Search

• Complete resection of the gastric GIST in a prompt matter must be done to avoid potentially deadly complications. • If there are the necessary tools to enhance the patient's recovery, we shouldn't hesitate to use them. • In emergencies, time is of essence, and surgical services must rise to the challenge. Upper gastrointestinal bleeding is one of the major manifestations of the stomach's gastrointestinal stromal tumors; when gastric GISTs bleed, they are associated with a poor prognosis and must be treated promptly to avoid dangerous complications. A worrisome side effect of the Covid-19 pandemic is the delay in surgical treatment for seriously ill patients, a rise in surgical complications due to delayed care, lack of access to the healthcare system, and patients' hesitancy to seek care due to fear of the virus. In Ecuador, where limitations were present even in the absence of a pandemic, we are yet to fully know the full extent of the damage this pandemic has caused to ourselves and our patients. We present the case of a 51-year-old female; she presented with upper gastrointestinal bleeding, and a gastric GIST was diagnosed. Due to the size and the symptoms, surgery was planned. Nonetheless, as Ecuador was hit hard by the Covid-19 pandemic to cope with the respiratory patients, surgeries were delayed or canceled. Our patient surgery was delayed for five months until she presented with severe gastrointestinal bleeding that required urgent action and care. Thankfully, she completely recovered. This case is an example of the many complications we expect due to the pandemic; delay in treatment leads to troublesome complications. In these emergencies, time is of the essence, and surgical services must rise to the challenge; in a particular way, this case also proves that if there are the necessary tools to enhance the patient's recovery, we should hesitate to use them. Complete resection of the gastric GIST in a prompt matter must be done to avoid these potentially deadly complications. [ABSTRACT FROM AUTHOR]

• Mirizzi Syndrome is a well-recognized syndrome that highlights the infrequent presentations of advanced gallstone disease. • Mirizzi Syndrome is a rare syndrome that can lead to anatomical disturbances and surgical difficulties. • High clinical awareness, an emphasis on the preoperative diagnosis, and safe surgical techniques are vital. Mirizzi syndrome is a type of biliary obstruction caused by an impacted stone in the gallbladder neck or cystic duct that causes and extrinsic obstruction of the common bile duct, this condition if left untreated can lead to duct erosion, fistula, and cholangitis. Preoperative diagnosis is difficult since if not diagnosed correctly can elevate the risk of intraoperative bile duct injury. We present the case of a 61-year-old patient, she presented to our hospital with obstructive jaundice, and a type III Mirizzi syndrome was identified. Preoperative diagnosis was completed, and she was successfully treated using a gallbladder free flap. On follow-ups, the patient is doing well. Mirizzi Syndrome is a rare syndrome that can lead to anatomical disturbances and surgical difficulties due to the hostile territory it creates. High clinical awareness, an emphasis on the preoperative diagnosis, and safe surgical techniques minimizing bile duct injury can improve patients outcome [ABSTRACT FROM AUTHOR]

• Pneumatosis cystoides intestinalis is a rare condition with a broad spectrum of clinical symptoms. • Images are typically striking, which can confuse the medical team and lead to unnecessary procedures. • Close follow up is needed as complications can lead to a troublesome outcome. Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas infiltration into the intestine wall. When gas is seen in the intestinal wall, it is usually a sign of bowel wall infarction and a surgical emergency; therefore, an adequate differentiation of benign and urgent conditions of pneumatosis intestinalis is necessary to prevent misdiagnosis and inadequate therapies. We present the case of a 79-year-old male with past medical history of Alzheimer's, cholecystectomy, and umbilical hernia. PCI was identified, and conservative therapy was started. Since the patient's pain persisted, a complication was suspected, and surgery was decided. After successful treatment, the patient completely recovered. There are many benign and life-threatening causes of pneumatosis intestinalis, the imaging appearance of both may look very similar. Therefore, clinical history, physical examination, and laboratory test results are the best indicators of whether it is due to a benign or life-threatening cause. PCI must be managed with a multidisciplinary team of clinicians, radiologists, and surgeons to achieve better results for our patients. [ABSTRACT FROM AUTHOR]

• Mycotic pseudoaneurysm of the carotid artery is a severe and rare disease. • High clinical awareness is imperative when approaching a mycotic pseudoaneurysm due to its wide spectrum of clinical symptoms, and must always be considered when diagnosing tumors of the neck. • Early detection and prompt treatment are critical as this disease though rare can have a fatal outcome. Mycotic pseudoaneurysm of the carotid artery is a severe and rare disease. When it ruptures, it can produce severe morbidity and high mortality. It presents clinically as a pulsatile mass, usually diagnosable by computed tomography angiography with definitive confirmation achieved by establishing the presence of the pathogen in the tissue sample. We present the case of a 68-year-old male patient with a history of total laryngectomy. He presented with painful and pulsatile mass in his neck and, after precise evaluation, a ruptured carotid mycotic pseudoaneurysm was promptly detected and treated. After a surgical intervention and an adequate course of antibiotics, the patient successfully recovered. Mycotic pseudoaneurysms of the extracranial carotid artery are uncommon and should always be surgically treated. Due to the high risk of potential complications, restoration of the arterial flow should be attempted in all occasions. High clinical awareness is imperative when approaching a mycotic pseudoaneurysm due to its wide spectrum of clinical symptoms, and must always be considered when diagnosing tumors of the neck. Despite its rarity, early detection and prompt treatment are critical to minimize the possibility of a fatal outcome. [ABSTRACT FROM AUTHOR]

• HIV and TB, are a lethal combination in resource-limited countries without adequate follow up. • Intestinal perforation due to TB in an HIV patient is a rare complication and depends on the immune status of the host. • If non-compliance is anticipated when treating TB and HIV, fully supervised therapy should be initiated. Coinfection involving Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis are particularly problematic in resource-limited countries. When both pathogens are present, they accelerate the deterioration of immunological functions in the patient leading to premature death if left untreated. A close follow-up is essential in these high-risk subjects, as inadequate healthcare usually leads to further complications. We present a case of a 26-year-old woman with a past medical history of HIV infection. Nonetheless, she lacked adequate treatment and did not have sufficient medical supervision to control her disease. She presented to the emergency department with an acute abdomen and multiple bowel perforations that demanded intestinal resection. TB/HIV coinfection was detected and a final diagnosis of bowel perforation due to TB was established. A high index of suspicion is essential when approaching patients with HIV and acute abdominal pain. A thorough clinical history examination including past medical history, HIV/AIDS (Acquired immunodeficiency syndrome) progression status, and a careful clinical exam are paramount to an early diagnosis and timely medical treatment. [ABSTRACT FROM AUTHOR]

• Trauma during pregnancy is an important cause of adverse fetal and maternal outcomes. • Gunshot wounds to the gravid uterus are generally lethal for the fetus, and cause significant morbidity to the mother. • Gunshot wounds in a pregnant woman must be handled by a multidisciplinary team. • Training in maternal and infant resuscitative measures and surgical techniques are vital. Gunshot wounds in pregnant women, although rare, represent an important cause of fetal and maternal mortality. Understanding the mechanism of injury is essential to identify the possible injuries and to adequately manage the complexity of these emergency scenarios. We present a case of a 27-year-old woman and her 37 week fetus who were the victims of a gunshot wound. The trajectory of the bullet injured not only the mother but also the developing fetus. An emergency c-section was performed and the bullet was removed from the infant's abdomen. The two patients fully recovered and on follow up controls both patients are doing well. Trauma events, and particularly gunshot wounds in pregnant women requires promptly and adequate intervention. Coordinated efforts from multidisciplinary clinical teams are needed as well as the appropriate training in maternal and infant resuscitative measures and surgical techniques. [ABSTRACT FROM AUTHOR]

The interest for the electrodes based on conductive boron-doped diamond powder (BDDP) is increasing in recent years due to their excellent physical and chemical stability, the wide potential window in both aqueous and organic electrolytes, the relatively large specific surface area, and their versatility in comparison to boron-doped diamond thin film electrodes. These materials have been proposed as alternative cathode catalyst support due to their high corrosion resistance when subjected to the highly positive potentials originated during the start-stop operations in fuel cells, especially in automobiles. In this work, we present three BDDP supports with different particle sizes and different surface oxygen contents as supports of different iron species for oxygen reduction reaction in alkaline solution. BDDP supports were modified with carbon nitride (C 3 N 4) or phthalocyanines (Pc) as anchoring points for iron. The different electrocatalytic performance observed confirmed the strong influence of the surface chemistry of the BDDP supports on the activity of the metallic sites for FePc samples while, for Fe-C 3 N 4 samples, the determining effect was the particle size of the BDDP support. Additionally, DFT calculations were used to obtain some insights about the interaction of the FePc with the diamond surface. [ABSTRACT FROM AUTHOR]

Thoracic outlet syndrome (TOS) is a rare syndrome caused by compression of one of the three neurovascular structures in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the sub coracoid space. The mainstay of management is nonsurgical; however, surgery may be needed when patients persist with symptoms despite conservative management and when vascular structures are involved. Symptoms are non-specific and require high clinical awareness since this pathology tends to affect otherwise healthy young patients. We present the case of a 45-year-old female without any past medical history. She was active and did plenty of exercises. After a high-intensity routine without any guidance, she presented with acute upper limb swelling with pain. After further examination, a venous thoracic outlet syndrome was identified and treated without complications. Venous TOS is a rare pathology associated with high long-term morbidity and disability if left untreated; heightened clinical awareness of the possibility of acute thrombosis obstructing venous return and producing these rare symptoms should lead the medical team to assess the patient further and lead to the appropriate medical and surgical intervention. • Venous TOS is a rare pathology associated with morbidity and disability if left untreated. • Due to its broad spectrum of clinical symptoms, it continues to be a challenge to the medical team • This disorder can affect the subclavian artery, vein, or brachial plexus, resulting in different syndromes. [ABSTRACT FROM AUTHOR]

Abstract: Lipopolysaccharide (LPS), a structural component of Gram-negative bacteria, is implicated in the pathogenesis of endotoxemia/sepsis and multi-organ injury, including liver damage. We have shown that argininosuccinate synthase (ASS), a hepatic enzyme of the urea cycle, accumulates in circulation within 1h after treatment with both LPS alone and hepatotoxic combination of LPS and d-Galactosamine. These findings indicate ASS as a sensitive biomarker of liver responses to bacterial endotoxin. Furthermore, we suggest that the ASS release represents a potential counteracting liver reaction to LPS, and demonstrates anti-LPS activity of recombinant ASS (rASS) in vitro and in rodent models of endotoxemia in vivo. rASS physically bound to LPS, as indicated by a gel shift assay, and suppressed Escherichia coli growth in cultures consistent with direct antimicrobial properties of ASS. rASS reduced LPS cytotoxicity, TNF-α production, and increased cell viability in cultured mouse macrophages, even when added one hour following LPS challenge. Intraperitoneal injection of rASS (5mg/kg) after treatment with a high dose of LPS remarkably increased survival of rodents, with a concomitant decrease of sepsis markers TNF-α, C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels in blood. These results suggest that the endogenous ASS constitutes a novel liver-derived component of the innate immune response to bacterial LPS, and that recombinant ASS could mitigate the lethal effects of bacterial endotoxins during sepsis. [Copyright &y& Elsevier]

Abstract The genome of the sulfate-reducing and anaerobic bacterium Desulfovibrio fructosovorans encodes different hydrogenases. Among them is Hnd, a tetrameric cytoplasmic [FeFe] hydrogenase that has previously been described as an NADP-specific enzyme (Malki et al., 1995). In this study, we purified and characterized a recombinant Strep-tagged form of Hnd and demonstrated that it is an electron-bifurcating enzyme. Flavin-based electron-bifurcation is a mechanism that couples an exergonic redox reaction to an endergonic one allowing energy conservation in anaerobic microorganisms. One of the three ferredoxins of the bacterium, that was named FdxB, was also purified and characterized. It contains a low-potential (E m = −450 mV) [4Fe4S] cluster. We found that Hnd was not able to reduce NADP+, and that it catalyzes the simultaneous reduction of FdxB and NAD+. Moreover, Hnd is the first electron-bifurcating hydrogenase that retains activity when purified aerobically due to formation of an inactive state of its catalytic site protecting against O 2 damage (H inact). Hnd is highly active with the artificial redox partner (methyl viologen) and can perform the electron-bifurcation reaction to oxidize H 2 with a specific activity of 10 μmol of NADH/min/mg of enzyme. Surprisingly, the ratio between NADH and reduced FdxB varies over the reaction with a decreasing amount of FdxB reduced per NADH produced, indicating a more complex mechanism than previously described. We proposed a new mechanistic model in which the ferredoxin is recycled at the hydrogenase catalytic subunit. Highlights • Hnd from Desulfovibrio fructosovorans is an [FeFe] electron-bifurcating hydrogenase. • Hnd catalyzes the simultaneous reduction of NAD+ and ferredoxin. • Hnd forms an O 2 -protected state of its catalytic site (H inact). • During electron-bifurcating reaction, Hnd produces less FdxB red than NADH. [ABSTRACT FROM AUTHOR]

Abstract: The reaction between sulfathiazole and cobalt(II) leads to a pink solid, [CoII(ST)2(H2O)4] (1), which, after 7–10 days in the mother solution, transforms into red crystals of [CoII(ST)2(H2O)3] n (2) (ST=sulfathiazolate). The Co(II) ion exhibits an octahedral environment in both compounds. Differences between them were noted in the IR spectra in the region corresponding to signals of the amine group. Antifungal properties of (1) were evaluated, showing activity against both Aspergillus fumigatus (the same as the ligand) and Aspergillus flavus (better than the ligand). [Copyright &y& Elsevier]