RESUMEN
INTRODUCTION: A chorionic bump is an increasingly recognized ultrasound finding in first-trimester scans, which has been associated with early pregnancy loss. In ongoing second-trimester pregnancies, however, chorionic bumps usually resolve over time with no deleterious effect on the fetus. In this report, we describe the incidental ultrasound detection of a chorionic bump in early pregnancy and its progression to a subamniotic hematoma in the second trimester of pregnancy that persisted as such until delivery. CASE REPORT: A round, echogenic mass protruding from the choriodecidual surface measuring 13 × 11 × 8 mm was first identified during a transvaginal scan at 6.3 weeks' gestation. Subsequent follow-up scan at 8.3 weeks revealed an increase in the size of the chorionic bump to 25 × 20 × 19 mm, which remained stable as determined by the routine late first-trimester scan. At the second-trimester scan, a subamniotic hematoma was identified in the surface of the placenta, close to the insertion of the umbilical cord. Subsequently, the pregnancy proceeded uneventfully. DISCUSSION: The etiopathology and clinical significance of a chorionic bump remain unclear. The case herein reported demonstrates that a chorionic bump can grow considerably without having a deleterious effect on the early embryo and, occasionally, can persist throughout pregnancy as a subamniotic hematoma. CONCLUSION: A chorionic bump can occasionally progress to a subamniotic hematoma from the second trimester onwards. This observation further supports the hypothesis that a chorionic bump is the result of choriodecidual bleeding. An alternative explanation for the development of subamniotic hematomas is proposed.
RESUMEN
The ISAV has a genome composed of eight segments of (-)ssRNA, segment 6 codes for the hemagglutinin-esterase protein, and has the most variable region of the genome, the highly polymorphic region (HPR), which is unique among orthomyxoviruses. The HPR has been associated with virulence, infectivity and pathogenicity. The full length of the HPR is called HPR0 and the strain with this HPR is avirulent, in contrast to strains with deleted HPR that are virulent to varying degrees. The molecular mechanism that gives rise to the different HPRs remains unclear. Here, we studied in vitro the evolution of reassortant recombinant ISAV (rISAV) in Atlantic salmon head kidney (ASK) cells. To this end, we rescued and cultivated a set of rISAV with different segment 6-HPR genotypes using a reverse genetics system and then sequencing HPR regions of the viruses. Our results show rapid multiple recombination events in ISAV, with sequence insertions and deletions in the HPR, indicating a dynamic process. Inserted sequences can be found in four segments of the ISAV genome (segments 1, 5, 6, and 8). The results suggest intra-segmental heterologous recombination, probably by class I and class II template switching, similar to the proposed segment 5 recombination mechanism.
Asunto(s)
Isavirus/genética , Isavirus/patogenicidad , Recombinación Genética , Animales , Línea Celular , Enfermedades de los Peces/virología , Genotipo , Hemaglutininas Virales/genética , Infecciones por Orthomyxoviridae/virología , Salmo salar , Análisis de Secuencia de ADN , Proteínas Virales de Fusión/genética , Virulencia/genéticaRESUMEN
En la población adolescente, la dismenorrea es la principal causa de consulta ginecológica y también de ausentismo escolar, laboral o de otras actividades. Aproximadamente el 10 por ciento de las adolescentes que refieren dismenorrea presentan una causa orgánica secundaria. Dismenorrea primaria comienza a manifestarse característicamente con la menarca o poco tiempo después de ésta, que coincide con la aparición del ciclos ovulatorios regulares. El clínico debe ser capaz de diferenciar las múltiples etiologías del dolor pélvico crónico: una historia clínica detallada y un buen examen físico pueden ser suficientes para diagnosticar esta entidad. Pese a la alta prevalencia de dismenorrea en las adolescentes, es alto el porcentaje que no solicita atención médica o es subtratada, por lo que el objetivo de esta revisión fue presentar una actualización de lo publicado en la literatura sobre la fisiopatología, enfrentamiento y manejo de la dismenorrea primaria, desde tratamientos clásicos a la medicina más alternativa. De esta manera podremos entregar a la adolescente un manejo más integral, y así, disminuir el impacto que provoca la dismenorrea primaria (DP) en la vida de nuestras pacientes.
Dysmenorrhea in adolescent is an important cause of gynecological consult, school and employment absenteeism. Approximately 10 percent of adolescents who report dysmenorrhoea have an organic cause. Primary dysmenorrhea begins to manifest characteristically with menarche or shortly thereafter, coinciding with the onset of regular ovulatory cycles. The clinician should beable to differentiate multiple etiologies of chronic pelvic pain: a detailed history and physical exam may be sufficient to diagnose this entity. Despite the high prevalence of dysmenorrhea in adolescent girls, a high percentage doesnt seek medical treatment or are undertreated. The objective of this review was to provide an update of the pathophysiology, and management of primary dysmenorrhea, from traditional treatments to alternative medicine. In this way adolescent can obtain a more integrated management, and improve her life quality.