Anestesia en un caso de estenosis traqueal secuela de COVID-19, para un procedimiento de traqueoplastía / Anesthesia in a case of tracheal stenosis sequelae of COVID-19, to a tracheoplasty procedure

Resumen: Introducción: La pandemia por COVID-19 es una enfermedad de predominio respiratorio que ha afectado a nivel mundial y ha dejado más de 151 millones de casos, los cuales suelen requerir un manejo de ventilación mecánica con la intensión de controlar las vías aéreas superiores para la adecuada oxigenación de las personas con COVID-19, y que se reduzca así el riesgo de contagio para el personal médico. Objetivo: Describir el abordaje anestésico para la inducción y mantenimiento de una traqueoplastía derivado a estenosis traqueal secundaria por COVID-19. Material y métodos: Se aborda la descripción de un caso y los lineamientos que se han dado para el manejo de la estenosis traqueal. Conclusiones: El control oportuno anestésico y la instalación de férula laríngea son apropiados para el manejo de la estenosis traqueal secundaria al proceso de intubación mecánica prolongada por COVID-19.

Abstract: Introduction: The COVID-19 pandemic is a predominantly respiratory disease that has affected worldwide and has left more than 151 million cases, which usually require mechanical ventilation management with the intention of managing the upper airways for ventilation adequate oxygenation of people with COVID-19 and that reduces the risk of contagion for medical personnel. Objective: To describe the anesthetic approach for the induction and maintenance of a tracheoplasty derived from tracheal stenosis secondary to COVID-19. Material and methods: The description of a case and the guidelines that have been given for the management of tracheal stenosis are addressed. Conclusions: Timely anesthetic management and installation of a laryngeal splint is appropriate for the management of tracheal stenosis secondary to the process of prolonged mechanical intubation due to COVID-19.

Infarto cerebeloso bilateral agudo en territorio de la arteria cerebelosa posterior inferior: reporte de caso / Acute bilateral cerebellar infarction in territory of the posterior inferior cerebellar artery: a case report

Antecedentes: Los infartos cerebelosos suponen una entidad rara con una incidencia baja del total de ictus isquémicos. El territorio más prevalente de los infartos cerebelosos son los de la arteria cerebelosa posterior inferior (PICA). Cuando los infartos se limitan al cerebelo, los pacientes típicamente experimentan síntomas no específicos, esto hace considerar otros diagnósticos de forma errónea. Descripción del caso clínico: paciente femenina de 54 años, con antecedente de hipertensión arterial, quien presentaba cefalea insidiosa y progresiva acompañado de vértigo, alteración en la marcha y deterioro progresivo del estado de conciencia. Se realizó imagen de Resonancia Magnética Cerebral (IRM), la cual reveló zonas hiper intensas bilaterales en región cerebelosa que delimitaban territorio vascular de la arteria cerebelosa posterior inferior además dilatación moderada del sistema ventricular. Fue intervenida quirúrgicamente, realizándose craniectomía suboccipital descompresiva; posterior a la cirugía presentó mejoría clínica. Conclusiones: El ictus isquémico cerebeloso bilateral es una forma infrecuente de ictus y su presentación clínica es muy diversa. El desarrollo de las neuroimágenes, juegan un papel importante para ayudar a los médicos a seleccionar el tratamiento adecuado. Alrededor de la mitad de los pacientes con infartos cerebelosos que presentan deterioro neurológico progresivo y son tratados con craniectomía suboccipital descompresiva tienen buenos resultados. El pilar fundamental de este caso fue el hacer un diagnóstico temprano de esta entidad, ya que permitió prevenir las posibles complicaciones graves asociadas al infarto cerebeloso, las cuales ocurren durante la primera semana del ictus y, por lo tanto, asegurar un pronóstico favorable para el paciente...(AU)

Infarto talámico bilateral por compromiso de la arteria de percheron / Bilateral Thalamic Infarct by Commitment of the Artery of Percheron

Introduccion: La arteria de Percheron se origina de un solo tronco arterial talamoperforante que proporciona suministro bilateral a los tálamos paramedianos y al mesencéfalo rostral. Esta es una variante anatómica que permite la irrigación bilateral de los tálamos, a partir de un tronco común de origen asimétrico en la arteria cerebral posterior. Las lesiones en esta área dan origen a una variedad de manifestaciones clínicas. Caso clínico: Presentamos el caso de una paciente femenina blanca de 89 años, quien fue admitida en el Hospital Virgen de los Lirios de Alcoy, diagnosticada con Infarto talámico bilateral de la arteria de Percherón. Discusión: Son muchos los factores por el cual este infarto es infradiagnosticado, entre ellos, la baja estimación de la frecuencia de este infarto junto con la gran heterogeneidad clínica y además la baja sensibilidad de la Tomografía computarizada en la fase hiperaguda. En general el pronóstico a largo plazo es bueno, este varía con respecto a los patrones radiológicos encontrados, siendo más afectados los casos en los que involucra mesencefalo...(AU)

Trombosis de un ictus isquemico en el Hospita Escuela Universitario, Tegucigalpa, Honduras / Ischemic stroke thrombolysis in the University School Hospital, Tegucigalpa, Honduras

Hipócrates padre de la medicina, reconoció la enfermedad cerebrovascular hace más de 2 400 años y utilizó el término apoplejía. En Estados Unidos esta enfermedad es la principal causa de discapacidad, así como la tercera causa de muerte. En Honduras se ha observado que en los últimos años la incidencia hospitalaria del evento cerebrovascular se ha elevado notablemente, lo que constituye la primera causa de morbilidad y mortalidad no traumática en la población adulta y refleja el impacto que la enfermedad tiene en la población. Objetivo: realizar un análisis del primer caso de trombólisis en enfermedad cerebrovascular isquémica en el Hospital Escuela Universitario, Tegucigalpa, Honduras. Caso clínico: paciente femenina de 79 años, quien 40 minutos previos a su ingreso a emergencia de Medicina Interna del Hospital Escuela Universitario, presentó abruptamente afasia neurológica se encontró afasia motora, hemiparesia faciobraquiocrural derecha, con afectación sensitiva superficial ipsilateral y Babinski derecho. La tomografía cerebral simple no fluente y disminución de la fuerza en hemicuerpo derecho. En la evaluación no demostró anormalidades, por lo que cumplió los criterios establecidos y se decide trombolizar. Se logró disminuir el puntaje en la Escala del Instituto Nacional de Salud de 18 a 7 puntos y en la Escala de Rankin Modificada de 4 a 1. Conclusión: la paciente ingresó con déficit motor hemicorporal con afectación del lenguaje; tras la intervención se rescató el área de penumbra y egresó con leve déficit secuelar del lenguaje en la comprensión, sin déficit motor, ni pérdida de la fluidez del lenguaje. El uso de activador recombinante tisular de plasminógeno para ictus isquémico, con tres horas o menos de evolución, aumenta los beneficios del paciente ya que disminuyen las secuelas y reduce los gastos del sistema de salud. Portal razón es catalogado como evidencia clase A...(AU)

Reporte de familia: distrofia muscular oculofaríngea / Family report: Muscular Dystrophy Oculopharyngeal

Antecedentes: La Distrofia Muscular Oculofaríngea es un trastorno hereditario de rara ocurrencia. Este síndrome se caracteriza fundamentalmente por ptosis palpebral progresiva, disfagia y debilidad proximal de las extremidades. Casos Clínicos: Se presenta una familia en la cual se encontraron dos casos afectados, en la confección del árbol genealógico se encontró consanguineidad entre los padres apoyando la existencia de un posible patrón hereditario para esta alteración. Conclusión: El conocimiento de esta entidad es fundamental para sospecharla, por lo infrecuente de esta condición y las pocas publicaciones en la literatura latinoamericana de estos casos se presenta la siguiente revisión...(AU)

Composition and biological activities of the aqueous extracts of three scleractinian corals from the Mexican Caribbean: Pseudodiploria strigosa, Porites astreoides and Siderastrea siderea

Background: Scleractinian corals (stony corals) are the most abundant reef-forming cnidarians found in coral reefs throughout the world. Despite their abundance and ecological importance, information about the diversity of their toxins and their biological activities is very scarce. In this study, the chemical composition and the biological activities of the aqueous extracts of Pseudodiploria strigosa, Porites astreoides and Siderastrea siderea, three scleractinian corals from the Mexican Caribbean, have been assessed for the first time. Methods: Toxicity of the extracts was assessed in crickets; the presence of cytolysins was detected by the hemolysis assay; the vasoconstrictor activity was determined by the isolated rat aortic ring assay; the nociceptive activity was evaluated by the formalin test. The presence of phospholipases A2 (PLA2), serine proteases, and hyaluronidases was determined by enzymatic methods. Low-molecular-weight fractions were obtained by gel filtration chromatography and ultrafiltration. Results: Extracts from the three species were toxic to crickets, induced hemolysis in human and rat erythrocytes, produced vasoconstriction on isolated rat aortic rings, and presented phospholipase A2 and serine-protease activity. Despite the fact that these corals are not considered to be harmless to humans, the extracts generated significant nociceptive responses. The matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry analysis of the low-molecular-weight fractions revealed the presence of peptides within a mass range of 3000 to 6000 Da. These fractions were toxic to crickets and two of them induced a transitory vasoconstrictor effect on isolated rat aortic rings. Conclusion: This study suggests that scleractinian corals produce low-molecular-weight peptides that are lethal to crickets and induce vasoconstriction.(AU)

Composition and biological activities of the aqueous extracts of three scleractinian corals from the Mexican Caribbean: Pseudodiploria strigosa, Porites astreoides and Siderastrea siderea

Scleractinian corals (stony corals) are the most abundant reef-forming cnidarians found in coral reefs throughout the world. Despite their abundance and ecological importance, information about the diversity of their toxins and their biological activities is very scarce. In this study, the chemical composition and the biological activities of the aqueous extracts of Pseudodiploria strigosa, Porites astreoides and Siderastrea siderea, three scleractinian corals from the Mexican Caribbean, have been assessed for the first time. Methods: Toxicity of the extracts was assessed in crickets; the presence of cytolysins was detected by the hemolysis assay; the vasoconstrictor activity was determined by the isolated rat aortic ring assay; the nociceptive activity was evaluated by the formalin test. The presence of phospholipases A2 (PLA2), serine proteases, and hyaluronidases was determined by enzymatic methods. Low-molecular-weight fractions were obtained by gel filtration chromatography and ultrafiltration. Results: Extracts from the three species were toxic to crickets, induced hemolysis in human and rat erythrocytes, produced vasoconstriction on isolated rat aortic rings, and presented phospholipase A2 and serine-protease activity. Despite the fact that these corals are not considered to be harmless to humans, the extracts generated significant nociceptive responses. The matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry analysis of the low-molecular-weight fractions revealed the presence of peptides within a mass range of 3000 to 6000 Da. These fractions were toxic to crickets and two of them induced a transitory vasoconstrictor effect on isolated rat aortic rings. Conclusion: This study suggests that scleractinian corals produce low-molecular-weight peptides that are lethal to crickets and induce vasoconstriction.

Cytolytic and systemic toxic effects induced by the aqueous extract of the fire coral Millepora alcicornis collected in the Mexican Caribbean and detection of two types of cytolisins

Background Millepora alcicornis is a branching hydrocoral common throughout the Caribbean Sea. Like other members of this genus, this species is capable of inducing skin eruptions and blisters with severe pain after contact. In the present study, we investigated the toxicity of theM. alcicornis aqueous extract on several animal models. Considering that some cnidarian hemolysins have been associated to local tissue damage, since they also induce lysis of other cell types, we also made a partial characterization of the hemolytic activity of M. alcicornis aqueous extract. This information is important for understanding the defense mechanisms of the "fire corals".Methods The effects of pH, temperature, and some divalent cations on the hemolytic activity of the extract were assayed, followed by a zymogram analysis to detect the cytolysins and determine their approximate molecular weight. The toxicity of the aqueous extract was assayed in mice, by intravenous administration, and histopathological changes on several tissues were analyzed by light microscopy. The toxicity of the extract was also tested inArtemia salina nauplii, and the damages caused on the crustaceans were analyzed by transmission and scanning electron microscopy.Results The hemolytic activity of the hydrocoral extract was enhanced in the presence of Ca 2+ (≥2 mM), Mg 2+ (≥6 mM), and Ba2+ (≥0.1 mM); however, it was reduced in the presence of Cu2+(≥0.1 mM), Zn 2+ (≥6 mM), and EDTA (≥0.34 mM). Differences in the pH did not affect the hemolytic activity, but it was temperature-sensitive, since preincubation at ≥ 50 °C sharply reduced hemolysis. The zymogram showed the presence of two types of hemolysins: ~ 28-30 kDa proteins with phospholipase A 2 activity and ~ 200 kDa proteins that do not elicit enzymatic activity. The aqueous extract of this cnidarian was lethal to mice (LD 50 = 17 μg protein/g), and induced kidney, liver, and lung damages. Under denaturing conditions, the aqueous extract completely lost its toxic and hemolytic activities.Conclusions The results showed that the M. alcicornis aqueous extract contains two types of thermolabile hemolysins: proteins of approximately 28-30 kDa with PLA 2 activity, while the others are larger proteins of approximately 200 kDa, which do not possess PLA 2activity. Those thermolabile cytolysins, which are stable to pH changes and whose activity is calcium dependent, are capable of inducing damage in lung, kidney and liver tissues, resulting in a slow death of mice. M. alcicorniscytolysins also provoke tissue dissociation inArtemia salina nauplii that might be attributed to pore forming mechanisms.(AU)

Cytolytic and systemic toxic effects induced by the aqueous extract of the fire coral Millepora alcicornis collected in the Mexican Caribbean and detection of two types of cytolisins

Background Millepora alcicornis is a branching hydrocoral common throughout the Caribbean Sea. Like other members of this genus, this species is capable of inducing skin eruptions and blisters with severe pain after contact. In the present study, we investigated the toxicity of theM. alcicornis aqueous extract on several animal models. Considering that some cnidarian hemolysins have been associated to local tissue damage, since they also induce lysis of other cell types, we also made a partial characterization of the hemolytic activity of M. alcicornis aqueous extract. This information is important for understanding the defense mechanisms of the fire corals.Methods The effects of pH, temperature, and some divalent cations on the hemolytic activity of the extract were assayed, followed by a zymogram analysis to detect the cytolysins and determine their approximate molecular weight. The toxicity of the aqueous extract was assayed in mice, by intravenous administration, and histopathological changes on several tissues were analyzed by light microscopy. The toxicity of the extract was also tested inArtemia salina nauplii, and the damages caused on the crustaceans were analyzed by transmission and scanning electron microscopy.Results The hemolytic activity of the hydrocoral extract was enhanced in the presence of Ca 2+ (2 mM), Mg 2+ (6 mM), and Ba2+ (0.1 mM); however, it was reduced in the presence of Cu2+(0.1 mM), Zn 2+ (6 mM), and EDTA (0.34 mM). Differences in the pH did not affect the hemolytic activity, but it was temperature-sensitive, since preincubation at 50 °C sharply reduced hemolysis. The zymogram showed the presence of two types of hemolysins: ~ 2830 kDa proteins with phospholipase A 2 activity and ~ 200 kDa proteins that do not elicit enzymatic activity. The aqueous extract of this cnidarian was lethal to mice (LD 50 = 17 g protein/g), and induced kidney, liver, and lung damages. Under denaturing conditions, the aqueous extract completely lost its toxic and hemolytic activities.Conclusions The results showed that the M. alcicornis aqueous extract contains two types of thermolabile hemolysins: proteins of approximately 2830 kDa with PLA 2 activity, while the others are larger proteins of approximately 200 kDa, which do not possess PLA 2activity. Those thermolabile cytolysins, which are stable to pH changes and whose activity is calcium dependent, are capable of inducing damage in lung, kidney and liver tissues, resulting in a slow death of mice. M. alcicorniscytolysins also provoke tissue dissociation inArtemia salina nauplii that might be attributed to pore forming mechanisms.

Mejora de defensas antioxidantes mediante ejercicio aeróbico en mujeres con síndrome metabólico / Aerobic training improves antioxidant defense system in women with metabolic syndrome

En la actualidad se acepta que el daño oxidativo juega un papel esencial en la patogénesis del síndrome metabólico. Estudios recientes proponen al daño oxidativo como diana terapéutica frente al síndrome metabólico. Precisamente nuestro objetivo fue mejorar el estatus total antioxidante (TAS) de mujeres con síndrome metabólico mediante ejercicio aeróbico. Participaron voluntariamente 100 mujeres con síndrome metabólico de acuerdo con los criterios del National Cholesterol Educational Program (Adult-Treatment-Panel-III) distribuidas aleatoriamente en grupo experimental (n = 60) y control (n = 40). El grupo experimental desarrolló un programa de entrenamiento aeróbico sobre tapiz rodante de intensidad ligera/moderada de 12 semanas (5 sesiones/semana). La determinación del TAS plasmático se realizó mediante espectrofotometría utilizando kits comercializados por Randox Lab. Este protocolo fue aprobado por un Comité de Etica Institucional. Tras completar el programa de entrenamiento se incrementó significativamente el TAS (0.79 ± 0.05 vs.1.01 ± 0.03 mmol/l; p = 0.027). No hubo cambios en grupo control. El ejercicio aeróbico de intensidad ligera/moderada aumenta las defensas antioxidantes en mujeres con síndrome metabólico. Son necesarios futuros estudios longitudinales para conocer su impacto en la evolución clínica.

A 12-week training protocol increased antioxidant defense system in young adult women with metabolic syndrome. It is generally accepted that oxidative stress is implicated in the pathogenesis of metabolic syndrome. Furthermore, recent studies have reported that stress may be acting as a therapeutic target in metabolic syndrome. Consequently, this study was designed to explore whether aerobic training may increase plasmatic total antioxidant status in women with metabolic syndrome. A total of 100 young adult women with metabolic syndrome according to the criteria reported by the National Cholesterol Education Program (Adult-Treatment-Panel-III) volunteered for this study. Of them, 60 were randomly included in the experimental group to enter a 12-week aerobic training program, 5 days/week, at low/moderate intensity. The control group included 40 age, sex and body mass index (BMI)-matched women with metabolic syndrome who did not enter any training program. Total antioxidant status (TAS) was assayed in plasma using colorimetric Randox kits. This protocol was approved by an Institutional Ethics Committee. When compared to baseline, plasmatic TAS was significantly increased (0.79 ± 0.05 Vs 1.01 ± 0.03 mmol/l; p = 0.027). No changes were found in controls. A 12-week aerobic training program increased plasmatic TAS in adult women with metabolic syndrome. Further long-term well-conducted studies are required in order to highlight the potential clinical benefits of TAS improvement.

Sistema Brãnemark Novum: Un moderno concepto en implantes para mandíbulas edéntulas / Brãnemark Novum System: A modern concept for implant restorattion of edentolus mandibles

El sistema Brãnemark Novun es una técnica que permite la reducción de tiempos quirúrgicos y protésicos con una menor agresión al paciente. Es una técnica que proporciona una solución prácticamente inmediata tanto estética como funcional...