Isquemia aguda por trombosis aórtica en COVID-19: A propósito de un caso

Objetivo: Presentar un caso de isquemia aguda por trombosis aórtica en paciente con infección por COVID-19 y exponer la importancia del diagnóstico y manejo oportuno. Introducción: El coronavirus (COVID-19) afecta principalmente al tracto respiratorio, pero presenta predisposición a fenómenos trombóticos y sus complicaciones, siendo una de las más graves la isquemia aguda por trombosis aórtica. Caso clínico: Paciente masculino de 68 años, que cursa con cuadro clínico de neumonía grave por COVID-19, presenta de forma concomitante episodio de trombosis aórtica aguda, resultando con isquemia aguda de extremidades inferiores. Se realizó trombectomía, post procedimiento y asociado a reperfusión, presentó paro cardiorrespiratorio con asistolia sostenida, falleciendo pese a maniobras de reanimación. Conclusión: Pese a las medidas de profilaxis con heparina de bajo peso molecular (HBPM), se deben sospechar y buscar las complicaciones tromboembólicas en pacientes que cursan con esta infección para dar un manejo oportuno y vigilar las complicaciones post quirúrgicas que pueden ser mortales.

Aim: To present a case of acute ischemia due to aortic thrombosis in a patient with COVID-19 infection and explain the importance of diagnosis and timely management. Introduction: The coronavirus (COVID-19) mainly affects the respiratory tract, but it has a predisposition to thrombotic phenomena and its complications, one of the most serious being acute ischemia due to aortic thrombosis. Clinical case: 68-year-old man, coronary heart disease with severe pneumonia due to COVID-19, presents aortic thrombosis, resulting in acute lower extremity ischemia. Thrombectomy was performed, post procedure and associated with reperfusion, presented cardiorespiratory arrest with sustained asystole, died despite resuscitation maneuvers. Conclusion: Despite prophylaxis measures with low molecular-weight heparins (LMWH), thromboembolic complications should be sought in patients with this infection to provide timely management and monitor post-surgical complications that can be fatal.

Double blind randomized clinical trial comparing minimally- invasive envelope flap and conventional envelope flap on impacted lower third molar surgery.

BACKGROUND: The latest trend in surgery is to look for minimally invasive procedures, with fewer complications and a shorter recovery time. This study aims to compare the minimally- invasive envelope flap, with smaller incision and fewer dissection and the conventional envelope flap, with a 20mm incision, on impacted mandibular third molar surgery, focusing on the hypothesis that there were no differences in postoperative outcomes. MATERIAL AND METHODS: A double-blind randomized clinical trial was designed to compare both incisions, focused on determining the approach with minor postoperative side-effects and minor impact on quality-of-life. A total of 60 patients were enrolled for the study if their presented impacted mandibular third molar and was 18-years-old or more. Both groups were evaluated from time elapsed on the surgery, maximum mouth opening, swelling and quality of life assessment. RESULTS: The flap choice influenced facial swelling (p=0,03), pain on the first three days (p=0,037), interference with oral hygiene (p=0,019) and discomfort on speech (p=0,07). Chewing, swallowing, trismus, pain after seven days, postoperative complications and other quality-of-life arrangements were no different between groups. CONCLUSIONS: The minimally- invasive envelope flap could lead to a less painful experience for the patient, with fewer impact on the oral hygiene and speech discomfort.

Helminth community structure of 13 species of anurans from Atlantic rainforest remnants, Brazil.

This study aimed to evaluate the community composition and structure of the helminths found in 13 anuran species, and to evaluate whether this parasite community is determined by anuran characteristics. We found that the helminth fauna of the amphibians from five anuran families consisted of 13 taxa and that Cosmocercidae gen. sp. was the most prevalent taxon, followed by Oswaldocruzia subauricularis. Host body size was a determining factor of the composition and structure of the parasitic fauna. Helminth abundance and richness were positively correlated with host body size. The host Leptodactylus latrans had the highest helminth richness (n = 8). The frog Hypsiboas faber had the greatest helminth diversity (H' = 0.711). The mean helminth species richness and diversity differed significantly between host species (P < 0.05). Taken together, our data indicate that, in sympatric species of amphibians, the morphological and behavioural characteristics of the hosts are important for structuring the helminth parasite communities.

Effect of sweet potato vines on performance parameters and some carcass characteristics of rabbits.

Conventional feedstuffs in Brazil are expensive, which has led to the search for less conventional cheaper and locally available feedstuffs. Thus, this study was carried out to determine the dietary effect of dry sweet potato vines (SPV) on the performance and some carcass characteristics of rabbits. A total of twenty-seven weaned White New Zealand rabbits (14 male and 13 female) 35 days old with an average initial weight of 755 g were allocated into three treatments. Nine rabbits were assigned to each treatment in a completely randomized design. Three diets were formulated to similar protein and energy levels: 0SPV - diet without inclusion of dry sweet potato vines; 10SPV - diet with 10% alfalfa hay replaced by dry sweet potato vines; and 15SPV - diet with 15% of alfalfa hay replaced by dry sweet potato vines. The experiment lasted for 49 days during which data for feed intake and body weight were recorded. The daily feed intake ranged from 73.17 to 78.02 g; daily weight gain from 22.32 to 23.17 g; feed conversion ratio (FCR) from 3.16 to 3.49 and final live weight ranged from 1839.44 to 1880.55 g. None of the evaluated performance parameters as well as carcass weight, heart weight and percentages of fat and protein in meat were significantly affected by any of the tested dietary treatments. However, the liver weight was statistically lower in animals fed the diets containing 10% of SPV, mainly due to lower glucose content. Glycogen within the tissue, did not differ significantly among treatments. It was therefore concluded that up to 15% of SPV can successfully be included in the diet of rabbits as a cheaper replacement for alfalfa hay without adversely affecting performance.

Advanced stage yolk sac ovarian tumour: clinical approach with cytoreductive surgery upfront.

The authors report the case of a 21-year-old woman that presented a Pseudo Meigs' syndrome, secondary to a pure endodermal sinus tumour (yolk sac tumour). Fine needle aspiration biopsy was compatible with high-grade carcinoma and the alpha fetoprotein (αFP) was at 13,185 U/ml. Cytoreductive surgery was performed, followed by bleomycin, etoposide, and cisplatin (BEP) chemotherapy.

Convergent Evolution of Tetrodotoxin-Resistant Sodium Channels in Predators and Prey.

Convergent evolution of similar adaptive traits may arise from either common or disparate molecular and physiological mechanisms. The forces that determine the degree of underlying mechanistic similarities across convergent phenotypes are highly debated and poorly understood. Some garter snakes are able to consume newts that possess the channel blocking compound tetrodotoxin (TTX). Despite belonging to unrelated lineages, both the predators and prey have independently evolved remarkably similar physiological mechanisms of resistance to TTX that involve chemical and structural changes in voltage-gated sodium channels (NaV). The evolution of TTX resistance in this predator-prey pair constitutes a natural experiment that allows us to explore the causes of molecular convergence. Here, we review broad patterns of convergence at the level of amino acid changes in NaV channels of animals that evolved TTX resistance and make comparisons to known TTX-resistant channels that did not evolve under the selective pressures imposed by TTX. We conclude that convergence likely stems from the interplay of the target specificity of TTX and functional constraints of NaV that are shared among taxa. These and other factors can limit channel evolution to favor a few functionally permissible paths of adaptation, which can explain the observed predictability of changes to channel structure. By studying the functional causes of convergence in NaV channels, we can further our understanding of the role of these important channel proteins at the center of the evolution of the nervous system.

Helminth parasite communities of two Physalaemus cuvieri Fitzinger, 1826 (Anura: Leiuperidae) populations under different conditions of habitat integrity in the Atlantic Rain Forest of Brazil.

Adults of Physalaemus cuvieri were collected and necropsied between November 2009 and January 2010. This was carried out in order to report and compare the helminth fauna associated with two populations of this anuran species from the Brazilian Atlantic rain forest under different conditions of habitat integrity. The hosts from the disturbed area were parasitized with five helminth taxa: Cosmocerca parva, Aplectana sp., Physaloptera sp., Rhabdias sp., Oswaldocruzia subauricularis (Nematoda) and Polystoma cuvieri (Monogenea) while those from the preserved area had four helminth taxa: C. parva, Aplectana sp., Physaloptera sp., Rhabdias sp., and Acanthocephalus saopaulensis (Acanthocephala). Prevalence, mean intensity of infection, mean abundance, mean richness, importance index and dominance frequency of helminth component communities were similar in both areas. The helminth community associated with anurans from the disturbed area had higher diversity than that from the preserved area. This study is the first to report on the acanthocephalan parasites of Ph. cuvieri, and the similarity between helminth fauna composition of two host populations under different selective pressures.

Helminth parasite communities of two Physalaemus cuvieri Fitzinger, 1826 (Anura: Leiuperidae) populations under different conditions of habitat integrity in the Atlantic Rain Forest of Brazil / Comunidade de helmintos parasitos de duas populações de Physalaemus cuvieri Fitzinger, 1826 (Anura: Leiuperidae) sob diferentes condições de integridade de habitat da Mata Atlântica, Brasil

Abstract Adults of Physalaemus cuvieri were collected and necropsied between November 2009 and January 2010. This was carried out in order to report and compare the helminth fauna associated with two populations of this anuran species from the Brazilian Atlantic rain forest under different conditions of habitat integrity. The hosts from the disturbed area were parasitized with five helminth taxa: Cosmocerca parva, Aplectana sp., Physaloptera sp., Rhabdias sp., Oswaldocruzia subauricularis (Nematoda) and Polystoma cuvieri (Monogenea) while those from the preserved area had four helminth taxa: C. parva, Aplectana sp., Physaloptera sp., Rhabdias sp., and Acanthocephalus saopaulensis (Acanthocephala). Prevalence, mean intensity of infection, mean abundance, mean richness, importance index and dominance frequency of helminth component communities were similar in both areas. The helminth community associated with anurans from the disturbed area had higher diversity than that from the preserved area. This study is the first to report on the acanthocephalan parasites of Ph. cuvieri, and the similarity between helminth fauna composition of two host populations under different selective pressures.

Resumo Adultos de Physalaemus cuvieri foram coletados e necropsiados entre Novembro de 2009 e Janeiro de 2010. Este estudo foi realizado com o objetivo de informar e comparar a helmintofauna associada a duas populações desta espécie de anuro proveniente da Mata Atlântica sob duas condições de integridade de hábitat. Os hospedeiros da área perturbada estavam parasitados por cinco taxa de helmintos: Cosmocerca parva, Aplectana sp., Physaloptera sp., Rhabdias sp., Oswaldocruzia subauricularis (Nematoda) e Polystoma cuvieri (Monogenea), enquanto aqueles da área preservada apresentaram quatro taxa de helmintos: C. parva, Aplectana sp., Physaloptera sp., Rhabdias sp., e Acanthocephalus saopaulensis (Acanthocephala). Prevalência, intensidade média de infecção, abundância média, riqueza média, índice de importância específica e freqüência de dominância da comunidade componente dos helmintos foram similares em ambas as áreas. A comunidade helmíntica associada aos anuros da área perturbada apresentou-se mais diversa do que a encontrada naqueles da área preservada. Este estudo é o primeiro a relatar parasitas acantocéfalos em Ph. cuvieri, e a semelhança entre a composição da helmintofauna de duas populações hospedeiras sob diferentes pressões seletivas.

Sphingomyelin derivatives increase the frequency of microvesicle and granule fusion in chromaffin cells.

Sphingomyelin derivatives like sphingosine have been shown to enhance secretion in a variety of systems, including neuroendocrine and neuronal cells. By studying the mechanisms underlying this effect, we demonstrate here that sphingomyelin rafts co-localize strongly with synaptosomal-associated protein of 25Kda (SNAP-25) clusters in cultured bovine chromaffin cells and that they appear to be linked in a dynamic manner. In functional terms, when cultured rat chromaffin cells are treated with sphingomyelinase (SMase), producing sphingomyelin derivatives, the secretion elicited by repetitive depolarizations is enhanced. This increase was independent of cell size and it was significant 15min after initiating stimulation. Interestingly, by evaluating the membrane capacitance we found that the events in control untreated cells corresponded to two populations of microvesicles and granules, and the fusion of both these populations is clearly enhanced after treatment with SMase. Furthermore, SMase does not increase the size of chromaffin granules. Together, these results strongly suggest that SNARE-mediated exocytosis is enhanced by the generation of SMase derivatives, reflecting an increase in the frequency of fusion of both microvesicles and chromaffin granules rather than an increase in the size of these vesicles.

Helminth communities of Leptodactylus latrans (Anura: Leptodactylidae) from the Atlantic rainforest, south-eastern Brazil.

The helminth fauna associated with Leptodactylus latrans, a large frog living in a disturbed environment of Atlantic rainforest in south-eastern Brazil, was evaluated. We found eight helminth taxa, including five nematode species, Falcaustra mascula, Oswaldocruzia subauricularis, Physaloptera sp., Rhabdias sp. and an unidentified cosmocercid, two trematodes, Gorgoderina parvicava and Haematoloechus fuelleborni, and one larval cestode. The overall prevalence of infection was 63.2% with a mean intensity of 11.3 ± 3.8. The cosmocercid nematode and O. subauricularis showed the highest prevalences, although the trematode G. parvicava was the most abundant and dominant parasite species. Host size positively influenced both the intensity of infection and parasite species richness. Our data suggest that the juvenile individuals of L. latrans are more susceptible to parasitic infection than the adults. The comparison of the similarity of this community component with that found in other studies in South America shows that, as well as the characteristics of the host, the sampling area also influences the parasitic fauna. Therefore, the results of this study agree that the helminth communities of frogs have relatively low species richness and dominance of generalist species.

Infection patterns of Paradollfusnema amphisbaenia (Nematoda: Cosmocercidae) in a population of Amphisbaena wuchereri (Squamata: Amphisbaenidae) from Minas Gerais state, south-eastern Brazil, and its relations with host size, sex and fat body mass.

Specimens (n= 41) of the amphisbaenid Amphisbaena wuchereri taken from a population in Minas Gerais state, south-eastern Brazil, were examined for gastrointestinal parasites. A single nematode species was found, Paradollfusnema amphisbaenia. This was a new host record for this nematode species. This parasite was encountered in the large intestine (prevalence of 100%), in the stomach (prevalence of 2%) and in the small intestine (prevalence of 7.3%). The intensity of infection ranged from 1 to 457 individual parasites per host and was positively correlated with body size of both male and female amphisbaenians. The discrepancy index (D) indicated that P. amphisbaenia tended to an even distribution in this host population. The nematode, which did not affect fat body mass, induced inflammatory infiltrations in the small intestine, indicating that the parasites might injure the host's organs.

Validación del cuestionario de calidad de vida ConQol, en niños chilenos portadores de cardiopatías congénitas / Validation of quality of life questionnaire ConQol for Chilean children with congenital heart diseases

Background: ConQoL questionnaire assesses health related quality of life among children with congenital heart diseases. It has a version for children aged 8 to 11 years and anotherfor children aged 12 to 16years. Aim: To validate ConQol questionnaire for Chilean children with a congenital heart disease. Material and Methods: Using a multicentric cross sectional design, 334 children from four hospitals (54% males), were surveyed. Among them 45% were aged 8 to 11 years and 55%, 12 to 16 years. The study involved three stages: cross cultural adjustment of the original questionnaire, pre-test study, and estimation of its psychometric properties. Content, construct and criterion validity and internal consistency with Cronbach's alpha, were assessed. Results: The version for children aged 8 to 11 years and comprised by three domains (symptoms, activity and relationships), obtained and α ≥ 0.60. In the questionnaire for children aged 12 to 16years, there is one more domain called coping, which obtained an α of 0.53, that was different to the other three domains that obtained an α > 0.70. The correlation between Health Quality of Life and Perception of Health Quality of Life was statistically significant for both groups. The association between Health Quality ofLife and health capability was only significant among children aged 12 to 16years (p < 0.01). Conclusions: The adapted ConQol questionnaire matched properly with the original one. The adapted questionnaire is valid and reliable to assess Health Quality ofLife among Chilean children with congenital heart diseases.

The nematode community in the Atlantic rainforest lizard Enyalius perditus Jackson, from south-eastern Brazil.

Studies focusing on communities of helminths from Brazilian lizards are increasing, but there are many blanks in the knowledge of parasitic fauna of wild fauna. This lack of knowledge hampers understanding of ecological and parasitological aspects of involved species. Moreover, the majority of research has focused on parasitic fauna of lizards from families Tropiduridae and Scincidae. Only a few studies have looked at lizards from the family Leiosauridae, including some species of Enyalius. This study presents data on the gastrointestinal parasite fauna of Enyalius perditus and their relationships with ecological aspects of hosts in a disturbed Atlantic rainforest area in the state of Minas Gerais, south-eastern Brazil. Two nematode species, Oswaldocruzia burseyi [(Molineidae) and Strongyluris oscari (Heterakidae) were found. Nematode species showed an aggregated distribution in this host population, with O. burseyi being more aggregated than S. oscari. The present study extends the range of occurrence of O. burseyi to the Brazilian continental area.

[Morphometric analysis of cervical pedicles in a Mexican population]. / Análisis morfométrico de los pedículos cervicales en una población mexicana.

BACKGROUND: Knowledge of the morphometric anatomy of cervical pedicles is essential for the safe and accurate placement of pedicle screws during instrumentation of the cervical spine. Screw placement in the lumbar and thoracic vertebrae is considered as a safe practice, unlike the cervical vertebrae due to the risks involved. There are few reports on this technique. The little available information comes from populations different from the Mexican population. Knowing the measurements of each cervical vertebra will provide proper screw orientation and selection at the time of screw placement. METHODS: Prospective, cross-sectional, descriptive study in subjects who presented at the outpatient and emergency services. Patient's in whom a CAT scan of the cervical spine was ordered as part of the work-up protocol, from April 1st 2010 to October 31st 2010, were included. A morphometric anatomic study was undertaken using the CAT software. In a saggital view: a) Saggital angle, b) Saggital diameter. In an axial view: a) Work distance, b) Cross-sectional angle and c) Cross-sectional diameter. RESULTS: The following measurements were obtained for each segment from C2 to C7: mean, standard deviation, range and minimal and maximal values. CONCLUSIONS AND CLINICAL RELEVANCE: Appropriate preoperative planning prior to cervical transpedicular instrumentation is essential to achieve greater accuracy during screw placement. The information obtained allows performing the procedure. As a result of this, a report based on out center's experience may be disseminated thus sharing our technique with the medical community.

Efeito embriotóxico, teratogênico e abortivo de plantas medicinais / Embryotoxic, teratogenic and abortive effects of medicinal plants

O uso milenar de plantas medicinais mostrou ao longo dos anos, que determinadas plantas apresentam substâncias potencialmente perigosas. Do ponto de vista científico, algumas pesquisas mostraram que muitas dessas plantas possuem substâncias agressivas e por essa razão devem ser utilizadas com cuidado, respeitando seus riscos toxicológicos. Os efeitos mais preocupantes do uso indiscriminado de plantas medicinais são embriotóxico, teratogênico e abortivo, uma vez, que os constituintes da planta podem atravessar a placenta, chegar ao feto e gerar um desses efeitos. Este estudo objetiva fornecer uma listagem das principais plantas medicinais que tenham efeitos embriotóxicos, teratogênicos e abortivos comprovados, conhecendo as partes da planta utilizadas e seus respectivos nomes científicos, com a finalidade de alertar gestantes quanto aos riscos de seu uso. Realizou-se buscas nas bases eletrônicas de dados SciELO, PubMed, MEDLINE, LILACS, CAPES e Google acadêmico. Nos resultados encontrados, plantas como Arnica (Arnica montana), Artemísia (Artemisia vulgaris), Arruda (Ruta chalepensis/ Ruta graveolens), Barbatimão (Stryphnodendron polyphyllum), Boldo (Vernonia condensata) dentre outras, podem vir a gerar um desses efeitos. A partir deste estudo comprova-se que para a maioria das plantas medicinais não há dados a respeito da segurança de seu uso durante a gravidez.

The ancient use of medicinal plants has shown over the years that certain plants have potentially dangerous substances. From a scientific point of view, some studies have shown that many of these plants contain aggressive substances and therefore should be used with caution, respecting their toxicological risks. The most important effects of the indiscriminate use of medicinal plants are embryotoxic, teratogenic and abortifacient since the plant constituents can cross the placenta, reaching the fetus and leading to one of these effects. This study aimed to provide a list of the major medicinal plants that have proven embryotoxic, teratogenic and abortifacient effects, including the used plant parts and their respective scientific names, in order to warn pregnant women about the risks of its use. Searches were carried out in the electronic databases SciELO, PubMed, MEDLINE, LILACS, CAPES and Google Scholar. Results indicated that plants such as mountain arnica (Arnica montana), mugwort (Artemisia vulgaris), fringed rue (Ruta chalepensis / Ruta graveolens), "Barbatimão" (Stryphnodendron polyphyllum) and "Boldo" (Vernonia condensata) are likely to generate such an effect. This study shows that for most medicinal plants there are not data regarding the safety of their use during pregnancy.

Efeito da fibra de coprodutos agroindustriais e sua avaliação nutricional para coelhos / Effect of agricultural by-products fiber and its nutritional evaluation for rabbits

Estudou-se a influência da fibra oriunda de diferentes fontes - feno de alfafa, polpa de cítrus e casca de soja - sobre o desempenho, coeficientes de digestibilidade, parâmetros sanguíneos e características da carne de coelhos submetidos às dietas experimentais. Os animais foram distribuídos em três tratamentos, que consistiram de: FA - ração-controle, com feno de alfafa; PC - substituição total do feno de alfafa por polpa de cítrus; e CS - substituição total do feno de alfafa por casca de soja. As diferentes frações da fibra advindas da polpa de cítrus e da casca de soja não influenciaram o desempenho dos animais aos 89 dias e mostram que esses ingredientes podem ser utilizados como substitutos do feno de alfafa na dieta de coelhos. A qualidade de fibra da polpa de cítrus reduziu os níveis séricos de triacilglicerol, colesterol e hemoglobina dos animais. A baixa quantidade de lignina em relação à celulose e à hemicelulose da casca de soja propiciou melhor coeficiente de digestibilidade dos nutrientes e maior maciez da carne, porém menor deposição proteica quando comparada com a dieta com polpa de cítrus.

The influence of fiber - alfalfa hay, citrus pulp, and soybean hulls - in diets of rabbits was studied on performance, digestibility coefficients, blood parameters, and meat characteristics. The animals were allotted into three treatments that consisted in: control diet, with alfalfa hay; total substitution of alfalfa hay by citrus pulp; and total substitution of alfalfa hay by soybean hulls. The different fiber fractions from citrus pulp and soybean hulls did not affect animal performance at the 89th day; thus, these ingredients can be used as substitute of alfalfa hay on diet of rabbits. Fiber quality of citrus pulp decreased blood triacylglycerol, cholesterol, and hemoglobin levels. Lower amount of lignin in relation to cellulose and hemicellulose of soybean hulls provided better nutrient digestibility coefficients and higher tenderness meat, however, lower protein deposition when compared with the citrus pulp diet.

Epithelial ovarian carcinoma: current evidences and future perspectives in the first-line setting

Epithelial ovarian carcinoma is still the most common cause of death from gynaecological cancer in USA and western Europe. The optimal therapy of epithelial ovarian carcinoma requires participation of a multidisciplinary team - from diagnosis through the entire natural history of each individual patient. Only 20-30% of patients are diagnosed at the initial stage, when appropriate staging surgery in combination with adjuvant chemotherapy for high-risk patients can be curative. Treating patients with advanced disease consists of a staging surgery with maximum cytoreductive effort, followed by chemotherapy with a combination of taxane and carboplatin. Unfortunately, the majority of patients with advanced disease will relapse and become candidates for therapy that comprises individualised chemotherapy, and surgery in selected cases. For this reason, there is still a need for new treatments and strategies in the first-line setting (AU)