Cuerpo extraño faríngeo migratriz. A propósito de un caso

RESUMEN Introducción: la faringe es el sitio más común de alojamiento de cuerpos extraños dentro del área otorrinolaringológica. Usualmente su diagnóstico y extracción resultan fáciles. Sin embargo, y afortunadamente, unos pocos se encarnan profundamente y causan infecciones en el cuello, o más raro aún, logran migrar y se sitúan inmediatamente por debajo de la piel. Presentación del caso: presentamos el caso de un paciente masculino de 27 años que fue atendido durante nuestra misión en Namibia en el 2018, quien se tragó una espina de pescado, la cual se alojó inicialmente en el espacio retrofaríngeo para luego migrar hasta el tejido celular subcutáneo del cuello. Discusión: el mecanismo por el cual un cuerpo extraño migra puede estar dado por la combinación del peristaltismo del esófago y los movimientos del cuello u otros factores como la configuración lineal y afilada del cuerpo extraño, la deglución forzada de alimentos de consistencia dura inmediatamente a la impactación del cuerpo extraño y la asistencia tardía del paciente a los servicios de salud. Conclusiones: la migración de un cuerpo extraño ingerido es una rara forma de evolución. Su tratamiento depende fundamentalmente de potenciales complicaciones que podrían poner en riesgo la vida del paciente.

ABSTRACT Introduction: the pharynx is the most common site of lodging of foreign bodies within the otorhinolaryngological area. Diagnosis and removal are usually easy. Fortunately, however, a few become deeply ingrown and cause neck infections, or more rarely, manage to migrate and lie just under the skin. Case presentation: we present the case of a 27-year-old male patient who was treated during our mission in Namibia in 2018, who swallowed a fish bone, which initially lodged in the retropharyngeal space and then migrated to the cellular tissue. subcutaneous neck. Discussion: the mechanism by which a foreign body migrates may be due to the combination of peristalsis of the esophagus and movements of the neck or other factors such as the linear and sharp configuration of the foreign body, the forced swallowing of food with a hard consistency immediately after impaction of the foreign body and late attendance of the patient to health services. Conclusions: the migration of an ingested foreign body is a rare form of evolution. Its treatment fundamentally depends on potential complications that could put the patient's life at risk.

RESUMO Introdução: a faringe é o local mais comum de alojamento de corpos estranhos na área otorrinolaringológica. O diagnóstico e a remoção geralmente são fáceis. Felizmente, no entanto, alguns ficam profundamente encravados e causam infecções no pescoço ou, mais raramente, conseguem migrar e ficam logo abaixo da pele. Apresentação do caso: apresentamos o caso de um paciente do sexo masculino de 27 anos que foi atendido durante nossa missão na Namíbia em 2018, que engoliu uma espinha de peixe, que inicialmente se alojou no espaço retrofaríngeo e depois migrou para o tecido celular. Discussão: o mecanismo pelo qual um corpo estranho migra pode ser devido à combinação de peristaltismo do esôfago e movimentos do pescoço ou outros fatores como a configuração linear e aguda do corpo estranho, a deglutição forçada de alimentos de consistência dura imediatamente após a impactação do corpo estranho e comparecimento tardio do paciente aos serviços de saúde. Conclusões: a migração de um corpo estranho ingerido é uma forma rara de evolução. Seu tratamento depende fundamentalmente de potenciais complicações que podem colocar em risco a vida do paciente.

Cuerpo extraño de presentación tardía en bronquiotronco izquierdo. Caso clínico

RESUMEN Introducción: la introducción fortuita de un cuerpo extraño en las vías respiratorias es un accidente dramático que puede provocar complicaciones, aunque raro en los adultos, y sobre todo su presentación tardía, y en bronquio izquierdo. Caso clínico: se reporta el caso de un paciente de 71 años con un cuerpo extraño de presentación tardía en bronquiotronco izquierdo, que consultó por un cuadro de sepsis respiratoria, sin otros síntomas asociados, cuatro meses posteriores a referir haberse tragado un hueso de pollo, ocasión ésta en que el examen físico y los estudios radiológicos fueron negativos. Se realizó estudio con TAC de tórax y broncoscopia flexible evidenciándose una imagen sugerente de un cuerpo extraño en el bronquiotronco izquierdo. Discusión: después de realizar broncoscopia rígida y extracción de cuerpo extraño, presenta varias complicaciones, que requieren ingreso en terapia intensiva, la evolución clínica posterior fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a los 55 días después del diagnóstico. Conclusiones: en presencia de un paciente con sepsis respiratoria después de un cuadro de broncoaspiración se debe tener en cuenta el diagnóstico de aspiración de un cuerpo extraño. La extracción del cuerpo extraño resulta la solución definitiva.

ABSTRACT Introduction: the fortuitous introduction of a foreign body in the respiratory tract is a dramatic accident that can cause complications, although rare in adults, and especially its late presentation, and in the left bronchus. Clinical case: we report the case of a 71-year-old patient with a late-onset foreign body in the left bronchial trunk, who consulted for respiratory sepsis, with no other associated symptoms, four months after reporting having swallowed a chicken bone. On which occasion the physical examination and radiological studies were negative. A CT scan of the chest and flexible bronchoscopy were performed, revealing an image suggestive of a foreign body in the left bronchial trunk. Discussion: after performing rigid bronchoscopy and extraction of a foreign body, he presented several complications, which required admission to intensive care, the subsequent clinical evolution was favorable, with a control chest X-ray with adequate lung re-expansion and being discharged 55 days later. of the diagnosis. Conclusions: in the presence of a patient with respiratory sepsis after a picture of bronchoaspiration, the diagnosis of aspiration of a foreign body should be taken into account. Extraction of the foreign body is the definitive solution.

RESUMO Introdução: a introdução fortuita de corpo estranho no trato respiratório é um acidente dramático que pode causar complicações, embora raras em adultos, e principalmente sua apresentação tardia, e no brônquio esquerdo. Caso clínico: relatamos o caso de um paciente de 71 anos com corpo estranho de início tardio no tronco brônquico esquerdo, que consultou por sepse respiratória, sem outros sintomas associados, quatro meses após relatar ter engolido osso de galinha. ocasião em que o exame físico e os estudos radiológicos foram negativos. Realizou-se TC de tórax e broncoscopia flexível, revelando imagem sugestiva de corpo estranho em tronco brônquico esquerdo. Discussão: após realização de broncoscopia rígida e extração de corpo estranho, apresentou diversas complicações, que exigiram internação em terapia intensiva, a evolução clínica posterior foi favorável, com radiografia de tórax de controle com reexpansão pulmonar adequada e alta hospitalar 55 dias depois do diagnóstico. Conclusões: na presença de um paciente com sepse respiratória após quadro de broncoaspiração, deve-se levar em consideração o diagnóstico de aspiração de corpo estranho. A extração do corpo estranho é a solução definitiva.

Cuerpo extraño faríngeo migratriz: a propósito de un caso / Migrant pharyngeal foreign body. About a case

Introducción: la faringe es el sitio más común de alojamiento de cuerpos extraños dentro del área otorrinolaringológica. Usualmente su diagnóstico y extracción resultan fáciles. Sin embargo, y afortunadamente, unos pocos se encarnan profundamente y causan infecciones en el cuello, o más raro aún, logran migrar y se sitúan inmediatamente por debajo de la piel. Presentación del caso: presentamos el caso de un paciente masculino de 27 años que fue atendido durante nuestra misión en Namibia en el 2018, quien se tragó una espina de pescado, la cual se alojó inicialmente en el espacio retrofaríngeo para luego migrar hasta el tejido celular subcutáneo del cuello. Discusión: el mecanismo por el cual un cuerpo extraño migra puede estar dado por la combinación del peristaltismo del esófago y los movimientos del cuello u otros factores como la configuración lineal y afilada del cuerpo extraño, la deglución forzada de alimentos de consistencia dura inmediatamente a la impactación del cuerpo extraño y la asistencia tardía del paciente a los servicios de salud. Conclusiones: la migración de un cuerpo extraño ingerido es una rara forma de evolución. Su tratamiento depende fundamentalmente de potenciales complicaciones que podrían poner en riesgo la vida del paciente(AU)

Introduction: the pharynx is the most common site of lodging of foreign bodies within the otorhinolaryngological area. Diagnosis and removal are usually easy. Fortunately, however, a few become deeply ingrown and cause neck infections, or more rarely, manage to migrate and lie just under the skin. Case presentation: we present the case of a 27-year-old male patient who was treated during our mission in Namibia in 2018, who swallowed a fish bone, which initially lodged in the retropharyngeal space and then migrated to the cellular tissue subcutaneous neck. Discussion: the mechanism by which a foreign body migrates may be due to the combination of peristalsis of the esophagus and movements of the neck or other factors such as the linear and sharp configuration of the foreign body, the forced swallowing of food with a hard consistency immediately after impaction of the foreign body and late attendance of the patient to health services. Conclusions: the migration of an ingested foreign body is a rare form of evolution. Its treatment fundamentally depends on potential complications that could put thepatient's life at risk(EU)

Cuerpo extraño de presentación tardía en bronquio tronco izquierdo: caso clínico / Late - presenting foreign body in the left bronchial trunk. Clinical case

Introducción: la introducción fortuita de un cuerpo extraño en las vías respiratorias es un accidente dramático que puede provocar complicaciones, aunque raro en los adultos, y sobre todo su presentación tardía, y en bronquio izquierdo. Caso clínico: se reporta el caso de un paciente de 71 años con un cuerpo extraño de presentación tardía en bronquiotronco izquierdo, que consultó por un cuadro de sepsis respiratoria, sin otros síntomas asociados, cuatro meses posteriores a referir haberse tragado un hueso de pollo, ocasión ésta en que el examen físico y los estudios radiológicos fueron negativos. Se realizó estudio con TAC de tórax y broncoscopia flexible evidenciándose una imagen sugerente de un cuerpo extraño en el bronquiotronco izquierdo. Discusión: después de realizar broncoscopia rígida y extracción de cuerpo extraño, presenta varias complicaciones, que requieren ingreso en terapia intensiva, la evolución clínica posterior fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a los 55 días después del diagnóstico. Conclusiones: en presencia de un paciente con sepsis respiratoria después de un cuadro de broncoaspiración se debe tener en cuenta el diagnóstico de aspiración de un cuerpo extraño. La extracción del cuerpo extraño resulta la solución definitiva(AU)

Introduction: the fortuitous introduction of a foreign body in the respiratory tract is a dramatic accident that can cause complications, although rare in adults, and especially its late presentation, and in the left bronchus. Clinical case: we report the case of a 71-year-old patient with a late-onset foreign body in the left bronchial trunk, who consulted for respiratory sepsis, with no other associated symptoms, four months after reporting having swallowed a chicken bone. On which occasion the physical examination and radiological studies were negative. A CTscan of the chest and flexible bronchoscopy were performed, revealing an image suggestive of a foreign body in the left bronchial trunk. Discussion: after performing rigid bronchoscopy and extraction of a foreign body, he presented several complications, which required admission to intensive care, the subsequent clinical evolution was favorable, with a control chest X-ray with adequate lung re-expansion and being discharged 55 days later. of the diagnosis. Conclusions: in the presence of a patient with respiratory sepsis after a picture of bronchoaspiration, the diagnosis of aspiration of a foreign body should be taken into account. Extraction of the foreign body is the definitive solution(EU)

Medical arguments for and against the liberalization of doping / Argumentos médicos a favor y en contra de la liberalización del dopaje

The use of doping has been banned for almost a century due to the risk involved to the athlete's health. Since then, the criterion of prohibiting substances has been reinforced to improve performance, becoming a rarely controversial issue nowadays. However, opinions defending the liberalization of doping has been sometimes given based on various arguments. One of the most common is the impossibility of completely eradicating doping and that this can be safe, from the point of view of health, if it is done by qualified doctors. This paper presents the arguments against the liberalization of doping from a medical point of view, contemplating various aspects. Those related to the use of substances such as: lack of clear criteria for inclusion in the list of prohibited substances and the unclear margin between the use of medication for treatment and for doping. Arguments related to health protection such as: the risk of sport for the athlete, the healthy sport, doping substances have few health risks, the use of medications, allow genetic doping because it is inevitable, risks of self-medication or use of medication without a prescription. Arguments related to sports performance such as: Doping products do not improve performance, doping is comparable to other performance improvement techniques, match genetic differences among athletes. And other arguments such as: prohibition favours doping, the control of doping increases the risks of doping itself, the high cost of anti-doping fight or the few anti-doping resources. The proposal for liberalization of doping under medical control is analyzed and discussed as well as the effects of liberalization on children and adolescents. At the end the medical ethical aspects related to doping are presented to conclude with the opposition of the medical profession against doping and its liberalization

El dopaje está prohibido desde hace casi un siglo debido al riesgo que implica para la salud del deportista. Desde entonces, el criterio de prohibición de sustancias se ha reforzado para mejorar el rendimiento, convirtiéndose en un tema poco controvertido en la actualidad. Sin embargo, a veces se han emitido opiniones en defensa de la liberalización del dopaje basadas en diversos argumentos. Uno de los más habituales es la imposibilidad de erradicar por completo el dopaje y que éste puede ser seguro, desde el punto de vista de la salud, si lo practica médicos titulados. Este artículo presenta los argumentos en contra de la liberalización del dopaje desde el punto de vista médico, contemplando diversos aspectos. Los relacionados con el uso de sustancias tales como: falta de criterios claros para su inclusión en la lista de sustancias prohibidas y el margen poco claro entre el uso de medicamentos para tratamiento y dopaje. Argumentos relacionados con la protección de la salud como: el riesgo del deporte para el deportista, el deporte sano, las sustancias dopantes tienen pocos riesgos para la salud, el uso de medicamentos, permitir el dopaje genético porque es inevitable, los riesgos de automedicación o uso de medicación sin prescripción. Argumentos relacionados con el rendimiento deportivo tales como: los productos antidopaje no mejoran el rendimiento, el dopaje es comparable a otras técnicas de mejora del rendimiento, diferencias genéticas entre los deportistas. Y otros argumentos como: la prohibición favorece el dopaje, el control del dopaje aumenta los riesgos del dopaje, el alto coste de la lucha antidopaje o los escasos recursos antidopaje. Se analiza y discute la propuesta de liberalización del dopaje bajo control médico y los efectos de la liberalización en niños y adolescentes. Al final se presentan los aspectos éticos médicos relacionados con el dopaje para concluir con la oposición de la profesión médica al dopaje y su liberalización

Extracellular vesicle-miRNAs as liquid biopsy biomarkers for disease identification and prognosis in metastatic colorectal cancer patients.

Disseminated disease is present in ≈50% of colorectal cancer patients upon diagnosis, being responsible for most of cancer deaths. Addition of biological drugs, as Bevacizumab, to chemotherapy, has increased progression free survival and overall survival of metastatic colorectal cancer (mCRC) patients. However, these benefits have been only reported in a small proportion of patients. To date, there are not biomarkers that could explain the heterogeneity of this disease and would help in treatment selection. Recent findings demonstrated that microRNAs (miRNAs) play an important role in cancer and they can be encapsulated with high stability into extracellular vesicles (EVs) that are released in biological fluids. EVs can act as cell-to-cell communicators, transferring genetic information, such as miRNAs. In this context, we aimed to investigate serum EV associated miRNAs (EV-miRNAs) as novel non-invasive biomarkers for the diagnosis and prognosis of Bevacizumab-treated mCRC patients. We observed that baseline miRNA-21 and 92a outperformed carcinoembryonic antigen levels in the diagnosis of our 44 mCRC patients, compared to 17 healthy volunteers. In addition, patients who died presented higher levels of miRNA-92a and 222 at 24 weeks. However, in the multivariate Cox analysis, higher levels of miRNA-222 at 24 weeks were associated with lower overall survival. Altogether, these data indicate that EV-miRNAs have a strong potential as liquid biopsy biomarkers for the identification and prognosis of mCRC.

Evaluation of the police operational tactical procedures for reducing officer injuries resulting from physical interventions in problematic arrests. The case of the Municipal Police of Cádiz (Spain).

OBJECTIVES: This paper describes some operational tactical procedures (OTP) and discusses the results of a 14-year-long study, spanning the period 2003-2016, conducted by the Municipal Police of Cádiz, Spain, which comprised 3 time periods: 2003-2006, when the officers were trained in traditional policing procedures; 2007-2013, when the officers were taught an innovative set of OTP in the form of a basic set of self-defense and arrest mechanisms, different from the traditional policing procedures that rely on martial arts and combat sports; and finally 2014-2016, when the OTP training was discontinued. The aim of this study was to improve policing and reduce officer injuries resulting from interventions in controversial or violent situations, such as problematic arrests. MATERIAL AND METHODS: The study involved 162 police officers and commanders of the Municipal Police of Cádiz, who were in street duty for their first time. There were 8 females and 154 males aged 24-55 years. Three OTP stages are shown as examples. RESULTS: Based on the analysis of "training hours" and "physical interventions in problematic arrests," the results were: 1) the number of sick leaves in the police was identical according to the number of arrests, and 2) data on sick leaves show remarkable differences among the 3 periods under analysis. CONCLUSIONS: The OTP-based training substantially reduced officer sick leaves. The overall reduction in sick leaves in the period 2007-2013 was observed that cannot be ascribed to a decrease in criminal acts, and hence in police physical interventions. Int J Occup Med Environ Health. 2020;33(1):35-43.

Effect of temperature on bone tissue: histological changes.

The analysis of burned human remains has been of great interest among forensic anthropologists largely due to the difficulty that their recovery, classification, reconstruction, and identification present. The main purpose of this analysis is to present histological methodology for the interpretation of bones altered by thermal processes. We include analyses of the microscopic changes among bones exposed to different temperatures, with the goal of establishing categories of histological morphology in relation to fire temperature. Samples of bone (ilium) were exposed systematically to controlled temperatures. Analysis of the resulting histological changes has allowed the formation of a clear four-stage classification of the alterations observed. This classification should prove useful in assessing bone changes in relation to temperature of exposure, particularly in cases where this temperature was previously not known.

Effects of temperature on bone tissue. Histological study of the changes in the bone matrix.

The analysis of burned human remains has given rise to many publications in the literature and has caused great interest among forensic specialists and physical anthropologists due to the difficulty in its analysis and interpretation. The main goal of this study has been to measure the changes that occur in bone matrix as a consequence of the increased temperature and establishing categories of histological morphology in relation to fire temperature. To this end, a total of 150 bone cylinders from the ilium obtained by bone biopsy. These samples have been obtained from forensic cadavers and burned at controlled temperatures between 100 and 1100°C in an oven. The samples were fixed in methyl methacrylate and stained with hematoxylin-eosin, Goldner's trichrome and toluidine blue stains. The samples were studied using an optical microscope at 100×. Our study classifies the morphological changes that occur in bone matrix in four stages as a result of the temperature.

Mitochondrial haplogroups and polymorphisms reveal no association with sporadic prostate cancer in a southern European population.

BACKGROUND: It is known that mitochondria play an important role in certain cancers (prostate, renal, breast, or colorectal) and coronary disease. These organelles play an essential role in apoptosis and the production of reactive oxygen species; in addition, mtDNA also reveals the history of populations and ancient human migration. All these events and variations in the mitochondrial genome are thought to cause some cancers, including prostate cancer, and also help us to group individuals into common origin groups. The aim of the present study is to analyze the different haplogroups and variations in the sequence in the mitochondrial genome of a southern European population consisting of subjects affected (n = 239) and non-affected (n = 150) by sporadic prostate cancer. METHODOLOGY AND PRINCIPAL FINDINGS: Using primer extension analysis and DNA sequencing, we identified the nine major European haplogroups and CR polymorphisms. The frequencies of the haplogroups did not differ between patients and control cohorts, whereas the CR polymorphism T16356C was significantly higher in patients with PC compared to the controls (p = 0.029). PSA, staging, and Gleason score were associated with none of the nine major European haplogroups. The CR polymorphisms G16129A (p = 0.007) and T16224C (p = 0.022) were significantly associated with Gleason score, whereas T16311C (p = 0.046) was linked with T-stage. CONCLUSIONS AND SIGNIFICANCE: Our results do not suggest that mtDNA haplogroups could be involved in sporadic prostate cancer etiology and pathogenesis as previous studies performed in middle Europe population. Although some significant associations have been obtained in studying CR polymorphisms, further studies should be performed to validate these results.

Clinical relevance associated to the analysis of circulating tumour cells in patients with solid tumours.

The distant growth of tumour cells escaping from primary tumours, a process termed metastasis, represents the leading cause of death among patients affected by malignant neoplasias from breast and colon. During the metastasis process, cancer cells liberated from primary tumour tissue, also termed circulating tumour cells (CTCs), travel through the circulatory and/or lymphatic systems to reach distant organs. The early detection and the genotypic and phenotypic characterisation of such CTCs could represent a powerful diagnostic tool of the disease, and could also be considered an important predictive and prognostic marker of disease progression and treatment response. In this article we discuss the potential relevance in the clinic of monitoring CTCs from patients suffering from solid epithelial tumours, with emphasis on the impact of such analyses as a predictive marker for treatment response.

Liver dysfunction associated with artificial nutrition in critically ill patients.

INTRODUCTION: Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients. METHODS: We conducted a prospective cohort study of incidence in 40 intensive care units. Different liver dysfunction patterns were defined: (a) cholestasis: alkaline phosphatase of more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, or bilirubin of more than 1.2 mg/dl; (b) liver necrosis: aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l, plus bilirubin of more than 1.2 mg/dl or international normalized ratio of more than 1.4; and (c) mixed pattern: alkaline phosphatase of more than 280 IU/l or gamma-glutamyl-transferase of more than 50 IU/l, plus aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l. RESULTS: Seven hundred and twenty-five of 3,409 patients received artificial nutrition: 303 received total parenteral nutrition (TPN) and 422 received enteral nutrition (EN). Twenty-three percent of patients developed liver dysfunction: 30% in the TPN group and 18% in the EN group. The univariate analysis showed an association between liver dysfunction and TPN (p < 0.001), Multiple Organ Dysfunction Score on admission (p < 0.001), sepsis (p < 0.001), early use of artificial nutrition (p < 0.03), and malnutrition (p < 0.01). In the multivariate analysis, liver dysfunction was associated with TPN (p < 0.001), sepsis (p < 0.02), early use of artificial nutrition (p < 0.03), and calculated energy requirements of more than 25 kcal/kg per day (p < 0.05). CONCLUSION: TPN, sepsis, and excessive calculated energy requirements appear as risk factors for developing liver dysfunction. Septic critically ill patients should not be fed with excessive caloric amounts, particularly when TPN is employed. Administering artificial nutrition in the first 24 hours after admission seems to have a protective effect.

Plasmocitoma solitario de laringe: presentación de un caso

Se presenta un caso de sexo masculino, edad 52 años, que aproximadamente 3 meses presenta molestias faríngeas en forma de pinchazos y disfonía. En el cuerpo de guardia se le realiza laringoscopía indirecta detectando lesión tumoral en cuerda vocal izquierda. Se le práctica laringoscopía directa bajo anestesia general confirmándose la tumoración ya descrita, la cual se extirpa en su totalidad con estricta normalidad en el resto de las estructuras laríngeas. Se práctica a de la lesión y su resultado histopatológico informa: Tumor de células plasmáticas de partes blandas: Plasmocitoma (B 00.1350)(AU)

Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study.

We investigated the effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity and mortality in critically ill patients who developed systemic inflammatory response syndrome after an acute event. Eleven intensive care units in tertiary-care hospitals participated in a prospective, randomized, single blind, multicenter trial. Eighty-four patients with systemic inflammatory response syndrome of any etiology were randomly allocated to receive a glutamine-enriched enteral diet or a control diet without glutamine.Most patients received the planned caloric intake. The number of infected patients was smaller in the glutamine group than in the control group (11 versus 17 patients, P < 0.05), with a relative risk of 0.5 (95% confidence interval = 0.3-0.9). The most frequent infection was nosocomial pneumonia, with 11 (33%) patients in the control group and 6 (14%) in the glutamine group. There were no differences with respect to other infections, mortality, or length of stay. Intestinal permeability as assessed by the lactulose-mannitol test was unchanged in both groups.Glutamine-enriched enteral diets can decrease nosocomial infections in patients with systemic inflammatory response syndrome.

Coagulación intravascular diseminada: un punto de vista obstétrico / Disseminated intravascular coagulation: an obstetrical viewpoint

Los trastornos hemorrágicos y trombóticos continúan siendo una de las principales causas de morbilidad y mortalidad materna. En las complicaciones obstétricas se observan frecuentemente estos trastornos y en particular la coagulación intravascular diseminada. Realizamos por ende una revisión bibliográfica sobre el tema tratando como aspectos fundamentales los cambios en la hemostasia durante la etapa gestacional, el comportamiento de esta entidad en los principales accidentes obstétricos y su enfoque terapéutico. Se concluye la necesidad de un diagnóstico clínico y de laboratorio precoz de estos accidentes, de la determinación del riesgo obstétrico y las causas que lo provocan, además de la necesidad de la evaluación multidisciplinaria de estas pacientes y de una protocolización terapéutica institucional(AU)