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. We report the case of a pregnant patient at 26.3 gestation weeks, who developed clinical features of TMA, neurological alterations, and septic shock; then after fetus and placental delivery, no clinical improvement was observed; a diagnostic protocol was performed due to suspicion of P-aHUS, showing improvement after the plasma exchange sessions and eculizumab. We present here a brief review of the case since it is an entity that needs to be suspected during pregnancy when TMA features and requires an immediate diagnosis to provide timely treatment.

At 50 years of the description of acute respiratory distress syndrome. / A 50 años de la descripción del síndrome de insuficiencia respiratoria aguda.

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. For its management, emphasis was made on the importance of intubation and mechanical ventilation with positive end-expiratory pressure. At 50 years of its first publication, great advances on the knowledge of this condition have been achieved, which has influenced on patient management and survival. To celebrate this 50th anniversary, the National Academy of Medicine of Mexico organized a symposium with the purpose to spread the knowledge about this condition, recognize the researchers who made the original description and those who over the course of 50 years of history have contributed to its better understanding. The symposium addressed the topics of lung-kidney interaction, molecular bases of the disease and therapeutic advances.

En 1967, Ashbaugh et al. publicaron en Lancet la descripción de una nueva entidad para la que acuñaron el nombre "síndrome de distress respiratorio del adulto". En ese artículo describieron minuciosamente a 12 enfermos que presentaban insuficiencia respiratoria, con infiltración pulmonar bilateral e hipoxemia resistente a oxigenoterapia. Para su manejo se hizo énfasis en la importancia de la intubación y la ventilación mecánica con presión positiva al final de la espiración. A 50 años de la publicación se han logrado grandes avances en el conocimiento de esta enfermedad, lo que ha influido en el manejo y supervivencia de los pacientes. Para celebrar este cincuentenario, la Academia Nacional de Medicina de México organizó un simposio que tuvo como objetivos difundir el conocimiento de esta enfermedad, reconocer a los personajes que hicieron la descripción original y a quienes en 50 años de historia han contribuido a su mejor entendimiento. El simposio abordó los temas de interacción pulmón-riñón, bases moleculares de la enfermedad y avances en el tratamiento.

[Use of thromboelastography and thromboelastometry for the rational and opportune transfusion of hemoderivatives in obstetric hemorrhage]. / Uso de tromboelastrografía y tromboelastometría para la transfusión racional y oportuna de hemoderivados en hemorragia obstétrica.

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.

[Aneurysm of the ascending aorta, hyperthyroidism and pregnancy. Case report]. / Aneurisma de aorta ascendente, hipertiroidismo y embarazo. Caso clinic.

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. CASE REPORT: Primiparity 18, is referred to present tachycardia, hyperthyroidism is diagnosed and drug treatment is initiated with antithyroid from week 14.1 echocardiogram reports bivalve aortic aneurysm in the sinus of Valsalva is performed. He was determined to continue the same under strict hemodynamic and fetal monitoring. Pregnancy concludes at the end obtained through the abdomen, at 40.4 weeks, with male product, weight 2250 g, Apgar 9/9, with growth restriction type I. The mother and baby were discharged simultaneously without complications. CONCLUSSIONS: The hyperdynamic state of pregnant patients in hyperthyroidism and aneurysms is complex and potentially complicable is why the hemodynamic patient monitoring is essential to detect changes in it that endanger the life of the binomial to this condition. Heart disease and hyperthyroidism, in this case, consistent with a fetal complications level is described as intrauterine growth restriction, however narrow and multidisciplinary monitoring and timely interventions binomial lead to satisfactory results in this case.

[Laparoscopic hysterectomy as first-line procedure in the treatment of women with benign uterine pathology]. / La histerectomía laparoscópica como procedimiento de primera línea en el tratamiento de mujeres con patología benigna del útero.

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. MATERIAL AND METHOD: Retrospective, longitudinal and descriptive study were carried out, the collection of data took place from the clinical records of patients who underwent total laparoscopic hysterectomy during January 1, 2007 through December 31 of the same year. It was performed in women older than 18 years with benign uterine pathology. Body mass index greater than 30 Kg/m2, uterus greater than 16 weeks of gestational age or more than 500 grams, illnesses than compromise life of patients o women that did not return to post-surgical evaluation were excluded. RESULTS: There were performe 75 laparoscopic hysterectonies, 72 underwent without any complication. The average hospital stay was 3 days. We founded 3 major surgical complications, a case of bleeding from the surgical area that was immediately attended by laparoscopic Vicril-00 single stitching. Also were founded 2 urinary lesions: 1 complex lesion of the trigonous. The follow up of this case was torpid it were needed to derivate for 15 day with a latex foley catheter after the secondary repair and was unsuccessfully. Thereafter a urogynecological team programed laparotomy for the final fistulectomy. And the third case of accident was referred to a ureteral section, was diagnosed by the leaking at opaquedye from the abdominal x ray, and the patient was programed to laparotomy to performed a termino-terminal anastomosis. CONCLUSIONS: Laparoscopic hysterectomy is a reliable treatment option for benign uterine pathology. We believe that this surgical technique should be offered as the regular way to perform the hysterectomy.

Maternal Consumption of Non-Nutritive Sweeteners during Pregnancy Is Associated with Alterations in the Colostrum Microbiota.

Non-nutritive sweeteners (NNSs) provide a sweet taste to foods and beverages without significantly adding calories. Still, their consumption has been linked to modifications in adult's and children's gut microbiota and the disruption of blood glucose control. Human milk microbiota are paramount in establishing infants' gut microbiota, but very little is known about whether the consumption of sweeteners can alter it. To address this question, we sequenced DNA extracted colostrum samples from a group of mothers, who had different levels of NNS consumption, using the Ion Torrent Platform. Our results show that the "core" of colostrum microbiota, composed of the genera Bifidobacterium, Blautia, Cutibacteium, Staphylococcus, and Streptococcus, remains practically unchanged with the consumption of NNS during pregnancy, but specific genera display significant alterations, such as Staphylococcus and Streptococcus. A significant increase in the unclassified archaea Methanobrevibacter spp. was observed as the consumption frequency of NNS increased. The increase in the abundance of this archaea has been previously linked to obesity in Mexican children. NNS consumption during pregnancy could be related to changes in colostrum microbiota and may affect infants' gut microbiota seeding and their future health.

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). Fetal ECs exhibited caveolar NP activity and widespread erythroblast contact. Brain ECs displayed micropodial extensions reaching luminal NP-loaded erythroblasts. Neurons and primitive glia displayed nuclear, organelle, and cytoplasmic NPs in both singles and conglomerates. Nanoscale Fe, Ti, and Al alloys, Hg, Cu, Ca, Sn, and Si were detected in placentas and fetal brains. Preeclamptic fetal blood NP vesicles are prospective neonate UFPM exposure biomarkers. NPs are reaching brain tissues at the early developmental PCW 8-15 stage, and NPs in maternal and fetal placental tissue compartments strongly suggests the placental barrier is not limiting the access of environmental NPs. Erythroblasts are the main early NP carriers to fetal tissues. The passage of UFPM/NPs from mothers to fetuses is documented and fingerprinting placental single particle composition could be useful for postnatal risk assessments. Fetal brain combustion and industrial NPs raise medical concerns about prenatal and postnatal health, including neurological and neurodegenerative lifelong consequences.

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. RESULTS: The experience with a first group of 20 women, pregnant (17) or in immediate puerperium (3) was successful in 18 cases with two unfortunate deaths. The five cases treated in an Internal Medicine service showed a positive outcome with two patients weaned from mechanical ventilation. Of the remaining 16 patients treated in an ambulatory setting, all got cured. Nitazoxanide seems to be useful against SARS-CoV-2, not only in an early intervention but also in critical condition as well as in pregnancy without undesired effects for the babies. As an adjunctive therapy budesonide was used that seems to contribute to the clinical improvement. CONCLUSIONS: Nitazoxanide could be useful against COVID-19 as a safe and available regimen to be tested in a massive way immediately.

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.g., SOFA). Ultrasonography has become widely accepted as a diagnostic tool for GI problems and pathology. We propose a sonographic examination of the abdomen, using the GUTS protocol (gastrointestinal and urinary tract sonography) in critically ill patients as part of the point-of-care ultrasound evaluation in patients with AGI. This article reviews possible applications of ultrasonography that may be relevant to monitor the GI function in critically ill patients. The GI ultrasound protocol (GUTS) focuses on four gastrointestinal endpoints: gastrointestinal diameter, mucosal thickness, peristalsis, and blood flow. Moreover, it is possible to examine the urinary tract and kidney function. Real-time ultrasound with the GUTS protocol is a simple, inexpensive, bedside imaging technique that can provide anatomical and functional information of the GI tract. Further studies are needed to investigate the utility of GUTS with other parameters, such as GI biomarkers, AGI class, and clinical outcomes.

Aspectos inmunológicos en preeclampsia / Immunologic Aspects in Preeclampsia

Resumen La preeclampsia es una patología con alta morbimortalidad a nivel mundial. En esta enfermedad la placenta es un órgano de choque donde la inflamación y la respuesta inmunológica generan el daño que se traduce en el cuadro clínico característico. La tríada clásica en preeclampsia está integrada por hipertensión, edema y proteinuria, por lo que se piensa que el endotelio debe estar afectado por la actividad inflamatoria-inmunológica. El sistema inmunológico actúa en el desarrollo del embarazo y lo hace a diferentes tiempos y regulando de manera fisiológica. Tanto componentes celulares como humorales de la respuesta innata y adquirida han sido estudiados en pacientes con preeclampsia y se ha determinado que su participación es decisiva en la fisiopatología de esta enfermedad. La participación del sistema inmunológico en la fisiopatología de la preeclampsia alcanza un alto nivel de complejidad pues interacciona con otros sistemas (coagulación, renal, cardiovascular y endocrinológico entre otros) favoreciendo así la enfermedad. Es por esto que el tratamiento debe ser integral, con una visión holística del padecimiento y que requiere de un equipo multidisciplinario, que actué armónicamente para así alcanzar el mayor éxito terapéutico con la menor frecuencia de secuelas para el binomio madre-feto o madre-recién nacido. En la gestación se desarrolla la denominada "tolerancia inmunológica del embarazo", en ese estado de tolerancia inmunológica las células B y T pueden reconocer antígenos específicos (por ejemplo, los paternos) y posteriormente activarse y generar la respuesta inmunológica, por lo que la preeclampsia podría ser considerada como una patología autoinmune, donde la perdida de la tolerancia inmunológica sería la piedra angular en la fisiopatología, conocer como limitar o regular esta activación celular anómala podría servir para proponer nuevos acercamientos terapéuticos y controlar así esta enfermedad.

Abstract Preeclampsia is a pathology with high morbidity and mortality worldwide. In this disease, the placenta is an organ of shock where inflammation and the immune response generate the damage that results in the characteristic clinical scenario. The classic triad in preeclampsia is made up of hypertension, edema, and proteinuria, so it is thought that the endothelium must be affected by inflammatory-immunological activity. The immune system acts in the development of pregnancy and does so at different times and regulating physiologically. Both, cellular and humoral components of the innate and acquired response have been studied in patients with preeclampsia and it has been determined that their participation is decisive in the pathophysiology of this disease. The involvement of the immune system in the pathophysiology of preeclampsia reaches a high level of complexity since it interacts with other systems (coagulation, renal, cardiovascular and endocrinological among others) thus favoring the disease. For this reason, treatment must be comprehensive, with a holistic vision of the condition and requires a multidisciplinary team that acts harmoniously to achieve the greatest therapeutic success with the least frequency of sequelae for the mother-fetus or mother-newborn dyads. During pregnancy, the so-called "immunological tolerance of pregnancy" develops, in this state of immunological tolerance the B and T cells can recognize specific antigens (for example, the paternal ones) and later activate and generate the immune response, which is why preeclampsia could being considered an autoimmune pathology, where the loss of immunological tolerance would be the cornerstone of pathophysiology, knowing how to limit or regulate this abnormal cell activation could help to propose new therapeutic approaches and thus control this disease.

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. In 2016, we designed a prospective, cross-sectional comparative study. A sample of 200 patients - 100 with severe preeclampsia and 100 with normotensive pregnancy - was obtained. Plasmatic uric acid levels were recorded in units of mg/dL as clinical variables and as laboratory and fetal growth data. We considered uric acid equal to or more than 6.0 mg/dL as the elevated level. To relate the significance of elevated uric acid levels with variables, chi-square tests and Mann-Whitney U test were applied. Any p value equal or <0.05 was accepted as significant. We found significant difference (p = 0.05) between serum uric acid levels among both groups. In comparison with the healthy patients, patients with severe preeclampsia and uric acid greater than 6 mg/dl presented significant differences in relation to fetal complications and maternal laboratory and clinical variables. Our conclusion is that values equal to or greater than 6 mg/dL of serum uric acid in patients with severe preeclampsia may be a valuable biomarker for preeclampsia and an association with the presence of adverse fetal and maternal effects.

[Placenta percreta with bladder and rectum invasion]. / Percretismo placentario con invasión de vejiga y recto.

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 28.4 week of pregnancy, by second trimester ultrasound, was diagnosed with placenta percreta with bladder and rectal invasion using magnetic resonance imaging. Multidisciplinary and sequential treatment included: Caesarean with placenta in situ, uterine artery embolisation immediately after caesarean, chemotherapy with methotrexate weekly for 4 doses, and finally obstetric hysterectomy after bilateral hypogastric artery ligation. The outcome was favourable and the patient was discharged in good general condition. CONCLUSIONS: The protocoled and sequential management including selective embolization immediately after caesarean section with placenta in situ, weekly chemotherapy with methotrexate and obstetric hysterectomy, preceded by bilateral ligation of the hypogastric arteries, is a therapeutic alternative to be considered in cases of placenta percreta.

Hemofilia adquirida A en embarazo. Caso clínico de medicina crítica en obstetricia por morbilidad extrema y su abordaje transdisciplinario perioperatorio / Acquired hemophilia A in pregnancy. Clinical case of critical medicine in obstetrics due to extreme morbidity and its perioperative transdisciplinary approach

Resumen: La identificación de múltiples factores de riesgo que predisponen a la hemorragia durante el evento obstétrico, como la hemofilia adquirida que es un trastorno que se desarrolla por la generación de autoanticuerpos inhibidores de factores de la coagulación, la interpretación objetiva de las pruebas de laboratorio rutinarias, el desarrollo de un pensamiento sistematizado en la integración diagnóstico-terapéutica por parte del personal de salud, y la disposición de los recursos farmacológicos hospitalarios, es lo que determina frecuentemente el pronóstico en pacientes obstétricas con morbilidad extrema que requieren atención multidisciplinaria en las diferentes unidades hospitalarias del sector salud de nuestro país. El objetivo es presentar un caso clínico de morbilidad extrema por hemofilia adquirida, su presentación clínica, evolución y desenlace fatal. Se presenta un caso referido de otra unidad del Sector Salud ISEM (Instituto de Salud del Estado de México), atendido en la Unidad de Cuidados Intensivos Obstétricos del Hospital «Mónica Pretelini Sáenz¼, resaltando la importancia en la integración diagnóstico-terapéutica y la interacción multifactorial de variables relacionadas con su desenlace fatal. Conclusiones: Desconocimiento de la patología, retraso en el diagnóstico, múltiples procedimientos condicionantes de hemorragia iatrógena y la limitación en recursos terapéuticos son factores que contribuyen a un desenlace fatal.

Abstract: The identification of multiple risk factors that predispose to bleeding during the obstetric event, such as acquired hemophilia, which is a disorder that develops due to the generation of autoantibodies that inhibit coagulation factors, the objective interpretation of routine laboratory tests , the development of systematized thinking in diagnostic-therapeutic integration by health personnel, and the provision of hospital pharmacological resources, is what frequently determines the prognosis in obstetric patients with extreme morbidity who require multidisciplinary care in the different hospital units of the health sector of our country. The objective is to present a clinical case of extreme morbidity due to acquired hemophilia, its clinical presentation, evolution and fatal outcome. A case referred from another unit of the ISEM (Instituto de Salud del Estado de México) Health Sector, treated at the Obstetric Intensive Care Unit of the «Mónica Pretelini Sáenz¼ Hospital, is presented, highlighting the importance of diagnostic-therapeutic integration, and the multifactorial interaction of variables related to its fatal outcome. Conclusions: Ignorance of the pathology, delay in diagnosis, multiple conditioning procedures of iatrogenic hemorrhage and the limitation in therapeutic resources are factors that contribute to a fatal outcome.

[Metabolic control in the critically ill patient an update: hyperglycemia, glucose variability hypoglycemia and relative hypoglycemia]. / Actualidades en el control metabólico del paciente crítico: hiperglucemia, variabilidad de la glucosa, hipoglucemia e hipoglucemia relativa.

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. OBJECTIVES: The purpose of this review is to present new data about the management and metabolic control of patients in critical areas. CONCLUSIONS: Currently glucose can no longer be regarded as an innocent element in critical patients; both hyperglycemia and hypoglycemia increase morbidity and mortality of patients. Protocols and better instruments for continuous measurement are necessary to achieve the metabolic control of our patients.

[Thrombotic microangiopathy and intravascular hemolysis in pregnancy-induced hypertension. The lie of HELLP syndrome]. / Microangiopatía trombótica y hemólisis intravascular en hipertensión por embarazo. La mentira del síndrome de HELLP.

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. Also, we retrospectively reviewed the medical charts from three Intensive Care Units from two specialized gyneco-obstetrics hospitals and from one General Hospital. From all the patients with pregnancy-induced hypertension and who developed TMIH confirmed clinically and by laboratory findings, we described the incidence of acute renal failure and the mortality in this group of patients.

[Toxic epidermic necrolysis]. / Necrólisis epidérmica tóxica.

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 %. METHODS: This is a prospective and descriptive study presenting the case of 12 patients with toxic epidermal necrolysis. Diagnosis was made by history of drug ingestion, clinical presentation and skin biopsy, which was corroborated by light microscopy. RESULTS: Twelve patients were treated with heparin, dypiridamol, potassium permanganate, methylcellulose, respiratory therapy treatments and early peritoneal dialysis for stabilization in one patient who development acute renal failure. All patients recovered between 20 and 25 days after the beginning of the disease with a mortality of 0%. CONCLUSIONS: The relationship between intravascular coagulation and TEN is corroborated by mediators of the inflammatory reaction that can trigger multiple organ dysfunction. By using anticoagulants and antiplatelet drugs at an early stage, the inflammatory response can be avoided as demonstrated in our group of patients.

[Peritoneal dialysis in obstetric patients]. / Diálisis peritoneal en pacientes obstétricas.

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. Early peritoneal dialysis (EPD) is the temporary treatment. For these patients, 100 % recovery in renal function was observed. When ARF is associated with multiple organ failure (MOF), the reported mortality ranges between 0 and 20 %. OBJECTIVE: To describe clinical features and medical outcomes of patients treated with early peritoneal dialysis in pregnancy complicated by ARF. METHODS: A case series was conducted at the Research Unit of the Instituto Materno Infantil del Estado de México. We reviewed the cases of patients admitted to the ICU matching the criteria for ARF. They were divided into two groups: those who received EPD vs. those who did not require EPD. The most important national series were included describing the association with preeclampsia and thrombotic microangiopathy with hemolysis. RESULTS: In a 5-year period, 1272 patients were admitted to the ICU; in 38 patients ARF was documented requiring peritoneal dialysis. In nine cases ARF was associated with thrombotic microangiopathy with hemolysis, two cases of stillbirth, and one case of mortality with MOF. A 100% recovery in renal function was observed in all cases, using 1.5% solution with an average of 34 dialysis treatments. CONCLUSIONS: The early use of peritoneal dialysis in obstetric patients with ARF has a good prognosis.

[Atipical uremic hemolityc syndrome in pregnancy]. / Síndrome urémico hemolítico atípico en el embarazo.

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. Multiple factors are required for the disease to manifest itself, including a trigger and gene mutations with adequate penetration. Being one of the differential diagnoses of preeclampsia- eclampsia and HELLP syndrome means that the clinician must be familiar with the disease due to its high mortality, which can be modified with early diagnosis and comprehensive treatment.

[Intracellular calcium-dependent contractile effects of serotonin in the human umbilical artery]. / Efectos contráctiles dependientes del calcio intracelular inducidos por la serotonina en la arteria umbilical humana.

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. MATERIALS AND METHODS: Umbilical arteries from normal pregnancies were dissected, cut in 5 mm rings and mounted in a temperature-controlled isolated organ chamber, using calcium-free Krebs solution. The contractile effects of serotonin, lantane, verapamil and cyclopiazonic acid were evaluated at different concentrations using a computer coupled biopac polygraph. RESULTS: No differences in response were observed in the presence and absence of intracellular calcium. The positive contractile effects observed with serotonin were significantly decreased with repeated stimulation. An increase in the basal tone of the vessel was observed after calcium supplementation was added to the solution. This effect was minimized in the presence of verapamil and lantane. The contractile effects of serotonin in the calcium-free solution were not affected by the presence of cyclopiazonic acid. CONCLUSIONS: Serotonin contractile effects in the human umbilical artery depend mainly on intracellular calcium levels which favor the gradual entrance of this ion over time. Calcium influx induced by serotonin is possible through L and Non-L channels apparently insensitive to ciclopiozonic acid.