Variables clínicas del parto en posición vertical y horizontal: revisión exhaustiva de literatura / Clinical Behavior of Vertical and Horizontal Deliveries: Exhaustive Literature Review / Variáveis clínicas do parto em posição vertical e horizontal: revisão abrangente de literatura

Introducción: El trabajo de parto representa el acontecimiento más importante durante la culminación del periodo de gestación y, por lo tanto, la adecuada elección de su posición, ya sea vertical u horizontal, resulta indispensable para minimizar las complicaciones maternas y neonatales. Objetivo: Llevar a cabo una revisión de la literatura sobre el comportamiento clínico del parto vertical y horizontal, describiendo los principales resultados en diferentes países del mundo. Método: Revisión documental mediante la búsqueda de la literatura entre 2009 y 2020 en bases de datos especializadas. Resultados: La posición vertical se asoció con una menor duración del trabajo de parto, dolor referido y necesidad de episiotomía; no obstante, esta posición puede incrementar el riesgo de hemorragia posparto y daño perineal. Conclusión: La variedad de desenlaces obstétricos y neonatales asociados a las posiciones de parto vertical y horizontal hacen complejo definir una posición de parto óptima; por lo tanto, se recomienda la libre elección de acuerdo con las características que presente cada paciente

Introduction: Parturition represents the most important event during the culmination of the gestation period and, therefore, the appropriate choice of its position, whether vertical or horizontal, it is essential to minimize maternal and neonatal complications. Objective: To carry out a review of the literature on the clinical behavior of vertical and horizontal delivery, describing the main results in different countries of the world. Method: Document review by searching the literature between the years 2009 and 2020, available in Specialized Databases. Results: The vertical position was associated with a shorter duration of labor obstetric, referred pain, and episiotomy; however, this position may increase the risk of postpartum hemorrhage and perineal damage. Conclusion: The variety of obstetric and neonatal outcomes associated with vertical and horizontal delivery positions make it difficult to define an optimal delivery position and, therefore, free choice is recommended according to the characteristics of each patient

Introdução: O trabalho de parto representa o acontecimento mais importante no final do período gestacional e, portanto, a escolha apropriada da posição, seja vertical ou horizontal, é indispensável para minimizar as complicações maternas e neonatais. Objetivo: Realizar uma revisão bibliográfica sobre o comportamento clínico do parto vertical e hori-zontal, descrevendo os principais resultados em diferentes países do mundo. Método: Revisão documental através de pesquisa da literatura em bases de dados especializadas entre os anos 2009 e 2020. Resultados: A posição vertical foi associada a uma duração mais curta do parto, dor referida e ne-cessidade de episiotomía; contudo, esta posição pode aumentar o risco de hemorragia pós-parto e dano perineal. Conclusão: A variedade de resultados obstétricos e neonatais associados às posições de parto vertical e horizontal torna complexa a escolha de uma posição de parto ótima; por conseguinte, recomen-da-se a livre escolha de acordo com as caraterísticas de cada paciente

Plasmodium falciparum pre-erythrocytic stage vaccine development.

Worldwide strategies between 2010 and 2017 aimed at controlling malarial parasites (mainly Plasmodium falciparum) led to a reduction of just 18% regarding disease incidence rates. Many biologically-derived anti-malarial vaccine candidates have been developed to date; this has involved using many experimental animals, an immense amount of work and the investment of millions of dollars. This review provides an overview of the current state and the main results of clinical trials for sporozoite-targeting vaccines (i.e. the parasite stage infecting the liver) carried out by research groups in areas having variable malaria transmission rates. However, none has led to promising results regarding the effective control of the disease, thereby making it necessary to complement such efforts at finding/introducing new vaccine candidates by adopting a multi-epitope, multi-stage approach, based on minimal subunits of the main sporozoite proteins involved in the invasion of the liver.

Effects of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors on COVID-19: a narrative review of the literature / Efectos de bloqueadores del receptor de angiotensina II e inhibidores de la enzima convertidora de angiotensina en COVID-19: una revisión narrativa de la literatura / Efeitos dos bloqueadores do receptor da angiotensina II e inibidores da enzima de conversão da angiotensina no COVID-19: uma revisão narrativa da literatura

Introduction: An outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is currently affec-ting worldwide. The association between this virus and the upregulation of Angiotensin-Converting Enzyme 2 (ACE2) has been suggested as a potential as an important factor in the development of Coronavirus Disease- 19 (COVID-19). Objective: To describe the relationship between some antihypertensive treatments and COVID-19. Methods: A research was conducted with the components of the PIO (Population, Intervention, Outcomes) strate-gy, including the literature of the last 20 years available in central PubMed, Web of Science, Scopus, and Embase databases. All relevant articles that assessed the epidemiological relationship between SARS-CoV-2 and hyperten-sion, the treatment and outcomes of the patients who have this comorbidity, as well as the relationship between the RAA axis and COVID-19 were included in the analysis. Results: A total of 292 items were found in the databases. After a thorough analysis, 17 papers were selected, including in vitro and in vivo tests, clinical trials, and epidemiological studies related to the topic analyzed. Conclusion: Due to the systemic benefits of antihypertensive drugs targeting the RAA axis, and the lack of eviden-ce of these treatments being a risk factor, It is not recommended to withdraw these medications from hypertensive patients infected with SARS-CoV 2, unless there is a clinical indication.

Introducción: el surgimiento y diseminación del coronavirus tipo 2 del síndrome respiratorio agudo severo (SARS-CoV-2), actualmente, afecta a la mayoría de los del mundo. La asociación entre este virus y la regulación positiva de la enzima convertidora de angiotensina 2 (ACE2) se ha sugerido como un factor potencial en el desarrollo de la enfermedad por coronavirus-19 (COVID- 19). Objetivo: describir la relación entre algunos tratamientos antihipertensivos y la COVID-19. Métodos: se revisaron los componentes de la estrategia PIO (población, intervención, resultados). Se incluyeron todos los artículos relevantes de los últimos 20 años disponibles en las bases de datos centrales PubMed, Web of Science, Scopus y Embase, que describen la relación epidemiológica entre SARS-CoV-2 e hipertensión, el tratamiento y el desenlace de los pacientes quienes tienen esta comor-bilidad, así como la relación entre el eje renina-angiotensina-aldosterona y COVID-19. Resultados: se encontraron inicialmente 292 artículos en las bases de datos, para finalmente seleccio-nar 17 artículos, incluyendo exámenes in vivo e in vitro, ensayos clínicos y estudios epidemiológicos relacionados con el tema analizado. Conclusión: debido a los beneficiosos efectos sistémicos del tratamiento antihipertensivo, cuyo blanco es el sistema renina-angiotensina- aldosterona, y a la falta de evidencia acerca de estos me-dicamentos en cuanto a la inducción de SARS-CoV-2, no se recomienda suspender o contraindicar el tratamiento con estos fármacos en pacientes hipertensos positivos para COVID-19, a menos que haya una indicación clínica

Introdução: Um surto de Síndrome Respiratória Aguda Grave Coronavirus 2 (SARS-CoV-2) está afe-tando atualmente em todo o mundo. A associação entre esse vírus e a suprarregulação da Enzima Conversora da Angiotensina 2 (ACE2) tem sido sugerida como um fator potencial importante no de-senvolvimento da Doença do Coronavírus-19 (COVID-19). Objetivo: Descrever a relação entre al-guns tratamentos anti-hipertensivos e COVID-19. Métodos: Foi realizada uma pesquisa com os com-ponentes da estratégia Population, Intervention, Resultados (PIR), incluindo a literatura dos últimos 20 anos disponível nas bases de dados centrais PubMed, Web of Science, Scopus e Embase. Todos os artigos relevantes que avaliaram a relação epide-miológica entre SARS-CoV-2 e hipertensão, o trata-mento e resultados dos pacientes que apresentam essa comorbidade, bem como a relação entre o eixo RAA e COVID-19 foram incluídos na análise. Resultados: Foram encontrados 292 itens nas bases de dados. Após análise aprofundada, foram selecionados 17 artigos, entre testes in vitro e in vivo, en-saios clínicos e estudos epidemiológicos relacionados ao tema analisado. Conclusão: Devido aos be-nefícios sistêmicos dos medicamentos anti-hipertensivos direcionados ao eixo RAA e à falta de evi-dência desses tratamentos serem um fator de risco, não é recomendado retirar esses medicamentos de pacientes hipertensos infectados com SARS-CoV 2, a menos que haja um indicação clínica.

Plasmodium falciparum Blood Stage Antimalarial Vaccines: An Analysis of Ongoing Clinical Trials and New Perspectives Related to Synthetic Vaccines.

Plasmodium falciparum malaria is a disease causing high morbidity and mortality rates worldwide, mainly in sub-Saharan Africa. Candidates have been identified for vaccines targeting the parasite's blood stage; this stage is important in the development of symptoms and clinical complications. However, no vaccine that can directly affect morbidity and mortality rates is currently available. This review analyzes the formulation, methodological design, and results of active clinical trials for merozoite-stage vaccines, regarding their safety profile, immunological response (phase Ia/Ib), and protective efficacy levels (phase II). Most vaccine candidates are in phase I trials and have had an acceptable safety profile. GMZ2 has made the greatest progress in clinical trials; its efficacy has been 14% in children aged less than 5 years in a phase IIb trial. Most of the available candidates that have shown strong immunogenicity and that have been tested for their protective efficacy have provided good results when challenged with a homologous parasite strain; however, their efficacy has dropped when they have been exposed to a heterologous strain. In view of these vaccines' unpromising results, an alternative approach for selecting new candidates is needed; such line of work should be focused on how to increase an immune response induced against the highly conserved (i.e., common to all strains), functionally relevant, protein regions that the parasite uses to invade target cells. Despite binding regions tending to be conserved, they are usually poorly antigenic and/or immunogenic, being frequently discarded as vaccine candidates when the conventional immunological approach is followed. The Fundación Instituto de Inmunología de Colombia (FIDIC) has developed a logical and rational methodology based on including conserved high-activity binding peptides (cHABPs) from the main P. falciparum biologically functional proteins involved in red blood cell (RBC) invasion. Once appropriately modified (mHABPs), these minimal, subunit-based, chemically synthesized peptides can be used in a system covering the human immune system's main genetic variables (the human leukocyte antigen HLA-DR isotype) inducing a suitable, immunogenic, and protective immune response in most of the world's populations.

Uso de plasmaféresis para el manejo del síndrome de la persona rígida / Use of plasmapheresis for the management of the syndrome of the rigid person

Introducción: el síndrome de la persona rígida (SPR) es una patología infrecuente caracterizada por la activación involuntaria de la unidad motora, causando rigidez fluctuante de la musculatura axial, espasmos musculares dolorosos y actividad motora continua en la electromiografía. En la mayoría de pacientes se encuentran niveles elevados de anticuerpos antiácido glutámico descarboxilasa. Presentación del caso: paciente de género femenino de 60 años de edad, con persistencia de sintomatología espasmódica muscular a pesar del manejo con medicamentos agonistas GABA e inmunomoduladores, por lo que se consideró el uso de plasmaféresis como tercera línea de tratamiento. Conclusiones: la experiencia con el uso de la técnica es favorable, hay disminución de los espasmos musculares en más del 50% al cabo de 7 sesiones. Aunque la plasmaféresis produjo alivio sintomático, son necesarios nuevos ensayos clínicos y reportes de caso para determinar su beneficio clínico y así protocolizar su aplicación.

Introduction: Stiff person syndrome (SPS) is an infrequent pathology, characterized by the involuntary activation of the motor unit, causing fluctuating rigidity of the axial muscles, painful muscle spasms and continuous motor activity in electromyography. In most patients, high levels of anti-glutamic acid decarboxylase antibodies are found. Case presentation: Female patient of 60 years of age, with persistence of muscular spasmodic symptoms despite management with GABA agonist drugs and immuno modulators, for which the use of plasmapheresis as the third line of treatment was considered. Conclusions: The experience in the use of the technique is favorable, with a decrease in muscle spasms greater than 50% after 7 sessions. Although plasmapheresis produced symptomatic relief, new clinical trials and case reports are necessary to determine its clinical benefit and thus protocolize its application

Disección experimental de la banda miocárdica ventricular / Experimental dissection of the ventricular myocardial band

Introducción: El modelo de disección de la banda miocárdica ventricular descrito por To-rrent-Guasp, permite conocer la anatomía macroscópica funcional cardiaca, abriendo un amplio campo de investigación al exponer nuevas nociones científicas. El presente trabajo pretende determinar la estructura de la banda miocárdica ventricular, siguiendo ese modelo, con algunas modificaciones en corazones de porcinos, por el parecido morfofuncional con el corazón humano, para describir la secuencia de disección de la banda y estudiar la dispo-sición de los haces de fibras miocárdicas ventriculares. Métodos: Estudio descriptivo, observacional y longitudinal con enfoque cuantitativo. La muestra fue de siete corazones porcinos con integridad anatómica y 48 horas de sacrificio. La técnica aplicada incluyó los pasos de limpieza y desengrase, disección del surco interven-tricular anterior, separación del tronco pulmonar, del segmento derecho, de la aorta con segmento ascendente y despliegue de la lazada apexiana. Con registro fotográfico. Resultados: En los corazones 1 y 2 se desdobló hasta el segmento derecho, por ruptura de banda apexiana, en el corazón 3 se desplegó el segmento ascendente con vista del segmento descendente. En el resto de los corazones no se logró avanzar con el desdoblamiento del segmento izquierdo y descendente. La reproducción de técnica descrita en la literatura, pre-senta la dificultad al desdoblar los últimos segmentos. Conclusión: Conocer la disposición anatómica de la banda miocárdica ventricular es fun-damental en los métodos de aprendizaje básicos y clínicos de la formación médica por una parte y por otra permite el entendimiento de diferentes patologías miocárdicas, favorece el planeamiento de abordajes quirúrgicos con técnicas más precisas y proyección de resultados posoperatorios.

Introduction: The dissection model of ventricular myocardial band described by Torrent-Guasp, let us know the heart gross functional anatomy, this opens a wide field of research to present new scientific notions. The current project pretends to determine the ventricular myocardial band structure, following this model, with some pig hearts, because of the similarity to the human heart, in order to describe the sequence of the band dissection and study the layout beams of ventricular myocardial fibers. Methods: A descriptive, observational and longitudinal study with quantitative focus. The isolate was of seven pig hearts with their anatomic integrity 48-hours sacrifice died. The applied technique involved the steps of cleaning, degreasing, and dissection of the anterior interven-tricular sulcus, separation of the pulmonary trunk, right segment of the ascending aorta and descending segment of the apical loop. Photographic record was taken. Results: In the hearts 1 and 2 will be unfolded until the right segment because of apical band disruption. Heart 3, the ascending segment of the descending segment view was displayed. In the other hearts, the left segment and descending segments were not shown. Respect to original technique this presents a difficulty unfolding with the later segments. Conclusion: Knowing the anatomical ventricular myocardial band arrangement is essential in the basic and clinical methods in the medical training. On the other hand, this allows the understanding of different myocardial diseases and promotes the surgical approaching with more precise technique and best postoperative screening results.