Complicaciones de la preeclampsia severa y su relación con variables demográficas y obstétricas

Introducción: La preeclampsia severa es una de las principales patologías que afectan a las mujeres embarazadas, sus complicaciones tienen un alto impacto en la salud del binomio madre-hijo. Materiales y métodos: Se realizo una serie de casos, durante un periodo de 1 año se revisaron las historias clínicas de las pacientes que ingresaron a la unidad de cuidado intensivo obstétrico de la Clínica Orquídeas, con diagnóstico de preeclampsia severa. Se describieron los datos demográficos y las complicaciones. Se realizó análisis univariado con las variables de interés y se calcularon diferencias significativas por medio del test exacto de Fisher. Resultados: Se registraron 196 pacientes con preeclampsia severa en el periodo de estudio. Las complicaciones mas frecuentes fueron síndrome HELLP (30,6%), insuficiencia renal aguda (16,3%) y edema pulmonar (10,2%); el ingreso de las pacientes con preeclampsia severa a la UCIO en embarazo aumenta el riesgo de sufrir complicaciones. El síndrome de HELLP se presento con mayor frecuencia en pacientes que realizaron 6 o mas controles prenatales (p=0.066). Discusión: Los resultados evidencian una prevalencia de preeclampsia severa mayor que la observada por otros autores, probablemente por ser una UCI exclusivamente obstétrica. Las complicaciones mas frecuentes son concordantes con otros estudios publicados. El mayor riesgo de complicaciones asociadas en pacientes que ingresan embarazadas a la UCIO podría estar en relación a la severidad de la patología. Se requieren estudios analíticos para establecer asociaciones entre cada una de las complicaciones y sus factores condicionantes.

Tratamiento de la ulcera venosa con escleroespuma versus manejo conservador

La úlcera venosa es una revelación clínica severa de la insuficiencia venosa crónica. Es la causa del 54-76% de las úlceras venosas de miembros inferiores. La ciencia médica ha generado diversos procedimientos en el manejo de esta patología, es así como a partir de conocimientos en fisiopatología de la ulceración venosa, se han aplicado procedimientos como opción de tratamiento. Objetivos: Valorar si el uso de rutina de la oclusión endoluminal con espuma guiada por ecografía del sistema venoso superficial insuficiente, en adicción al manejo convencional de la ulcera venosa (vendaje no compresivo, gasa vaselinada y curaciones) podría mejorar la tasa de curación a las 24 semanas de tratamiento. Diseño: Estudio clínico aleatorizado prospectivo de pacientes de la consulta externa de cirugía vascular del Hospital Occidente de Kennedy-Bogotá, durante el 01 de junio del 2011 hasta el 30 junio del 2012. Métodos: Un total de 44 pacientes con ulcera activa que cumplieron criterios de selección ingresaron al estudio, correspondientes a 48 extremidades con clasificación CEAP (C6), los pacientes fueron a aleatorizados a manejo convencional (control) o con manejo adicional de oclusión endoluminal con espuma eco-guiada. El objetivo principal fue el cierre de la ulcera a las 24 semanas. Resultados: La Curación de la ulcera a las 24 semanas de la aleatorización fue de 20 (83.3%) extremidades del grupo de oclusión endoluminal con espuma eco-guiada Vs 3(12.5%) para el grupo de control P: 0.0005 Discusión: Las tasas de curación de la ulcera luego de la oclusión endoluminal con espuma eco-guiada es muy superior al manejo convencional con curaciones y vendaje no compresivo, las tasa de curación son tan altas como las reportadas con sistemas de alta compresión y cirugía a las 24 semanas. La oclusión endoluminal eco-guiada es segura, mínimamente invasiva y clínicamente efectiva.

Procesos de privatización del agua en América Latina: análisis y seguimiento de la interacción estratégica entre movimientos sociales versus multinacionales en Bolivia, Uruguay y México. Período 2000 – 2006

El presente escrito, constituye una aproximación a los procesos de privatización del agua en América Latina. Lo anterior, en el marco de la acción colectiva, específicamente de los movimientos sociales y su interacción estratégica con oponentes como las compañías multinacionales, las organizaciones financieras internacionales y el Estado. Tomando como referencia las luchas ocurridas en Bolivia, Uruguay y México, con especial énfasis en La Guerra del Agua en Cochabamba (Bolivia).

Reinventar un héroe: narrativas sobre los soldados rasos de la Guerra de Corea

Esta investigación se pregunta sobre las diferentes narrativas históricas que se han construido sobre la figura de los soldados rasos de la guerra de Corea, y por cómo ellos han generado estrategias en su relato que se ajustan a unos procesos históricos determinados.

Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Obligación política en el caso del genocidio armenio

La autoridad legítima del soberano y la obligación política del ciudadano constituyen el fundamento del poder del Estado, no obstante, una y otra se ven seriamente cuestionadas ante situaciones de extrema injusticia como lo es el Genocidio. En casos como este la obligación de obedecer la ley por parte del súbdito puede e, incluso, debe ser exceptuada y sustituida por los mandatos de la razón moral. El caso de un tribunal alemán que decide absolver al asesino del principal perpetrador del Genocidio Armenio, desobedeciendo de esta manera la ley penal de su país, apoya la tesis enunciada apoyándose en argumentos de la teoría contractualista de Thomas Hobbes y John Locke. La misma tesis es analizada desde la perspectiva del Juego Limpio, en este caso la conclusión no es tan clara, sin embargo, plantea un nuevo problema sobre el Derecho de los Pueblos que deberá ser abordado en otra instancia.

The use of insect cells to identify potent and selective inhibitors of the replication of the Dengue and Chikungunya viruses and unravel their molecular mechanism of action

Dengue and Chikungunya viruses cause the most important arthropod-borne viral infections for humans. These viruses are predominant in tropical and subtropical regions. In addition, these viruses are predominant in tropical and subtropical regions. Dengue mortality rate is around 1.2 to 3.5% and deaths due to chikungunya fever are around 1 in 1000; however, half of chikungunya-infected patients evolve into a chronic state that can persist for months up to years. There are no antiviral drugs available for DENV and CHIKV treatment and prevention. Moreover, vector control strategies have failed so far. Thus, the development of potent inhibitors for a broad spectrum of RNA viruses is urgently needed. We established and characterized a new embryonic insect cell line from Culex quinquefasciatus mosquito. Also we established the flaviviruses and alphavirus replication, both in C6/36 and Lulo insect cell lines, as well as in Vero cell line. In addition we carried out a reference compound library and reference panel of assays and data for DENV, which provides a benchmark for further studies. During this study, a panel of 9 antiviral molecules, with proven in vitro anti-dengue virus activity and that act at different stages of the DENV life cycle, was selected. Finally, Favipiravir or T-705, was identified as inhibitor in vitro and in vivo of alphaviruses and the mutation K291R in nsP4, which is responsible of the polymerase activity, was found as the mode of action in CHIKV. Interestingly, lysine in motif F1 is also highly conserved in positive-stranded RNA viruses and this might explain the broad spectrum of T-705 antiviral activity.

Resolució de l'estructura tridimensional de l'helicasa hexamètrica DnaB

Es presenta el model atòmic a 4.5 Å de DnaB, la principal helicasa replicativa bacteriana, d'Aquifex aeolicus. És un anell hexamèric de 100 Å d'amplada i 80 Å d'alçada amb dues capes de simetria diferenciada, la dels dominis N-terminals en C3 i la dels C-terminals propera a C6. El diàmetre central és de 25 Å al llarg d'ambdues capes, principal diferència amb les estructures prèvies, on era 25 Å més estret a la capa N-terminal. L'estretament s'origina pel trencament d'una de les dues superfícies d'interacció entre monòmers N-terminals, cosa que augmenta la flexibilitat del subdomini implicat. Només l'ssDNA pot atravessar l'anell, quan a les estructures prèvies hi podia passar tant ssDNA com dsDNA. L'estructura aquí presentada és més propera a la conformació funcional de DnaB durant la realització de l'activitat helicasa, mentre que les anteriors correspondrien a la forma inactiva o a la conformació capaç de translocar-se sobre dsDNA.

Formation and circulation of the cold intermediate layer in the Gulf of Saint Lawrence

[ 1] The local heat content and formation rate of the cold intermediate layer (CIL) in the Gulf of Saint Lawrence are examined using a combination of new in situ wintertime observations and a three-dimensional numerical model. The field observations consist of five moorings located throughout the gulf over the period of November 2002 to June 2003. The observations demonstrate a substantially deeper surface mixed layer in the central and northeast gulf than in regions downstream of the buoyant surface outflow from the Saint Lawrence Estuary. The mixed-layer depth in the estuary remains shallow (< 60 m) throughout winter, with the arrival of a layer of near-freezing waters between 40 and 100 m depth in April. An eddy-permitting ice-ocean model with realistic forcing is used to hindcast the period of observation. The model simulates well the seasonal evolution of mixed-layer depth and CIL heat content. Although the greatest heat losses occur in the northeast, the most significant change in CIL heat content over winter occurs in the Anticosti Trough. The observed renewal of CIL in the estuary in spring is captured by the model. The simulation highlights the role of the northwest gulf, and in particular, the separation of the Gaspe Current, in controlling the exchange of CIL between the estuary and the gulf. In order to isolate the effects of inflow through the Strait of Belle Isle on the CIL heat content, we examine a sensitivity experiment in which the strait is closed. This simulation shows that the inflow has a less important effect on the CIL than was suggested by previous studies.

Seasonal and interannual variability in the Mozambique Channel from moored current observations

Direct observations from an array of current meter moorings across the Mozambique Channel in the south-west Indian Ocean are presented covering a period of more than 4 years. This allows an analysis of the volume transport through the channel, including the variability on interannual and seasonal time scales. The mean volume transport over the entire observational period is 16.7 Sv poleward. Seasonal variations have a magnitude of 4.1 Sv and can be explained from the variability in the wind field over the western part of the Indian Ocean. Interannual variability has a magnitude of 8.9 Sv and is large compared to the mean. This time scale of variability could be related to variability in the Indian Ocean Dipole (IOD), showing that it forms part of the variability in the ocean-climate system of the entire Indian Ocean. By modulating the strength of the South Equatorial Current, the weakening (strengthening) tropical gyre circulation during a period of positive (negative) IOD index leads to a weakened (strengthened) southward transport through the channel, with a time lag of about a year. The relatively strong interannual variability stresses the importance of long-term direct observations.

Generation of candidate human influenza vaccine strains in cell culture: rehearsing the European response to an H7N1 pandemic threat

Background: Although H5N1 avian influenza viruses pose the most obvious imminent pandemic threat, there have been several recent zoonotic incidents involving transmission of H7 viruses to humans. Vaccines are the primary public health defense against pandemics, but reliance on embryonated chickens eggs to propagate vaccine and logistic problems posed by the use of new technology may slow our ability to respond rapidly in a pandemic situation. Objectives: We sought to generate an H7 candidate vaccine virus suitable for administration to humans whose generation and amplification avoided the use of eggs. Methods: We generated a suitable H7 vaccine virus by reverse genetics. This virus, known as RD3, comprises the internal genes of A/Puerto Rico/8/34 with surface antigens of the highly pathogenic avian strain A/Chicken/Italy/13474/99 (H7N1). The multi-basic amino acid site in the HA gene, associated with high pathogenicity in chickens, was removed. Results: The HA modification did not alter the antigenicity of the virus and the resultant single basic motif was stably retained following several passages in Vero and PER. C6 cells. RD3 was attenuated for growth in embryonated eggs, chickens, and ferrets. RD3 induced an antibody response in infected animals reactive against both the homologous virus and other H7 influenza viruses associated with recent infection by H7 viruses in humans. Conclusions: This is the first report of a candidate H7 vaccine virus for use in humans generated by reverse genetics and propagated entirely in mammalian tissue culture. The vaccine has potential use against a wide range of H7 strains.

High-resolution crystal structure of the intramolecular d(TpA) thymine-adenine photoadduct and its mechanistic implications

A high-resolution crystal structure is reported for d(TpA)*, the intramolecular thymine-adenine photoadduct that is produced by direct ultraviolet excitation of the dinucleoside monophosphate d(TpA). It confirms the presence of a central 1,3-diazacyclooctatriene ring linking the remnants of the T and A bases, as previously deduced from heteronuclear NMR measurements by Zhao et al. (The structure of d(TpA)*, the major photoproduct of thymidylyl-(3'-5')-deoxyadenosine. Nucleic Acids Res., 1996, 24, 1554-1560). Within the crystal, the d(TpA)* molecules exist as zwitterions with a protonated amidine fragment of the eight-membered ring neutralizing the charge of the internucleotide phosphate monoanion. The absolute configuration at the original thymine C5 and C6 atoms is determined as 5S,6R. This is consistent with d(TpA)* arising by valence isomerization of a precursor cyclobutane photoproduct with cis-syn stereochemistry that is generated by [2 + 2] photoaddition of the thymine 5,6-double bond across the C6 and C5 positions of adenine. This mode of photoaddition should be favoured by the stacked conformation of adjacent T and A bases in B-form DNA. It is probable that the primary photoreaction is mechanistically analogous to pyrimidine dimerization despite having a much lower quantum yield.

Induction of aquaporin 1 but not aquaporin 4 messenger RNA in rat primary brain microvessel endothelial cells in culture

Aquaporins (AQPs) are a family of proteins that mediate water transport across cells, but the extent to which they are involved in water transport across endothelial cells of the blood-brain barrier is not clear. Expression of AQP1 and AQP4 in rat brain microvessel endothelial cells was investigated in order to determine whether these isoforms were present and, in particular, to examine the hypothesis that brain endothelial expression of AQPs is dynamic and regulated by astrocytic influences. Reverse-transcriptase-polymerase chain reaction (RT-PCR) and immunocytochemistry showed that AQP1 mRNA and protein are present at very low levels in primary rat brain microvessel endothelial cells, and are up-regulated in passaged cells. Upon passage, endothelial cell expression of mdr1a mRNA is decreased, indicating loss of blood-brain barrier phenotype. In passage 4 endothelial cells, AQP1 mRNA levels are reduced by coculture above rat astrocytes, demonstrating that astrocytic influences are important in maintaining the low levels of AQP1 characteristic of the blood-brain barrier endothelium. Reverse-transcriptase-PCR revealed very low levels of AQP1 mRNA present in the RBE4 rat brain microvessel endothelial cell line, with no expression detected in primary cultures of rat astrocytes or in the C6 rat glioma cell line. In contrast, AQP4 mRNA is strongly expressed in astrocytes, but no expression is found in primary or passaged brain microvessel endothelial cells, or in RBE4 or C6 cells. Our results support the concept that expression of AQP1, which is seen in many non-brain endothelia, is suppressed in the specialized endothelium of the blood-brain barrier.

Surrounding buildings and wind pressure distribution on a high-rise building

The effect of the surrounding lower buildings on the wind pressure distribution on a high-rise building is investigated by computational fluid dynamics (CFD). When B/H=0.1, it is found that the wind pressure on the windward side was reduced especially on the lower part, but for different layers of surrounding buildings, there was no great difference, which agrees with our previous wind tunnel experiment data. Then we changed the aspect ratio from 0.1 to 2, to represent different airflow regimes: skimming flow (SF), and wake interference (WI). It shows that the average Cp increases when B/H increases. For different air flow regimes, it is found that insignificant difference exists when the number of the building layers is more than 2. From the engineering point of view, it is sufficient to only include the first layer for natural ventilation design by using CFD simulation or wind tunnel experiment.

Asymmetric synthesis of peptides

The present invention provides a process comprising substitution of an acceptor molecule comprising a group -XC(O)- wherein X is O, S or NR8, where R8 is C1-6 alkyl, C6-12 aryl or hydrogen, with a nucleophile, wherein the acceptor molecule is cyclised such that said nucleophilic substitution at -XC (O)- occurs without racemisation. This process has particular application for the production of a peptide by extension from the activated carboxy-terminus of an acyl amino acid residue without epimerisation.