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Introduction : la transfusion sanguine est un acte thérapeutique capital dans la pratique médicale et constitue une préoccupation majeure de santé publique Objectif : identifier les facteurs associés au décès chez les patients transfusés Patients et méthode : il s'est agi d'une étude transversale descriptive et analytique à collecte de données rétrospective, menée du 1 er Janvier 2018 au 31 Juillet 2023. Etaient inclus les patients hospitalisés et ayant bénéficié d'une transfusion sanguine. Résultats : 645 patients étaient inclus sur 3639 patients hospitalisés, correspondant à un taux transfusionnel de 17,7%. L'âge moyen des patients était de 49 ± 16 ans et 66,1% étaient de sexe masculin (sex-ratio = 1,95). La transfusion sanguine était indiquée pour une hémorragie digestive dans 65,6% des cas. Les produits sanguins les plus utilisés étaient le concentré de culot globulaire et le plasma frais congelé respectivement dans 93,6% et 6,5% des cas. Le délai entre la prescription des produits sanguins et la transfusion sanguine était supérieur à 24 heures dans 46,5% des cas. Sur les 645 patients transfusés, 150 (23,2%) étaient décédés. Un délai de transfusion supérieur à 24 heures était associé au décès chez les patients transfusés.

Introduction: blood transfusion is an important therapeutic procedure in medical practice and a major public health concern Objective: identify factors associated with death in transfuses patients Patients and method: This was a descriptive and analytical cross-sectional study with retrospective data collection, conducted from January 1, 2018 to July 31, 2023. Patients who were hospitalized and received a blood transfusion were included. Results: 645 patients were included out of 3639 hospitalized, corresponding to a transfusion rate of 17.7%. The mean age of the patients was 49 ± 16 years, and 66.1% were male (sex ratio = 1.95). Blood transfusion was indicated for gastro-intestinal bleeding in 65.6% of cases. The blood products most frequently used were packed red blood cells and fresh frozen plasma in 93.6% and 6.5% of cases respectively. The time between blood product prescription and blood transfusion was greater than 24 hours in 46.5% of cases. Of the 645 patients transfused, 150 (23.2%) died. A transfusion delay of more than 24 hours was associated with death in patients transfused. Conclusion: Blood transfusion is a frequent therapeutic procedure of vital importance in the management of gastroenterology emergencies

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Introducción: la hemofilia es un trastorno hemorrágico hereditario en el cual la sangre no coagula de manera adecuada debido a niveles bajos de los factores de la coagulación VIII o IX, que pueden causar sangrados espontáneos, cuya gravedad está determinada por la cantidad del factor en la sangre. Objetivo: identificar los principales sitios de hemorragia espontánea y sus complicaciones, lo cual es clave para el cuidado, prevención y pronóstico de estos pacientes. Métodos: la búsqueda de la literatura se realizó en las bases de datos de Pubmed, Access Medina, ClinicalKey y Science Direct entre el 23 agosto 2021 y enero 2023. Discusión: se describen las complicaciones y características principales del paciente con hemofilia, las manifestaciones clínicas que se relacionan con eventos hemorrágicos, observando según la literatura la gravedad de acuerdo con la concentración de los factores. Conclusiones: tanto la hemofilia A como la B cursan con hemorragias espontáneas o causadas por lesiones o intervenciones quirúrgicas. Las presentaciones clínicas varían dependiendo de los sistemas que se vean afectados. Una adecuada terapia de reemplazo ayuda a prevenir los episodios de sangrado y el desarrollo de sus diferentes complicaciones.

Introduction: hemophilia is an inherited bleeding disorder in which blood does not clot properly due to low levels of clotting factors VIII or IX, which can cause spontaneous bleeding, the severity of which is determined by the amount of factor in the blood. Objective: to identify the main sites of spontaneous bleeding and its complications, which is key to the care, prevention and prognosis of these patients. Methods: the literature search was performed in Pubmed, Access Medina, ClinicalKey and Science Direct databases between 23 August 2021 and January 2023. Discussion: we describe the complications and main characteristics of the patient with hemophilia, the clinical manifestations related to hemorrhagic events, observing according to the literature the severity according to the concentration of the factors. Conclusions: both hemophilia A and B are associated with spontaneous bleeding or bleeding caused by injuries or surgical interventions. Clinical presentations vary depending on which systems are affected. Adequate replacement therapy helps to prevent bleeding episodes and the development of their different complications.

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A hemofilia por deficiência do fator XIII é uma doença que possui inúmeros riscos em cirurgia ou procedimentos invasivos, sendo o maior deles, a hemorragia. Na odontologia, para o profissional realizar procedimentos cirúrgicos em pacientes hemofílicos precisa estar capacitado com conhecimento teórico-prático de como realizar o pré, trans e pós-operatório, a fim de amenizar possíveis riscos e trazer segurança para o paciente e para ele. O presente estudo visa relatar uma exodontia em um paciente portador de hemofilia com deficiência do fator XIII, na Clínica Escola de Odontologia do Instituto Esperança de Ensino Superior (IESPES), objetivando trazer informações relacionadas à essa disfunção sanguínea e a conduta do cirurgião-dentista para um bom manejo odontológico neste grupo de pacientes.

Factor XIII hemophilia is a disease that poses several risks in surgery or invasive procedures, the greatest of which is hemorrhage. In dentistry, for the professional to perform surgical procedures in hemophilia patients need to be trained with theoretical and practical knowledge of how to perform the pre, trans and postoperative, in order to mitigate possible risks and bring safety for the patient and for him. The present study aims to report an exodontia in a patient with hemophilia with factor XIII deficiency in the Clínica Escola de Odontologia do Instituto Esperança de Ensino Superior (IESPES), aiming to bring information related to this blood dysfunction and the dental surgeon's conduct for a good dental management in patients affected by this pathology.

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La hematoma amigdalino espontáneo, es un cuadro clínico raro con baja incidencia a nivel mundial, resultado de un proceso inflamatorio local secundario a la amigdalitis, donde el factor de riesgo más significativo es la amigdalitis a repetición. Desde el punto de vista clínico, su distinción del absceso periamigdalino, puede ser un desafío, lo cual es crucial debido a diferencias en el tratamiento y el pronóstico entre ambas. Al ser un cuadro de baja prevalencia es importante tener un alto nivel de sospecha diagnóstica para abordar adecuadamente esta entidad clínica y prevenir consecuencias potencialmente mortales.

Spontaneous tonsillar hematoma is a rare clinical condition with low incidence worldwide, resulting from a local inflammatory process secondary to tonsillitis, where the most significant risk factor is recurrent tonsillitis. From a clinical standpoint, its distinction from a peritonsillar abscess can be challenging, which is crucial due to differences in treatment and prognosis between the two. Given its low prevalence, maintaining a high level of diagnostic suspicion is important to address this clinical entity and prevent potentially life-threatening consequences appropriately.

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A doença renal crônica em estágio terminal pode levar a alterações sistêmicas que tornam o manejo clínico odontológico desses indivíduos desafiador, especialmente se os procedimentos forem invasivos. As preocupações incluem alteração do metabolismo de drogas, da resposta imunológica e do metabolismo ósseo, além do risco aumentado de sangramento e discussão sobre risco aumentado para endocardite infecciosa. O objetivo deste estudo retrospectivo foi conhecer a frequência e o tipo de complicações durante e após execução de procedimentos odontológicos em indivíduos com insuficiência renal crônica em diálise (IRC-D), atendidos no Centro de Atendimento a Pacientes Especiais (CAPE) da Faculdade de Odontologia da USP (FOUSP). Adicionalmente, comparamos a quantidade e o tipo de complicações entre os indivíduos que usaram antibiótico profilático e aqueles que não usaram, antes dos procedimentos odontológicos. Para tanto desenvolvemos um formulário específico para este estudo, no qual compilamos as informações relativas aos períodos trans e pós-operatórios de procedimentos odontológicos realizados nos pacientes com IRC em diálise. Nossa hipótese era a de que a prevalência de complicações durante e após os procedimentos odontológicos de indivíduos com IRC em diálise fosse baixa, e que ouso do antibiótico prescrito profilaticamente não interferiria na qualidade dareparação ou na incidência de complicações relacionadas aos procedimentos odontológicos. Analisamos retrospectivamente 225 prontuários de pacientes com IRC em diálise atendidos no CAPE-FOUSP desde 1990 até os dias atuais. Desse total, 130 eram pacientes do sexo masculino e do 95 do feminino. A idade média destes indivíduos foi de 48,4 anos. As principais doenças de base que levaram a ocorrência da IRC-HD foram a hipertensão arterial sistêmica (48 pacientes) e o diabetes mellitus (23 pacientes). Nos 225 pacientes, 1.390 procedimentos odontológicos foram realizados, dos quais 856 foram não invasivos, 443 invasivos e 91 tratamentos endodônticos. Dentre os procedimentos invasivos, houve 259 exodontias. Antes de 80 das 259 intervenções cirúrgicas (31%) houve a prescrição de antibiótico profilático em diferentes posologias; em 29 exodontias (11%) foram utilizados hemostáticos locais no momento da realização da sutura. Foram descritos nos prontuários 16 casos de sangramento transoperatório (6%), 5 casos de sangramento pós-operatório (2%) e 2 casos de complicação pós-operatória (0,8%), definidos como uma alveolite e uma infecção alveolar. Nossos resultados permitiram nos concluir que a incidência de complicações após exodontias é baixa e que o uso de antibiótico profilático (AP) não interferiu nessa incidência.

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Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

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OBJECTIVES@#To investigate the clinical characteristics and risk factors of delayed bleeding after intestinal polypectomy in children, and to provide a theoretical basis for clinical surgical intervention of intestinal polyps.@*METHODS@#A retrospective analysis was conducted on the clinical data of 2 456 children with intestinal polyps who underwent endoscopic high-frequency electrocoagulation loop resection in the Endoscopy Center of Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. According to the presence or absence of delayed bleeding after surgery, they were divided into bleeding group with 79 children and non-bleeding group with 2 377 children. A multivariate logistic regression analysis was used to investigate the risk factors for delayed bleeding. The receiver operating characteristic (ROC) curve was used to investigate the value of various indicators in predicting delayed bleeding.@*RESULTS@#Of all 2 456 children, 79 (3.22%) experienced delayed bleeding, among whom 5 children with severe delayed bleeding underwent emergency colonoscopy for hemostasis and 74 received conservative treatment, and successful hemostasis was achieved for all children. There were significant differences between the bleeding and non-bleeding groups in age, body mass index, constipation rate, location of lesion, time of endoscopic procedure, resection method (P<0.05). Children with a diameter of polyps of 6-10 mm and >20 mm were more likely to develop delayed bleeding after resection (P<0.05). The multivariate logistic regression analysis showed that endoscopic operation time, polyp diameter, and resection method were significantly associated with delayed bleeding (P<0.05). The ROC curve analysis showed that the endoscopic operation time, polyp diameter, and resection method had a good value in predicting delayed bleeding after intestinal polypectomy, with an area under the ROC curve of 0.706, 0.688, and 0.627, respectively.@*CONCLUSIONS@#Endoscopic high-frequency electrocoagulation loop resection has a lower incidence of delayed bleeding in children with intestinal polyps, and the endoscopic operation time, polyp diameter, and resection method are closely associated with the occurrence of postoperative delayed bleeding.

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Introducción: la hemorragia del intestino delgado representa 5% de las hemorragias digestivas y se debe en especial a malformaciones vasculares. El diagnóstico se realiza mediante cápsula endoscópica, aunque depende del estado del paciente así como de la disponibilidad de acceso. Presentación del caso: mujer de 22 años que cursa con un cuadro de hematoquecia que condujo a un estado de choque hipovolémico y paro cardiorrespiratorio, con estudios de endoscopia alta y baja negativos. Ante la imposibilidad de acceder a cápsula endoscópica, se realizó intervención quirúrgica con identificación de ectasia vascular de yeyuno.

Introduction: bleeding from the small bowel represents 5% of all cases of gastrointestinal (GI) bleeding and is mainly due to vascular malformations. Diagnosis is made by capsule endoscopy, although it depends on the patient ́s condition as well as capsule endoscopy availability. Case report: a 22-year-old female patient presenting with hematochezia leading to hypovolemic shock and cardiorespiratory arrest, with negative upper and lower GI endoscopies. Given the impossibility of accessing capsule endoscopy, a surgical intervention was performed which identified jejunal vascular ectasia.

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Introducción: la enfermedad relacionada con IgG4 (ER-IgG4) es una entidad reciente, caracterizada por infiltración de plasmocitos IgG4+ y esclerosis de patrón estoriforme mediada por linfocitos CD4+ y T-foliculares ayudadores (Tfh). La mayoría de los pacientes presentan adenopatías y pérdida de peso. Entre los sitios más afectados se encuentran páncreas, glándulas salivales y lacrimales, aorta y retroperitoneo, siendo raro el compromiso gástrico. El diagnóstico se establece en el estudio histopatológico del órgano comprometido, la clínica y la serología. Los glucocorticoides constituyen la primera línea de manejo. Presentación del caso: paciente masculino de 38 años con síntomas sugestivos de sangrado digestivo superior, la endoscopia de vías digestivas altas reveló una ulceración en el cuerpo del estómago, sospechosa de una lesión subepitelial gástrica ulcerada, de posible origen del estroma gástrico (GIST), por lo que se realizó gastrectomía subtotal por vía laparoscópica. La histología fue compatible con un tumor ulcerado fibroesclerosante relacionado con IgG4. Se inició tratamiento con glucocorticoides con respuesta favorable. Conclusión: en esta revisión se analizarán los casos de compromiso gástrico encontrados en la literatura para describir las características más importantes de esta entidad.

Introduction: IgG4-related disease (IgG4-RD) is a recently described entity, characterized by IgG4+ infiltration of plasma cells and storiform pattern sclerosis mediated by CD4+ lymphocytes and follicular helper T-cells (Tfhs). Most patients present with adenopathy and weight loss. Among the most affected sites are the pancreas, salivary and lacrimal glands, aorta, and retroperitoneum. Gastric involvement is rare. Diagnosis is based on histopathological examination of the involved organ, clinical manifestations, and serological results. Glucocorticoid therapy is the first line management. Case report: a 38-year-old male patient with symptoms suggestive of upper gastrointestinal (GI) bleeding, upper GI endoscopy revealed a gastric corpus ulcer, suspicious of an ulcerated gastric subepithelial lesion, possibly a gastrointestinal stromal tumor (GIST). Consequently, laparoscopic subtotal gastrectomy was performed. Histology was compatible with an ulcerated IgG4-related fibrosclerosing tumor. Glucocorticoid therapy was started with patient ́s favorable response. Conclusion: in this paper, we will review the cases of IgG4-RD with gastric involvement reported in the literature to describe the most important features of this condition.

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Abstract Objective To analyze whether there is more bleeding in patients undergoing total knee arthroplasty (TKA) without using a tourniquet. The secondary objectives were to analyze the operative time, the length of hospital stay, the need for transfusion, and the complication rate. Methods The present is a retrospective study through the analysis of medical records. The patients were divided into two groups: TKA with and without the use of a tourniquet. Reductions in the levels of hemoglobin and packed cell volume 24 h and 48 h after surgery, the operative time, the length of hospital stay, the need for transfusion, and the rate of complications up to 6 months postoperatively were compared between the groups. Results During the period analyzed, 104 patients underwent TKA, and 94 were included in the study. There were no differences between the groups regarding the mean values of hemoglobin and packed cell volume before surgery (p = 0.675 and p = 0.265), 24 h (p = 0.099 and p = 0.563), and 48 h (p = 0.569 and p = 0.810) after the procedure. Neither were there differences between the groups in terms of the operative time and the length of hospital stay (p = 0.484 and p > 0.05). Moreover, there were no differences regarding the need for transfusion and the complication rate. Conclusion It is possible to forgo the use a tourniquet in TKA without a significant change in hemoglobin and packed cell volume levels 24 h and 48 h after surgery when compared with the group using a tourniquet. There were no significant differences in the total operative time, length of stay, need for transfusion, and complication rate.

Resumo Objetivo Analisar se há mais sangramento em pacientes submetidos a artroplastia total do joelho (ATJ) sem a utilização do torniquete. Os objetivos secundários foram analisar os tempos cirúrgico e de internação, a necessidade de transfusão e a taxa de complicações. Métodos Estudo retrospectivo por meio da análise de prontuários. Os pacientes foram divididos em dois grupos: ATJ com e sem a utilização de torniquete. Foram comparados os valores das quedas da hemoglobina e do hematócrito 24 h e 48 h após a cirurgia, os tempos cirúrgico e de internação, a necessidade de transfusão e a taxa de complicações até 5 meses de pós-operatório. Resultados No período, foram operados 104 pacientes, sendo 94 incluídos no estudo. Não houve diferença entre as médias dos valores da hemoglobina e do hematócrito entre os grupos no pré-operatório (p = 0,675 e p = 0,265, respectivamente), 24 h (p = 0,099 e p = 0,563, respectivamente) e 48 h (p = 0,569 e p = 0,810, respectivamente) após a cirurgia. O tempo cirúrgico e o tempo de internação também não foram diferentes entre os grupos (p = 0,484 e p > 0,05, respectivamente). Não houve diferença com relação à necessidade de transfusões, nem com relação à taxa de complicações analisadas. Conclusão Podemos dispensar o uso do torniquete nas cirurgias de ATJ sem alteração significativa no valor dos níveis de hemoglobina e de hematócrito 24 h e 48 h após a cirurgia quando comparado ao grupo com uso de torniquete. Não houve diferenças significativas no tempo total das cirurgias, no tempo de internação, na necessidade de transfusões e nas taxas de complicações analisadas.

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Uretero-arterial fistula (UAF) is an uncommon but potentially life-threatening condition that usually manifests as hematuria. We report a new case of UAF presenting with massive bleeding and hypovolemic shock in a patient with a history of vascular prosthetic surgery and long-term ureteral stenting for urinary lithiasis. Recognizing this condition is difficult but crucial for a prompt diagnosis and appropriate treatment. Angiography offers the highest diagnostic benefit and arterial stent-graft placement is nowadays the treatment of choice. In our patient early clinical suspicion made curative endovascular treatment possible in an effective and safe way (AU)

La fístula ureteroarterial (FAU) es una afección infrecuente pero potencialmente mortal que suele manifestarse como hematuria. Se presentó un nuevo caso de FAU que cursó con hemorragia masiva y choque hipovolémico en paciente femenina con antecedentes de cirugía vascular protésica y colocación de endoprótesis ureteral a largo plazo por litiasis urinaria. Reconocer esta afección es difícil pero crucial para un diagnóstico rápido y un tratamiento adecuado. La angiografía ofrece el mayor beneficio diagnóstico y la colocación de un stent arterial es hoy en día el tratamiento de elección. En esta paciente la sospecha clínica precoz hizo posible el tratamiento endovascular curativo de forma eficaz y segura (AU)

A fístula ureteroarterial (UAF) é uma condição rara, mas potencialmente fatal, que geralmente se manifesta como hematúria. Foi apresentado um novo caso de UAF que apresentou hemorragia maciça e choque hipovolêmico em uma paciente do sexo feminino com história de cirurgia protética vascular e colocação de stent ureteral de longa duração para litíase urinária. Reconhecer esta condição é difícil, mas crucial para um diagnóstico rápido e tratamento adequado. A angiografia oferece o maior benefício diagnóstico e o implante de stent arterial é atualmente o tratamento de escolha. Neste paciente, a suspeita clínica precoce possibilitou o tratamento endovascular curativo de forma eficaz e segura (AU)

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Abstract Managing anemia before surgery is extremely important as it is a clinical condition that can significantly increase surgical risk and affect patient outcomes. Anemia is characterized by a reduction in the number of red blood cells or hemoglobin levels leading to a lower oxygen-carrying capacity of the blood. Proper treatment requires a multifaceted approach to ensure patients are in the best possible condition for surgery and to minimize potential complications. The challenge is recognizing anemia early and implementing a timely intervention to correct it. Anemic patients are more susceptible to surgical complications such as increased infection rates, slower wound healing and increased risk of cardiovascular events during and after surgery. Additionally, anemia can exacerbate existing medical conditions, causing greater strain on organs and organ systems. To correct anemia and optimize patient outcomes, several essential measures must be taken with the most common being identifying and correcting iron deficiency.

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Abstract Hemostasis plays a critical role in surgical procedures and is essential for a successful outcome. Advances in hemostatic agents offer new approaches to controlling bleeding thereby making surgeries safer. The appropriate choice of these agents is crucial. Volume replacement, another integral part of Patient Blood Management (PBM), maintains adequate tissue perfusion, preventing cellular damage. Individualization in fluid administration is vital with the choice between crystalloids and colloids depending on each case. Colloids, unlike crystalloids, increase oncotic pressure, contributing to fluid retention in the intravascular space. Understanding these aspects is essential to ensure safe and effective surgery, minimizing complications related to blood loss and maintaining the patient's hemodynamic status.

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Aim: The present study aimed to investigate if cannabis use can be associated with gingival bleeding and caries experience among Brazilian students. Methods: A cross-sectional study was performed in 2016 with first-semester university students in Pelotas. Data was collected via a self-administered questionnaire. Self-reported gingival bleeding and caries experienced were collected. Cannabis use was assessed using a modified version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). We define cannabis users as individuals who report using cannabis at least once a month. A Poisson regression model with robust variance was used to analyze the data. Results: A total of 2,058 (64.5% of eligible students) students were assessed. The prevalence of caries experience was 68.2% and gingival bleeding was 50.8%. The prevalence of cannabis use was 11.7%. After controlling (sex, skin color, age, family income, depressive symptoms, oral health self-perception tobacco use), individuals who use cannabis present a prevalence of gingival bleeding 2.51 (CI95%[1.42­4;53]) higher than individuals who did not use cannabis. The association was maintained even when the individuals who used tobacco were excluded from the sample (PR=2.24, CI95%[1.16 ­ 4.31]). Cannabis use did not show an association with the experience of dental caries in both crude (PR 0.91 CI95%[0.82 ­ 1.01]) and adjusted models (PR 0.93 CI 95%[0.83 ­ 1.05]). Conclusion: Cannabis use was associated with the presence of gingival bleeding among the students of a public university in the south of Brazil. However, the experience of dental caries did not present an association with cannabis use

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A nivel mundial, la hemorragia sigue siendo la causa principal de mortalidad de la gestante y origina el 25% a 30% de los fallecimientos en la fase periobstetrica. En nuestro país las principales causas de muerte materna. El 63% de estas las principales causas fueron las hemorragias (59%) por retención placentaria y atonía uterina. Reportamos el caso de gestante de 38 años con diagnóstico de embarazo de 34 semanas; placenta previa oclusiva total sangrante programada para cesárea de emergencia. Es intervenida quirúrgicamente bajo bloqueo subaracnoideo que por la hemorragia severa secundaria a hipotonía uterina se decide histerectomía de emergencia. Se pasa a anestesia general con reposición de volemia con cristoloides y componentes hemáticos. Es transferida a Terapia Intensiva Extrainstitucional. La Hemorragia postparto es una complicación grave que es la causa más prevenible de mortalidad materna

Worldwide, hemorrhage continues to be the main cause of mortality in pregnant women and causes 25% to 30% of deaths in the periobstetric phase. In our country the main causes of maternal death. A 63% of these the main causes were hemorrhages (59%) due to placental retention and uterine atony. We report the case of a 38-year-old pregnant woman with a diagnosis of 34-week pregnancy; Bleeding total occlusive placenta previa scheduled for emergency cesarean section. She underwent surgery under subarachnoid block and due to the severe hemorrhage secondary to uterine hypotony, an emergency hysterectomy was decided. General anesthesia is followed with volume replacement with cristoloids and blood components. She is transferred to Extra-Institutional Intensive Care. Postpartum hemorrhage is a serious complication that is the most preventable cause of maternal mortality

ABSTRACT

Introducción: La hemorragia digestiva alta tiene una elevada morbimortalidad. La endoscopía digestiva alta es el estudio de elección para su diagnóstico y tratamiento. Objetivo: Describir la conducta ante la hemorragia digestiva alta. Métodos: Para la revisión bibliográfica se consultaron artículos científicos indexados en idioma español e inglés, relacionados con la hemorragia digestiva, publicados en las bases de datos PubMed, SciELO, Medline y Cochrane, pertenecientes a autores dedicados al estudio de este tema. Desarrollo: La hemorragia digestiva alta se clasifica, según la etiología de origen, en variceal y no variceal. La mayoría de los pacientes con hemorragia digestiva alta el sangrado se autolimita. La causa más habitual es la úlcera péptica, pero en caso de sangrado masivo la etiología más frecuente es la variceal. El empleo precoz de la terlipresina en los pacientes con hemorragia digestiva alta variceal mejora el control del sangrado y disminuye la mortalidad. Se debe hacer uso de escalas validadas de estratificación del riesgo: escala de riesgo de Rockall (tiene como propósito principal predecir la mortalidad y riesgo de resangrado del paciente) y la escala de Glasgow-Blatchford). Conclusiones: Sospechar la presencia de hemorragia digestiva alta, estratificar su riesgo e instaurar el manejo inicial y apropiado constituye una prioridad para el médico de urgencia(AU)

Introduction: Upper gastrointestinal bleeding presents high morbidity and mortality. Upper gastrointestinal endoscopy is the study of choice for its diagnosis and treatment. Objective: To describe the management of upper gastrointestinal bleeding. Methods: For the bibliographic review, the consultation was carried out of scientific articles indexed in Spanish and English, related to gastrointestinal bleeding, published in the databases PubMed, SciELO, Medline and Cochrane, belonging to authors dedicated to the study of this subject. Development: Upper gastrointestinal bleeding is classified, according to the etiology of origin, into variceal and nonvariceal. In most patients with upper gastrointestinal bleeding the bleeding as such is self-limiting. The most common cause is peptic ulcer; however, in the case of massive bleeding, the most frequent etiology is variceal. Early use of terlipressin in patients with variceal upper gastrointestinal bleeding improves bleeding control and decreases mortality. Validated risk stratification scales should be used: Rockall risk scale (its main purpose is to predict patient mortality and risk of bleeding recurrence) and the Glasgow-Blatchford scale. Conclusions: Suspecting the presence of upper gastrointestinal bleeding, stratifying its risk, as well as instituting initial and appropriate management, are a priority for the emergency physician(AU)

ABSTRACT

La neumonía por Pneumocystis jirovecii es una enfermedad fúngica oportunista descrita principalmente en pacientes con VIH, sin embargo, tras la introducción de la TARV, ha incrementado su incidencia en pacientes con inmunosupresión no asociada a VIH, como neoplasias hematológicas y trasplantes de órganos sólidos. Presentamos el caso de un varón de 17 años, receptor de un trasplante renal, con inmunosupresión prolongada con corticoesteroides, con cuadro clínico de tos, disnea y fiebre. La TC mostró micronódulos pulmonares centrolobulillares y vidrio esmerilado. El LBA fue compatible con hemorragia alveolar difusa (HAD), con RPC positiva para P. jirovecii. Se descartaron otras infecciones y enfermedades autoinmunes. Recibió tratamiento con cotrimoxazol con buena evolución clínica y mejoría radiológica. Si bien las causas más frecuentes de HAD son etiologías autoinmunes como enfermedades reumatológicas o vasculitis, es prioritario descartar causas infecciosas, incluyendo P. jirovecii, ya que el tratamiento dirigido puede tener un impacto significativo en la mortalidad en este grupo de pacientes.

Pneumocystis jirovecii pneumonia is an opportunistic fungal infection, described mainly in HIV patients, however, after the introduction of ART, its presentation has increased in patients with non-HIV immunosuppression, such as hematological cancers, solid or hematopoietic stem cell transplantation. We report the case of a 17-year-old male, kidney transplant patient, with prolonged immunosuppression with corticoesteroids, with history of cough, dyspnea, and fever. Chest CT evidences centrilobular pulmonary micronodules with ground glass. BAL was performed compatible with diffuse alveolar hemorrhage, with positive PCR for P. jirovecii. Other infections and autoimmune disease were ruled out. He received treatment with cotrimoxazole with clinical improvement of the patient, and follow up chest CT at the end of treatment showed decrease of pulmonary infiltrates. Although the most frequent causes of DAH are autoimmune etiologies such as rheumatic diseases or vasculitis, it is a priority to rule out infectious causes, including P. jirovecii, since targeted treatment could have a significant impact on mortality outcomes in this group of patients.

ABSTRACT

Background: Hemolacria or the presence of blood in tears is a rare condition, and there are only a few cases reported in the literature. Hemolacria is associated with multiple underlying diseases, including vicarious menstruation due to extragenital endometriosis. Case report: We present a 26-year-old woman with hemolacria and abdominal pain related to her menstrual cycle. The patient was diagnosed with bilateral ovarian endometriomas. After ruling out other possible causes of hemolacria, a progestin-only treatment was applied, with improvement of the abdominal pain and complete remission of hemolacria. Conclusions: When faced with hemolacria, a thorough anamnesis and physical examination must be performed, sometimes involving more than one specialist to reach a diagnosis. Considering hemolacria is a sign of a subjacent pathology, its treatment should be specific one for the disease in each case.

Antecedentes: La hemolacria o presencia de sangre en las lágrimas es una afección poco frecuente y sólo hay unos pocos casos descritos en la literatura. La hemolacria se asocia a múltiples enfermedades subyacentes, incluida la menstruación vicaria debida a endometriosis extragenital. Caso clínico: Presentamos a una mujer de 26 años con hemolacria y dolor abdominal relacionado con su ciclo menstrual. La paciente fue diagnosticada de endometriomas ováricos bilaterales. Tras descartar otras posibles causas de hemolacria, se aplicó un tratamiento sólo con progestágenos, con mejoría del dolor abdominal y remisión completa de la hemolacria. Conclusiones: Ante una hemolacria se debe realizar una anamnesis y exploración física minuciosa, en la que a veces interviene más de un especialista para llegar al diagnóstico. Teniendo en cuenta que la hemolacria es signo de una patología subyacente, su tratamiento debe ser el específico para la enfermedad en cada caso.