Platelet Counts in Uncomplicated Pregnancies at Term.

OBJECTIVE: This study aimed to evaluate platelet counts at delivery in uncomplicated pregnancies between 37 and 41 weeks of gestation. STUDY DESIGN: Platelet counts in women 16 to 45 years of age from August 1, 2011, through May 15, 2018, with a singleton pregnancy that delivered from 370/7 to 416/7 weeks of gestation. Women with pregnancy-related complications, preexisting disorders, or on medications that could affect platelet counts were excluded. RESULTS: A total of 18,526 women had uncomplicated pregnancies with mean platelet count from 370/7 to 416/7 weeks of gestation of 220 × 109/L. The lower limit 95th percentile (2.5% quantile) was 120 × 109/L. Platelet counts decreased weekly from 37 to 41 weeks of gestation, becoming significant at 39 weeks of gestation and beyond, compared with 37 weeks (p < 0.01). Mean platelet counts: 225 × 109/L at 37 weeks, 223 × 109/L at 38 weeks, 219 × 109/L at 39 weeks, 218 × 109/L at 40 weeks, and 216 × 109/L at 41 weeks of gestation. Platelet counts of less than 150 × 109/L occurred in 9.7%. CONCLUSION: Platelet counts in uncomplicated pregnancies decrease weekly from 37 to 41 weeks of gestation. This will be important to consider when serial platelet values are monitored for other indications.

A risk assessment tool (OsteoRisk) for identifying Latin American women with osteoporosis.

OBJECTIVE: To develop a simple and easy-to-use tool for identifying osteoporotic women (femoral neck bone mineral density [BMD] T-scoresor=50 in Latin America who had femoral neck BMD measurements. MEASUREMENTS AND MAIN RESULTS: A risk index was developed from 1,547 patients based on least square regression using age, weight, history of fractures, and other variables as predictors for BMD T-score. The final model was simplified by reducing the number of predictors; sensitivity and specificity were evaluated before and after reducing the number of predictors to assess performance of the index. The final model included age, weight, country, estrogen use, and history of fractures as significant predictors for T-score. The resulting scoring index achieved 91% sensitivity and 47% specificity. Simplifying the index by using only age and weight yielded similar performance (sensitivity, 92%; specificity, 45%). Three risk categories were identified based on OsteoRisk, the index using only age and body weight: high-risk patients (index <=-2; 65.6% were osteoporotic), moderate-risk patients (-2< index <=1; 26.7% were osteoporotic), and low-risk patients (index>1; 8% were osteoporotic). Similar results were seen in a validation sample of 279 women in Brazil. CONCLUSION: Age and weight alone performed well for predicting the risk of osteoporosis among postmenopausal women. The OsteoRisk is an easy-to-use tool that effectively targets the vast majority of osteoporotic patients in Latin America for evaluation with BMD.

Parálisis hipokalémica debida a acidosis tubular renal tipo I: caso clínico / Hipokalemic paralysis owing to aciclosis renal tubular type I: clinical case

Se presenta el caso de un paciente masculino de 28 años quien presentó cuadriplejia aguda con insuficiencia respiratoria que ingreso a cuidados intensivos ameritando ventilación mecánica y con un diagnóstico presuntivo de síndrome de Guillian-Barré Esto coincidió con severas alteraciones electrolíticas (hipokalemia e hipofosfatemia) y con persistencia de acidosis metabólica hiperclorémica por lo que se procedió a realizar pruebas diagnósticas que revelaron la presencia de una acidosis tubular renal distal. Su evolución fue satisfactoria. El caso constituye un ejemplo de una rara causa de parálisis que debe ser tomado en cuenta en los diagnósticos diferenciales de pacientes que presenten esta sitomatología.

Marcadores bioquímicos de remodelamiento óseo: fosfatasa ácida tartrato resistente (TRAP): fosfatasa alcalina (FAT) y cociente calcio/creatinina urinarios, en menopáusicas aparentemente sanas fumadoras y no fumadoras / Biochemical markers of bone remodeling: tartrate resistant acid phosphatase (TRAP), alkaline phosphatase (TAP), and urinary calcium/creatinine quotient, in seemingly healthy, smoking and non-smoking menopausic women

Durante la menopausia tienen lugar muchos cambios en la vida de la mujer entre los cuales se encuentran cambios en el metabolismo mineral óseo, existiendo factores que puedan influenciar negativamente sobre el remodelamiento del hueso. Con el objeto de evaluar el efecto causado por el hábito tabáquico moderado se estudiaron 54 mujeres menopáusicas aparentemente sanas quienes manifestaron no padecer osteoporosis y que no recibían terapia de reemplazo hormonal. Se deternminó Fosfatasa Acida Tartrato Resistente (TRAP), Fosfatasa Alcalina Total (FAT) y cociente urinario Calcio/Creatinina. Además se aplicó una encuesta de hábitos y factores de riesgo que afectan el metabolismo óseo. La edad promedio de las pacientes fue 53,2 ± 3,9 a¤os y el promedio de años con menopausia fue 4,8 ± 3,9 años. La encuesta de factores de riesgo mostró que 14,8 por ciento de las pacientes fumaban entre 10 y 20 cigarrillos al día, 5,6 por ciento m s de 20 cigarrillos igualmente 20,4 por ciento presentaron hábitos alcoh¢licos moderados (2 tragos diarios o menos). El 44,4 por ciento manten¡a actividad f¡sica (caminar diariamente). El 81 por ciento consum¡a proteínas animales 2 a 3 veces por semana y 72,2 por ciento ingería lácteos diariamente. Los valores de TRAP no mostraron diferencia significativa entre fumadoras y no fumadoras (6,93 ± 2,9 vs. 8,19 ± 3,3 UI/Lp<0,05), al igual que la FAT (49,4 ± 12 vs. 44,2 ± 10 UI/Lp<0,05). Igualmente el cociente Calcio/Creatinina urinario no resultó diferente entre ambos grupos (0,15 ± 0,09 vs 0,18 ± 0,2). En conclusión nuestro estudio no mostró diferencias significativas entre mujeres menopáusicas con o sin hábitos tabáquicos moderado en cuanto a los valores de los marcadores del remodelamiento óseo TRAP, FAT y conciente Calcio/Creatinina urinario