Utilidad de la ecocardiografía transesofágica en el diagnóstico de disección aórtica: reporte de un caso

Acute aortic syndrome includes intramural hematoma, penetrating atherosclerotic ulcer, and aortic dissection. The latter is characterized by a tear in the intima of the aorta, which exposes the medial layer, allowing pulsatile blood flow to enter, dissecting it and extending longitudinally, which creates a false lumen and an intimal flap, which can be complicated by aortic rupture. cardiac tamponade, heart failure and sudden death. The case of a patient is reported, in which, thanks to the transesophageal echocardiogram, it was possible to reach a rapid diagnosis and provide urgent treatment without complications.El síndrome aórtico agudo incluye al hematoma intramural, la úlcera aterosclerótica penetrante y la disección aórtica. Esta última se caracteriza por un desgarro en la íntima de la aorta, que expone la capa media, permitiendo la entrada al flujo  sanguíneo  pulsátil, disecándola y extendiéndose longitudinalmente, lo que crea una luz falsa y un flap intimal, pudiendo complicarse con ruptura aórtica, taponamiento cardiaco, insuficiencia cardíaca y muerte súbita. Se reporta el caso de un paciente, en el cual, gracias al ecocardiograma transesofágico se pudo llegar a un diagnóstico rápido y brindar un tratamiento urgente y sin complicaciones

Malt1-Induced Cleavage of Regnase-1 in CD4+ Helper T Cells Regulates Immune Activation

SummaryRegnase-1 (also known as Zc3h12a and MCPIP1) is an RNase that destabilizes a set of mRNAs, including Il6 and Il12b, through cleavage of their 3′ UTRs. Although Regnase-1 inactivation leads to development of an autoimmune disease characterized by T cell activation and hyperimmunoglobulinemia in mice, the mechanism of Regnase-1-mediated immune regulation has remained unclear. We show that Regnase-1 is essential for preventing aberrant effector CD4+ T cell generation cell autonomously. Moreover, in T cells, Regnase-1 regulates the mRNAs of a set of genes, including c-Rel, Ox40, and Il2, through cleavage of their 3′ UTRs. Interestingly, T cell receptor (TCR) stimulation leads to cleavage of Regnase-1 at R111 by Malt1/paracaspase, freeing T cells from Regnase-1-mediated suppression. Furthermore, Malt1 protease activity is critical for controlling the mRNA stability of T cell effector genes. Collectively, these results indicate that dynamic control of Regnase-1 expression in T cells is critical for controlling T cell activation

Naturaleza y cultura en Ámerica Latina

La concreción del XVIII Foro de Estudiantes Latinoamericanos de Antrología y Arqueología: Cultura y naturaleza en América Latina: escenarios para un modelo de desarrollo no civilizatorio, efectuado en Quito desde el 17 al 23 de julio del 2011, se constituyó en un acontecimiento sumamente significativo para la antropología latinoamericana debido a dos motivos. Primero porque coincidió con la emergencia del movimiento universitario estudiantil latinoamericano que expresaba sus tendencias, propuestas y exigencias de cambios tanto de las prácticas académicas como de los patrones civilizatorios que rigen las relaciones actuales. Segundo, porque se inscribía en un contexto de consolidación de las nuevas democracias de los países andinos, de carácter antineoliberal y basadas en los sujetos de derecho entre los cuales se incluye la naturaleza. Estos contextos determinaron que el Foro no ponga en escena certidumbres teóricas o metodológicas, ni se preste al exhibicionismo estéril de los avances disciplinares. Más bien, la convocatoria de la antropología y la arqueología fue apenas un pretexto para hablar, con su lenguaje, de nosotros mismos, de lo que somos, de lo que pensamos, de lo que aspiramos y sentimos sobre nuestra Latinoamérica. Lo que hemos visto, oído y compartido, en realidad, no han sido solamente ideas o conceptos sino opciones y toma de posiciones respecto a múltiples encrucijadas. Posición ante situaciones que amenazan la vida, la justicia y los derechos de todos, un desafío epistemológico todavía en ciernes y que no termina de cuajar aún en nuestras prácticas académicas

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Phosphorylation of the adaptor ASC acts as a molecular switch that controls the formation of speck-like aggregates and inflammasome activity.

炎症応答を制御する新たな仕組みを解明 -慢性炎症や自己炎症性疾患の病態理解に貢献-. 京都大学プレスリリース. 2013-11-04.The inflammasome adaptor ASC contributes to innate immunity through the activation of caspase-1. Here we found that signaling pathways dependent on the kinases Syk and Jnk were required for the activation of caspase-1 via the ASC-dependent inflammasomes NLRP3 and AIM2. Inhibition of Syk or Jnk abolished the formation of ASC specks without affecting the interaction of ASC with NLRP3. ASC was phosphorylated during inflammasome activation in a Syk- and Jnk-dependent manner, which suggested that Syk and Jnk are upstream of ASC phosphorylation. Moreover, phosphorylation of Tyr144 in mouse ASC was critical for speck formation and caspase-1 activation. Our results suggest that phosphorylation of ASC controls inflammasome activity through the formation of ASC specks

Modificar los hábitos de vida que afectan la salud de la población entre los 15 y 60 años en el Departamento de Nariño, disminuyendo los riesgos de padecer Hipertensión Arterial

La hipertensión arterial es el motivo de consulta más frecuente en la población general, especialmente en mayores de 45 años de ambos sexos, para los mayores de 65 años, la diabetes, la hipertensión, y las enfermedades isquémicas del corazón se encuentran entre las diez primeras causas de consulta de los servicios de urgenciasHypertension is the most frequent reason for consultation in the general population, especially in those over 45 years of both sexes, for those over 65, diabetes, hypertension, and ischemic heart disease are among the top ten Reasons for consulting the emergency service