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Introducción: El amniocele es una hernia del saco amniótico a través de un defecto en la pared del útero, el cual puede deberse a ruptura uterina, secundario a daños preexistentes, anomalías uterinas o en un útero sin cicatrices. Caso clínico: Presentamos el caso de una paciente de 37 años, con antecedente de dos partos por cesárea, a quien en la semana 25,5 de embarazo se le diagnostica por ecografía amniocele en la pared anterior de útero contenido por la vejiga, además de signos ecográficos de acretismo placentario. La posterior realización de resonancia magnética confirma el diagnóstico. Se realiza manejo expectante con estancia continua intrahospitalaria estricta. Resolución obstétrica a las 34 semanas por cesárea, con extracción fetal por fondo uterino sin complicaciones, con posterior realización de histerectomía con placenta in situ. Conclusiones: Este reporte de caso ilustra la importancia de la identificación temprana de esta condición por ser una complicación infrecuente, pero de grave pronóstico fetomaterno en ausencia de atención inmediata.
Introduction: Amniocele is a hernia of the amniotic sac through a defect in the uterine wall, which can be caused by uterine rupture secondary to preexisting damage, uterine anomalies, or a scarless uterus. Case report: We present a case of a 37-year-old patient with a history of two previous cesarean deliveries. At 25.5 weeks of gestation, the diagnosis of amniocele in the anterior uterine wall, contained by the bladder, along with ultrasound signs of placenta accreta, was confirmed through ultrasound. Subsequent magnetic resonance imaging further confirmed the diagnosis. Expectant management with strict continuous intrahospital stay was implemented. Obstetric resolution was achieved at 34 weeks through cesarean delivery, with uncomplicated fetal extraction through the uterine fundus. Subsequently, a hysterectomy was performed with the placenta left in situ. Conclusions: This case report illustrates the importance of early identification of this condition due to its infrequent but serious feto-maternal prognosis in the absence of immediate attention.
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Humanos , Feminino , Gravidez , Adulto , Placenta Acreta/diagnóstico por imagem , Ultrassonografia Pré-Natal , Placenta Acreta/cirurgia , Ruptura Uterina , Imageamento por Ressonância Magnética , Cesárea , Âmnio , Hérnia/diagnóstico por imagem , HisterectomiaRESUMO
Recent developments in the use of natural product-based molecules as antiparasitic agents for Malaria, leishmaniasis (LE), Chagas disease (CD), and Human African trypanosomiasis (HAT) are reviewed. The role of diverse plants in developing bioactive species is discussed in addition to analyzing the structural diversity of natural products as active agents and the diverse biological applications in CD, HAT, LE, and Malaria. This review focuses on medicinal chemistry, emphasizing the structural characteristics of natural molecules as bioactive agents against parasitic infections caused by Leishmania, Trypanosoma, and Plasmodium parasites.
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Antiprotozoários , Produtos Biológicos , Doença de Chagas , Leishmaniose , Malária , Tripanossomíase Africana , Animais , Humanos , Antiparasitários/farmacologia , Antiparasitários/uso terapêutico , Antiparasitários/química , Antiprotozoários/farmacologia , Antiprotozoários/uso terapêutico , Antiprotozoários/química , Produtos Biológicos/farmacologia , Produtos Biológicos/uso terapêutico , Produtos Biológicos/química , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/parasitologia , Tripanossomíase Africana/tratamento farmacológico , Leishmaniose/tratamento farmacológico , Doença de Chagas/tratamento farmacológico , Malária/tratamento farmacológicoRESUMO
Resumen OBJETIVO: Describir un esquema de atención no quirúrgica en pacientes con embarazo en cicatriz de cesárea en el contexto de un sistema de salud con bajos recursos. Además, describir la tolerancia, vigilancia, evolución y desenlace de cada una de las pacientes tratadas con el esquema propuesto. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo de serie de casos de pacientes que acudieron al servicio de Urgencias de una institución de tercer nivel de atención en Barranquilla, Colombia, entre los meses de mayo de 2020 a marzo 2023 debido a síntomas obstétricos o fueron remitidas a la institución con diagnóstico, confirmado por ultrasonografía, de embarazo en cicatriz de cesárea. Parámetros de estudio: medición de variables sociodemográficas, obstétricas, de evolución clínica y complicaciones maternas. Se efectuó el análisis descriptivo de los datos. RESULTADOS: Se documentaron 11 pacientes que dieron una incidencia de 1.85 casos por cada 5000 embarazos. El dolor pélvico y el sangrado fueron los síntomas más prevalentes. Cinco pacientes tuvieron dos o más cesáreas, el resto una sola previa y cinco antecedente de legrado obstétrico. Nueve de 11 pacientes se atendieron con menos de 8 semanas de embarazo. La tasa de éxito alcanzada fue en las 11 pacientes, con negativización de la beta hCG a los 38.7 días en promedio. No se registraron complicaciones severas ni requerimiento de atención quirúrgica. CONCLUSIONES: Se describió la implementación de un esquema combinado sistémico y local con metotrexato que resultó seguro y efectivo, con preservación de la fertilidad.
Abstract OBJECTIVE: To report a scheme of non-surgical care in patients with cesarean scar pregnancy in the context of a health system with low resources. In addition, to describe the tolerance, monitoring, evolution and outcome of each of the patients treated with the proposed scheme. MATERIALS AND METHODS: Descriptive study of a case series of patients who, between May 2020 and March 2023, attended the emergency room of a tertiary care institution in Barranquilla, Colombia, because of obstetric symptoms or were referred to the institution with a diagnosis of cesarean scar pregnancy confirmed by ultrasound. Study parameters: measurement of sociodemographic, obstetric, clinical evolution and maternal complication variables. Descriptive analysis of data was performed. Results: Eleven patients were documented, giving an incidence of 1.85 cases per 5000 pregnancies. Pelvic pain and bleeding were the most common symptoms. Five patients had two or more previous cesarean sections, the remainder had only one previous cesarean section, and five had a history of obstetric curettage. Nine of the 11 patients were treated at less than 8 weeks'; gestation. The success rate was 100%, with a mean beta-hCG negativity of 38.7 days. There were no major complications and no surgical intervention was required. CONCLUSIONS: We describe the implementation of a combined systemic and local regimen with methotrexate that was safe and effective, with preservation of fertility.
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In situ combustion (ISC) is one of the oldest thermal enhanced oil recovery methods to have been applied in Venezuela to increase the production of highly viscous crude oils, with a first field application in 1959 in the Tia Juana Field-Lake Maracaibo Basin. This method, which is characterized by high energy efficiency, consists of injecting air into the reservoir where exothermic oxidation reactions initiate to increase the mobility of the oil. Compared to other thermal enhanced oil recovery methods such as steam injection, ISC has a lower environmental impact in terms of water and fuel consumption, and emission of gases as the produced gases can be reinjected or stored. Several ISC projects have been carried out in Venezuela in Tia Juana, Morichal, Miga, and Melones fields. Although the technical results have been satisfactory in terms of viscosity reduction and improved crude oil properties (such as °API), other important aspects of project evaluations have not been convincing due to the following factors: high temperatures in producing wells, acid gases management, generation of complex emulsions, corrosion, and high CAPEX and OPEX costs. Nevertheless, additional research work has been conducted on process optimization, using catalysts and hydrogen donors, to better address these other factors. Due to the great need to increase hydrocarbon production in Venezuela and to the advantages of ISC as an upgrading technique where low-carbon fuels and hydrogen as byproducts are generated, this paper presents a revisit of ISC projects in Venezuela from R&D technical aspects to field applications. It seeks to identify the main insights regarding the success and failure of the evaluated projects and make substantiated recommendations in the case of future applications of this technology.
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La placenta acreta se define como una invasión trofoblástica anormal de una parte o de toda la placenta a nivel de las paredes miometriales del útero. La incidencia de acretismo placentario viene cada vez más y más en aumento. El factor de riesgo más común es la presencia de cesárea y la posibilidad de cursar con acretismo placentario aumenta entre más cesáreas tenga la paciente. Hay pocos datos acerca de acretismo placentario localizado en mioma uterino, sobre todo en el contexto de una paciente primigestante. Se presenta el caso de una primigestante tardía, quien cursó con embarazo de alto riesgo dado por acretismo placentario localizado en mioma intramural; asimismo, hacemos una revisión de la literatura acerca del diagnóstico oportuno y pronóstico de esta condición. (provisto por Infomedic International)
Placenta accreta is defined as an abnormal trophoblastic invasion of part or all of the placenta at the level of the myometrial walls of the uterus. The incidence of placental accreta is increasingly on the rise. The most common risk factor is the presence of cesarean section and the likelihood of placental accreta increases the more cesarean sections the patient has. There is little data on placental accreta located in uterine myoma, especially in the context of a primigestational patient. We present the case of a late primigestation, who had a high-risk pregnancy due to placental accreta located in an intramural myoma; we also review the literature on the timely diagnosis and prognosis of this condition. (provided by Infomedic International)
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This paper presents an upper limb exoskeleton that allows cognitive (through electromyography signals) and physical user interaction (through load cells sensors) for passive and active exercises that can activate neuroplasticity in the rehabilitation process of people who suffer from a neurological injury. For the exoskeleton to be easily accepted by patients who suffer from a neurological injury, we used the ISO9241-210:2010 as a methodology design process. As the first steps of the design process, design requirements were collected from previous usability tests and literature. Then, as a second step, a technological solution is proposed, and as a third step, the system was evaluated through performance and user testing. As part of the technological solution and to allow patient participation during the rehabilitation process, we have proposed a hybrid admittance control whose input is load cell or electromyography signals. The hybrid admittance control is intended for active therapy exercises, is easily implemented, and does not need musculoskeletal modeling to work. Furthermore, electromyography signals classification models and features were evaluated to identify the best settings for the cognitive human-robot interaction.
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Thyroid hormones (THs) induce pleiotropic effects in vertebrates, mainly through the activation or repression of gene expression. These mechanisms involve thyroid hormone binding to thyroid hormone receptors, an event that is followed by the sequential recruitment of coactivator or corepressor proteins, which in turn modify the rate of transcription. In the present study, we looked for specific coregulators recruited by the long isoform of the teleostean thyroid hormone receptor beta 1 (L-Trb1) when bound to the bioactive TH, 3,5-T2 (T2). We found that jun activation domain-binding protein1 (Jab1) interacts with L-Trb1 + T2 complex. Using both the teleostean and human TRB1 isoforms, we characterized the Jab1-TRB1 by yeast two-hybrid, pull-down and transactivation assays. Our results showed that the TRB1-Jab1 interaction was ligand dependent and involved the single Jab1 nuclear receptor box, as well as the ligand-binding and N-terminal domains of TRB1. We also provide evidence of ligand-dependent, dual coregulatory properties of Jab1. Indeed, when T2 is bound to L-Trb1 or hTRB1, Jab1 acts as a coactivator of transcription, whereas it has corepressor activity when interacting with the T3-bound S-Trb1 or hTRB1. These mechanisms could explain some of the pleiotropic actions exerted by THs to regulate diverse biological processes.
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Regulação da Expressão Gênica/efeitos dos fármacos , Proteínas/metabolismo , Receptores beta dos Hormônios Tireóideos/metabolismo , Hormônios Tireóideos/farmacologia , Animais , Complexo do Signalossomo COP9 , Linhagem Celular , Relação Dose-Resposta a Droga , Peptídeos e Proteínas de Sinalização Intracelular , Proteínas/genética , Ratos , Receptores dos Hormônios Tireóideos/metabolismoRESUMO
T3 and cortisol activate or repress gene expression in virtually every vertebrate cell mainly by interacting with their nuclear hormone receptors. In contrast to the mechanisms for hormone gene activation, the mechanisms involved in gene repression remain elusive. In teleosts, the thyroid hormone receptor beta gene or thrb produces two isoforms of TRß1 that differ by nine amino acids in the ligand-binding domain of the long-TRß1, whereas the short-TRß1 lacks the insert. Previous reports have shown that the genomic effects exerted by 3,5-T2, a product of T3 outer-ring deiodination, are mediated by the long-TRß1. Furthermore, 3,5-T2 and T3 down-regulate the expression of long-TRß1 and short-TRß1, respectively. In contrast, cortisol has been shown to up-regulate the expression of thrb. To understand the molecular mechanisms for thrb modulation by thyroid hormones and cortisol, we used an in silico approach to identify thyroid- and cortisol-response elements within the proximal promoter of thrb from tilapia. We then characterized the identified response elements by EMSA and correlated our observations with the effects of THs and cortisol upon expression of thrb in tilapia. Our data show that 3,5-T2 represses thrb expression and impairs its up-regulation by cortisol possibly through a transrepression mechanism. We propose that for thrb down-regulation, ligands other than T3 are required to orchestrate the pleiotropic effects of thyroid hormones in vertebrates.
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Di-Iodotironinas/farmacologia , Hidrocortisona/farmacologia , Receptores beta dos Hormônios Tireóideos/genética , Tilápia/metabolismo , Animais , Simulação por Computador , Proteínas de Peixes/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Regiões Promotoras Genéticas , Elementos de Resposta , Transdução de Sinais/efeitos dos fármacos , Receptores beta dos Hormônios Tireóideos/metabolismo , Tilápia/genética , Transcrição Gênica/efeitos dos fármacosRESUMO
The stereospecific removal of iodine from thyroid hormones is an essential first step for T3 action and is catalyzed by three different deiodinases: D2 and D3 remove iodine only from the outer or inner ring, respectively, whereas D1 catalyzes both pathways. We used in silico predictions from vertebrate deiodinase sequences to identify two domains: the N-terminal variable region (VR) containing the transmembrane, hinge and linker domains, and the conserved or globular region (CR). Given the high sequence and structural identity of the CR among paralogs as well as of the VR among orthologs but not paralogs, we hypothesized that both the catalytic properties and the subcellular localization rely on the VR. We used shark D2 and D3 as templates to build the chimeric enzymes D2VR/D3CR and D3VR/D2CR. Biochemical characterization revealed that D3VR/D2CR has inner-ring deiodination activity and T3 as preferred substrate, whereas D2VR/D3CR showed no deiodinating activity. Also, D2VR/D3CR and D3VR/D2CR reside in the endoplasmic reticulum and plasmatic membrane, respectively, as do their D2 and D3 wild-type counterparts. We conclude that the VR determines the subcellular localization and is critical in defining the catalytic properties and activity of thyroid hormone deiodinases.
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Proteínas de Peixes/química , Iodeto Peroxidase/química , Tubarões , Sequência de Aminoácidos , Animais , Domínio Catalítico , Células Cultivadas , Clonagem Molecular , Proteínas de Peixes/metabolismo , Iodeto Peroxidase/metabolismo , Cinética , Dados de Sequência Molecular , Transporte Proteico , Tiroxina/química , Tri-Iodotironina/química , Xenopus laevisRESUMO
Virtual reality (VR) in neurorehabilitation allows to reduce patient's risk and allows him to learn on a faster way. Up to now VR has been used in patients with Parkinson disease (PD) as a research tool and none of the developed systems are used in clinical practice. The goal of this project is to develop a VR-based system for gait therapy, and gait research of patients with PD designed based on published evidence. The developed system uses a digital camera to measure spatiotemporal gait parameters. The software was developed in C#, using Open-Source libraries that facilitates VR programming. The system has potential uses in clinical and research settings.