Ovarian torsion in second trimester of pregnancy: a case report

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. Although the exact etiology is unknown, common predisposing factors include moderate size cyst, free mobility and long pedicle. Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. Here, we report a case of ovarian torsion in second trimester of pregnancy. Ovarian torsion is an urgent gynecological surgery and can occur during pregnancy. Surgical techniques should be considered in the development of the adnexal torsion regardless of the gestational age.

Case series on placenta accreta spectrum disorder and its management

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The main complication of PAS is due to it抯 massive obstetric haemorrhage which leads to maternal morbidity and mortality. The incidence of placenta accreta spectrum increases day by day due to an alarming increase in caesarean section rates. Depending on the range of invasiveness, The Placenta accreta spectrum is classified as placenta accreta, placenta increta and placenta percreta. We report here a series of 5 cases of placenta accreta spectrum and their management at our centre. With all due pre-op preparedness and anticipation of complications. All 5 cases had good maternal and fetal outcome. In 3 cases hysterectomy was required and 2 cases uterus could be preserved.

Flow diverter stent as a definitive endovascular strategy to obliterate acute spontaneous rupture of brain aneurysmal subarachnoid hemorrhage in elderly: a case report in Indonesia

Spontaneous rupture of brain aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating disease, half of which occurs in individuals under 50 years old. Challenges in its management arise from the decision-making process regarding the preferred method of definitive aneurysm obliteration, whether through surgical intervention or endovascular approach. This study described the role of flow diverter stent as an effective endovascular approach to obliterate aSAH in the acute phase. A 70-yearold female presented with thunderclap headache, slight right hemiparesis, and pupillary-sparing left oculomotor palsy corresponding with ruptured brain aSAH. Endovascular management of flow diverter stent was preferred and inserted within the third day onset. Double antiplatelet was administered prior to and following the procedure. Three-day follow-up showed resolution of brain aSAH with no neurological sequelae. Flow diverter stent offers several advantages over coiling when treating wide-neck, giant, saccular, or fusiform aneurysm. It is also safer for elderly, especially with multiple comorbids, compared with clipping. However, it has risks of either parent/ distal artery occlusion due to its thrombogenic properties or the potential for rebleeding following dual antiplatelet administration. Effective management and thorough evaluation are essential to maximize the likelihood of favorable outcomes when employing this approach. Flow diverter stent is a promising endovascular management for ruptured brain aSAH, particularly in elderly with many comorbids and wide neck/ giant aneurysm at anterior circulation which is not candidate for coiling or clipping. It is also crucial to monitor, evaluate, and manage risk of rebleeding and thrombosis to ensure long-term success of this management approach.

Development and validation of a diagnostic prediction model for severe periventricular-intraventricular hemorrhage in newborns: insights from a retrospective analysis utilizing the MIMIC-III database

Abstract Objective: Periventricular-intraventricular hemorrhage is the most common type of intracranial bleeding in newborns, especially in the first 3 days after birth. Severe periventricular-intraventricular hemorrhage is considered a progression from mild periventricular-intraventricular hemorrhage and is often closely associated with severe neurological sequelae. However, no specific indicators are available to predict the progression from mild to severe periventricular-intraventricular in early admission. This study aims to establish an early diagnostic prediction model for severe PIVH. Method: This study was a retrospective cohort study with data collected from the MIMIC-III (v1.4) database. Laboratory and clinical data collected within the first 24 h of NICU admission have been used as variables for both univariate and multivariate logistic regression analyses to construct a nomogram-based early prediction model for severe periventricular-intraventricular hemorrhage and subsequently validated. Results: A predictive model was established and represented by a nomogram, it comprised three variables: output, lowest platelet count and use of vasoactive drugs within 24 h of NICU admission. The model's predictive performance showed by the calculated area under the curve was 0.792, indicating good discriminatory power. The calibration plot demonstrated good calibration between observed and predicted outcomes, and the Hosmer-Lemeshow test showed high consistency (p = 0.990). Internal validation showed the calculated area under a curve of 0.788. Conclusions: This severe PIVH predictive model, established by three easily obtainable indicators within the NICU, demonstrated good predictive ability. It offered a more user-friendly and convenient option for neonatologists.

A case report on caesarean myomectomy

Routine myomectomy at the time of caesarean section has been condemned in the past due to fear of uncontrolled haemorrhage and peripartum hysterectomy. It is still a topic of debate worldwide. However, in recent years, many case studies of caesarean myomectomy have been published validating its safety without any significant complications like excessive blood loss. We describe the case of a 23-year-old nulliparous women at 38 weeks of pregnancy with history of previous abortion. Her ultrasound was suggestive of singleton live intrauterine pregnancy with multiple intramurals and subserosal uterine fibroids seen in fundus, body region, posterior and anterior myometrium with largest fibroid of size 9×6.1 cm. The patient was taken up for elective caesarean section along with caesarean myomectomy. Live baby was delivered and successful myomectomy was done. Prophylactically oxytocin drip was given and intra myometrial carboprost was given to avoid blood loss. Patient was discharged on post-operative day 12 without any complications. Routine myomectomy at the time of caesarean section is not a standard procedure. However, it may be considered a safe option in carefully selected cases in the hands of an experienced obstetrician.

Deficiencia de factor VII: reporte de un caso / Factor VII deficiency: a case report

Resumen Introducción: La deficiencia congénita de factor VII es una condición hereditaria extremadamente rara, con una prevalencia de 1 por cada 500,000 personas. Se estima que la verdadera prevalencia de deficiencia de FVII está subestimada, debido a que una parte considerable de los pacientes son asintomáticos. Los pacientes sintomáticos muestran manifestaciones como epistaxis, sangrado mucocutáneo, equimosis y menorragia. Caso clínico: Se presenta el caso de un paciente masculino de 33 años con historia de melena, adinamia y astenia. Niega patologías previas, pero refiere antecedentes de sangrado recurrente desde la infancia. Exámenes de laboratorio revelan anemia microcítica e hipocrómica y prolongación del tiempo de protrombina. Se realiza una prueba de mezcla debido a las alteraciones en los tiempos de coagulación y su correlación con antecedentes de sangrado. Se realizan niveles de actividad coagulante de FVIIa los cuales dan como resultado <1%, confirmando una coagulopatía hemorrágica por defecto congénito de FVII. Discusión: La deficiencia de FVII representa un trastorno congénito poco común y que, debido a su variabilidad clínica, pasa desapercibido. La sospecha clínica es necesaria para el diagnóstico y tratamiento oportunos de esta condición.

Abstract Background. Congenital factor VII deficiency is an extremely rare hereditary condition, with a prevalence of 1 in every 500,000 individuals. The true prevalence of FVII deficiency is estimated to be underestimated because a considerable number of patients are asymptomatic. Symptomatic patients may exhibit manifestations such as epistaxis, mucocutaneous bleeding, ecchymosis, and menorrhagia. Clinical case. 33-year-old male patient with a history of melena, adynamia, and asthenia. He denies previous pathologies but reports a history of recurrent bleeding since childhood. Laboratory tests reveal microcytic and hypochromic anemia, as well as prolonged prothrombin time. A mixing test is performed due to abnormalities in coagulation times and their correlation with bleeding history. Coagulant activity levels of FVIIa are measured, resulting in <1%, confirming a hemorrhagic coagulopathy due to congenital FVII deficiency. Discussion . FVII deficiency represents a rare congenital disorder that often goes unnoticed due to its clinical variability. Clinical suspicion is necessary for the timely diagnosis and treatment of this condition.

Visión general de las várices gástricas y su tratamiento / Overview of gastric varices and their treatment

Las várices gástricas (VG) son un complejo de colaterales vasculares entre la circulación portal y sistémica, condición que se desarrolla como resultado de la presión elevada en el sistema venoso portal. Se encuentran en el 20 % de los pacientes con cirrosis, y son menos frecuentes que las várices esofágicas. Según la clasificación de Sarin, las VG se dividen en cuatro tipos según su ubicación en el estómago y su relación con las várices esofágicas (GOV1, GOV2, IGV1 e IGV2). Entender su hemodinámica con respecto a las rutas de drenaje de las VG es importante para guiar su tratamiento.

Gastric varices (GV) are a complex of vascular collaterals between portal and systemic circulation, a condition that develops as a result of elevated pressure in the portal venous system. They are found in 20% of patients with cirrhosis, and are less common than esophageal varices. According to the Sarin classification, GV are divided into four types based on their location in the stomach and their relationship with esophageal varices (GOV1, GOV2, IGV1, and IGV2). Understanding their hemodynamics with respect to GV drainage routes is important to guide their treatment.

Planejamento e execução cirúrgica em paciente hemofílico fator XIII - relato de Caso / Surgical planning and execution in hemophiliac patient factor XIII ­ case report

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.

The compression of myometrium and occlusion of uterine artery by COMOC-MG technique for the management of postpartum haemorrhage: clinical perspective from ten cases

Compression of myometrium and occlusion of uterine artery by Dr. Mahesh Gupta (COMOC-MG) technique is an improved B-lynch stitch technique used to control postpartum hemorrhage (PPH). Objective was to study clinical perspective of the COMOC-MG technique on the effect of PPH in Indian women. Data of 10 patients with PPH who were managed by using the COMOC-MG technique in a tertiary care center in Gujarat from April 2022 to December 2022 were retrieved. Baseline characteristics, medical problems and history of women were recorded. Decision to perform COMOC-MG stitch was taken based on the indications such as PPH, per vaginal bleeding and degree of uterine contractility. Out of 10 women, four women had medical problems such as pregnancy-induced hypertension, dysfunctional uterine bleeding and using psychiatric medicines; two women had uterine surgery/ Laparotomy; four women were diagnosed with ailments such as pregnancy induced hypertension (PIH) and hypertension during the third trimester of pregnancy. Indications such as twins during a previous pregnancy, deflexed head, previous lower segment caesarean section (LSCS) with intrauterine growth restriction (IUGR), breech, prim parity, severe oligohydramnios, placental insufficiency and second baby were considered to carry out the CS delivery. Women were managed by COMOC-MG stitch followed by Misoprostol tablets; Carbetocin, Oxytocin, Methylergometrine and Carboprost injections to control PPH. Mean time between uterine closure to COMOC-MG was 10 min. COMOC-MG stitch resulted in good outcomes in seven patients except one patient had atonic PPH. Out of ten patients, one patient required a hysterectomy and three patients required blood transfusion. COMOC-MG stitch is an easy, simple method to control PPH.

Maternal and fetal outcome in second stage caesarean section: a retrospective study

Background: This study aims to observe the maternal and neonatal outcomes of caesarean delivery performed in the second stage of labor.Methods: This was retrospective observational study conducted at Cheluvamba hospital, Mysore medical college, Mysore, in the department of Obstetrics and Gynaecology. All second stage caesarean sections performed between January 2023 to June 2023 were analyzed in terms of incidence, indications of caesarean-section, intra-operative and postoperative complications, maternal and fetal outcome.Results: During the study period there were total 4194 deliveries. Out of this 1771 deliveries were done by caesarean section. Out of them 48 were 2nd stage caesarean sections contributing to 2.71% of total sections. Patwardhan method was used in 41.6% cases for delivery of deeply engaged head. Intra-operative complications were higher in terms of atonic pph (25%), hematuria (16.66 %). 14% cases had postoperative fever and 41.6% cases need prolonged catheterization. 20.83% babies required NICU admissions and neonatal death was 4.16%.Conclusions: Caesarean section in the 2nd stage of labour is associated with increased maternal and neonatal morbidity. A proper judgement is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.

Efficacy of routine second-look endoscopy after endoscopic hemostasis in patients with acute peptic ulcer bleeding: systematic review and meta-analysis / Eficacia de la endoscopia control de rutina después de la hemostasia endoscópica en pacientes con hemorragia por úlcera péptica aguda: revisión sistemática y meta-análisis

ABSTRACT Objective: To evaluate the efficacy of scheduled second-look endoscopy in patients with acute peptic ulcer bleeding (PUB). Materials and methods: We systematically search in four databases for randomized controlled trials (RCTs) that evaluated the usefulness of scheduled second-look endoscopy vs. single endoscopy in patients with PUB. Our primary outcome was rebleeding. Secondary outcomes were surgery, mortality, and the number of units of blood transfused (NUBT). All meta-analyses were performed using a randomeffects model. Pooled risk ratio (RR) and mean difference (MD), with their 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively. The risk of bias was assessed using the Cochrane RoB 2.0 tool, and the quality of evidence (QoE) was rated with the GRADE approach. Results: Eight full-text RCTs and two RCT abstracts were included (n=1513). We did not find differences in rebleeding (RR, 0.78; 95% CI, 0.531.14, moderate QoE), surgery (RR, 0.58; 95% CI, 0.29-1.15, moderate QoE), mortality (RR, 0.89; 95% CI, 0.46-1.71, moderate QoE) or NUBT (MD, -0.01 units; 95% CI, -0.3 to 0.28, low QoE) between second-look and single endoscopy. Sensitivity analyses had similar results to the main analyses. Conclusions: Routine second-look endoscopy was not more efficacious than single endoscopy in patients with PUB.

RESUMEN Objetivo: Evaluar la eficacia de la endoscopia de revisión programada en pacientes con hemorragia por úlcera péptica aguda (UPA). Materiales y métodos: Buscamos de forma sistemática en cuatro bases de datos ensayos controlados aleatorios (ECA) que evaluaran la utilidad de la endoscopia de control programada versus la endoscopia única en pacientes con UPA. Nuestro outcome primario fue el resangrado. Los outcomes secundarios fueron la necesidad de cirugía, la mortalidad y el número de unidades de sangre transfundidas (NUST). Todos los meta-análisis se realizaron mediante un modelo de efectos aleatorios. Se calcularon el riesgo relativo (RR) combinado y la diferencia de medias (DM), con sus intervalos de confianza (IC) del 95% para los resultados categóricos y continuos, respectivamente. El riesgo de sesgo se evaluó mediante la herramienta Cochrane RoB 2.0 y la calidad de la evidencia (QoE) se calificó con el enfoque GRADE. Resultados: Se incluyeron ocho ECA de texto completo y dos resúmenes de ECA (n = 1513). No encontramos diferencias en resangrado (RR, 0,78; IC 95%, 0,53-1,14, QoE moderada), cirugía (RR, 0,58; IC 95%, 0,291,15, QoE moderada), mortalidad (RR, 0,89; 95% IC, 0,46-1,71, QoE moderada) o NUST (DM, -0,01 unidades; IC del 95%, -0,3 a 0,28, QoE baja) entre la segunda revisión y la endoscopia única. Los análisis de sensibilidad tuvieron resultados similares a los análisis principales. Conclusiones: La endoscopia de control de rutina no fue más eficaz que la endoscopia única en pacientes con UPA.

Hemorragia digestiva como debut de enfermedad celiaca complicada / Gastrointestinal bleeding as debut of complicated celiac disease

RESUMEN La enfermedad celiaca (EC) es un síndrome malabsortivo autoinmune que se presenta con intolerancia al gluten (gliadina). Los síntomas más frecuentes son diarrea, esteatorrea, pérdida de peso, debilidad, deficiencia de vitaminas y minerales. La probabilidad de desarrollar una EC complicada es relativamente baja, entre las principales manifestaciones de la misma tenemos esprue refractario, el linfoma de células T y la yeyunoileitis ulcerativa (YU) de los cuales pocos casos debutan con hemorragia digestiva. A continuación, presentamos el caso de un paciente de 51 años de edad que debutó con hemorragia digestiva debido a EC complicada, en donde se realizó video endoscopía digestiva alta (VEDA), videocolonoscopia (VCC), cápsula endoscópica (CE), enteroscopia y biopsia de yeyuno e íleon confirmando el diagnóstico de EC y yeyunoileitis ulcerativa.

ABSTRACT Celiac disease (CD) is an autoimmune malabsorption syndrome that presents with intolerance to gluten (gliadin), a protein found in wheat. The most common symptoms are diarrhea, steatorrhea, weight loss, weakness, vitamin and mineral deficiency. The probability of developing complicated CD is relatively low, among its main manifestations we have refractory sprue, T-cell lymphoma and ulcerative jejunitis (UY) of which a few cases develop gastrointestinal bleeding. Furthermore, we present the case of a 51-year-old patient who developed intestinal hemorrhage due to complicated CD, where upper digestive video endoscopy (VEDA), video colonoscopy (VCC), capsule endoscopy (CE) and biopsy of the jejunum and ileum were performed confirming the diagnosis of CD along with ulcerative jejunoileitis.

Hemorragia intraventricular y factores asociados en recién nacidos pretérmino: Cohorte retrospectiva / Intraventricular hemorrhage and factors associated in preterm newborns

RESUMEN Objetivo: Estimar la frecuencia de la hemorragia intraventricular y los factores asociados en neonatos pretérmino hospitalizados en una unidad de cuidado intensivo neonatal de alta complejidad. Metodología: Estudio de cohorte, en el que se incluyeron neonatos menores de 37 semanas de gestación, atendidos en una institución de alta complejidad, entre enero de 2015 hasta diciembre de 2018; se valoró el desarrollo de hemorragia intraventricular diagnosticada por métodos de imagen. Los datos se obtuvieron a partir de la revisión de las historias clínicas electrónicas y se analizaron variables sociodemográficas y clínicas. Resultados: Se incluyeron 296 pacientes, 128 (43,2%) eran mujeres; 23 pacientes (7,8%) desarrollaron hemorragia intraventricular, la cual predominó en el sexo femenino (11,7%). La mediana de edad gestacional fue de 34 semanas. Los factores asociados al desarrollo de hemorragia intraventricular fueron el peso al nacer por debajo de 1500 gr, las infecciones (p<0,0001), los cuadros de apneas (<0,0001), la hiperglicemia (p = 0,025) y la necesidad de surfactante (p= 0,019); por su parte, los esteroides prenatales se comportaron como un factor protector (p=0,002). Los pacientes con hemorragia intraventricular tuvieron mayor necesidad de ventilación mecánica, mayor uso de inotrópicos o vasopresores, más transfusiones y mayor estancia hospitalaria. Conclusiones: A pesar de que la hemorragia intraventricular resultó ser una patología poco frecuente en la población de neonatos analizada, existen factores de riesgo que se relacionan con su desarrollo, como la edad gestacional, el bajo peso al nacer, las infecciones, las apneas y la hiperglicemia.

ABSTRACT Objective: Estimate the frequency of intraventricular hemorrhage and associated factors in hospitalized preterm infants in a highly complex neonatal intensive care unit. Methodology: Cohort study, which included neonates younger than 37 weeks gestation, attended in a highly complex institution, between January 2015 and December 2018; The development of intraventricular hemorrhage diagnosed by imaging methods was assessed. The data was obtained from the review of the electronic medical records and sociodemographic and clinical variables were analyzed. Results: 296 patients were included, 128 (43.2%) were women; 23 patients (7.8%) developed intraventricular hemorrhage, which predominated in the female sex (11.7%). The median gestational age was 34 weeks. The factors associated with the development of intraventricular hemorrhage were birth weight below 1500 gr, infections (p <0.0001), apnea symptoms (<0.0001), hyperglycemia (p = 0.025) and surfactant requirement (p = 0.019); meanwhile, prenatal steroids behaved as a protective factor (p = 0.002). Patients with intra-ventricular hemorrhage had a greater need for mechanical ventilation, use of inotropics or vasopressors, more transfusions, and a longer hospital stay. Conclusions: Despite the fact that intraventricular hemorrhage turned out to be a rare pathology in the analyzed neonatal population, there are risk factors related to its development, such as gestational age, low birth weight, infections, apneas, and hyperglycemia.

Complicaciones maternas y embarazo adolescente en América Latina: Revisión sistemática y metaanálisis / Maternal complications and adolescent pregnancy in Latin America: A systematic review and meta-analysis

RESUMEN Objetivo: Evaluar el riesgo de complicaciones maternas en el embarazo adolescente en Latinoamérica y El Caribe durante el periodo 2012 al 2021. Métodos: Se realizó una búsqueda sistemática en 6 bases de datos: PubMed, SCOPUS, Web Of Science, EMBase, LILACS y Scielo. Los artículos incluidos fueron procedentes de paises de Latinoamérica y contaron con cualquiera de las siguientes variables: preeclampsia, eclampsia, hemorragia puerperal y sepsis puerperal publicados desde el 2012 al 2021 y que compararan adolescentes y adultas embarazadas. Se excluyeron artículos que no presentaron hallazgos separados de Latinoamérica y/o El Caribe, que no se encontraban disponibles la versión completa y que estaban enfocados en pacientes con alguna enfermedad en específico. Para el riesgo de sesgo se empleó la Escala de Newcasttle-Ottawa para estudios de casos y controles. La medida de resumen empleada fue el Odds Ratio con un intervalo de confianza al 95% para cada estudio. Resultados: Se incluyeron 4 estudios. No se evidenció el riesgo de preeclampsia en adolescentes embarazadas (OR = 0.93, IC 95% 0.69 - 1.25) ni hemorragia puerperal (OR = 0.86, IC 95% 0.74 - 0.99). Por otro lado, se mostró el riesgo de eclampsia (OR = 2.43, IC 95% 1.29 - 4.58) en adolescentes embarazadas, pero con alta heterogeneidad entre los estudios (I2 = 76%). Conclusiones: Se evidenció un riesgo de eclampsia en adolescentes embarazadas, pero no en preeclampsia ni hemorragia puerperal; sin embargo, estos resultados deben de tomarse con cautela. Registro de protocolo: CRD42021286725 (PROSPERO)

ABSTRACT Objective: To assess whether maternal complications are a risk in adolescent pregnancy in Latin America and the Caribbean during the period 2012 to 2021. Methods: A systematic search was carried out in 6 databases: PubMed, SCOPUS, Web of Science, EMBase, LILACS and Scielo. The articles included were from Latin American countries and had any of the following variables: preeclampsia, eclampsia, puerperal hemorrhage and puerperal sepsis published from 2012 to 2021 and comparing pregnant adolescents and adults. Articles that did not present separate findings from Latin America and/or the Caribbean, that the full version was not available, and that were focused on patients with a specific disease were excluded. For risk of bias, the Newcastle-Ottawa Scale Case-Control Studies was used. The summary measure used was the Odds Ratio with a 95% confidence interval for each study. Results: 4 studies were included. The risk of preeclampsia in pregnant adolescents and postpartum hemorrhage (OR = 0.86, 95% CI 0.74 - 0.99) were not evidenced (OR = 0.93, 95% CI 0.69 - 1.25). On the other hand, the risk of eclampsia (OR = 2.43, 95% CI 1.29 - 4.58) in pregnant adolescents was shown, but with high heterogeneity between studies (I2 = 76%). Conclusions: A risk of eclampsia was evidenced in pregnant adolescents, but not in preeclampsia nor postpartum hemorrhage. However, these results should be taken with caution. Protocol record: CRD42021286725 (PROSPERO)

Reporte de un caso de amiloidosis sistémica al en un varón de 65 años con diarrea crónica y hemolacria / Report of case of systemic al amyloidosis in a 65-year-old man with chronic diarrhea and hemolacria

RESUMEN Se describe el caso de un varón de 65 años con diarrea crónica, equimosis palpebral y hemolacria. Se realizaron estudios de laboratorio, biopsia y análisis inmunohistoquímico para confirmar el diagnóstico. La variable dependiente fue el diagnóstico confirmado de amiloidosis AL, mientras que las variables independientes incluyeron los síntomas clínicos y los resultados de las pruebas diagnósticas. Se emplearon técnicas descriptivas para analizar los datos clínicos y de laboratorio. El paciente presentó diarrea crónica sin respuesta al tratamiento convencional, equimosis palpebral y hemolacria. Los estudios diagnósticos revelaron depósitos de amiloide en los tejidos. El análisis inmunohistoquímico confirmó amiloidosis sistémica de cadenas ligeras tipo AL. Se inició tratamiento específico, mejorando parcialmente los síntomas y estabilizando la condición del paciente. La amiloidosis sistémica de tipo AL requiere un alto índice de sospecha clínica para su diagnóstico oportuno. La combinación de estudios diagnósticos y tratamiento precoz puede mejorar el pronóstico de estos pacientes.

ABSTRACT The case of a 65-year-old male with chronic diarrhea, periorbital ecchymosis, and hemolacria is described. Laboratory studies, biopsy, and immunohistochemical analysis were performed to confirm the diagnosis. The dependent variable was the confirmed diagnosis of AL amyloidosis, while the independent variables included clinical symptoms and diagnostic test results. Descriptive techniques were used to analyze the clinical and laboratory data. The patient presented with chronic diarrhea unresponsive to conventional treatment, periorbital ecchymosis, and hemolacria. Diagnostic studies revealed amyloid deposits in the tissues. Immunohistochemical analysis confirmed systemic light chain AL amyloidosis. Specific treatment was initiated, partially improving the symptoms and stabilizing the patient's condition. Systemic AL amyloidosis requires a high index of clinical suspicion for timely diagnosis. The combination of diagnostic studies and early treatment can improve the prognosis of these patients.

Manejo de aneurismas cerebrales: revisión de la literatura pasada, presente y futura / Management of cerebral aneurysms: Review of the past, present, and future literature

Resumen Introducción: El manejo de los aneurismas cerebrales ha ido evolucionando con el paso de los siglos, se busca evaluar el manejo médico, endovascular y quirúrgico de los aneurismas cerebrales rotos y no rotos a lo largo del tiempo, desde las primeras veces en que fueron tratados hasta las innovaciones que se están llevando a cabo. Materiales y métodos: Se realizó una revisión de artículos buscados en la base de datos de PubMed, buscando "Mesh Terms" (o descriptores en ciencias de la salud) con palabras seleccionadas relacionadas al tema y también se seleccionaron artículos según el criterio de los autores; además de la extracción de datos en Rayyan. Resultados: Se seleccionaron 48 artículos dentro de la búsqueda en Pubmed y según criterios propios de los autores, de los cuales 8 artículos se incluyeron en la sección "pasado", 35 artículos en la sección "presente" y 5 artículos en la sección "futuro". Discusión: Se dividió el manejo de aneurismas en tres secciones: pasado (pasado-1999), presente (20002020) y futuro (2021-futuro). Cada sección tuvo tres grupos: manejo médico, endovascular y quirúrgico. Conclusiones: El manejo de los aneurismas no rotos y rotos tiene métodos farmacológicos, de neuro-intervencionismo y neuro-quirúrgicos para abordar, de la mejor manera, la patología de cada paciente de forma individualizada e integral.

Abstract Introduction: The management of brain aneurysms has evolved over the centuries, it seeks to evaluate the medical, endovascular and surgical management of the broken and not broken brain aneurysms over time, from the first times they were treated even the innovations that are being carried out. Materials and methods: A review of articles searched in the PubMed database was carried out, searching for Mesh Terms with selected words related to the topic and articles were also selected according to the author's criteria. Data extraction in Rayyan. Results: 48 articles were selected within the Pubmed search and according to the author's own criteria. 8 articles were included in the Past section, 35 articles in the Present section, and 5 articles in the Future section. Discussion: Aneurysm management was divided into 3 sections: past (past-1999), present (2000-2020) and future (2021-future). Each section had 3 groups: medical, endovascular and surgical management. Conclusions: The management of non-broken and broken aneurysms has pharmacological, neuro-interventionism and neuro-surgical methods to be able to address each patient's pathology in an individualized and integral way.

Síntomas neurológicos focales transitorios por microsangrados cerebrales en hipofibrinogenemia congénita: reporte de un caso / Cerebral microbleeds' transient focal neurological symptoms in congenital hypofibrinogenemia: a case report

Resumen Introducción: Un espectro de enfermedad hemorrágica intracraneal se puede presentar con síntomas neurológicos focales transitorios; aunque las enfermedades congénitas del fibrinógeno son inusuales y rara vez se manifiestan de esta manera, a continuación se presenta un caso de microsangrados cerebrales por hipofibrinogenemia congénita con síntomas neurológicos focales transitorios. Presentación del caso: Paciente masculino de 29 años de edad con microsangrados cerebrales por hipofibrinogenemia congénita con síntomas neurológicos focales transitorios. Discusión: La hemorragia intracerebral de vasos pequeños es una causa de síntomas neurológicos focales transitorios. La prevalencia de microhemorragias cerebrales en la población adulta mayor es un problema altamente reconocido, sin embargo, la incidencia de estos microsangrados en personas más jóvenes es baja y desconocida. Las discrasias sanguíneas, como el trastorno hereditario del fibrinógeno, son una causa de anomalías hereditarias de la coagulación sanguínea, donde este tiene una función importante en el control del sangrado por agregación plaquetaria y en la cascada de coagulación. La ausencia de fibrinógeno normal conduce a una altercación en la hemostasia y, por tanto, a complicaciones hemorrágicas. Conclusiones: Los síntomas neurológicos focales transitorios pueden ser causados por una enfermedad vascular cerebral hemorrágica de vasos pequeños, donde las discrasias sanguíneas congénitas son una causa rara de este tipo de enfermedad cerebrovascular.

Abstract Introduction: Intracranial hemorrhagic disease can present with transient focal neurological symptoms. Congenital fibrinogen diseases are unusual and can rarely manifest in this way. Below we present a case of cerebral microbleeds due to congenital hypofibrinogenemia with transient focal neurological symptoms. Case presentation: This is a 29-year-old man with cerebral microbleeds due to congenital hypofibrino-genemia with transient focal neurological symptoms. Discussion: Cerebral microbleed and intracerebral hemorrhage is a cause of transient focal neurological symptoms. The prevalence of cerebral microbleeds in the elderly population is a highly recognized problem. However, the incidence of these microbleeds in younger people is low and unknown. Blood dyscrasias, such as inherited fibrinogen disorder, are a cause of inherited abnormalities of blood clotting. Fibrinogen has an important role in the control of bleeding due to platelet aggregation and is part of the coagulation cascade. The absence of normal fibrinogen induces alteration in platelet and coagolation hemostasis and, therefore, causes hemorrhagic complications. Conclusions: Transient focal neurological symptoms may be caused by small vessel hemorrhagic cere-brovascular disease. Congenital blood dyscrasias are a rare cause of this type of cerebrovascular disease.

Plan de cuidados de enfermería en puérperas con hemorragia en la unidad de cuidados intensivos / Nursing care plan for postpartum women with hemorrhage in the intensive care unit

La hemorragia puerperal produce el incremento en el número de ingresos en las unidades de cuidados intensivos, que a su vez requiere de una mayor y mejor atención por parte del personal de enfermería. Este trabajo tiene como objetivo, reflexionar sobre los principales elementos a tener en cuenta para el cuidado de enfermería de puérperas con hemorragia, en el contexto de la unidad de cuidados intensivos. El plan de cuidados en puérperas con hemorragia debe estar basado en los diagnósticos de enfermería, que logren un enfoque más hacia la enfermedad; en el que la planificación de acciones sea más específica a puérperas con hemorragia. Asimismo, combinar lo estandarizado con la individualización, para lograr una mayor efectividad en la atención a esta complicación grave principal causa de la mortalidad materna en el mundo. Por ello el cuidado de enfermería deberá asumir acciones frente a la seguridad de la paciente, desde la promoción del trabajo en equipo, hasta fortalecimiento de competencias para la implementación guías de prácticas que garanticen un accionar más rápido y eficiente(AU)

Puerperal hemorrhage causes an increase in the number of admissions to intensive care units, which in turn requires greater and better care from nursing staff. This work aims to reflect on the main elements to take into account for nursing care of postpartum women with hemorrhage, in the context of the intensive care unit. The care plan for postpartum women with hemorrhage should be based on nursing diagnoses that focus more on the disease; in which action planning is more specific to postpartum women with hemorrhage. Likewise, combine standardization with individualization, to achieve greater effectiveness in the care of this serious complication, the main cause of maternal mortality in the world. Therefore, nursing care must take actions regarding patient safety, from promoting teamwork to strengthening skills for the implementation of practice guides that guarantee faster and more efficient action(AU)

Correlation between vitamin D levels in third trimester and postpartum hemorrhage

Background: The aim of this study was to assess the correlation between antenatal vitamin D levels and postpartum hemorrhage.Methods: An analytical study was conducted among 385 term pregnant women admitted at Hassan institute of Medical Sciences and who went in spontaneous onset of labour or induced labour. Basic demographic details were noted. Vitamin D levels were assessed on admission in these patients prior to childbirth. Incidence of postpartum haemorrhage among these patients after delivery were noted and analysed.Results: Vitamin D levels were deficient in 225 (58.5%) antenatal women in the study. The overall rates of atonic postpartum haemorrhage were higher in vitamin D deficient women that is 19 (54.2%) when compared to woman having normal vitamin D levels.Conclusions: Our results suggest that vitamin D deficiency is highly prevalent among pregnant woman and is a risk factor for atonic postpartum hemorrhage. Hence antenatal supplementation of vitamin D could help prevent vitamin D deficiency and uterine atony.

Development and validation of a clinical prediction model for prognostic factors in patients with primary pontine hemorrhage

Abstract We aimed to develop a prognostic model for primary pontine hemorrhage (PPH) patients and validate the predictive value of the model for a good prognosis at 90 days. A total of 254 PPH patients were included for screening of the independent predictors of prognosis, and data were analyzed by univariate and multivariable logistic regression tests. The cases were then divided into training cohort (n=219) and validation cohort (n=35) based on the two centers. A nomogram was developed using independent predictors from the training cohort to predict the 90-day good outcome and was validated from the validation cohort. Glasgow Coma Scale score, normalized pixels (used to describe bleeding volume), and mechanical ventilation were significant predictors of a good outcome of PPH at 90 days in the training cohort (all P<0.05). The U test showed no statistical difference (P=0.892) between the training cohort and the validation cohort, suggesting the model fitted well. The new model showed good discrimination (area under the curve=0.833). The decision curve analysis of the nomogram of the training cohort indicated a great net benefit. The PPH nomogram comprising the Glasgow Coma Scale score, normalized pixels, and mechanical ventilation may facilitate predicting a 90-day good outcome.