Peripheral arterial disease (PAD) frequently coexists with coronary artery disease. Our objective was to determine the prevalence of traditional and emergent cardiovascular risk factors in patients with acute coronary syndrome (ACS), with or without PAD. Patients and method. A prospective study of 141 consecutive patients (< 70 years old) admitted to our hospital with ACS was performed. PAD was diagnosed when the ankle-brachial index (ABI) was ≤ 0.9. Traditional cardiovascular risk factors were evaluated. C-reactive protein, homocysteine, amyloid A, lipoprotein (a), fibrinogen, apolipoprotein A1, and apolipoprotein B100 serum levels, and microalbuminuria were measured. Specific genotypes were also determined. Results. Patients were divided into two groups according to whether PAD was present (37 patients, 26% of total, ACS-PAD group) or absent (104 patients, ACS group). In the ACS-PAD group, patients were older, and diabetes and hypertension were significantly more common. Moreover, levels of C-reactive protein (3.1 mg/L vs 2.18 mg/L; P<.05), homocysteine (11.45 mmol/L vs 9.4 mmol/L; P<.01), amyloid A (5.2 mg/mL vs 3.7 mg/mL; P<.05), and microalbuminuria (4.89 mg/L vs 3.1 mg/L; P<.05) were significantly higher in this group. Logistic regression analysis showed that poorly controlled diabetes (OR = 6.3; 95% CI, 1.1-36.7), time-dependent tobacco exposure (OR = 1.5 per decade; 95% CI, 1.2-2.0), and high pulse pressure (OR = 1.9 per 10 mmHg; 95% CI, 1.3-2.7) were independent predictors of the presence of PAD. Conclusions. Several traditional and emergent cardiovascular risk factors were more prevalent in patients with acute coronary syndrome and peripheral arterial disease. Moreover, some factors were independent predictors of peripheral arterial disease

Disección intramiocárdica postinfarto de la pared posterior del ventrículo izquierdo con comunicación con el seno coronario / Intramyocardial Dissection of the Posterir Wall of the Left Ventricle with a Shunt to the Coronary Sinus after Myocardial Infarction

Paciente diabética de 83 años ingresada en nuestro centro por infarto agudo de miocardio posteroinferior en evolución. Al cuarto día de estancia presentó un soplo pansistólico en mesocardio y ápex de nueva aparición. El ecocardiograma transtorácico puso de manifiesto acinesia de la pared posterior e inferior con imagen indicativa de disección de la pared posterior del ventrículo izquierdo, que se originaba en el segmento medio-distal de la misma, con orificio de entrada de 7 mm de diámetro. Se apreciaba flujo turbulento en el interior de la aurícula derecha, indicativo de proceder del seno coronario. Con el ecocardiograma transesofágico se confirmó la disección intramiocárdica de la pared posterior del ventrículo izquierdo y su comunicación con el seno coronario, identificando el flujo turbulento de la aurícula derecha como procedente del mismo. Tras optar por el tratamiento médico, la paciente ha sido seguida por espacio de dos años. El diámetro del orificio de entrada del trayecto disecante permaneció sin cambios, si bien se observó crecimiento del diámetro de la zona disecada y del seno coronario, aunque no dilatación significativa de las cavidades derechas (AU)