Depuración de lactato a gran altitud / Lactate clearance at high altitude

OBJETIVO: el estudio pretende caracterizar la depuración de lactato (DL) en pacientes críticamente enfermos, a gran altitud. DISEÑO: estudio prospectivo de cohorte. ÁMBITO: unidad de Cuidados Intensivos de Adultos del Hospital del Norte de la ciudad de El Alto, La Paz (Bolivia), a 4 150 metros sobre el nivel del mar, periodo 25 de abril 2016-01 de junio 2018. PACIENTES: todos los pacientes ingresados a la Unidad de Cuidados Intensivos de Adultos, nativos de gran altitud, así como residentes de la misma por lo menos los últimos 6 meses. RESULTADOS: se incluyeron 250 pacientes, con sobrevida de 68%, promedio de edad 50 años; en el grupo de 170 supervivientes, poco más de la cuarta parte del lactato de ingreso fue depurado (26%), a comparación del grupo de 80 fallecidos, en el cual incluso el valor de lactato se vio incrementado alrededor de la quinta parte del lactato de ingreso (21%), ambos con p ≤ 0.05 mediante el test de ANOVA. En pacientes críticamente enfermos a gran altitud, el riesgo relativo entre depuración de lactato ≥ 26% y sobrevida es de 2.7 con sensibilidad 0.72 y especificidad de 1. DISCUSIÓN Y CONCLUSIONES: la depuración de lactato en individuos críticamente enfermos nativos de gran altitud, se asocia a mayor sobrevida y debería ser considerado como un objetivo durante la reanimación en pacientes críticos, de forma similar a estudios realizados en otras latitudes

OBJECTIVE: to characterize the lactate clearance on critically ill patients, at high altitude. DESIGN: prospective cohort study. FIELD: critical Care Unit of "Hospital del Norte" in El Alto, La Paz (Bolivia), during the period April 25, 2016 ­ June 01, 2018. PARTICIPANTS: critically ill patients residents of high altitude at least the last 6 months, admitted to the Adult Critical Care Unit. RESULTS: 250 patients were included, with survival of 68%, age average of 50 years; in the 170 survivors, lactate clearance average was 26%, in contrast with 80 deceased patients who presented an increased lactate level of 25%, p ≤ 0.05, both of them through ANOVA test. In high landers critically ill patients, relative risk of lactate clearance ≥ 26% and survival was 2.7 with sensitivity 0.72 and specificity 1. DISCUSSION AND CONCLUSIONS: lactate clearance in critically ill high landers dwellers, is associated with survival and it should be considered also as a reanimation objective, comparable to other studies developed in different latitudes

[Tumor lysis syndrome in a pregnancy complicated with acute lymphoblastic leukemia]. / Síndrome de lisis tumoral en un embarazo complicado con leucemia linfoblástica aguda.

Acute leukemia is rare during pregnancy, affects about 1 in 75,000 pregnancies, of all leukemias diagnosed only 28% are acute lymphoblastic leukemia, this is a risk factor to develop spontaneous tumor lysis syndrome, it's a oncologic complication potentially deadly if the prophylactic treatment its avoided. Cases of acute lymphoblastic leukemia associated with pregnancy has been poorly documented in the literature the association of these two entities to pregnancy is the first report published worldwide, so the information is limited.

[Cholestasis in pregnancy. Report of a case]. / Colestasis del embarazo. Presentación de un caso.

We present a case of Cholestasis and pregnancy that developed associated in the puerperium, to tecaluteinic ovaries and hemoperitoneum. For this reason it was necessary surgical management. We considered that it is a very unusual case so we felt interest on presenting it. To finish we would to make reference to itns possible patogenia, symptoms, and management of it.

[Isoxsuprine in hypertension during pregnancy]. / Isoxuprina en la hipertensión del embarazo.

The objective of this paper is to demonstrate that isoxsuprine is an effective, quick hypotensive of easy management in the hypertension of pregnancy that does not have adverse effects on the mother-fetus binomial. This study was carried out at the Obstetric Intensive Care Unit at the Gyneco-Obstretrics Hospital in the Centro Médico Nacional La Raza of the IMSS. Fifty patients were chosen and managed according to the protocol management of the hospital; they had a diagnosis of severe toxemia or preeclampsia in patients with 24 weeks or more of pregnancy, with hypertension, edema, convulsions and/or coma state or without concomitant or previous pathological states. All of the patients received isoxsuprine (50 mg in 250 ml of DW5%). We evaluated the hypotensive effect of isoxsuprine according to the time and average dose administered, and its effect on the mother and fetus heart frequency according to the basal values. We valued the APGAR score at minute one and minute five, seconds after the delivery. We analyzed according to the degrees of toxemia and at the end of the obstetric event. We demonstrated a significant decrease in the arterial tension after administration fifteen minutes later with a dose of nine drops (0.29 mcg/min) average and demonstrated at the same time that there are no adverse effects on the mother fetus binomial. Isoxsuprine is an affective, quick and economical hypotensive of easy management that has no adverse effects on mother-fetus glycemia, obstetric bleeding and APGAR score.