Hemorrhagic shock secondary to ruptured hypogastric artery pseudoaneurysm. A rare complication of colorectal anastomotic leakage.

Massive bleeding due to rupture of hypogastric artery pseudoaneurysm is an exceptional complication of colorectal anastomotic leakage. A 41-year-old woman with history of rectal cancer surgery, who debuted with massive rectorrhagia and hypovolemic shock due to rupture of a hypogastric artery pseudoaneurysm as a late complication of a colorectal anastomosis leak. The ruptured hypogastric artery pseudoaneurysm should be taken into account in the differential diagnosis of patients with massive rectorrhagia and history of colorectal anastomosis leak. Endovascular embolization is considered the first-line treatment.

La hemorragia masiva por rotura de un pseudoaneurisma de la arteria hipogástrica es una complicación muy rara de la fuga anastomótica colorrectal. Mujer de 41 años con antecedentes de cirugía por cáncer de recto, que debutó con un cuadro de rectorragias masivo y shock hipovolémico secundario a la rotura de un pseudoaneurisma de la arteria hipogástrica como complicación tardía de una fuga de la anastomosis colorrectal. La rotura de un pseudoaneurisma de la arteria hipogástrica se debe tener presente en el diagnostico diferencial de pacientes con rectorragia masiva y antecedentes de dehiscencia de anastomosis colorrectal. La embolización endovascular es actualmente el tratamiento de elección.

Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits.

Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.

Stakeholder governance and sustainability in football: A bibliometric analysis.

This study presents a bibliometric analysis of stakeholder governance and sustainability in football. The PRISMA statement and the main techniques from the existing bibliometric analysis toolbox are applied to guide the research. The analysis includes 127 documents from Scopus and WoS, covering the period from 2007 to mid-2023, to examine the performance analysis and science mapping of the subject over time. The study's key findings highlight publication-related metrics, citation-and-publication-related metrics, co-authorship analysis, and co-word analysis. The analysis also identifies research gaps, including the need to explore barriers to stakeholder governance in football, the application of stakeholder pressure frameworks in football clubs, the examination of mimetic and normative pressures in the context of sustainability and governance in football, and the involvement of stakeholders and football institutions in collaborative efforts to enhance the effectiveness and impact of sustainability initiatives.

Axillary management in patients with breast cancer and positive axilla at diagnosis. Experience in a Spanish university hospital with a 5-year follow-up.

Background: Axillary lymph node dissection (ALND) was the standard in breast cancer with axillary involvement until recently. Along with the number of metastatic nodes, axillary positivity was considered a main prognostic factor and scientific evidence shows that the administration of radiotherapy on ganglion areas decreases the risk of recurrence even in positive axilla. The objective of this study was to evaluate the axillary treatment in patients with positive axilla at diagnosis, the evolution of them over time, and to assess patient's follow-up with the aim of avoiding the morbidity associated with axillary dissection. Methods: A retrospective observational study of breast cancer patients diagnosed between 2010 and 2017 was performed. In total, 1,100 patients were studied, out of which 168 were women with clinically and histologically positive axilla at diagnosis. Seventy-six percent received primary chemotherapy and subsequent treatment with sentinel node biopsy, axillary dissection, or both. Patients with positive sentinel lymph node biopsy received either radiotherapy or lymphadenectomy depending on the year time they were diagnosed. Results: For 60 patients out of 168, neoadjuvant chemotherapy resulted in a complete pathological axillary response. Axillary recurrence was registered for six patients. No recurrence was detected in the biopsy group associated with radiotherapy. These results support the benefit of lymph node radiotherapy for patients with positive sentinel node biopsy after receiving primary chemotherapy. Conclusion: Sentinel node biopsy provides useful and reliable information about cancer staging and might prevent lymphadenectomy, leading to a decrease in morbidity. Pathological response to systemic treatment came out as the most important predictive factor of disease-free survival of breast cancer.

Metaplastic carcinoma of the breast with squamous differentiation: prognostic factors and multidisciplinary treatment.

BACKGROUND: The objective of this study was to analyze the characteristics of patients diagnosed with metaplastic carcinoma of the breast with squamous differentiation and to identify the particular clinical and histological characteristics that need to be taken into account in this type of tumors. CASE PRESENTATION: Retrospective observational study of two patients managed at our hospital between 2014 and 2020 (15 months mean follow-up), plus all cases published in the last 7 years (8 patients). Thus, a total of 10 cases were analyzed, all with less than 2 years mean global survival. Studied variables were: age, medical background, tumor size, axillary involvement, radiological characteristics, surgical approach, complementary treatments, histologic characteristics, and progression of the disease. In 50% of cases, the disease appeared as a palpable mass of rapid growth, associated with axillary infiltration; 80% of the tumors were triple negative; 30% of them progressed to distant metastatic disease in 30%. CONCLUSIONS: This unusual carcinoma requires a complex multidisciplinary treatment. Its prognosis is unfavorable due to its high local aggressiveness, with rapid progression and appearance of metastatic disease. The predominance of different histological components may determine the response to medical treatments.

Post-vaccination SARS-CoV-2 axillary adenopathy. Differences with axillary metastases from breast cancer.

The differential diagnosis of the metastatic axillary lymphadenopathies of breast cancer with which they occur secondary to the Pfizer-BioNTech vaccine against COVID-19, is imperative. In a series of cases, we analyzed the characteristics of unilateral axillary lymphadenopathy in patients after Pfizer-BioNTech vaccination. Axillary lymphadenopathy were observed ipsilateral to the vaccination arm. The axillary ultrasound defined these as reactive and that they disappeared in 3 weeks. The pathological findings were benign. The anamnesis, the place and date of vaccination and the radiological findings, play an essential role to carry out a correct differential diagnosis and follow-up of these adenopathies.

El diagnóstico diferencial de las adenopatías axilares metastásicas del cáncer de mama con las que se producen secundarias a la vacuna de Pfizer-BioNTech contra la COVID-19 es imperioso. Analizamos una serie de casos con las características de las adenopatías axilares unilaterales tras la administración de la vacuna de Pfizer-BioNTech. Se observaron adenopatías axilares homolaterales al brazo de vacunación. La ecografía axilar las definió como reactivas y que desaparecían en 3 semanas. Los hallazgos anatomopatológicos fueron de benignidad. La anamnesis, el lugar y la fecha de vacunación, así como los hallazgos radiológicos, desempeñan un papel esencial para realizar un correcto diagnóstico deferencial y el seguimiento de estas adenopatías.

Microbial Diversity in Cultivated and Feral Vanilla Vanilla planifolia Orchids Affected by Stem and Rot Disease.

The worldwide production of vanilla, a native orchid from Mexico, is greatly affected by stem and root rot disease (SRD), typically associated with Fusarium oxysporum fungi. We hypothesized that the presence of Fusarium species in vanilla is not sufficient for the plant to express symptoms of the disease. We described the taxonomic composition of endophytic microbiomes in symptomatic and asymptomatic vanilla plants using 16S and ITS rDNA metabarcoding, and ITS Sanger sequences generated from fungal isolates. We compared the bacterial and fungal diversity in vanilla plants from a long-term plantation, and from feral plants found near abandoned plantations that did not present SRD symptoms. No significant differences were found in the species richness of the bacterial and fungal microbiome among feral, or asymptomatic and symptomatic cultivated vanilla. However, significant differences were detected in both fungal and bacterial diversity from different organs in the same plant, with roots being more diverse than stems. We found that Proteobacteria and Actinobacteria, as well as the fungal families Nectriaceae and Xylariaceae, constitute the core of the vanilla microbiome that inhabits the root and stem of both cultivated and feral plants. Our work provides information on the microbial diversity associated to root and stem rot in vanilla and lays the groundwork for a better understanding of the role of the microbiome in vanilla fungal diseases.

In vitro cytotoxic potential of extracts from Aristolochia foetida Kunth against MCF-7 and bMECs cell lines.

The aim of this study was to evaluate the cytotoxic potential of Aristolochia foetida Kunth. Stems and leaves of A. foetida Kunth (Aristolochiaceae) have never been investigated pharmacologically. Recent studies of species of the Aristolochiaceae family found significant cytotoxic activities. Hexane, dichloromethane, ethyl acetate and methanol extracts were analyzed by 1H NMR and GC-MS to know the metabolites in each extract. In GC-MS analysis, the main compounds were methyl hexadecanoate (3); hexadecanoic acid (4); 2-butoxyethyl dodecanoate (9); ethyl hexadecanoate (20); methyl octadeca-9,12,15-trienoate (28) and (9Z,12Z,15Z)-octadeca-9,12,15-trienoic acid (40). The results showed a significant reduction in cell viability of the MCF-7 (breast cancer) cell line caused by organic extracts in a dose-dependent manner. The cytotoxicity activity of the dichloromethane extract from the stems (DSE) showed IC50 values of 45.9 µg/mL and the dichloromethane extract of the leaves (DLE) showed IC50 values of 47.3 µg/mL. DSE and DLE had the highest cytotoxic potential in an in vitro study against the MCF-7 cell line and non-tumor cells obtained from the bovine mammary epithelial (bMECs). DSE and DLE induced a loss in mitochondrial membrane potential (ΔΨm) and can cause cell death by apoptosis through the intrinsic pathway in the MCF-7 cell line. DSE and DLE are cytotoxic in cancer cells and cause late apoptosis. Higher concentrations of DSE and DLE are required to induce a cytotoxic effect in healthy mammary epithelial cells. This is the first report of the dichloromethane extract of A. foetida Kunth that induces late apoptosis in MCF-7 cancer cells and may be a candidate for pharmacological study against breast cancer.

Efectividad en reducción de unidades formadoras de colonias con soluciones desinfectantes en tina ultrasónica / Effectiveness in reducing colony forming units with disinfecting solutions in an ultrasonic vat

En la práctica clínica, los odontólogos se encuentran expuestos al riesgo de infecciones, que se transmiten a través de instrumentos contaminados con exudados. Instrumentos en contacto con el personal deben estar esterilizados o sometidos a un proceso de desinfección. Se realizó un estudio transversal-prospectivo a 30 pacientes, de los que se tomaron tres muestras con espejos estériles, pasando por fondo de saco, carrillos y lengua, después las muestras se desinfectaron, se realizó el hisopado de cada espejo y se incubó en agar tripticaseína-soya (TSA) 24 horas a 37 oC. Pasadas 24 horas se realizaron diluciones en tubos Eppendorf, y se sembraron en cajas de Petri con agar sangre, se incubaron por 48 horas a 37 oC; se contabilizaron las unidades formadoras de colonias (UFC) y registraron para su análisis. Al obtener los resultados se encontró que ID 213 tuvo mayor reducción con una media = 62.5 en comparación con Zeta 1 Ultra, media = 89.23, y control, media = 164.50, de igual manera se observó una diferencia en reducción de UFC/mL entre ID 213 con respecto a Zeta 1 Ultra con significancia de 0.012. Ambos desinfectantes resultaron efectivos, pero se estableció que ID 213 utilizando la tina ultrasónica resulta más efectivo en la reducción de UFC, que Zeta 1 Ultra (AU)

In clinical practice, dentists are exposed to the risk of infections, which are transmitted through instruments contaminated with exudates. Instruments in contact with personnel must be sterilized or subjected to a disinfection process. A cross-sectional-prospective study was carried out in 30 patients. From which three samples were taken with sterile mirrors, passing through cul-de-sac, cheeks and tongue, later the samples were disinfected with disinfectants, each mirror was swabbed and incubated in TSA 24 hours at 37 oC. After 24 hours, dilutions were made in Eppendorf tubes, and they were seeded in Petri dishes with blood agar, they were incubated 48 hours at 37 oC; CFUs were accounted for and recorded for analysis. When obtaining the results, it was found that ID 213 had a greater reduction with mean = 62.5 compared to Zeta 1 Ultra mean = 89.23 and control mean = 164.50, in the same way a difference in reduction of CFU/mL was observed between ID 213 with respect to Zeta 1 Ultra with significance of 0.012. Both disinfectants were effective but it was established that ID 213 using the ultrasonic tub is more effective in reducing CFU, than Zeta 1 Ultra (AU)

Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study.

Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636.

Genotyping-By-Sequencing diversity analysis of international Vanilla collections uncovers hidden diversity and enables plant improvement.

Genomics-based diversity analysis of natural vanilla populations is important in order to guide conservation efforts and genetic improvement through plant breeding. Vanilla is a cultivated, undomesticated spice that originated in Mesoamerica prior to spreading globally through vegetative cuttings. Vanilla extract from the commercial species, mainly V. planifolia and V. × tahitensis, is used around the world as an ingredient in foods, beverages, cosmetics, and pharmaceuticals. The global reliance on descendants of a few foundational clones in commercial production has resulted in an industry at heightened risk of catastrophic failure due to extremely narrow genetic diversity. Conversely, national and institutional collections including those near the center of cultivation contain previously undiscovered diversity that could bolster the genetic improvement of vanilla and guide conservation efforts. Towards this goal, an international vanilla genotyping effort generated and analyzed 431,204 single nucleotide polymorphisms among 412 accessions and 27 species from eight collections. Phylogenetic and STRUCTURE analysis sorted vanilla by species and identified hybrid accessions. Principal Component Analysis and the Fixation Index (FST) were used to refine relationships among accessions and showed differentiation among species. Analysis of the commercial species split V. planifolia into three types with all V. × tahitensis accessions being most similar to V. planifolia type 2. Finally, an in-depth analysis of V. × tahitensis identified seven V. planifolia and six V. odorata accessions as most similar to the estimated parental genotypes providing additional data in support of the current hybrid theory. The prevalence of probable V. × tahitensis parental accessions from Belize suggests that V. × tahitensis could have originated from this area and highlights the need for vanilla conservation throughout Central and South America. The genetic groupings among accessions, particularly for V. planifolia, can now be used to focus breeding efforts on fewer accessions that capture the greatest diversity.

Adenocarcinoma of the small intestine in Crohn's disease.

The first case of small-bowel carcinoma (SBC) associated with Crohn's disease (CD) was described by Ginzburg in 1956. Since then, only 220 cases have been published in the literature.

Superior mesenteric vein aneurysm.

A 41-year-old female patient was under study for abdominal pain located in the epigastrium and mesogastrium with no other associated symptoms. There was no record of previous episodes of pancreatitis and she denied abdominal trauma and laboratory tests were normal. A computed tomography (CT) scan was performed.

Novel Sesquiterpenoid Skeletons by Wagner-Meerwein Rearrangements of Longipinane-9,13-diol-1-one Derivatives.

The partial or total hydrolysis of (3R,4S,5S,6S,9R,10R,11R)-9,13-diangeloyloxylongipinan-1-one (1), isolated from the roots of Stevia viscida, gave alcohols 2 or 3, respectively, which were subjected to molecular rearrangements with boron trifluoride etherate. Compound 2 afforded (3R,4R,5R,6S,9R,10S,11S)-11,13-oxyneomorelian-1-one (10) and (4S,5R,6S,8S,10R)-10,13-oxyneojiquilp-2-en-1-one (11), both possessing novel sesquiterpenoid skeletons. In turn, 3 provided (3R,4R,5S,6S,9R,11R)-13-hydroxymoreli-10(14)-en-1-one (7) and 10. Acetylation of 3 gave 4, thus allowing reduction of the C-1 carbonyl group to yield 5, which was rearranged to (1S,3R,4S,5S,6S,9R,10R,11R)-13-acetoxy-9,11-epoxyjiquilpane (6), while an attempt to mesylate 3 directly gave rearranged (3R,4R,5S,6S,9R,11R)-13-mesyloxymoreli-10(14)-en-1-one (8) through expulsion of the C-9 mesylate group by the antiperiplanar C-4-C-10 bond migration to C-4-C-9. In addition, treatment of 1 with boron trifluoride etherate generated (3R,4R,5S,6S,9R,11R)-13-angeloyloxymoreli-10(14)-en-1-one (9). The structures of 2-11 were elucidated by 1D and 2D NMR experiments and those of 2, 3, 8, 10, and 11 were confirmed by single-crystal X-ray diffraction analysis.

Factores de riesgo del cáncer cérvico uterino en adolescentes de la Universidad de Ciencias Médicas de Matanzas / Risk factors of cervical cancer in adolescents of the Matanzas University of Medical Sciences

RESUMEN Introducción: el cáncer cérvico uterino constituye un problema de salud para la humanidad. El estudio de sus factores de riesgo representa prioridad para el sistema de salud cubano. Objetivo: conocer el comportamiento de los factores de riesgo del cáncer cérvico uterino, en estudiantes de las carreras de Higiene-Epidemiología-Vigilancia y Lucha Antivectorial de la Universidad de Ciencias Médicas de Matanzas. Materiales y métodos: investigación descriptiva, transversal, retrospectiva que se insertó en el Programa Ramal Enfermedades Crónicas no Transmisibles. Se trabajó con el universo de 50 alumnos de las carreras de Higiene- Epidemiología-Vigilancia y Lucha Antivectorial de la Universidad de Ciencias Médicas de Matanzas. Resultados: según edad de inicio de las relaciones sexuales, se observó mayor predominio a los 14 años de edad. Presencia de múltiples compañeros sexuales, relaciones sexuales desprotegidas, uso de tabletas anticonceptivas, hábito de fumar, manipulaciones ginecológicas, así como infecciones de transmisión sexual. Especial significación tuvo la evidencia de cifras significativas de múltiples compañeros sexuales y el uso de tabletas anticonceptivas. Entre la distribución de motivos que impulsaron al inicio de relaciones sexuales, se destacaron los de experimentar sensaciones nuevas con el 28 %, y búsqueda de placer con la pareja en 55 %. El 92 %, desconocían los factores de riesgo de la enfermedad. Conclusiones: los estudiantes presentaron factores de riesgo de considerable magnitud de padecer cáncer cérvico uterino (AU).

SUMMARY Introduction: cervical cancer is a health problem for the humankind. The study of its risk factors stands as a priority for the Cuban health system. Objective: to know the behavior of cervical cancer risk factors in students of the studies of Hygiene-Epidemiology-Vector Surveillance and Control of the Matanzas University of Medical Sciences. Materials and methods: retrospective, cross-sectional, descriptive research inserted into the Branch Program of Chronic Non-communicable Diseases. It dealt with the universe of 50 students of the studies of Hygiene-Epidemiology-Vectorial Surveillance and Control of the Matanzas University of Medical Sciences. Results: in relation to the age of beginning to have sexual relationships, it was observed the predominance of the age of 14 years. The presence of multiple sexual partners, unprotected intercourse, use of contraceptive tablets, smoking habit, gynecological manipulations, and sexually transmitted infections are other risk factors found. Special significance had the existence of multiple sexual partners and the use of contraceptive tables. Among the motivations leading to early beginning to have sexual relationships, experiencing new sensations with 28 % and seeking for pleasure with the couple with 55 % stood out. 92 % did not know the disease's risk factors. Conclusions: the students presented pronounced magnitude risk factors of suffering cervical cancer (AU).