[Cerebral gas embolism as a complication of diffuse interstitial lung disease] / Embolismo gaseoso cerebral como complicación de una enfermedad pulmonar intersticial difusa.

Introduction: Cerebral gas embolism is an unusual but extremely serious condition that occurs when air is introduced into the arterial or venous circulation of the brain. Although rare, it can lead to significant neurological deficits and even the death of the patient. Clinical Case: 76-year-old patient with pre-existing diffuse interstitial lung disease, who experienced a massive stroke due to spontaneous pneumomediastinum. Her presentation included confusion, seizures, and motor weakness. Imaging tests revealed air bubbles in the cerebral sulci and hypodense areas in the cerebellum and parietooccipitals. In addition, pneumothorax and air in the upper mediastinum were noted on chest radiographs and chest CT scan. Despite therapeutic measures such as hyperbaric oxygen, the patient unfortunately died due to multiple organ failure. Discussion: The diagnosis of cerebral gas embolism generally involves performing a cerebral computed tomography, which is highly sensitive for detecting the presence of air in the cerebral vessels. Management includes monitoring of vital and neurological signs, as well as specific measures such as airway closure, venous catheter aspiration, Trendelenburg positioning, and hyperbaric oxygen. Conclusion: Cerebral gas embolism is a potentially fatal condition that requires a brain computed tomography for diagnosis and it is vitally important to know the prevention measures to avoid the appearance of this complication and also to know the general measures to adopt when it occurs.

Introducción: La embolia gaseosa cerebral es una afección inusual pero extremadamente grave que se produce cuando se introduce aire en la circulación arterial o venosa del cerebro. Aunque poco común, puede derivar en déficits neurológicos significativos e incluso la muerte del paciente. Caso Clínico: Paciente de 76 años con una enfermedad pulmonar intersticial difusa preexistente, que experimentó un ictus masivo debido a un neumomediastino espontáneo. Su presentación incluyó confusión, convulsiones y debilidad motora. Las pruebas de imagen revelaron burbujas de aire en los surcos cerebrales y áreas hipodensas en el cerebelo y parietooccipitales. Además, se observó neumotórax y aire en el mediastino superior en las radiografías de tórax y la tomografía torácica. A pesar de las medidas terapéuticas como el oxígeno hiperbárico, la paciente lamentablemente falleció debido al fallo multiorgánico. Discusión: El diagnóstico de embolia gaseosa cerebral generalmente implica la realización de una tomografía computarizada cerebral, que es altamente sensible para detectar la presencia de aire en los vasos cerebrales. El manejo incluye el control de las constantes vitales y neurológicas, así como medidas específicas como cierre de la entrada de aire, aspiración de catéteres venosos, posicionamiento de Trendelenburg y oxígeno hiperbárico. Conclusión: La embolia gaseosa cerebral es una afección potencialmente mortal que requiere una tomografía computarizada cerebral para el diagnóstico y de vital importancia conocer las medidas de prevención para evitar la aparición de esta complicación y así mismo conocer las medidas generales a adoptar cuando ésta se presenta.

Molecular and Genetic Mechanisms of Neurotoxicity During Anti-seizure Medications Use.

Abstract: Epilepsy is a multifactorial pathology that has allowed the development of various drugs aiming to combat it. This effort was formally initiated in the 1940s when phenytoin began to be used. It eventually turned out to be a drug with great anticonvulsant efficacy. At present, several potentially good new generation anti-seizure medications (ASMs) have been developed. Most of them present more tolerability and less toxic effects. However, they continue to have adverse effects at different levels. In addition, some seizures are difficult to treat with ASMs, representing 30% of the total cases of people who suffer from epilepsy. This review aims to explore the genetic and molecular mechanisms of ASMs neurotoxicity, proposing the study of damage caused by epileptic seizures, in addition to the deterioration generated by anti-seizure drug administration within the central nervous system. It is beyond question that there is a need to develop drugs that lower the lower the risk of secondary and toxic effects of ASMs. Simultaneously, we must find strategies that produce fewer harmful interactions and more health benefits when taking anti-seizure drugs.

Molecular and Genetic Mechanisms of Neurotoxicity During Anti-seizure Medications Use

ABSTRACT Epilepsy is a multifactorial pathology that has allowed the development of various drugs aiming to combat it. This effort was formally initiated in the 1940s when phenytoin began to be used. It eventually turned out to be a drug with great anticonvulsant efficacy. At present, several potentially good new generation anti-seizure medications (ASMs) have been developed. Most of them present more tolerability and less toxic effects. However, they continue to have adverse effects at different levels. In addition, some seizures are difficult to treat with ASMs, representing 30% of the total cases of people who suffer from epilepsy. This review aims to explore the genetic and molecular mechanisms of ASMs neurotoxicity, proposing the study of damage caused by epileptic seizures, in addition to the deterioration generated by anti-seizure drug administration within the central nervous system. It is beyond question that there is a need to develop drugs that lower the lower the risk of secondary and toxic effects of ASMs. Simultaneously, we must find strategies that produce fewer harmful interactions and more health benefits when taking anti-seizure drugs.

Aneuploids and its increment on diversity of Lippia alba polyploid complex: genetic aspects and origin.

BACKGROUND: Aneuploidy is associated with add or lack of individual chromosomes. The knowledge regarding aneuploidy is still rare in wild and tropical populations. Lippia alba is a tropical polyploid complex naturally formed, with 2x, 3x, 4x, 6x, and aneuploid individuals. The species presents pharmacological and medicinal importance, due to its essential oil compounds, which are related to the ploidal level. Considering the singularity of aneuploids emergence and stability, we proposed to investigate putative cytotypes involved in the aneuploids formation. METHODS AND RESULTS: Molecular, cytogenetic, reproductive, and chemical approaches were adopted. The results showed that the aneuploids possibly have independent origin considering the genetic, chemical and karyotypical profiles. The chemical composition of aneuploids is related to genetic similarity. The aneuploid origin may involve 2x and 3x cytotypes being possible to rise four scenarios of crosses to explain that. CONCLUSIONS: The results, in general, contribute to the comprehension of the origin of aneuploids and highlight the genetic profile of these accessions as a key element on the understanding of the chemical profile of L. alba accessions.

Environmentally friendly analysis of sulphonamides in Brazilian honey through automated and miniaturised sample preparation coupled with LC-MS/MS.

Increased use of environmentally friendly practices has become a trend in science because of the current awareness regarding climate change and related issues. Similarly for analytical chemistry, considering the development of greener methods for reducing the use of reagents and samples and also toxic waste generation. To meet such goals, automation, and miniaturisation of sample preparation-a well-recognised laborious and time-consuming analytical step-are two promising strategies. This work associates the greener aspects of miniaturisation and the performance of automated sample preparation. Therefore, we proposed an analytical method using a miniaturised extraction column for pre-concentrating sulphamerazine, sulphamethazine, sulphamethoxazole, sulphadimethoxine, sulphathiazole, and sulphachlorpyridazine from honey and cleaning-up the samples. Several variables were optimised: extractive phase, loading flow, loading phase, and loading time. Under optimised conditions, the method showed adequate linearity between 5.0 and 60 ng g-1 with R > 0.99, and also good selectivity and recovery (114.6-124.1%) which are acceptable according to Brazilian legislation. Intra and inter-day precision were in the range 3.0-5.0%. Although sulphonamides were detected in one of the eight commercial honey samples, the value was below the established MRL. The method showed efficiency, while also exhibiting greener characteristics resulting from miniaturisation and automation, representing a promising environmentally friendly alternative for conventional sample preparation methods.

Chromosomal view of Lippia alba, a tropical polyploid complex under genome stabilization process.

Lippia alba is a phenotypically variable tropical shrub thought to comprise a young autopolyploid complex. Chromosome numbers in L. alba include 2n = 30, 38, 45, 60, and 90. High levels of chemical and phenotypic variation associated with economic and medicinal importance were reported. However, the genetic background including chromosome composition remains under-explored. Furthermore, the occurrence of at least four ploidal levels in L. alba and the lack of data for polyploid plants in tropical areas also merit further study of L. alba. Here we assessed the chromosome composition using two new satellite repeats (CL98 and CL66) applied as FISH probes to mitotic chromosomes, and we proposed to calculate the degree of homozygosis for CL66 satDNA (named as index h) and to associate it to meiotic instability. The CL98 mapping showed few variations in both number of signals and position. However, the levels of structural homozygosity for a satellite repeat CL66 were very variable. The numbers of CL66-bearing-chromosomes were under-represented in tetraploids relative to diploids implying that CL66 arrays have been lost in tetraploid lineages as a result of increased meiotic instability. High percentage of irregularities was observed in meiotic cells, especially in polyploids. L. alba complex comprised a mixture of homomorphic and heteromorphic chromosomes. Overall, the polyploid complex presents features typical of both young and older stable polyploids. It seems that L. alba genome is still in the process of stabilization.

Características anatómicas del asa mandibular evaluada por tomografía computarizada de haz cónico / Anatomical characteristics of the mandibular loop evaluated by cone beam computed tomography

Introducción: El nervio dentario inferior es una estructura anatómica de la mandíbula, la cual presenta variaciones como el asa mandibular, ambas estructuras están relacionadas con iatrogenias con tratamientos como cirugías orales, regeneraciones óseas e implantes. El objetivo del presente estudio es evaluar las características del asa mandibular y el agujero mentoniano utilizando tomografía axial computarizada de haz cónico (CBCT) en pacientes del Postgrado de Periodoncia de la Universidad Autónoma de Nuevo León. Material y métodos: Se analizaron un total de 110 CBCT, de los cuales 61 entraron al estudio cumpliendo con los criterios de inclusión, se realizaron cortes transversales utilizando el software On Demand® para identifi car y medir el asa mandibular y localizar la posición del agujero mentoniano de ambos lados separando los grupos por género. Resultados: La prevalencia del asa mandibular fue de 32.8% de 61 CBCT que se analizaron, se observó más comúnmente en hombres y de manera bilateral, y cuando fue unilateral sólo se encontró en el lado derecho, la longitud promedio fue de 6 ± 1 mm. El agujero mentoniano se detectó en mayor porcentaje apical al segundo premolar inferior con un diámetro promedio de 3.5 ± 0.5 mm, alejándose de la raíz del diente adyacente en un promedio de 6 ± 1 mm y del borde de la mandíbula 12.5 mm ± 0.5 mm. Conclusión: Es de suma importancia identifi car las características anatómicas del asa mandibular y localizar la posición del agujero mentoniano durante la planifi cación del tratamiento para evitar complicaciones durante y después del acto quirúrgico (AU)

Introduction: The inferior dental nerve is an anatomical structure of the mandible which presents variations such as the anterior loop, both structures are related to iatrogenies with treatments such as oral surgeries, bone regenerations and implants. The aim of the present study is to evaluate the characteristics of the anterior loop and the mental foramen using cone beam computed tomography (CBCT) in patients of the Graduate Periodontics Program, School of Dentistry, Universidad Autónoma de Nuevo León. Material and methods: 110 CBCT were analyzed of which 61 entered the study fulfi lling the inclusion criteria, cross sections were made using the On Demand® software to identify and measure the anterior loop and locate the position of the mental foramen both sides separating our groups by gender. Results: The prevalence of the anterior loop was 32.8% of 61 CBCT that were analyzed, it was found more commonly in men and bilaterally, and when it was unilateral only found on the right side, the average length was 6 ± 1 mm. The mental hole was found in greater percentage apical to the second lower premolar with an average diameter of 3.5 ± 0.5 mm, moving away from the root of the adjacent tooth by an average of 6 ± 1 mm and from the edge of the mandible 12.5 ± 0.5 mm. Conclusion: It is very important to locate these anatomical structures during treatment planning and avoid complications during and after the surgical act (AU)

Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument.

BACKGROUND: The Michigan Neuropathy Screening Instrument is an easy-to-use questionnaire aimed at screening and detecting diabetic polyneuropathy. OBJECTIVE: To translate and cross-culturally adapt the MNSI to Brazilian Portuguese and evaluate its measurement properties. METHODS: Two bilingual translators translated from English into Brazilian Portuguese and made a synthetic version. The synthetic version was back translated into English. A committee of specialists and the translator checked the cultural adaptations and developed a pre-final questionnaire in Brazilian Portuguese (prefinal version). In pretesting, the prefinal version was applied to a sample of 34 subjects in which each subject was interviewed to determine whether they understood each item. For the later assessment of measurement properties, 84 subjects were assessed. RESULTS: A final Brazilian Portuguese version of the instrument was produced after obtaining 80% agreement (SEM<0.01%) among diabetic patients and specialists. We obtained excellent intra-rater reliability (ICC3,1=0.90), inter-rater reliability (ICC2,1=0.90) and within-subject reliability ICC3,1=0.80, excellent internal consistency (Cronbach's alpha>0.92), reasonable construct validity for the association between the MNSI and Neuropathy Symptom Score (r=0.46, p<0.05) and excellent association between the MNSI and Neuropathy Disability Score (r=0.79, p<0.05). We did not detect floor and ceiling effects (<9.5% of patients with maximum scores). CONCLUSIONS: The Brazilian Portuguese version of the MNSI is suitable for application in the Brazilian diabetic population and is a reliable tool for the screening and detection of DPN. The MNSI can be used both in clinical practice and also for research purposes.

Carotid artery stenting in a single center, single operator, single type of device and 15 years of follow-up.

BACKGROUND: Revascularization with carotid stent (CAS) is considered the therapeutic alternative to endarterectomy (CEA). However, its role compared to CEA remains questioned, mainly due of the heterogeneity of long-term results. The objective of this study was to report the efficacy and durability of CAS in terms of stroke prevention in a "real world experience". METHOD: This was a single-center retrospective analysis of 344 patients treated with CAS between January 2001 and December 2015.The primary outcome of the trial was stroke, myocardial infarction, or death during a periprocedural period or any stroke event over a 15-year follow-up. The secondary aim was to identify risk factors for 30-day complications, long-term neurological complications, and intra-stent restenosis. RESULTS: The primary composite end point (any stroke, myocardial infarction, or death during the periprocedural period) was 2.3%. The use of an EPD was protective against major complications.Long-term follow-up was achieved in 294 patients (85,5%) with a median of 50 months (range 0-155 months). Fifty-six (16,3%) died within this period, most commonly of nonvascular causes (4 patients had stroke-related deaths). During the follow-up period, 8 strokes and 3 TIAs were diagnosed (3.2%).ISR determined by sequential ultrasound was assessed in 4.4% of the patients and remained asymptomatic in all but 2 patients (0.6%). All patients with restenosis underwent revascularization with balloon angioplasty. CONCLUSION: The long-term follow-up results of our study validate CAS as a safe and durable procedure with which to prevent ipsilateral stroke, with an acceptable rate of restenosis, recurrence and mortality.

Abdomen agudo por aneurisma disecante del tronco celíaco / Acute abdomen caused by a dissecting celiac trunk aneurysm

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rDNA mapping, heterochromatin characterization and AT/GC content of Agapanthus africanus (L.) Hoffmanns (Agapanthaceae).

Agapanthus (Agapanthaceae) has 10 species described. However, most taxonomists differ respect to this number because the great phenotypic plasticity of the species. The cytogenetic has been an important tool to aid the plant taxon identification, and to date, all taxa of Agapanthus L'Héritier studied cytologically, presented 2n = 30. Although the species possess large chromosomes, the group is karyologically little explored. This work aimed to increase the cytogenetic knowledge of Agapanthus africanus (L.) Hoffmanns by utilization of chromosome banding techniques with DAPI / CMA3 and Fluorescent in situ Hybridization (FISH). In addition, flow cytometry was used for determination of DNA content and the percentage of AT / GC nitrogenous bases. Plants studied showed 2n = 30 chromosomes, ranging from 4.34 - 8.55 µm, with the karyotype formulae (KF) = 10m + 5sm. Through FISH, one 45S rDNA signal was observed proximally to centromere of the chromosome 7, while for 5S rDNA sites we observed one signal proximally to centromere of chromosome 9. The 2C DNA content estimated for the species was 2C = 24.4 with 59% of AT and 41% of GC. Our data allowed important upgrade for biology and cytotaxonomy of Agapanthus africanus (L.) Hoffmanns.

Metástasis pulmonar atípica / Atypical Lung Metastasis

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Colecistitis aguda enfisematosa / Emphysematous cholecystitis

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Aneurisma de la arteria pulmonar / Pulmonary Artery Aneurysm

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