Reporte de caso clínico y revisión bibliográfica de aborto diferido de 17.2 semanas de gestación con implantación en cavidad rudimentaria no comunicante de útero unicorne.

Mullerian congenital anomalies are those that affect the development and morphology of the fallopian tubes, uterus and/or vagina, with or without associated anomalies of the ovary, urinary tract, skeletal or other organs. The normal development of the female reproductive tract involves a series of complex processes characterized by the differentiation, migration, fusion and subsequent channeling of the Müllerian system, although it should be noted that many of the Müllerian anomalies could originate as mesonephric (Wolffian) defects1, They do not include abnormalities or defects of sexual determination, such as chromosomal alterations, or of sexual differentiation, such as pseudohermaphroditism1 The unicornuate uterus with a rudimentary horn is the most infrequent congenital anatomical alteration of the female genital tract caused by the premature arrest of the development of one of the two Müllerian ducts1,. The association of a unicornuate uterus with anomalies of the urinary tract is frequent 1. It is estimated that 0.5% of the general population is a carrier of a congenital uterine anomaly and unicornuate uterus constitutes approximately 5% of uterine malformations9. Missed abortion: Abortion characterized by the retention in the uterine cavity of a dead embryo or fetus; or the arrest of the normal progression of pregnancy, may or may not be accompanied by variable bleeding and crampy pain similar to labor Of childbirth.  Las anomalías congénitas Mullerianas son las que afectan al desarrollo y la morfología de las trompas de Falopio, del útero y/o de la vagina, con o sin anomalías asociadas de ovario, del tracto urinario, esqueléticas o de otros órganos. El desarrollo normal del tracto reproductivo femenino implica una serie de procesos complejos caracterizados por la diferenciación, la migración, la fusión y la posterior canalización del sistema mülleriano, aunque hay que señalar que muchas de las anomalías mullerianas podrían originarse como defectos mesonéfricos (wolffianos). No incluyen anomalías o defectos de la determinación sexual, como alteraciones cromosómicas, o de la diferenciación sexual, como los pseudohermafroditismos1. El útero unicorne con cuerno rudimentario es la alteración anatómica congénita del aparato genital femenino más infrecuente producida por la detención prematura del desarrollo de uno de los dos conductos Müllerianos 1. La asociación de útero unicorne con anomalías del tracto urinario es frecuente se estima que el 0,5% de la población general es portadora de una anomalía uterina congénita y el útero unicorne constituye aproximadamente el 5% de las malformaciones uterinas9. Aborto diferido: Aborto caracterizado por la retención en la cavidad uterina, de un embrión o feto muerto o la detención de la progresión normal del embarazo, puede acompañarse o no de sangrado variable y dolor tipo cólico semejante al de trabajo de parto22

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity