Acute Fatty Liver of Pregnancy: Incidence and Clinical Evolution in Toluca, Mexico.

Objective: The objective of this study was to determine the incidence and evolution of patients with acute fatty liver of pregnancy (AFLP) over a period of 18 years in the city of Toluca, Mexico.

Methods: This was a descriptive and retrospective study of eighteen years. All women with AFLP confirmed by biopsy were included and the incidence, laboratory test values and complications were registered.

Pregnancy-associated atypical hemolytic uremic syndrome. Case report.

Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is a rare disease. There are only few reports in the literature, and most are in the puerperium period. It is a thrombotic microangiopathy (TMA) characterized for microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction.

Environmental Nanoparticles Reach Human Fetal Brains.

Anthropogenic ultrafine particulate matter (UFPM) and industrial and natural nanoparticles (NPs) are ubiquitous. Normal term, preeclamptic, and postconceptional weeks(PCW) 8-15 human placentas and brains from polluted Mexican cities were analyzed by TEM and energy-dispersive X-ray spectroscopy. We documented NPs in maternal erythrocytes, early syncytiotrophoblast, Hofbauer cells, and fetal endothelium (ECs).

Abordaje hemodinámico y ventilatorio en pacientes con COVID-19.

The severe acute respiratory syndrome (SARS-Cov-2) is a clinical entity generated by this new virus a Coronavirus (COVID-19). Disease called COVID-19 (CoronaVIrus Disease 2019) by the World Health Organization. Its presentation is acute respiratory failure characterized by hyperinflation of the lung that leads to an increase in capillaries and epithelial permeability, with loss of ventilation of lung tissue and increases lung stiffness.

Nitazoxanide against COVID-19 in three explorative scenarios.

Introduction: Nitazoxanide has shown efficacy in vitro against coronavirus infections (MERS, SARS, SARS-CoV-2). The aim of this report is to describe the results of treating COVID-19 positive patients with nitazoxanide in three clinical settings: pregnancy/puerperium, hospitalized patients in an Internal Medicine Service and in an ambulatory setting.

Methodology: This was a prospective follow-up and report of COVID-19 cases in three different situations, pregnant women, hospitalized patients receiving medical attention in an Internal Medicine Service and ambulatory patients residing in Toluca City, and Mexico City.

Perioperative ultrasound neuromonitoring: transcraneal Doppler and optic nerve.

Monitoring of the neurocritical in the perioperatory is in constant evolution. There are essentially two ultrasonographic application of neuromonitoring: the diameter of the sheath of the optic nerve and transcranial Doppler. Ultrasound-guided neuromonitoring can detect stenosis or occlusion of intracranial arteries, monitor the evolution of patients with vasospasm after subarachnoid hemorrhage, detect cerebral embolism, evaluate the cerebral collateral system, determine brain death, calculate indirectly Intracranial pressure and cerebral perfusion and helps in clinical decisions and early therapeutic interventions in neurocritical care.

[Nuevos conceptos de la reanimación hídrica intravenosa].

Antecedentes: La reanimación hídrica intravenosa es esencial en el manejo de los pacientes hospitalizados, en especial en aquellos con enfermedad aguda o crítica. En la actualidad se proponen cuatro premisas con cuatro indicaciones, cuatro preguntas y cuatro fases para la reanimación hídrica intravenosa.

Objetivo: El objetivo de esta revisión es dar a conocer esta propuesta de manejo en la reanimación hídrica intravenosa.

[At 50 years of the description of acute respiratory distress syndrome].

In 1967, Ashbaugh et al. published in the Lancet the description of a new entity, for which they coined the name "adult respiratory distress syndrome". On that article, they thoroughly described 12 patients who had respiratory distress with bilateral pulmonary infiltrates and oxygen therapy-refractory hypoxemia.

Uric Acid in Pregnancy: New Concepts.

The relationship between hyperuricemia and hypertensive disorders is well established; however, until today, the role of uric acid in the clinical course of severe preeclampsia has not been elucidated. Some recent studies suggest that at the time of presentation, subjects with severe preeclampsia frequently have significantly elevated serum uric acid levels, and that the degree of elevation correlates with the severity of the maternal syndrome and fetal morbimortality. In this chapter, we present our workgroup experience.

Point-of-care gastrointestinal and urinary tract sonography in daily evaluation of gastrointestinal dysfunction in critically ill patients (GUTS Protocol).

There is currently a lack of universally accepted criteria for gastrointestinal (GI) failure or dysfunction in critical care. Moreover, the clinical assessment of intestinal function is notoriously difficult and thus often goes unrecognized, contributing to poor outcomes. A recent grading system has been proposed to define acute gastrointestinal injury (AGI) in conjunction with other organ function scores (e.

[Metabolic control in the critically ill patient an update: hyperglycemia, glucose variability hypoglycemia and relative hypoglycemia].

Background: Metabolic changes of glucose in critically ill patients increase morbidity and mortality. The appropriate level of blood glucose has not been established so far and should be adjusted for different populations. However concepts such as glucose variability and relative hypoglycemia of critically ill patients are concepts that are changing management methods and achieving closer monitoring.

[Atipical uremic hemolityc syndrome in pregnancy].

Atypical haemolytic uraemic syndrome is one of the main variants of thrombotic microangiopathy, and is characterized by excessive complement activation in the microvasculature. It is also characterised by the clinical triad; non-immune haemolytic anaemia, thrombocytopenia, and acute renal failure. In addition, 60% of patients have mutations in the genes encoding complement regulators (factor H, factor I, membrane cofactor proteins, and thrombomodulin), activators (factor B and C3), as well as autoantibodies against factor H.

[Aneurysm of the ascending aorta, hyperthyroidism and pregnancy. Case report].

Unlabelled: Aortic aneurysms are a rare condition in childhood and youth, etiology, evolution, natural progression and prognosis in pregnancy unknown. Hyperthyroidism occurs when there is a synthesis and/or excessive secretion of thyroid hormones during pregnancy poses difficulty for diagnosis. The new monitoring hemodynamics in pregnancy by transthoracic bioimpedance is a feasible alternative, noninvasive and real-time hemodynamic monitoring pregnant women.

[Placenta percreta with bladder and rectum invasion].

Background: Placenta percreta may lead to massive obstetric haemorrhage, haemodynamic decompensation, and ultimately death. Total obstetric hysterectomy is universally accepted as treatment; however, the emergence of new techniques such as the uterine artery angioembolisation approach, and the use of chemotherapy agents such as methotrexate, are alternatives also described in the literature.

Clinical Case: A 28 year-old patient, in her fourth gestation, with a previous history of 2 vaginal and 1 caesarean birth 4, in her 28.

[Use of thromboelastography and thromboelastometry for the rational and opportune transfusion of hemoderivatives in obstetric hemorrhage].

Obstetric hemorrhage is the leading cause of maternal mortality, responsible of 143,000 deaths every year. Thromboelastography is a tool that allows measuring the viscoelastic, dynamic and global properties of the blood, offering valuable information of coagulation alterations and help to guide early goal directed transfusional therapy. The purpose of this review is to evaluate the evidence of this tool in obstetric hemorrhage and the management of the associated coagulopathy.

[Laparoscopic hysterectomy as first-line procedure in the treatment of women with benign uterine pathology].

Background: It is estimated that a total of 600,000 abdominal hysterectomies, vaginal and laparoscopic there are performed in USA, these figures make the hysterectomy the first ranked surgery. In our country, since the first description of the technique in 1989, laparoscopic hysterectomy (HL) has developed and evolved. However, the learning curve for mastering this procedure results in larger and more complex complications than other approaches.

[DRESS syndrome. A clinical case report].

Background: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) or reaction to drugs with eosinophilia and systemic symptoms is a serious drug reaction associated with the use of aromatic anticonvulsants and allopurinol. At least 44 drugs have been associated with DRESS. The aim was to present the case of a patient with DRESS syndrome associated with phenytoin.

[Toxic epidermic necrolysis].

Background: Toxic epidermal necrolysis is a dermatological disease that evolves with an elevated mortality. Our objective was to show the utility of a nonconventional treatment for toxic epidermal necrolysis in place of conventional treatment where the mortality is <50 %. With this suggested treatment, mortality is 0 %.

[Peritoneal dialysis in obstetric patients].

Introduction: The prevalence of acute renal failure (ARF) in obstetric patients in our country is estimated to be between 3 and 42.8%. The most important causes are preeclampsia, especially when associated with thrombotic microangiopathy and hemolysis and less frequently to hemorrhagic shock.

[Thrombotic microangiopathy and intravascular hemolysis in pregnancy-induced hypertension. The lie of HELLP syndrome].

We reviewed the literature regarding pregnancy-induced hypertension and its relation with thrombotic microangiopathy and intravascular hemolysis (TMIH). In the present work we described the background, frequency, mortality, clinical picture, classification, diagnosis, complications and treatment. In addition, we analyzed Weinstein's report of 1982, and we concluded that the reported data of the HELLP syndrome is not conclusive because the presence of TMIH is not demonstrable in his group of patients.

[Intracellular calcium-dependent contractile effects of serotonin in the human umbilical artery].

Background: Absence of innervation is a hallmark of human umbilical vessels. Intervillous space blood flow is regulated by vasoactive substances and calcium dependent contractility, both in normal and pathological conditions such as preeclampsia-eclampsia.

Objective: To obtain additional information on the intracellular calcium contractile effects of serotonin in human umbilical arteries.