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Gómez-Gutiérrez AK, Morelos-Ulibarri A, Trejo-Ponce de Leon D, Gomez-Flores CD, Luna-Ceron E. Bacterial Brain Abscesses in a Patient With Transposition of the Great Arteries and Interventricular Communication. Cureus 2023; 15:e47119. [PMID: 38021873 PMCID: PMC10648060 DOI: 10.7759/cureus.47119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Brain abscesses are localized infections in the brain's parenchyma, characterized by inflammation, pus formation, and the development of a surrounding capsule. These lesions typically occur due to underlying factors such as immunosuppression, ear and sinus infections, and contamination during neurosurgery. While brain abscesses are a life-threatening complication of cyanotic heart defects, they are rarely reported, with only sporadic cases previously documented. This article presents the case of an eight-year-old male patient with an uncorrected transposition of the great arteries, who was evaluated for symptoms including headache, fever, and neurological focalization. Diagnostic imaging revealed three lesions consistent with brain abscesses. Furthermore, the causal agents were identified as Streptococcus intermedius and Fusobacterium spp., representing oral microorganisms. Additionally, the patient exhibited poor oral hygiene and dental caries in multiple teeth. This article discusses and integrates the possible pathophysiological mechanisms that allowed a localized dental infection to spread hematogenously and cause brain abscesses in this patient. Prompt management of the infectious source is crucial to prevent a poor prognosis associated with brain abscesses. Therefore, this case emphasizes the importance of regular dental assessments and thromboprophylaxis for patients with underlying cardiomyopathies that cause right-to-left shunting to prevent potential complications.
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Affiliation(s)
| | - Araceli Morelos-Ulibarri
- Department of Bronchial Hyperreactivity, National Institute of Respiratory Diseases, Mexico City, MEX
| | | | | | - Eder Luna-Ceron
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, USA
- Laboratory of Cardiovascular Medicine and Metabolomics, Hospital Zambrano Hellion, Monterrey, MEX
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Hassan S, Wang T, Shi K, Huang Y, Urbina Lopez ME, Gan K, Chen M, Willemen N, Kalam H, Luna-Ceron E, Cecen B, Elbait GD, Li J, Garcia-Rivera LE, Gurian M, Banday MM, Yang K, Lee MC, Zhuang W, Johnbosco C, Jeon O, Alsberg E, Leijten J, Shin SR. Self-oxygenation of engineered living tissues orchestrates osteogenic commitment of mesenchymal stem cells. Biomaterials 2023; 300:122179. [PMID: 37315386 PMCID: PMC10330822 DOI: 10.1016/j.biomaterials.2023.122179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
Oxygenating biomaterials can alleviate anoxic stress, stimulate vascularization, and improve engraftment of cellularized implants. However, the effects of oxygen-generating materials on tissue formation have remained largely unknown. Here, we investigate the impact of calcium peroxide (CPO)-based oxygen-generating microparticles (OMPs) on the osteogenic fate of human mesenchymal stem cells (hMSCs) under a severely oxygen deficient microenvironment. To this end, CPO is microencapsulated in polycaprolactone to generate OMPs with prolonged oxygen release. Gelatin methacryloyl (GelMA) hydrogels containing osteogenesis-inducing silicate nanoparticles (SNP hydrogels), OMPs (OMP hydrogels), or both SNP and OMP (SNP/OMP hydrogels) are engineered to comparatively study their effect on the osteogenic fate of hMSCs. OMP hydrogels associate with improved osteogenic differentiation under both normoxic and anoxic conditions. Bulk mRNAseq analyses suggest that OMP hydrogels under anoxia regulate osteogenic differentiation pathways more strongly than SNP/OMP or SNP hydrogels under either anoxia or normoxia. Subcutaneous implantations reveal a stronger host cell invasion in SNP hydrogels, resulting in increased vasculogenesis. Furthermore, time-dependent expression of different osteogenic factors reveals progressive differentiation of hMSCs in OMP, SNP, and SNP/OMP hydrogels. Our work demonstrates that endowing hydrogels with OMPs can induce, improve, and steer the formation of functional engineered living tissues, which holds potential for numerous biomedical applications, including tissue regeneration and organ replacement therapy.
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Affiliation(s)
- Shabir Hassan
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA; Department of Biology, College of Arts and Sciences, Khalifa University (Main Campus), Abu Dhabi, P.O. Box, 127788, United Arab Emirates; Advanced Materials Chemistry Center (AMCC), Khalifa University (SAN Campus), Abu Dhabi, P.O. Box, 127788, United Arab Emirates
| | - Ting Wang
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA; Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, China
| | - Kun Shi
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA; Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yike Huang
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Maria Elizabeth Urbina Lopez
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Kaifeng Gan
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Mo Chen
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Niels Willemen
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA; Leijten Lab, Department of Developmental Bioengineering, Faculty of Science and Technology, TechMed Centre, University Twente, Enschede, 7522 NB, the Netherlands
| | - Haroon Kalam
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA, 02139, USA
| | - Eder Luna-Ceron
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Berivan Cecen
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Gihan Daw Elbait
- Department of Biology, College of Arts and Sciences, Khalifa University (Main Campus), Abu Dhabi, P.O. Box, 127788, United Arab Emirates
| | - Jinghang Li
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Luis Enrique Garcia-Rivera
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Melvin Gurian
- Leijten Lab, Department of Developmental Bioengineering, Faculty of Science and Technology, TechMed Centre, University Twente, Enschede, 7522 NB, the Netherlands
| | - Mudassir Meraj Banday
- Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Kisuk Yang
- Center for Nanomedicine, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Division of Bioengineering, College of Life Sciences and Bioengineering, Incheon National University, Incheon, 22012, Republic of Korea
| | - Myung Chul Lee
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Weida Zhuang
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Castro Johnbosco
- Leijten Lab, Department of Developmental Bioengineering, Faculty of Science and Technology, TechMed Centre, University Twente, Enschede, 7522 NB, the Netherlands
| | - Oju Jeon
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Eben Alsberg
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60612, USA; Departments of Orthopaedic Surgery, Pharmacology and Regenerative Medicine, and Mechanical and Industrial Engineering, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Jeroen Leijten
- Leijten Lab, Department of Developmental Bioengineering, Faculty of Science and Technology, TechMed Centre, University Twente, Enschede, 7522 NB, the Netherlands.
| | - Su Ryon Shin
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA.
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Huerta-Delgado AS, Roffe-Vazquez DN, Luna-Ceron E, Gonzalez-Gil AM, Casillas-Fikentscher A, Villarreal-Calderon JR, Enriquez C, de la Peña-Almaguer E, Castillo EC, Silva-Platas C, Garcia-Rivas G, Elizondo-Montemayor L. Association of irisin levels with cardiac magnetic resonance, inflammatory, and biochemical parameters in patients with chronic heart failure versus controls. Magn Reson Imaging 2022; 93:62-72. [PMID: 35842196 DOI: 10.1016/j.mri.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Chronic heart failure (CHF) represents a significant cause of morbidity and mortality globally. Metabolic maladaptation has proven to be critical in the progression of this condition. Preclinical studies have shown that irisin, an adipomyokine involved in metabolic regulations, can induce positive cardioprotective effects by improving cardiac remodeling, cardiomyocyte viability, calcium delivery, and reducing inflammatory mediators. However, data on clinical studies identifying the associations between irisin levels and functional imaging parameters are scarce in CHF patients. The objective of this study was to determine the association of irisin levels with cardiac imaging measurements through cardiac magnetic resonance, inflammatory markers, and biochemical parameters in patients with CHF compared with control subjects. METHODS AND RESULTS Thirty-two subjects diagnosed with CHF and thirty-two healthy controls were evaluated in a cross-sectional study. Serum irisin levels were significantly lower in patients with CHF than in controls. This is the first study to report a significant positive correlation between irisin levels and cardiac magnetic resonance parameters such as left ventricular ejection fraction, fraction shortening, and global radial strain. A negative correlation was demonstrated between irisin levels and brain natriuretic peptide, insulin levels, and Homeostatic model assessment for insulin resistance index. We did not observe significant correlations between irisin levels and inflammatory cytokines. CONCLUSIONS Given the importance of fraction shortening and global radial strain as accurate markers of ventricular wall motion, these results support the hypothesis that irisin may play an essential role in maintaining an adequate myocardial wall architecture, deformation, and thickness.
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Affiliation(s)
- Anna S Huerta-Delgado
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico
| | - Daniel N Roffe-Vazquez
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico
| | - Eder Luna-Ceron
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico
| | - Adrian M Gonzalez-Gil
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico
| | - Andrea Casillas-Fikentscher
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico
| | - José R Villarreal-Calderon
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico
| | - Cecilio Enriquez
- Tecnologico de Monterrey, Centro de Investigacion Biomedica, Hospital Zambrano Hellion, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Erasmo de la Peña-Almaguer
- Tecnologico de Monterrey, Centro de Investigacion Biomedica, Hospital Zambrano Hellion, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Elena C Castillo
- Tecnologico de Monterrey, Centro de Investigacion Biomedica, Hospital Zambrano Hellion, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Christian Silva-Platas
- Tecnologico de Monterrey, Centro de Investigacion Biomedica, Hospital Zambrano Hellion, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Gerardo Garcia-Rivas
- Tecnologico de Monterrey, Centro de Investigacion Biomedica, Hospital Zambrano Hellion, 66278 San Pedro Garza-Garcia, N.L., Mexico; Tecnologico de Monterrey, Cardiovascular Medicine and Metabolomics Research Group, Escuela de Medicina, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Leticia Elizondo-Montemayor
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico; Tecnologico de Monterrey, Cardiovascular Medicine and Metabolomics Research Group, Escuela de Medicina, 66278 San Pedro Garza-Garcia, N.L., Mexico.
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4
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Luna-Ceron E, González-Gil AM, Elizondo-Montemayor L. Current Insights on the Role of Irisin in Endothelial Dysfunction. Curr Vasc Pharmacol 2022; 20:205-220. [PMID: 35538838 DOI: 10.2174/1570161120666220510120220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/29/2021] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction is a crucial physiopathological mechanism for cardiovascular diseases that results from the harmful impact of metabolic disorders. Irisin, a recently discovered adipomyokine, has been shown to exert beneficial metabolic effects by increasing energy consumption, improving insulin sensitivity, and reducing the proinflammatory milieu. Multiple preclinical models have assessed irisin's possible role in the development of endothelial dysfunction, displaying that treatment with exogenous irisin can decrease the production of oxidative stress mediators by up-regulating Akt/mTOR/Nrf2 pathway, promote endothelial-dependent vasodilatation through the activation of AMPK-PI3K-Akt-eNOS pathway, and increase the endothelial cell viability by activation of ERK proliferation pathway and downregulation of Bad/Bax/Caspase 3 pro-apoptotic pathway. However, there is scarce evidence of these mechanisms in clinical studies, and available results are controversial. Some have shown negative correlations of irisin levels with the burden of coronary atherosclerosis and leukocyte adhesion molecules' expression. Others have demonstrated associations between irisin levels with increased atherosclerosis risk and higher carotid intima-media thickness. Since the role of irisin in endothelial damage remains unclear, in this review, we compare, contrast, and integrate the current knowledge from preclinical and clinical studies to elucidate the potential preventive role and the underlying mechanisms and pathways of irisin in endothelial dysfunction. This review also comprises original figures to illustrate these mechanisms.
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Affiliation(s)
- Eder Luna-Ceron
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico.,Tecnologico de Monterrey, Cardiovascular Medicine and Metabolomics Research Group, Escuela de Medicina, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Adrian M González-Gil
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico.,Tecnologico de Monterrey, Cardiovascular Medicine and Metabolomics Research Group, Escuela de Medicina, 66278 San Pedro Garza-Garcia, N.L., Mexico
| | - Leticia Elizondo-Montemayor
- Tecnologico de Monterrey, Center for Research in Clinical Nutrition and Obesity, Escuela de Medicina, 64710 Monterrey, N.L., Mexico.,Tecnologico de Monterrey, Cardiovascular Medicine and Metabolomics Research Group, Escuela de Medicina, 66278 San Pedro Garza-Garcia, N.L., Mexico
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5
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Gómez-Gutiérrez AK, Flores-Camargo AA, Casillas Fikentscher A, Luna-Ceron E. Primary Varicella or Herpes Zoster? An Educational Case Report From the Primary Care Clinic. Cureus 2022; 14:e23732. [PMID: 35509746 PMCID: PMC9057244 DOI: 10.7759/cureus.23732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Varicella-zoster virus is a pathogenic virus that can present itself as a primary infection or secondary infection, also known as herpes zoster. Recently, there has been a re-emergence of this vaccine-preventable disease due to gaps in vaccination. Primary varicella in immunocompetent adults is highly uncommon, and it could result in severe complications within this population. Given this delicate scenario, family physicians should be well trained to recognize the characteristic cutaneous lesions of varicella and dictate adequate management for these patients to obtain the best possible outcome and prevent life-threatening complications. We present the case of a 43-year-old immunocompetent woman with the onset of a generalized pruritic dermatosis characterized primarily by the presence of macules, vesicles, and crusts. The patients' lesions were compatible with primary varicella, and serological studies confirmed the diagnosis. Given the absence of acute complications in this individual, supportive treatment and close follow-up were the therapeutic modalities. This article focuses on the educational discussion of the primary differential diagnosis, evaluation for possible complications, and management of this uncommon clinical scenario. We also reinforce the importance of immunization in preventing re-emergent diseases as a critical element within primary care management.
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6
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Morsink M, Severino P, Luna-Ceron E, Hussain MA, Sobahi N, Shin SR. Effects of electrically conductive nano-biomaterials on regulating cardiomyocyte behavior for cardiac repair and regeneration. Acta Biomater 2022; 139:141-156. [PMID: 34818579 PMCID: PMC11041526 DOI: 10.1016/j.actbio.2021.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
Myocardial infarction (MI) represents one of the most prevalent cardiovascular diseases, with a highly relevant and impactful role in public health. Despite the therapeutic advances of the last decades, MI still begets extensive death rates around the world. The pathophysiology of the disease correlates with cardiomyocyte necrosis, caused by an imbalance in the demand of oxygen to cardiac tissues, resulting from obstruction of the coronary flow. To alleviate the severe effects of MI, the use of various biomaterials exhibit vast potential in cardiac repair and regeneration, acting as native extracellular matrices. These hydrogels have been combined with nano sized or functional materials which possess unique electrical, mechanical, and topographical properties that play important roles in regulating phenotypes and the contractile function of cardiomyocytes even in adverse microenvironments. These nano-biomaterials' differential properties have led to substantial healing on in vivo cardiac injury models by promoting fibrotic scar reduction, hemodynamic function preservation, and benign cardiac remodeling. In this review, we discuss the interplay of the unique physical properties of electrically conductive nano-biomaterials, are able to manipulate the phenotypes and the electrophysiological behavior of cardiomyocytes in vitro, and can enhance heart regeneration in vivo. Consequently, the understanding of the decisive roles of the nano-biomaterials discussed in this review could be useful for designing novel nano-biomaterials in future research for cardiac tissue engineering and regeneration. STATEMENT OF SIGNIFICANCE: This study introduced and deciphered the understanding of the role of multimodal cues in recent advances of electrically conductive nano-biomaterials on cardiac tissue engineering. Compared with other review papers, which mainly describe these studies based on various types of electrically conductive nano-biomaterials, in this review paper we mainly discussed the interplay of the unique physical properties (electrical conductivity, mechanical properties, and topography) of electrically conductive nano-biomaterials, which would allow them to manipulate phenotypes and the electrophysiological behavior of cardiomyocytes in vitro and to enhance heart regeneration in vivo. Consequently, understanding the decisive roles of the nano-biomaterials discussed in the review could help design novel nano-biomaterials in future research for cardiac tissue engineering and regeneration.
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Affiliation(s)
- Margaretha Morsink
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Cambridge, MA 02139, United States of America; Translational Liver Research, Department of Medical Cell BioPhysics, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, Netherlands; Department of Developmental BioEngineering, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
| | - Patrícia Severino
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Cambridge, MA 02139, United States of America; University of Tiradentes (Unit), Biotechnological Postgraduate Program. Av. Murilo Dantas, 300, 49010-390 Aracaju, Brazil; Institute of Technology and Research (ITP), Nanomedicine and Nanotechnology Laboratory (LNMed), Av. Murilo Dantas, 300, 49010-390 Aracaju, Brazil; Tiradentes Institute, 150 Mt Vernon St, Dorchester, MA 02125, United States of America
| | - Eder Luna-Ceron
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Cambridge, MA 02139, United States of America
| | - Mohammad A Hussain
- Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah 21569, Saudi Arabia
| | - Nebras Sobahi
- Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah 21569, Saudi Arabia
| | - Su Ryon Shin
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Cambridge, MA 02139, United States of America.
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7
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Valdez-Garcia JE, Dominguez-Cherit G, Luna-Ceron E, Pherez-Farah A, Muzquiz-Aguirre S, Mancilla-Ortega JP, Vichi-Lima LJ, Montejo-Romo SJ, Bonilla-Hernandez R, Arizpe-Vilana D, Jimenez-Becerril K, Rios-Barrientos E, Garibay-Huarte TR, Jean-Silver ER, Zaragoza-Guerra VA, Diaz-Elizondo JA, Rivero-Sigarroa E, Zerón-Gutierrez L. Educative Hybrid Intervention as a Strategy for Reintegration to the Clinical Courses of Undergraduate Students in COVID-19 Pandemic. Cureus 2021; 13:e15699. [PMID: 34277286 PMCID: PMC8285254 DOI: 10.7759/cureus.15699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
The SARS-CoV-2 pandemic generated the need to modify the current clinical educational model with the challenge of promoting safety and the continuity of clinical education through the use of virtual platforms. Since clinical training in hospital institutions cannot be substituted, a strategic training plan was developed to guarantee protection, safety, and academic continuity for students upon returning to clinical clerkships. The objective of this project was to develop and evaluate the impact of a massive hybrid training plan as an educative strategy to give the theoretical and practical knowledge required for the safe return of undergraduate students to their respective clinical activities in the context of this pandemic. An academic program was designed through a massive hybrid strategy to train 616 undergraduate students studying clinical cycles by presential, virtual, synchronous, and asynchronous activities. To know the program's impact, a study based on an initial evaluation and a final evaluation was carried out to evaluate the acquisition of the critical knowledge and skills of the program. A significant difference was found between the means of the initial and final evaluations (p <0.001), as well as a high impact of the intervention (d 1.6). Significant improvements in the areas of COVID-19 initial management (p <0.001) and personal protective equipment use (p <0.001) were seen in the post-test when compared to the initial evaluation. Both a quantitative and a qualitative analysis were carried out, finding positive results on the course design, quality of didactic resources, and instructors' performance. Massive hybrid training is an effective strategy to facilitate the reintegration of undergraduate students into their face-to-face clinical rotations.
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Affiliation(s)
| | | | - Eder Luna-Ceron
- Department of Clinical Sciences, Tecnológico de Monterrey, Monterrey, MEX
| | | | | | | | - Laura J Vichi-Lima
- Department of Clinical Sciences, Tecnológico de Monterrey, Mexico City, MEX
| | - Sahaira J Montejo-Romo
- Department of Anaesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, MEX
| | | | - Daniel Arizpe-Vilana
- Department of Clinical Sciences, Universidad Popular Autónoma de Puebla, Puebla, MEX
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8
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Villarreal-Calderon JR, Cuellar-Tamez R, Castillo EC, Luna-Ceron E, García-Rivas G, Elizondo-Montemayor L. Metabolic shift precedes the resolution of inflammation in a cohort of patients undergoing bariatric and metabolic surgery. Sci Rep 2021; 11:12127. [PMID: 34108550 PMCID: PMC8190106 DOI: 10.1038/s41598-021-91393-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
Bariatric and metabolic surgery has shown to promote weight loss and reduce systemic inflammation. However, the sequence and timing of events regarding metabolic improvement and inflammation resolution has been rarely explored. Furthermore, data on inflammatory markers of Th17 and Th1 cell responses after bariatric surgery is scarce. We conducted a prospective study in subjects with obesity that underwent bariatric and metabolic surgery, with follow-ups at 3 and 6 months. Anthropometric and metabolic markers such as insulin levels, HOMA-IR, and lipid parameters declined significantly 3 months after surgery; while hs-CRP, TNF-α, IL-1β, IL-6, and IL-8 serum concentrations decreased 6 months after the procedure. Concentrations of Th1 signature and driver cytokines, particularly IFN-γ, IL-12, and IL-18, and of Th17 driver IL-23 also decreased significantly after 6 months. Significant positive correlations between triglyceride levels and hs-CRP, IL-1β, and IFN-γ concentrations, and between Apo B and IFN-γ levels were observed 6 months after bariatric and metabolic surgery. In addition, BMI was associated with hs-CRP and TNF-α concentrations. Fat mass correlated with hs-CRP, TNF-α, and IL-12. Analysis of the temporality of metabolic and inflammatory events suggests that improvement in the metabolic status occurs before resolution of systemic inflammation and may be a requisite for the later event.
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Affiliation(s)
- Jose Romeo Villarreal-Calderon
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey, Centro de Investigación en Obesidad y Nutrición Clínica, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Ricardo Cuellar-Tamez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Elena C Castillo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Eder Luna-Ceron
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Gerardo García-Rivas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico. .,Tecnologico de Monterrey, Centro de Investigación Biomédica, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico. .,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico.
| | - Leticia Elizondo-Montemayor
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico. .,Tecnologico de Monterrey, Centro de Investigación en Obesidad y Nutrición Clínica, 64710, Monterrey, Mexico. .,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico.
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Luna-Ceron E, Gómez-Gutiérrez AK, Gonzalez-Hernandez C, Gatica-Torres M. An Uncommon Presentation of Pyogenic Granuloma. Cureus 2021; 13:e12509. [PMID: 33564515 PMCID: PMC7861056 DOI: 10.7759/cureus.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Benign vascular neoplasms are common clinical problems encountered in the practice of primary care. Pyogenic granulomas are one of the most common benign vascular lesions in young adults. Although the physiopathological mechanism for the development of this condition is still not well understood, it has been commonly associated with several triggers such as treatment with retinoids, biological agents, invasive cutaneous therapies and trauma. The development of pyogenic granulomas on sites of vascular malformations like port wine stains has been described in the literature to occur rarely. Most of these types of cases have been studied to occur in the setting of pregnancy and after cryotherapy or pulsated laser therapy. The aim of this article is to present the case of a 21-year-old man with a recent appearance of a pyogenic granuloma within an underlying port wine stain in the posterior cervical region without any history of triggers or risk factors. Excision of the vascular lesion was done, and histopathological report confirmed the diagnosis. The objective of this manuscript is to discuss the possible mechanisms involved in the development of this uncommon presentation and to summarize the current literature related to this clinical scenario.
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Affiliation(s)
- Eder Luna-Ceron
- Clinical Sciences, Tecnológico de Monterrey, Mexico City, MEX
| | - Ana K Gómez-Gutiérrez
- Clinical Sciences, Tecnológico de Monterrey, Mexico City, MEX.,Family and Community Medicine, Centro de Salud con Servicios Ampliados, Anáhuac, MEX
| | | | - Michelle Gatica-Torres
- Clinical Sciences, Tecnológico de Monterrey, Mexico City, MEX.,Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
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