Microsurgical technique for reconstruction of Hemi-uterus with non-communicating rudimentary uterine horns

Case description: Three patients diagnosed with Hemi-uterus with non-communicating functional rudimentary cavity are reported. Clinical findings: Adolescent patients with disabling pelvic pain during menstrual periods, depressive states, and functional disability secondary to pain. Treatment and outcome: Reconstruction of Hemi-uterus with non-communicating functional rudimentary cavity using a microsurgical technique, without the need for non-communicating horn resection. The patients were assessed at the 1st, third, and sixth months, showing a marked improvement in their dysmenorrhea. In addition, there was an improvement in the depressive state; there was no change in the volume of her menstrual bleeding, and one of these patients achieved pregnancy with normal prenatal control and cesarean delivery, obtaining a full-term newborn without complications.  Clinical Relevance: Description of a novel microsurgical technique for the management of the hemi-uterus with a non-communicating functional rudimentary cavity, which could benefit not only the reduction of associated symptoms but could also become an alternative to improve fertility.

Adipose tissue development and lipid metabolism in the human fetus: The 2020 perspective focusing on maternal diabetes and obesity

During development, the human fetus accrues the highest proportion of fat of all mammals. Precursors of fat lobules can be found at week 14 of pregnancy. Thereafter, they expand, filling with triacylglycerols during pregnancy. The resultant mature lipid-filled adipocytes emerge from a developmental programme of embryonic stem cells, which is regulated differently than adult adipogenesis. Fetal triacylglycerol synthesis uses glycerol and fatty acids derived predominantly from glycolysis and lipogenesis in liver and adipocytes. The fatty acid composition of fetal adipose tissue at the end of pregnancy shows a preponderance of palmitic acid, and differs from the mother. Maternal diabetes mellitus does not influence this fatty acid profile. Glucose oxidation is the main source of energy for the fetus, but mitochondrial fatty acid oxidation also contributes. Indirect evidence suggests the presence of lipoprotein lipase in fetal adipose tissue. Its activity may be increased under hyperinsulinemic conditions as in maternal diabetes mellitus and obesity, thereby contributing to increased triacylglycerol deposition found in the newborns of such pregnancies. Fetal lipolysis is low. Changes in the expression of genes controlling metabolism in fetal adipose tissue appear to contribute actively to the increased neonatal fat mass found in diabetes and obesity. Many of these processes are under endocrine regulation, principally by insulin, and show sex-differences. Novel fatty acid derived signals such as oxylipins are present in cord blood with as yet undiscovered function. Despite many decades of research on fetal lipid deposition and metabolism, many key questions await answers.

Coronavirus (COVID 19) Infection in Pregnancy

Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health's teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

5-Nitroimidazole refractory giardiasis is common in Matanzas, Cuba and effectively treated by secnidazole plus high-dose mebendazole or quinacrine: a prospective observational cohort study

OBJECTIVE

To evaluate the effectiveness and tolerability of secnidazole combined with high-dose mebendazole for treatment of 5-nitroimidazole-resistant giardiasis.

METHOD

Adults with microscopically verified Giardia intestinalis monoinfection attending a secondary level hospital in Matanzas City, Cuba were prospectively included in a cohort. A recently introduced treatment ladder consisting of metronidazole as first-line treatment, followed by secnidazole, tinidazole, secnidazole plus mebendazole and quinacrine as second-to fifth-line treatments, respectively, was used. Adverse events and treatment success were determined by questioning and microscopy on concentrated stool samples, respectively on days 3, 5 and 7 after the end of treatment. If G. intestinalis was detected on day 3, 5 or 7, then the infection was classified as refractory and no further microscopy was performed.

RESULTS

A total of 456 individuals were included. Metronidazole, 500 mg three times daily for 5 days, cured 248/456 (54%) patients. A single 2-g secnidazole dose as second-line treatment cured 50/208 (24%) patients. A single 2-g tinidazole dose as third-line treatment cured 43/158 (27%) patients. Three rounds of 5-nitroimidazole therapy therefore cured 341/456 (75%) patients. Secnidazole plus mebendazole (200 mg every 8 hours for 3 days) cured 100/115 (87%) of nitroimidazole refractory infections. Quinacrine cured the remaining 15 patients. All treatments were well tolerated.

CONCLUSIONS

5-Nitroimidazole refractory giardiasis was common, indicating that an alternative first-line treatment may be needed. Retreatment of metronidazole refractory giardiasis with an alternative 5-nitroimidazole was suboptimal, indicating cross-resistance. Mebendazole plus secnidazole were well tolerated and effective for the treatment of 5-nitroimidazole refractory G. intestinalis infection in this setting.

Extreme Maternal Morbidity: a tracer event to improve the quality of obstetric care in Latin America

This article reviews critical aspects that have had an impact on the implementation of epidemiological surveillance of extreme maternal morbidity, as a tracer event of quality maternal care at population and institutional level; taking into account that maternal mortality has been usually monitored, and its analysis allows interventions to avoid maternal death. Until 2015, very few countries had been able to meet the goals established in the Millennium Development Goals (MDGs), especially MDG 5 - improving maternal health. As of today, it is observed that maternal mortality rate is quite heterogeneous, with rates from 1 case per 100,000 live births in developed countries, to more than 100 cases per 100,000 live births in developing countries. Therefore, complementary strategies such as surveillance of the extreme maternal morbidity could offer a more effective alternative to identify and implement interventions that allow us to prevent mortality and strengthen the quality of obstetric care. In addition, the importance of extreme maternal morbidity as a quality tracer event is that, unlike what is observed with maternal mortality, this is an event that occurs more frequently, is anticipatory of death, and the surviving pregnant woman is the primary source of information.

Transitando hacia el ejercicio de autonomía y liderazgo: … «para el posicionamiento hay que luchar»

Introducción: En Chile, las enfermeras/os tienen respaldo legal para gestionar el cuidado, esto facilita el desarrollo de competencias para ejercer autonomía y liderazgo. Actualmente persisten barreras para transitar hacia un reconocimiento real de la independencia profesional. Objetivo: Develar la experiencia vivida de enfermeras con cargos en niveles de jefatura respecto al propio desarrollo para lograr el liderazgo y autonomía profesional. Metodología: Estudio cualitativo descriptivo-interpretativo, desde la trayectoria fenomenológica de Edmund Husserl. Muestreo selectivo de caso homogéneo de tres enfermeras que desempeñaban rol de jefatura en instituciones de salud, región Valparaíso, Chile. Participación consentida. Entrevista no estructurada. Análisis del discurso utilizando el modelo de liderazgo integral de Ken Wilber. Resultados: Categorías: Conciencia del líder «ser inquieta...intelectualmente». Construyendo competencias «el liderazgo se aprende». Transitando hacia el ejercicio de la autonomía y el liderazgo, “para el posicionamiento hay que luchar”. El peso de las estructuras organizacionales «tu rol es parte de un hospital». Interpretación: El eEjercicio del liderazgo y la autonomía se fundamenta en competencias actitudinales por sobre las cognitivas y técnicas. Existe mayor apoyo y reconocimiento a nivel institucional, que al interior del equipo de salud. Persisten limitaciones para lograr máxima expresión del liderazgo y autonomía, por persistencia de modelos institucionales hegemónicos, centrados en decisiones médicas y desconocimiento del rol integrado. Conclusión: El líder se mueve en un escenario dual, entre un menor reconocimiento del equipo y un creciente empoderamiento del rol autónomo y visibilidad a nivel directivo institucional.

Genetic variation at the glycosaminoglycan metabolism pathway contributes to the risk of psoriatic arthritis but not psoriasis

OBJECTIVE

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis affecting up to 30% of patients with psoriasis (Ps). To date, most of the known risk loci for PsA are shared with Ps, and identifying disease-specific variation has proven very challenging. The objective of the present study was to identify genetic variation specific for PsA.

METHODS

We performed a genome-wide association study in a cohort of 835 patients with PsA and 1558 controls from Spain. Genetic association was tested at the single marker level and at the pathway level. Meta-analysis was performed with a case-control cohort of 2847 individuals from North America. To confirm the specificity of the genetic associations with PsA, we tested the associated variation using a purely cutaneous psoriasis cohort (PsC, n=614) and a rheumatoid arthritis cohort (RA, n=1191). Using network and drug-repurposing analyses, we further investigated the potential of the PsA-specific associations to guide the development of new drugs in PsA.

RESULTS

We identified a new PsA risk single-nucleotide polymorphism at B3GNT2 locus (p=1.10e-08). At the pathway level, we found 14 genetic pathways significantly associated with PsA (p_FDR<0.05). From these, the glycosaminoglycan (GAG) metabolism pathway was confirmed to be disease-specific after comparing the PsA cohort with the cohorts of patients with PsC and RA. Finally, we identified candidate drug targets in the GAG metabolism pathway as well as new PsA indications for approved drugs.

CONCLUSION

These findings provide insights into the biological mechanisms that are specific for PsA and could contribute to develop more effective therapies.

Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications

Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.

Effect of Supplemental Corn Dried Distillers Grains with Solubles Fed to Beef Steers Grazing Native Rangeland during the Forage Dormant Season

Two experiments were conducted to evaluate the effects of the level of corn dry distillers grains with solubles (CDDGS) supplementation on growing performance, blood metabolites, digestion characteristics and ruminal fermentation patterns in steers grazing dormant forage. In Exp. 1, of growth performance, 120 steers (204±5 kg initial body weight [BW]) were distributed randomly into 3 groups (each of 40 steers), which were provided with the following levels of CDDGS supplement: 0%, 0.25%, or 0.50% BW. All groups of steers were grazed for 30 days in each of 3 grazing periods (March, April, and May). Approximately 1,000 ha of the land was divided with electric fencing into 3 equally sized pastures (333 ha in size). Blood samples were collected monthly from 20 steers in each grazing group for analysis of glucose (G), urea-nitrogen (UN) and non-esterified fatty acids. Final BW, average daily gain (ADG) and supplement conversion (CDDGS-C) increased with increasing levels of CDDGS supplementation (p<0.05).The CDDGS supplementation also increased the plasma G and UN concentrations (p<0.05). In Exp. 2, of digestive metabolism, 9 ruminally cannulated steers (BW = 350±3 kg) were distributed, following a completely randomized design, into groups of three in each pasture. The ruminally cannulated steers were provided the same levels of CDDGS supplementation as in the growing performance study (0%, 0.25%, and 0.50% BW), and they grazed along with the other 40 steers throughout the grazing periods. The dry matter intake, crude protein intake, neutral detergent fiber intake (NDFI), apparent digestibility of dry matter (ADDM), crude protein (ADCP) and neutral detergent fiber (ADNDF) increased with increasing levels of CDDGS supplementation (p<0.05). The ruminal degradation rates of CP (kdCP), NDF (kdNDF) and passage rate (kp) also increased with increasing levels of CDDGS supplementation (p<0.05). Ruminal ammonia nitrogen (NH₃-N) and propionate concentrations also increased with increasing levels of CDDGS supplementation (p<0.05). However, acetate concentrations decreased with increasing levels of CDDGS supplementation (p<0.05). Liquid dilution rate increased with increasing levels of CDDGS supplementation but ruminal liquid volume decreased (p<0.05). On the basis of these findings, we can conclude that CDDGS supplementation enhanced the productive performance of cattle grazing native rangeland without negatively affecting forage intake, glucose and urea-nitrogen blood concentrations, ruminal degradation and ruminal fermentation patterns.

[A core deficit in Parkinson disease?]

INTRODUCTION

Parkinson disease is a neurodegenerative condition involving motor, cognitive, and linguistic deficits. It is important to know why all these different deficits co-occur in the affected people. This paper aims to clarify whether these comorbid deficits result from the selective impairment of a computational primitive, namely, a context-sensitive computational ability according to Chomsky's Hierarchy (a well-established research tool in comparative neuroscience).

PATIENTS AND METHODS

A total of 15 medicated subjects with Parkinson disease and 15 controls were selected. They were matched in age and education. A battery of tasks was designed to test 3 different domains (motor capacities, cognition, and language) and 2 different computational abilities (context-free and context-sensitive operations).

RESULTS

Significant differences between groups were observed only regarding the linguistic task involving context-sensitive computations (correferences).

CONCLUSIONS

The observed deficits in our patients with Parkinson disease cannot be explained in terms of the selective impairment of one only unspecific, low-level computational process. At the same time, differences between patients and controls are expected to be greater if the former are not medicated. Moreover, we should pursue in the search of (this kind of) computational primitives than can be selectively impaired in people with Parkinson disease, because they may help to achieve an earlier diagnosis of this condition.

A deletion at ADAMTS9-MAGI1 locus is associated with psoriatic arthritis risk

OBJECTIVE

Copy number variants (CNVs) have been associated with the risk to develop multiple autoimmune diseases. Our objective was to identify CNVs associated with the risk to develop psoriatic arthritis (PsA) using a genome-wide analysis approach.

METHODS

A total of 835 patients with PsA and 1498 healthy controls were genotyped for CNVs using the Illumina HumanHap610 BeadChip genotyping platform. Genomic CNVs were characterised using CNstream analysis software and analysed for association using the χ(2) test. The most significant genomic CNV associations with PsA risk were independently tested in a validation sample of 1133 patients with PsA and 1831 healthy controls. In order to test for the specificity of the variants with PsA aetiology, we also analysed the association to a cohort of 822 patients with purely cutaneous psoriasis (PsC).

RESULTS

A total of 165 common CNVs were identified in the genome-wide analysis. We found a highly significant association of an intergenic deletion between ADAMTS9 and MAGI1 genes on chromosome 3p14.1 (p=0.00014). Using the independent patient and control cohort, we validated the association between ADAMTS9-MAGI1 deletion and PsA risk (p=0.032). Using next-generation sequencing, we characterised the 26 kb associated deletion. Finally, analysing the PsC cohort we found a lower frequency of the deletion compared with the PsA cohort (p=0.0088) and a similar frequency to that of healthy controls (p>0.3).

CONCLUSIONS

The present genome-wide scan for CNVs associated with PsA risk has identified a new deletion associated with disease risk and which is also differential from PsC risk.

Three axis vector magnet set-up for cryogenic scanning probe microscopy

We describe a three axis vector magnet system for cryogenic scanning probe microscopy measurements. We discuss the magnet support system and the power supply, consisting of a compact three way 100 A current source. We obtain tilted magnetic fields in all directions with maximum value of 5T along z-axis and of 1.2T for XY-plane magnetic fields. We describe a scanning tunneling microscopy-spectroscopy (STM-STS) set-up, operating in a dilution refrigerator, which includes a new high voltage ultralow noise piezodrive electronics and discuss the noise level due to vibrations. STM images and STS maps show atomic resolution and the tilted vortex lattice at 150 mK in the superconductor β-Bi2Pd. We observe a strongly elongated hexagonal lattice, which corresponds to the projection of the tilted hexagonal vortex lattice on the surface. We also discuss Magnetic Force Microscopy images in a variable temperature insert.

169 INFLUENCE OF TIME BEFORE BOS INDICUS OOCYTE ASPIRATION ON EMBRYO DEVELOPMENTAL COMPETENCE, EXPRESSION OF MATER AND OCT-4, AND FOLLICULAR STEROID CONCENTRATION

The ability of bovine embryos to develop to the blastocyst stage, to implant, and to generate healthy offspring, depends greatly on the oocyte contribution. Oocyte competence is attributed to its close communication with the follicular environment and to its capacity to synthesise and store great amounts of mRNA. Higher developmental competence of bovine oocytes has been associated with the expression of certain genes and with the steroid concentration in the follicular fluid. Hence, the aim of this study was to establish the influence of OCT-4 and MATER mRNA abundance in the oocyte and the influence of progesterone and oestradiol follicular fluid concentration on the competence of bovine oocytes retrieved 30 min or 4 h after slaughter. Cumulus–oocyte complexes (COC) were left in postmortem ovaries for 30 min (Group I) or 4 h (Group II) at 30°C before aspiration. Progesterone and oestradiol concentrations were measured in the follicular fluid in both groups by immunoassay using an Immulite 2000 analyzer. Immature oocytes were evaluated for MATER and OCT-4 mRNA abundance by real-time PCR (total RNA isolated from pools of 100 oocytes per repeat) or were subjected to in vitro maturation (IVM), in vitro fertilization (IVF), and in vitro culture (IVC). For in vitro embryo production, 455 (Group I) and 470 (Group II) COC were used in three repeats. Progesterone concentration was lower (P ≤ 0.05) in Group II than in Group I. Conversely, oestradiol concentration did not vary between groups. Similarly, Group II oocytes exhibited the highest (P < 0.05) MATER and OCT-4 abundance. For embryo development, there were no significant differences between cleavage rates (72 h post-insemination) between both groups. However, blastocyst (168 h post-insemination) and hatching (216 h post-insemination) rates in Group II were greater (P < 0.05) with 21.3 compared with 30.7% and 54.2 compared with 75.3%, respectively. These results indicate that progesterone concentration in the follicle and the abundance of MATER and OCT-4 transcripts could be good predictors of embryo developmental competence and that retrieving COC 4 h after slaughter could increase blastocyst and hatching rates. This work was supported by COLCIENCIAS COD 122852128473 Colombia.

Cold modalities with different thermodynamic properties have similar effects on muscular performance and activation

Although tissue cooling is widely used in the treatment of musculoskeletal injuries there is still controversy about its effects on muscular performance. The combination of cooling and exercise justifies the study of this topic. The aim was to compare the effects of ice pack and cold-water immersion on the muscular performance parameters of plantar flexors and muscular activation of the triceps surae. 41 healthy men (mean age: 22.1 years, SD: 2.9) were randomly assigned to cooling with either ice pack (n=20) or cold-water immersion (n=21). Independent variables were cold modality (ice pack or cold-water immersion) and pre- and post-cooling measurement time. Dependent variables were muscular performance (measured during isometric and concentric contractions of plantar flexors) and electromyography parameters of the triceps surae (median frequency and root mean square amplitude). Dependent-samples t-tests were used to compare pre- and post-cooling data and independent-samples t-tests were used to compare the difference (pre- and post-cooling) between groups. Ice pack increased isometric peak torque (mean: 9.00 Nm, P=0.01) and both cold modalities reduced muscular activation in triceps surae (P<0.0001); Cold-water immersion and ice pack reduced peak torque and total work during dynamic isokinetic contraction at both velocities (mean: -11,00 Nm, P<0.05) and affected muscular activation in different ways. In conclusion, ice pack increases isometric torque, while both ice pack and cold-water immersion decrease concentric muscular performance. These results indicate that these cooling methods should be chosen with caution, considering the type of task required during training or rehabilitation. New studies investigating other muscle groups and joints are necessary.

Chemical Composition, In vitro Gas Production, Ruminal Fermentation and Degradation Patterns of Diets by Grazing Steers in Native Range of North Mexico

The objective of the study was to quantify annual and seasonal differences in the chemical composition, in vitro gas production, in situ degradability and ruminal fermentation of grazing steers’ diets. Diet samples were collected with four esophageal cannulated steers (350±3 kg BW); and four ruminally cannulated heifers (342±1.5 kg BW) were used to study the dry matter degradation and fermentation in rumen. Data were analyzed with repeated measurements split plot design. The crude protein, in vitro dry matter digestibility and metabolizable energy were higher during the first year of trial and in the summer (p<0.01). The values of calcium, phosphorus, magnesium, zinc and copper were higher in summer (p<0.05). The gas produced by the soluble and insoluble fractions, as well as the constant rate of gas production were greater in summer and fall (p<0.01). The ammonia nitrogen (NH₃N) and total volatile fatty acids concentrations in rumen, the soluble and degradable fractions, the constant rate of degradation and the effective degradability of DM and NDF were affected by year (p<0.05) and season (p<0.01). Our study provides new and useful knowledge for the formulation of protein, energetic and mineral supplements that grazing cattle need to improve their productive and reproductive performance.

Risk variants for psoriasis vulgaris in a large case-control collection and association with clinical subphenotypes

Recent genome-wide association studies (GWASs) have identified >20 new loci associated with the susceptibility to psoriasis vulgaris (PsV) risk. We investigated the association of PsV and its main clinical subphenotypes with 32 loci having previous genome-wide evidence of association with PsV (P < 5e-8) or strong GWAS evidence (P < 5e-5 in discovery and P < 0.05 in replication sample) in a large cohort of PsV patients (n = 2005) and controls (n = 1497). We provide the first independent replication for COG6 (P = 0.00079) and SERPINB8 (P = 0.048) loci with PsV. In those patients having developed psoriatic arthritis (n = 955), we found, for the first time, a strong association with IFIH1 (P = 0.013). Analyses of clinically relevant PsV subtypes yielded a significant association of severity of cutaneous disease with variation at LCE3D locus (P = 0.0005) in PsV and nail involvement with IL1RN in purely cutaneous psoriasis (PsC, P = 0.007). In an exploratory analysis of epistasis, we replicated the previously described HLA-C-ERAP1 interaction with PsC. Our findings show that common genetic variants associated with a complex phenotype like PsV influence different subphenotypes of high clinical relevance.

Validation of a new tool to assess health-related quality of life in psoriasis: the PSO-LIFE questionnaire

Background

Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE).

Methods

Observational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes.

Results

The final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach’s alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = −0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting ‘much improved’ health status at study completion was 1.01 (large effect size).

Conclusions

The present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.

Implication of low level inflammation in the insulin resistance of adipose tissue at late pregnancy

Insulin resistance is a characteristic of late pregnancy, and adipose tissue is one of the tissues that most actively contributes to the reduced maternal insulin sensitivity. There is evidence that pregnancy is a condition of moderate inflammation, although the physiological role of this low-grade inflammation remains unclear. The present study was designed to validate whether low-grade inflammation plays a role in the development of insulin resistance in adipose tissue during late pregnancy. To this end, we analyzed proinflammatory adipokines and kinases in lumbar adipose tissue of nonpregnant and late pregnant rats at d 18 and 20 of gestation. We found that circulating and tissue levels of adipokines, such as IL-1β, plasminogen activator inhibitor-1, and TNF-α, were increased at late pregnancy, which correlated with insulin resistance. The observed increase in adipokines coincided with an enhanced activation of p38 MAPK in adipose tissue. Treatment of pregnant rats with the p38 MAPK inhibitor SB 202190 increased insulin-stimulated tyrosine phosphorylation of the insulin receptor (IR) and IR substrate-1 in adipose tissue, which was paralleled by a reduction of IR substrate-1 serine phosphorylation and an enhancement of the metabolic actions of insulin. These results indicate that activation of p38 MAPK in adipose tissue contributes to adipose tissue insulin resistance at late pregnancy. Furthermore, the results of the present study support the hypothesis that physiological low-grade inflammation in the maternal organism is relevant to the development of pregnancy-associated insulin resistance.

Heterotopic pregnancy. Presentation of four cases

Heterotopic pregnancy is defined as intrauterine and extrauterine pregnancy entity coexisting simultaneously and which has been on the rise in recent years with the development of assisted reproductive techniques. We report 4 cases of heterotopic pregnancy, three of them resulting from assisted reproductive technologies and a spontaneous case. We also describe the methods used for diagnosis, therapies and behavior and perinatal outcome.

Differences in the implications of maternal lipids on fetal metabolism and growth between gestational diabetes mellitus and control pregnancies

AIMS

To evaluate the potential contribution of maternal glucose and lipids to fetal metabolic variables and growth in pregnancies with normal glucose tolerance in comparison with pregnancies with well-controlled gestational diabetes previously reported by us.

METHODS

In 190 pregnancies with normal oral glucose tolerance tests (controls), insulin, glucose and lipid components were determined in maternal and arterial cord blood serum. Birthweight and neonatal fat mass were obtained after delivery. Values were adjusted for maternal pre-pregnancy BMI, Caesarean section and gestational age. Measurements were compared with those of gestational diabetes previously reported.

RESULTS

Maternal serum glucose, triacylglycerol, free fatty acid and cholesterol levels did not differ between control pregnancies and those with gestational diabetes, whereas insulin, homeostasis model assessment and glycerol values were significantly lower in the former (2.6 vs. 5.6 μmol/l and 176 vs. 193 μmol/l, respectively). In contrast, cord blood glucose and free fatty acids were significantly lower in control pregnancies than in those with gestational diabetes (3.9 vs. 4.4 mmol/l and 80.7 vs. 137 μmol/l, respectively); the same was valid for insulin (0.03 vs. 0.05 nmol/l) and homeostasis model assessment (1.0 vs. 1.87). In control pregnancies, maternal serum glucose, free fatty acids and glycerol correlated with those in cord blood, but not with neonatal weight and fat mass, as seen for free fatty acids in those with gestational diabetes. The negative correlation between cord blood triacylglycerols and neonatal weight or fat mass previously reported in gestational diabetes could not be confirmed in control pregnancies, where all fetal lipids showed a positive correlation to neonatal anthropometrics.

CONCLUSION

In normal pregnancies, in contrast to those with gestational diabetes, maternal lipids do not influence neonatal weight. Similar levels of maternal lipids in pregnancies with gestational diabetes and control pregnancies, but higher free fatty acids in the cord blood of those with gestational diabetes, indicate their enhanced placental transport and/or enhanced lipolysis as a result of decreased fetal insulin responsiveness.

Myasis in uterine prolapse, successful treatment

We describe the case of an elderly female with total genital prolapse and superinfected uterine myasis. The successful treatment included mechanical extraction of the larvae, antibiotics, and ivermectin (this last one reported for the first time); along with the surgical correction of the prolapse.

Photodynamic therapy in the treatment of extensive Bowen's disease

BACKGROUND

Surgical excision is the preferred method of eradicating Bowen´s disease (BD). Photodynamic therapy (PDT) has been successfully used for treatment of actinic keratosis, basal cell carcinoma, and BD.

OBJECTIVE

Our aim was to evaluate the efficacy and tolerability of PDT for treatment of extensive BD.

METHOD

Eighteen patients with 23 biopsy-proven BD lesions were treated with PDT. We defined as extensive those lesions large than 3 cm. Methyl aminolevulinate cream was applied for 3 h before illumination with an light emitting diode light source at a wavelength of 630 nm (energy density of 37 J/cm²). Treatment was repeated 1 week later.

RESULTS

After 12 weeks of treatment, 22 of 23 BD lesions (90%) showed complete clinical response. Only three lesions recurred after a follow-up period of 12 months. Cosmetic outcome at 12 months was good or excellent in 94% of patients.

CONCLUSION

Methyl aminolevulinate PDT is an effective treatment option for extensive BD with excellent cosmesis.

Isolation of Brucella melitensis from a RB51-vaccinated seronegative goat

The purpose of this study is to determine the etiology of abortions presented in a goat herd declared as free of brucellosis and vaccinated with RB51 located in Mexico. The serological diagnosis of brucellosis in 33 animals was performed. The study included three goats that aborted in the last third of gestation and 15 goats that gave birth normally; samples of milk and vaginal exudate were subjected to bacteriological study. All animals were negative for serological diagnosis, and isolation of Brucella melitensis was achieved in a single goat from vaginal exudate. However, the particularity is that this goat was negative to the card, indirect ELISA, and radial immunodiffusion tests. Isolation of a field strain was confirmed by biochemical test resistance to rifampicin and PCR. It is concluded that a goat which aborted in the last third of gestation was found spreading B. melitensis through vaginal discharge despite being vaccinated with RB51 and seronegative for brucellosis.

[The current challenge of imported leprosy in Spain: a study of 7 cases]

BACKGROUND

although the foci of leprosy once present in Spain are now under control and almost inactive, isolated cases are still occasionally diagnosed. Meanwhile, population migration has brought about an increase in the incidence of cases corresponding to individuals from countries where leprosy is endemic, leading to changes in the epidemiology of this disease.

OBJECTIVES

the aim of this paper was to describe the clinical, epidemiologic, dermatologic, microbiologic, and therapeutic characteristics of cases of leprosy in our department in the last 5 years.

MATERIAL AND METHODS

we report the cases of imported leprosy seen in our department between 2004 and 2009.

RESULTS

seven patients with leprosy (3 men and 4 women; age range, 26-80 years) were diagnosed; 2 were cases of tuberculoid leprosy, 2 borderline tuberculoid leprosy, and 3 indeterminate. All patients acquired the disease in South American or South African countries, but were residing in Spain at the time of diagnosis. One patient was a Spaniard, from Malaga, who had worked as a missionary in Venezuela for 25 years. The presence of the bacterium by either Ziehl-Neelsen stain or bacilloscopy could not be demonstrated in any of the patients.

CONCLUSIONS

we would like to draw attention to the changes we have observed in the characteristics of cases of leprosy seen in our department, the majority of which are imported. It is important to maintain a clinical suspicion of leprosy in cases of granulomatous dermatitis, particularly in patients from countries where the disease is endemic.