Yearlong Near-Syncope: Presentation of a Rare Right Atrial Myxoma.

Atrial myxomas are the most common form of primary benign cardiac tumors. The left atrium is typically the most common location while right atrial myxomas are much rarer and only occur in about 15%-25% of all myxoma patients. Typically, left atrial myxomas have the ability to cause symptoms such as syncope. We report a case of a 67-year-old female who presented with complaints of palpitations, dizziness, and near-syncope that had been ongoing for about a year. Other causes of syncope were investigated and ruled out. A transthoracic echocardiogram (TTE) found a large 4.3 x 4.0 cm spherical mass in the right atrium which was confirmed by surgical resection and immunohistochemistry to be a myxoma. The patient's condition of syncope-like symptoms warrants elevating atrial myxomas to a higher position in the diagnostic differential.

In vitro and in silico studies of the acaricidal and anticholinesterase activities of Randia aculeata seeds against the southern cattle tick Rhipicephalus (Boophilus) microplus.

Rhipicephalus (Boophilus) microplus is a leading cause of significant economic losses in the livestock industry, and tick populations have developed multiple forms of resistance to acaricides; therefore, the potential of novel natural bioactive compounds that are effective for targeting ticks must be addressed. The aim of this study was to evaluate the acaricidal and anticholinesterase activities of R. aculeata seeds and to identify naturally occurring compounds that potentially inhibit anticholinesterase through in silico docking. The acaricidal activity of the extract of R. aculeata seeds against larval and adult R. microplus ticks was assessed through immersion tests. Inhibition of anticholinesterase activity was measured spectrophotometrically. Extracts of R. aculeata seeds showed activity against larvae and engorged females of R. microplus, and a reduction in the reproductive index were also observed. Rutin, chlorogenic acid, quercetin, and epicatechin exhibited noteworthy interactions with the active site residues of RmAChE. These findings could significantly contribute to the exploration of novel natural products that can potentially inhibit RmAChE and could be used in the development of new acaricides for tick control.

Decaimiento de coliformes fecales en lagunas aireadas de plantas de tratamiento de aguas residuales en Lima metropolitana / Decay of fecal coliforms in aerated lagoons of wastewater treatment plants in metropolitan Lima

A nivel mundial, el 44% de las aguas residuales domésticas no se tratan de forma segura, la recolección y tratamiento de aguas residuales, se ha convertido en un desafío, particularmente en áreas urbanas de bajos ingresos dentro de los países en desarrollo, donde las aguas residuales pueden fluir sin tratar a transportes de aguas pluviales o canales de drenaje informales. No es raro encontrar efluentes, desechos sólidos, excretas humanas y descargas líquidas de industrias y hospitales en las aguas superficiales de muchas zonas urbanas de los países en desarrollo. El proceso de tratamiento de aguas residuales puede ser llevado en lagunas mediante reacciones tanto oxidativas como reductoras. En la capa superior de la laguna, donde las aguas residuales son aeróbicas, ocurre el mecanismo convencional de la demanda bioquímica de oxígeno aeróbico (DBO) y se produce la oxidación del amoníaco. La capa inferior de la laguna es anaerobia, y en esta zona tiene lugar la digestión de los sólidos del lodo, un intermedio, la zona facultativa permite la respiración con aceptores de electrones terminales distintos del oxígeno, esto permite reacciones como la desnitrificación. Los gases producidos en las zonas inferiores se estabilizan en la zona aeróbica por disolución oxígeno, y esto reduce los problemas de olores. Este estudio tiene como objetivo, estudiar el descenso de coliformes fecales en lagunas aireadas de plantas de tratamiento de aguas residuales en la ciudad de Lima, Perú. Los resultados señalan que la separación diferencial de las aguas tratadas, experimentó un descenso del 13 al 26% de coleiformes fecales en todas las lagunas de tratamiento(AU)

Globally, 44% of domestic wastewater is not treated safely, and wastewater collection and treatment has become a challenge, particularly in low-income urban areas within developing countries, where wastewater may flow untreated into stormwater conveyances or informal drainage channels. It is not uncommon to find effluents, solid wastes, human excreta, and liquid discharges from industries and hospitals in the surface waters of many urban areas in developing countries. The wastewater treatment process can be carried out in lagoons through both oxidative and reductive reactions. In the upper layer of the lagoon, where the wastewater is aerobic, the conventional mechanism of aerobic biochemical oxygen demand (BOD) occurs and ammonia oxidation occurs. The lower layer of the lagoon is anaerobic, and in this zone the digestion of the sludge solids takes place, an intermediate, the facultative zone allows respiration with terminal electron acceptors other than oxygen, and this allows reactions such as denitrification. The gases produced in the lower zones are stabilized in the aerobic zone by dissolving oxygen, and this reduces odor problems. The objective of this study is to study the decrease of fecal coliforms in aerated lagoons of wastewater treatment plants in the city of Lima, Peru. The results indicate that the differential separation of the treated waters experienced a decrease from 13 to 26% of fecal coleiforms in all treatment lagoons(AU)

Myocarditis following COVID-19 mRNA vaccination.

Messenger RNA vaccines are the main COVID-19 vaccines authorized for use in the United States. Side effects are typically minor and transient. We report a case series of four subjects with an acute myocarditis-like illness following mRNA COVID-19 vaccination who were hospitalized at our hospital in Lubbock, Texas. Three patients were young men who presented with acute chest pain after the second dose of the mRNA-1273 vaccine. Another patient was a 53-year-old white woman who presented with acute left arm pain 3 days after the first dose of the mRNA-1273 vaccine. She was later found to have acute decompensated heart failure, and endomyocardial biopsy revealed eosinophilic injury-mediated myocarditis.

33-year-old HIV-positive patient presenting with primary effusion lymphoma.

Our patient presenting with symptoms of shortness of breath and fever, noncompliant with antiretroviral therapy was found to have a rare HIV-associated non-Hodgkin's lymphoma that carries a dismal prognosis. Early recognition of this condition with prompt treatment may provide a marginal benefit to the patient's overall life expectancy.

Routine Angiographic Follow-Up After Coronary Artery Disease Revascularization: Is Seeing Believing?

PURPOSE OF THE REVIEW: Coronary artery disease is a major cause of mortality and morbidity in the world, and PCI and CABG account for over a million procedures performed annually in the USA. The goal of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is to achieve complete revascularization (CR) if at all possible. However, restenosis and stent thrombosis (ST) remain the Achilles heel of contemporary PCI with restenosis rates between 10 and 30% with bare metal stents to 5-15% after drug-eluting stents and ST rates of around 0.8 vs 1.2%, respectively. Routine angiography after revascularization seems theoretically attractive as this may allow intervention before clinical events occur. In this manuscript, we review the literature regarding routine angiography after PCI or CABG and its outcomes. RECENT FINDINGS: According to the 2016 update from the American Heart Association (AHA), 15.5 million people above the age of 20 have coronary heart disease (CHD) in the USA. The prevalence of CHD is now almost similar in both men and women, and one American suffers from a myocardial infarction (MI) every 42 s. Recent data from randomized clinical trials and observational studies does not support the use of routine coronary angiography after revascularization in asymptomatic patients. There are some studies which show that routine angiography may have a role in left main or complex coronary interventions; however, these findings are exploratory and were not seen in randomized trials. After reviewing the data on routine angiography after coronary revascularization, we came to the conclusion that current data does not support the use of routine angiography for asymptomatic patients. However, there is a lack of randomized controlled trial in this field with only one recent trial reporting negative outcomes.

Actualización en la fisiopatología de la preeclampsia: update

La preeclampsia constituye una de las complicaciones más frecuentes y a la vez más serias de la gestación y contribuye de manera significativa a la mortalidad materna y perinatal. No obstante los avances en el estudio de la preeclampsia, aún no está del todo esclarecido su mecanismo fisiopatológico. En este capítulo, intentamos revisar nuevas teorías propuestas acerca de su fisiopatología. Los aspectos genéticos y angiogénicos serán revisados en otros capítulos de este simposio.

Preeclampsia is one of the most frequent and serious disorders of pregnancy. It is a significant contributor of maternal and perinatal mortality worldwide. An important amount of research has been devoted in the research of preeclampsia in the recent years; nonetheless, its pathophysiology is yet to be completely understood. In this review, we will discuss new proposed theories on the pathophysiology of preeclampsia. Genetic and angiogenic aspects of preeclampsia will be reviewed elsewhere in this issue.

Enfermedad de Paget extramamaria de escroto / Extramammary Paget's disease of scrotum

La enfermedad de Paget es un adenocarcinoma intraepidérmico poco frecuente que se presenta en el complejo areola-pezón o en su forma extramamaria en áreas como las regiones anogenital, perineal y axilar. La enfermedad de Paget extramamaria fue descrita por primera vez en 1889 por Crocker, quien publicó un caso en el área genita1 de un varón. Se presenta el caso de un paciente adulto mayor sin antecedentes patológicos con compromiso del escroto; así como la discusión de la literatura de esta rara enfermedad.

Paget's disease is a rare intraepidermal adenocarcinoma that occurs in the nipple-areola complex or, as its extramammary presentation, in areas such as anogenital, perineal, and axillary regions. Extramammary Paget's disease was first described in 1889 by Crocker, who published a case in the genital area of a male patient. We present a case of an elderly patient without previous medical pathologies, with involvement of the scrotum; and then we discuss the literature of this rare disease.

[Cesarean section: current management of postoperative acute pain. Continuous and intermittent epidural analgesia with and without elastomeric infusion device]. / Cesárea: manejo contemporáneo del dolor agudo postoperatorio. Analgesia epidural continua e intermitente con y sin infusor elastomérico.

OBJECTIVE: To compare the analgesia quality obtained in the management of the acute pain in 50 puerperae post-cesarean section using one of the two therapeutic modalities. The results were evaluated using descriptive and inferential statistics. MATERIAL AND METHOD: Controlled, systematized a clinical trial, carried out from January to June of 2001. REGIMES AND RESULTS: A) Continuous epidural analgesia. With fentanyl citrate plus bupivacaine using a low flow elastomerics infuser (Single day Baxter infuser) 85% referred mild pain in rest or activity; 3% or less in analogic scale visual (VAS) in the first 24 hours of postoperative. B) Intermittent epidural analgesia. With bupivacaine plus intravenous Ketorolaco; 59% of the cases referred mild pain, 32% moderate pain and 9% severe. CONCLUSION: Management of acute pain postcesarean section should be priority with continuous epidural analgesia using the infuser and concentrations of drugs referred in order to minimize the incidence and magnitude of acute postoperative pain.

Parto vaginal en cesareada anterior dos veces. Hospital San Bartolomé / Vaginal delivery in previous cesarean twice. Hospital San Bartolome

Presentamos tres casos de gestantes a término con el antecedente cada una de haber sido cesareada anterior en 2 ocasiones, a quienes se les ofreció la oportunidad de parto por vía vaginal en la gestación actual. Se evalúa y revisa el tipo de cesárea previa, las indicaciones y contraindicaciones para parto vaginal en cesárea anterior, solicitando el consentimiento informado por parte de la paciente. Así mismo, se evalúa el trabajo de parto, el parto y el desarrollo neonatal temprano y tardío.

We present three cases of pregnant women each with history of two previous cesarean sections to whom we offered trial of labor. Following patient’s informed consent, we considered type of previous cesarean section, indications and contraindications for trial of labor, as well as early and late neonatal development care.