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Introduction: The risk of progression to tuberculosis disease is highest within the first year after M. tuberculosis infection (TBI). We hypothesize that people with newly acquired TBI have a unique cytokine/chemokine profile that could be used as a potential biomarker. Methods: We evaluated socio-demographic variables and 18 cytokines/chemokines in plasma samples from a cohort of people deprived of liberty (PDL) in two Colombian prisons: 47 people diagnosed with pulmonary TB, 24 with new TBI, and 47 non-infected individuals. We performed a multinomial regression to identify the immune parameters that differentiate the groups. Results: The concentration of immune parameters changed over time and was affected by the time of incarceration. The concentration of sCD14, IL-18 and IP-10 differed between individuals with new TBI and short and long times of incarceration. Among people with short incarceration, high concentrations of MIP-3α were associated with a higher risk of a new TBI, and higher concentrations of Eotaxin were associated with a lower risk of a new TBI. Higher concentrations of sCD14 and TNF-α were associated with a higher risk of TB disease, and higher concentrations of IL-18 and MCP-1 were associated with a lower risk of TB disease. Conclusions: There were cytokines/chemokines associated with new TBI and TB disease. However, the concentration of immune mediators varies by the time of incarceration among people with new TBI. Further studies should evaluate the changes of these and other cytokines/chemokines over time to understand the immune mechanisms across the spectrum of TB.

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Introducción. En la actualidad, el trauma de recto continúa siendo una situación clínica compleja y temida por ser potencialmente mortal. Su detección y manejo temprano es la piedra angular para impactar tanto en la mortalidad como en la morbilidad de los pacientes. Hoy en día, aún existe debate sobre la aproximación quirúrgica ideal en el trauma de recto y las decisiones de manejo intraoperatorias se ven enormemente afectadas por la experiencia y preferencias del cirujano. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Clinical Key, Google Scholar y SciELO utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes publicados en los últimos 20 años; se tuvieron en cuenta los artículos escritos en inglés y español. Discusión. El recto es el órgano menos frecuentemente lesionado en trauma, sin embargo, las implicaciones clínicas que conlleva pasar por alto este tipo de lesiones pueden ser devastadoras para el paciente. Las opciones para el diagnóstico incluyen el tacto rectal, la tomografía computarizada y la rectosigmoidoscopía. El manejo quirúrgico va a depender de la localización, el grado de la lesión y las lesiones asociadas. Conclusión. El conocimiento de la anatomía, el mecanismo de trauma y las lesiones asociadas permitirán al cirujano realizar una aproximación clínico-quirúrgica adecuada que lleve a desenlaces clínicos óptimos de los pacientes que se presentan con trauma de recto.

Introduction. Currently, rectal trauma continues to be a complex clinical and potentially fatal situation. Its early detection and management is the cornerstone to avoid both mortality and morbidity of patients. Today there is still debate about the ideal surgical approach in rectal trauma, and intraoperative management decisions are greatly affected by the experience and preferences of the surgeon. Methods. A literature search was performed in the PubMed, Clinical Key, Google Scholar and SciELO databases using the keywords described. The most relevant articles published in the last 20 years were selected. Articles written in English and Spanish were considered.Discussion. The rectum is the organ less frequently injured in trauma; however, the clinical implications of overlooking this injury can be devastating for the patient. Options for diagnosis include digital rectal examination, computed tomography and rectosigmoidoscopy. Surgical management will depend on the location, degree of the injury and the associated injuries. Conclusion. Knowledge of the anatomy, the mechanism of trauma and the associated injuries will allow the surgeon to make an adequate clinical-surgical approach that leads to optimal clinical outcomes in patients presenting with rectal trauma.

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People deprived of liberty (PDL) are at high risk of acquiring Mycobacterium tuberculosis infection (latent tuberculosis infection [LTBI]) and progressing to active tuberculosis (TB). We sought to determine the incidence rates and factors associated with LTBI and active TB in Colombian prisons. Using information of four cohort studies, we included 240 PDL with two-step tuberculin skin test (TST) negative and followed them to evaluate TST conversion, as well as, 2,134 PDL that were investigated to rule out active TB (1,305 among people with lower respiratory symptoms of any duration, and 829 among people without respiratory symptoms and screened for LTBI). Latent tuberculosis infection incidence rate was 2,402.88 cases per 100,000 person-months (95% CI 1,364.62-4,231.10) in PDL with short incarceration at baseline, and 419.66 cases per 100,000 person-months (95% CI 225.80-779.95) in individuals with long incarceration at baseline (who were enrolled for the follow after at least 1 year of incarceration). The TB incidence rate among PDL with lower respiratory symptoms was 146.53 cases/100,000 person-months, and among PDL without respiratory symptoms screened for LTBI the incidence rate was 19.49 cases/100,000 person-months. History of Bacillus Calmette-Guerin vaccination decreased the risk of acquiring LTBI among PDL who were recently incarcerated. Female sex, smoked drugs, and current cigarette smoking were associated with an increased risk of developing active TB. This study shows that PDL have high risk for LTBI and active TB. It is important to perform LTBI testing at admission to prison, as well as regular follow-up to control TB in prisons.

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Two new species of yellow Cantharellus and a new record of Cantharellus tabernensis associated with tropical species of Quercus are presented, based on the taxonomic study of fresh specimens and in a phylogenetic analysis of transcription elongation factor 1-alpha (tef-1α) and the large subunit of the ribosome (nLSU) sequences. One of the new species proposed here, corresponds to a choice edible mushroom, which, in our molecular phylogeny, resulted in it being related to the group of species around C. lateritius and sister with Craterellus confluens type specimen. This latter is here formally transferred to Cantharellus and consequently a new name, Cantharellus furcatus, is proposed to replace the homonym Cantharellus confluens (Schwein.) Schwein. 1834 a later synonym of Byssomerulius corium. Detailed macroscopic and microscopic descriptions accompanied with illustrations and a taxonomic discussion are presented for each species.

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Salmonella spp. causes digestive clinical signs in horses. Foals and hospitalized animals are more susceptible to the disease. Nowadays, the report of multidrug-resistant Salmonella spp. producer of extended-spectrum ß-lactamases, is more frequent. The aim of this work was to study the clonal relationship and antimicrobial susceptibility profiles among Salmonella ser. Typhimurium isolates, obtained during a salmonellosis outbreak in an Argentinian equine hospital. Thus, in 2017, we studied the genotypic profiles and the susceptibility to antimicrobials of the strains isolated from three animals with diarrhea in an equine hospital of Argentina. The pulsotype identified by pulsed-field gel electrophoresis was the same among the isolates. Also, this pulsotype had been previously detected in human and porcine isolates, suggesting the circulation of the same strains in different species. Multidrug-resistant isolates with different ß-lactam susceptibility profiles were identified and blaCTX-M-14 was detected for the first time from an isolate of equine-origin in Argentina. Salmonella ser. Typhimurium is an important pathogen in public and veterinary health, so our results emphasize the relevance of appropriate measures to prevent and control this disease. Furthermore, routine antibiotic susceptibility tests of local strains are needed to improve the empiric treatment of equine salmonellosis.

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In the last 10 years, Salmonella Heidelberg has been extensively isolated from poultry in several countries. In this context, molecular characterization is essential to understand whether the strains have entered the farms from a single or several sources. Thus, the aim of this study was to determine the genetic relationship and antimicrobial susceptibility of S. Heidelberg strains isolated between 2011 and 2012 from broiler farms belonging to three integrated poultry companies located in Argentina. The genetic relatedness of the S. Heidelberg isolates was determined by pulsed-field gel electrophoresis (PFGE), and resistance to 21 antimicrobials was determined by the disc diffusion method. The isolates were assigned to four PFGE patterns. Most of the strains showed 100% similarity and belonged to the same integrated poultry company. This PFGE pattern was also prevalent in S. Heidelberg strains isolated from humans in several provinces of Argentina, which suggests an epidemiological association between human and poultry strains. All the isolates were classified as multidrug-resistant (MDR), and no clear relationship was observed between PFGE and resistance patterns. S. Heidelberg strains may circulate among farms from the same integrated company due to common sources of contamination. To guarantee the safety of the poultry product for the consumers, holistic approaches including surveillance of Salmonella throughout the production chain together with control measures are crucial.

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Salmonella is a worldwide-distributed pathogen that affects both humans and animals and is usually associated with intensive animal production such as poultry and swine. This bacterium carries different virulence genes, whose expression favors its interaction with the host and may influence the course of the infection. Extended usage of antibiotics for metaphylaxis or prophylaxis and as growth promoters favors the emergence of multiresistant Salmonella strains. The aim of this work was to assess the association between the presence of virulence-associated genes and the antimicrobial resistance phenotype in Salmonella isolates obtained from swine intensive and backyard farms in Argentina during 2012-2018. A total of 59 Salmonella strains belonging to several serotypes were studied. All the strains carried the sopB and ssaQ genes, whereas more than 90% of the isolates carried the mgtC, avrA, and siiD genes. Some isolates also carried the bcfC, sodC1, gipA, sopE1 and spvC genes; however, their presence varied among them. Susceptibility to the antibiotics tested was diverse. Isolates from intensive farms were resistant to a larger number of antimicrobials than those from backyard farms and some of the strains showed high virulence potential and extensive antimicrobial resistance profiles. Continuous surveillance is essential to detect the emergence of strains that may represent a significant risk not only for animal production but also for the human population.

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Callous-unemotional traits are considered to be precursors of psychopathy, and are related to behaviors such as aggression, delinquency, antisocial behavior, and bullying in adolescents. For this reason, it is important to study these traits in childhood and adolescence with appropriate and reliable instruments. The aim of the current study is to develop a Mexican adaptation of the Inventory of Callous-Unemotional Traits and Antisocial Behavior (INCA) because few questionnaires in Spanish assess these traits, and even fewer have been validated for the Mexican population. The INCA questionnaire, developed in Spain, assesses the same three factors as the ICU questionnaire (unemotional, callousness, and uncaring), and it includes an additional factor of antisocial behavior with items on challenging authority and breaking social rules. It controls two response biases: social desirability and acquiescence. We administered the Mexican adaptation, named INCA-M, to 699 adolescents aged between 12 and 18 years old. Factor analysis yielded three dimensions, because most of the items referring to uncaring and antisocial behavior loaded on a common factor, which can be explained by cultural differences. We decided to remove these items of antisocial behavior so as to maintain the same three factors assessed by the ICU questionnaire. The results suggest that the INCA-M has good psychometric properties, with high factor simplicity and good reliability. Moreover, we found the expected correlations with impulsivity and the Big Five subscales, and also with the equivalent subscales assessed by the ICU questionnaire.

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BACKGROUND: Immune parameters (IP) have been extensively studied to distinguish between latent tuberculosis (LTBI) and active tuberculosis (TB). OBJECTIVE: To determine the IP associated with LTBI, compared to active TB and individuals not infected by M. tuberculosis published in literature. METHODS: We conducted a systematic search using Google Scholar and PubMed databases, combining the MeSH terms latent tuberculosis, Mycobacterium tuberculosis, cytokines, and biological markers, with the free terms, biomarkers and cytokines. Spanish, English, and Portuguese articles comparing the concentration of IP associated with LTBI, either in plasma/serum or in vitro, in adults and nonimmunocompromised versus individuals with TB or without M. tuberculosis infection between 2006 July and 2018 July were included. Two blinded reviewers carried out the searches, read the abstracts, and selected the articles for analysis. Participants' information, diagnostic criteria, IP, detection methods, and biases were collected. RESULTS: We analyzed 36 articles (of 637 abstracts) with 93 different biomarkers in different samples. We found 24 parameters that were increased only in active TB (TGF-α, CSF3, CSF2, CCL1 [I-309], IL-7, TGF-ß1, CCL3 [MIP-1α], sIL-2R, TNF-ß, CCL7 [MCP-3], IFN-α, fractalkine, I-TAG, CCL8 [MCP-2], CCL21 [6Ckine], PDGF, IL-22, VEGF-A, LXA4, PGE2, PGF2α, sCD163, sCD14, and 15-Epi-LXA4), five were elevated in LTBI (IL-5, IL-17F, IL-1, CCL20 [MIP-3α], and ICAM-1), and two substances were increased among uninfected individuals (IL-23 and basic FGF). We found high heterogeneity between studies including failure to account for the time/illness of the individuals studied; varied samples and protocols; different clinical classification of TB; different laboratory methods for IP detection, which in turn leads to variable units of measurement and assay sensitivities; and selection bias regarding TST and booster effect. None of the studies adjusted the analysis for the effect of ethnicity. CONCLUSIONS: It is mandatory to harmonize the study of immune parameters for LTBI diagnosis. This systematic review is registered with PROSPERO CRD42017073289.

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Palm oil is the most consumed vegetable oil globally, and Colombia is the largest palm oil producer in South America and fourth worldwide. However, oil palm plantations in Colombia are affected by bud rot disease caused by the oomycete Phytophthora palmivora, leading to significant economic losses. Infection processes by plant pathogens involve the secretion of effector molecules, which alter the functioning or structure of host cells. Current long-read sequencing technologies provide the information needed to produce high-quality genome assemblies, enabling a comprehensive annotation of effectors. Here, we describe the development of genomic resources for P. palmivora, including a high-quality genome assembly based on long and short-read sequencing data, intraspecies variability for 12 isolates from different oil palm cultivation regions in Colombia, and a catalog of over 1,000 candidate effector proteins. A total of 45,416 genes were annotated from the new genome assembled in 2,322 contigs adding to 165.5 Mbp, which represents an improvement of two times more gene models, 33 times better contiguity, and 11 times less fragmentation compared with currently available genomic resources for the species. Analysis of nucleotide evolution in paralogs suggests a recent whole-genome duplication event. Genetic differences were identified among isolates showing variable virulence levels. We expect that these novel genomic resources contribute to the characterization of the species and the understanding of the interaction of P. palmivora with oil palm and could be further exploited as tools for the development of effective strategies for disease control.

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BACKGROUND: IgM titers of Mycoplasma pneumoniae can remain high for months or years, and specific DNA can be detected in asymptomatic people. METHODS: We compared the performance of serology and PCR in children with and without community-acquired pneumonia (CAP) for the diagnosis of M. pneumoniae. RESULTS: In children with CAP, a positive test by M. pneumoniae (PCR and/or paired serology or both) were found in 13.9%. Of these, 10.3% were positive by multiplex PCR (Seeplex-Seegen), and 6.7% exhibited quadrupled titers (22 for IgG, 6 for IgM and 5 for both). Both tests were positive in 2.8% of cases. In the group without CAP, 3.3% were positive by PCR. Thirty-two percent of children with CAP and 38.3% of healthy children had IgM titers >11 in the acute phase. CONCLUSIONS: The detection of IgM is not useful for diagnosing acute M. pneumoniae infection, and a positive PCR result can be due to colonization and not infection. New and better diagnostic techniques are required.

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Due to poor diagnostics and increased co-infections, HIV-associated Legionella infections are underreported. We aimed to retrospectively determine the frequency of Legionella infections in bronchoalveolar lavage (BAL) from HIV-associated pneumonia patients hospitalized in Medellin, Colombia, between February 2007 and April 2014. Although culture was negative, 17 BAL (36%) were positive for Legionella by quantitative polymerase chain reaction, most of which were in the Mycobacterium tuberculosis or Pneumocystis jirovecii co-infected patients, and included L. anisa (n = 6), L. bozemanae (n = 4), L. pneumophila (n = 3), and L. micdadei (n = 2). All L. bozemanae and L. micdadei associated with Pneumocystis, while all L. pneumophila associated with M. tuberculosis. Legionella probable cases had more complications and higher mortality rates (P = 0.02) and were rarely administered empirical anti-Legionella therapy while in hospital. Clinicians should be aware of the possible presence of Legionella in HIV and M. tuberculosis or P. jirovecii co-infected patients.

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Bud rot (BR) is the most devastating disease affecting oil palm (Elaeis guineensis) crops in Colombia. Its causal agent, Phytophthora palmivora, initiates the infection in immature oil palm leaflets producing necrotic lesions, followed by colonization of opportunistic necrotrophs, which increases disease damage. To improve the characterization of the disease, we transformed P. palmivora using Agrobacterium tumefaciens-mediated transformation (ATMT) to include the fluorescent proteins CFP-SKL (peroxisomal localization), eGFP and mRFP1 (cytoplasmic localization). The stability of some transformants was confirmed by Southern blot analysis and single zoospore cultures; additionally, virulence and in vitro growth were compared to the wild-type isolate to select transformants with the greatest resemblance to the WT isolate. GFP-tagged P. palmivora was useful to identify all of the infective structures that are commonly formed by hemibiotrophic oomycetes, including apoplastic colonization and haustorium formation. Finally, we detected cell death responses associated with immature oil palm tissues that showed reduced susceptibility to P. palmivora infection, indicating that these tissues could exhibit age-related resistance. The aim of this research is to improve the characterization of the initial disease stages and generate cell biology tools that may be useful for developing methodologies for early identification of oil palm materials resistant or susceptible to BR.

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RESUMEN Posterior al reconocimiento de agentes patógenos las plantas activan una serie de cascadas de señalización que culminan con la activación de factores de transcripción. Esto genera una concomitante reprogramación de la expresión génica que incluye la activación de la transcripción de los genes PR (relacionados con patogenicidad). Las proteínas PR son conocidas por poseer actividad antimicrobiana y evitan la posterior colonización del patógeno. En este estudio se empleó una aproximación bioinformática para identificar el repertorio de posibles proteínas PR en el genoma de yuca. Adicionalmente, se evaluó la expresión de nueve genes PR a lo largo del tiempo en variedades de yuca resistentes y susceptibles en respuesta a la inoculación con la bacteria Xanthomonas axonopodis pv. manihotis (Xam) mediante RT-PCR. Se encontró que varios genes PR fueron inducidos producto de la herida que se realiza durante el proceso de inoculación. Con el fin de evaluar cuantitativamente la contribución real de la infección bacteriana en la expresión de estos genes, se llevó a cabo una RT-PCR en tiempo real (QRT, Quantitative Real-Time PCR). Se encontró que en la variedad resistente el gen que codifica para MePR1 (Manes06G026900.1) presentó una inducción en su expresión a diferentes tiempos post-inoculación, lo cual no se observó en la variedad susceptible. De esta manera, este gen se constituye en un excelente marcador para evaluar la respuesta molecular de resistencia en plantas de yuca.

ABSTRACT Once pathogens are perceived by plants a signal transduction pathway is activated leading to the induction of transcription factors, which in turn reprogram the host gene expression including the transcription of PR (Pathogenesis-Related) genes. The PR proteins are well known for their antimicrobial activity and for contributing to arrest the invasion of pathogens. In this work, a bioinformatics approach was used to identify the repertoire of possible PR proteins in the cassava genome. Additionally, the expression of nine PR genes was evaluated over a time course in resistant and susceptible cassava varieties in response to inoculation with the bacterium Xanthomonas axonopodis pv. manihotis (Xam) by semiquantitative RT-PCR. It was found that several PR genes were induced as a result of the wound that is made during the inoculation process. In order to evaluate quantitatively the real contribution of the bacterial infection in the expression of the genes, a Real Time RT-PCR (qRT, quantitative Real-Time PCR) was carried out. In the resistant variety the gene coding for MePR1 (Manes06G026900) was induced at different post-inoculation times, which was not observed in the susceptible variety. Therefore, this gene constitutes an excellent marker to evaluate the molecular resistance response in cassava plants.

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Two species of Lactarius are documented from fragments of tropical lowland oak forest in central Veracruz. Lactarius trichodermoides, described here as new, was found in association with Quercus sapotifolia and Lactarius subplinthogalus with Quercus glaucescens. Both Lactarius species were identified morphologically and supported by phylogenetic analyses of nuc rDNA internal transcribed spacers (ITS1-5.8S-ITS2) and D1-D2 domains of nuc 28S rDNA sequences. Confirmation of mycobionts in ectomycorrhizal (ECM) associations was verified by molecular identification of ECM root tips. Detailed macroscopic and microscopic descriptions and photographs and illustrations of basidiomes and ectomycorrhizas are presented. The new binomial Lactarius chiangmaiensis is proposed for L. subplinthogalus var. chiangmaiensis.

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During explorations of tropical oak forests in central Veracruz (eastern Mexico), the authors discovered a Cantharellus species that produces basidiomes with strikingly violet pileus and a hymenium with yellow, raised gill-like folds. It is harvested locally and valued as a prized edible wild mushroom. Systematic multiyear sampling of basidiomes allowed the recording of the morphological variation exhibited by fresh fruit bodies in different growth stages, which supports the recognition of this Cantharellus species from others in the genus. Two molecular phylogenetic analyses based on a set of sequences of species of all major clades in Cantharellus, one including sequences of the transcription elongation factor 1-alpha (tef-1α) and a combined tef-1α and nLSU region (the large subunit of the ribosome), confirm the isolated position of the new species in a clade close to C. lewisii from USA, in the subgenus Cantharellus. Detailed macroscopic and microscopic descriptions, accompanied by illustrations and a taxonomic discussion are presented.

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BACKGROUND: The diagnosis of community-acquired pneumonia (CAP) caused by Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae is traditionally based on cultures and serology, which have special requirements, are time-consuming, and offer delayed results that limit their clinical usefulness of these techniques. We sought to develop a multiplex PCR (mPCR) method to diagnosis these bacterial infections in CAP patients and to compare the diagnostic yields obtained from mPCR of nasopharyngeal aspirates (NPAs), nasopharyngeal swabs (NPSs), and induced sputum (IS) with those obtained with specific PCR commercial kits, paired serology, and urinary antigen. RESULTS: A total of 225 persons were included. Of these, 10 patients showed serological evidence of L. pneumophila infection, 30 of M. pneumoniae, and 18 of C. pneumoniae; 20 individuals showed no CAP. The sensitivities were mPCR-NPS = 23.1%, mPCR-IS = 57.1%, Seeplex®-IS = 52.4%, and Speed-oligo®-NPA/NPS = 11.1%, and the specificities were mPCR-NPS = 97.1%, mPCR-IS = 77.8%, Seeplex®-IS = 92.6%, and Speed-oligo®-NPA/NPS = 96.1%. The concordance between tests was poor (kappa <0.4), except for the concordance between mPCR and the commercial kit in IS (0.67). In individuals with no evidence of CAP, positive reactions were observed in paired serology and in all PCRs. CONCLUSIONS: All PCRs had good specificity but low sensitivity in nasopharyngeal samples. The sensitivity of mPCR and Seeplex® in IS was approximately 60%; thus, better diagnostic techniques for these three bacteria are required.

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El objetivo de este trabajo consistió en conocer los efectos psicológicos en la salud mental derivados de la violencia psicosocial entre la población del Estado de Coahuila. Mediante la aplicación de la batería "Evaluación psicosocial de la vivencia de sucesos vitales", se diagnosticó la percepción subjetiva de la violencia en las ciudades con mayor incidencia de eventos violentos. Más concretamente, se analizó la correlación entre variables sociodemográficas, considerando particularidades regionales y variables psicológicas vinculadas a la violencia psicosocial desde el modelo de la representación social, así como las implicaciones, cambios y efectos que los eventos violentos causan en las personas. En Monclova y Torreón, los resultados indican que se debe afrontar la violencia y tomar precauciones; y en Saltillo, se destaca la búsqueda de soluciones y olvidar. En general, las mujeres reportaron miedo y tristeza; los hombres, enojo.

This paper aims underline the psychological effects on mental health as a result of psychosocial violence among people from Coahuila, the battery "Psychosocial assessment of the experience of life events" was used to diagnose a subjective perception of violence, mainly in violent cities. The correlation between socio demographic and psychological variables related to psychosocial violence variable, considering regional particularities and based on social model representation involving implications, changes and violent effects caused in people, were analyzed. In the Mon-clova and Torreón regions the results showed the perception that violence had to be confronted head on and that precautionary measures should be taken; in Saltillo the results showed the perception to be- to look for solutions and put it aside. In other words, women showed fear and sadness while men showed anger.

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Carcinoid crisis is an infrequent and little-described complication of neuroendocrine tumors that can be life threatening. It may develop during induction of anesthesia, intraoperatively, during tumor manipulation and arterial embolization, or even spontaneously. The massive release of neuroendocrine substances can lead to potentially fatal complications. Somatostatin analogs inhibit the release of these substances and are the mainstay of treatment. The following case report describes a patient with reversible acute right-sided heart failure posterior to hepatic artery embolization.

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Very late stent thrombosis is a rare and not-well-understood complication after bare metal stent implantation. It usually presents as an ST elevation acute coronary syndrome and it is associated with high rates of morbidity and mortality. Pathophysiologic mechanisms are not well defined; nevertheless, recent studies have proposed a neoatherosclerotic process as the triggering mechanism. We present the case of a patient with bare metal very late stent thrombosis 12 years after implantation.