Manejo de una paciente embarazada con déficit congénito de factor VII leve / Management of a pregnant patient with mild factor VII congenital deficiency

RESUMEN No hay guías específicas para el manejo de pacientes embarazadas con la deficiencia de Factor VII; no hay una correlación entre el nivel de FVII y el riesgo de hemorragia y el nivel del Factor VII aumento durante el embarazo. Presentamos un caso clínico, el manejo y las recomendaciones del consenso.

Simultaneous presence of Paralytic and Diarrheic Shellfish Poisoning toxins in Mytilus chilensis samples collected in the Chiloe Island, Austral Chilean Fjords

The study shown here provides the first indisputable evidence that shellfish can be contaminated with Paralytic Shellfish Poisoning (PSP) and Diarrheic Shellfish Poisoning (DSP) toxins during the summer season in the Southern Chilean fjords. Quantitative analysis of the simultaneous presence of PSP and DSP toxins in Mytilus chilensis samples collected in the Chiloe Island are shown. The High Performance Liquid Chromatography (HPLC) analysis with pre-column derivatization method for DSP toxins and the post-column derivatization methods for PSP toxins, both with fluorescent on-line detections, showed that both type of toxins were concentrated by the filter bivalve Mytilus chilensis in amounts above the international safe limits. The phytoplankton analysis showed the presence of both Alexandrium catenella and Dinophysis acuta in the water column. The data shows stratification of the toxic dinoflagellates in the water column, since the lowest amount of both DSP and PSP toxins were measured in the superficial and deeper levels of the water column. Moreover, the highest toxicities of both types of toxins were shown by the shellfish samples collected at a depth of 6 meters with 190 nanograms of DTX-1 / gram of digestive gland and 709.8 mg of PSP toxins / 100 grams of mussel meat.

The Gonyautoxin 2/3 epimers reduces anal tone when injected in the anal sphincter of healthy adults

The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2 ± 6.2 % and 47.0 ± 6.8 % (Mean Value ± Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001)..

Quantification of diarrhetic shellfish poisong toxins in chilean mussel using pyrenyldiaomethane as fluorescent labeling reagent

Diarrhetic shellfish poisoning (DSP) is a gastrointestinal disease caused by lipid soluble polyether toxins produced by dinoflagellates and accumulated in shellfish. Diarrhetic shellfish poisoning is a worldwide threat to public health and the shellfish industry. To date, only four lipid soluble polyethers have been known as diarrhetic shellfish toxins. Among them, Okadaic acid (OA), Dinophysistoxin 1 (DTX-1, 35-methyl OA), Dinophysistoxin 2 (DTX-2, OA isomers) and Dinophysistoxin 3 (DTX-3, 7-O-acyl-35-methyl OA), all of which have free carboxilic groups. To perform quantitative analysis of DSP toxins in shellfish samples is a requirement, because DSP toxins are endemic in the Chilean mollusks of the southern regions, and although human symptoms of DSP appear relatively mild in comparison with the Paralytic Shellfish Poisoning (PSP), the necessity of monitoring the chronic effects of continued uptake of low doses of DSP toxins more closely is imperative, since DSP toxins have been described as potent tumor promoters. This paper shows the synthesis pathway of a chromophore, 1-pyrenyldiazomethane (PDAM), a fluorescent labeling reagent for determination of carboxilic acids, using High Performance Liquid Chromatography with fluorescence on-line detection . This procedure was developed in order to have a quantitative method for DSP toxins analysis that would be useful for health public services and private shellfish industries. The features of this labeling reagent are compared against ADAM and used for quantitative analysis of DSP toxins in Chilean mussels and cultured dinoflagellates samples

Microalgal blooms: a global issue with negative impact in Chile

Ecological and health problems posed by microalgal blooms (red tides) occurring in the Southern part of Chile are reviewed. Out of the six human illnesses provoked by microalgal toxins, paralytic shellfish poisoning is the most important, because of its high mortality rate and the high levels of phycotoxins found in contaminated molluscs. Saxitoxin and its analogues bind to a receptor in the voltage-gated sodium channel of neural membranes. The most important toxin-producer microalgae are Alexandrium catenella and Dinophysis acuta. Phycotoxins become concentrated by filter-feeding shellfish, like Mytilus chilensis. Highly sensitive methods available for detection of microalgal toxins are analyzed.