Ruptured subcapsular liver hematoma as a rare complication of HELLP syndrome. A therapeutic challenge.

HELLP syndrome (HS), a low-incidence condition of uncertain pathogenesis associated with pregnancy hypertensive syndromes, is characterized by hemolysis, elevated liver enzymes and low platelet count. Ruptured subcapsular liver hematoma complicated with hemoperitoneum is an uncommon but very serious condition where early recognition and multidisciplinary management are key to reduce its associated maternal, infant mortality rate. Symptoms are nonspecific, characterized by por epigastric pain, nausea and vomiting; clinical suspicion and appropriate imaging studies are of crucial importance. We report the case of a 36-year-old primiparous woman at 39 weeks of gestation. She was admitted for early membrane rupture, with delivery complicated by retained placenta. During the immediate puerperium she had blood pressure > 140/90 mmHg, epigastric pain and vomiting, which required respiratory and hemodynamic support. An exploratory laparotomy was performed that revealed a massive hemoperitoneum as well as CR in the RLL with multifocal active bleeding. The left liver lobe was macroscopically normal. The patient underwent hemoperitoneum drainage and hepatic packing (HP); biopsy findings were consistent with necrosis. Polytransfusion was initiated with blood products and antihemorrhagic agents.

Allometry, sexual selection and evolutionary lines of least resistance shaped the evolution of exaggerated sexual traits within the genus Tyrannus.

Variational properties hold a fundamental role in shaping biological evolution, exerting control over the magnitude and direction of evolutionary change elicited by microevolutionary processes that sort variation, such as selection or drift. We studied the genus Tyrannus as a model for examining the conditions and drivers that facilitate the repeated evolution of exaggerated, secondary sexual traits in the face of significant functional limitations. In particular, we explore the role of allometry, sexual selection and their interaction, on the diversification of tail morphology in the genus, assessing whether and how they promoted or constrained phenotypic evolution. Non-deep-forked species tend to show reduced sexual dimorphism and moderate allometric variation in tail shape. The exaggerated and functionally constrained long feathers of deep-forked species, T. savana and T. forficatus, which show both marked sexual dimorphism and allometric tail shape variation, independently diverged from the rest of the genus following the same direction of main interspecific variation accrued during the evolution of non-deep-forked species. Moreover, the latter direction is also aligned with axes summarising sexual dimorphism and allometric variation on deep-forked species, a feature lacking in the rest of the species. Thus, exaggerated tail morphologies are interpreted as the result of amplified divergence through reorientation and co-option of allometric variation by sexual selection, repeatedly driving morphology along a historically favoured direction of cladogenetic evolution.

Use of Linear Programming to Develop Complementary Feeding Recommendations to Improve Nutrient Adequacy and Dietary Diversity Among Breastfed Children in the Rural Philippines.

BACKGROUND: Lack of dietary diversity in complementary feeding contributes to nutrient gaps leading to undernutrition. Food-based strategies have been successfully used to enrich the complementary diets of infants and young children. However, context-specific recommendations based on an objective diet optimization are needed to formulate sound and practical nutritional guidelines. OBJECTIVES: The present study aimed to identify problem nutrients in complementary diets and formulate complementary feeding recommendations (CFRs) using linear programming analysis for children aged 6 to 23 months in the rural Philippines. METHODS: A cross-sectional survey was conducted in the municipality of Mercedes, Philippines. Dietary intakes of breastfed children 6 to 8, 9 to 11, and 12 to 23 months of age (n = 297) were assessed using a multipass 24-hour recall method with 7-day food consumption frequency. A linear programming tool was used to identify the recommended nutrient intakes that could not be met within the existing local food patterns and develop CFRs that would best fulfill nutrient adequacy for 11 modeled micronutrients. RESULTS: Problem nutrients in the current diets were iron and calcium in any age-group, zinc for 6 to 8 and 9 to 11 months old, and thiamine and folate for 12 to 23 months old children. Adoption of CFRs with 4 to 5 food groups in the diet would ensure the adequacy of 7 to 8 nutrients, depending on the age-group. CONCLUSION: Within the boundaries of local dietary patterns, adequacy for most nutrients could be achieved by promoting realistic servings of nutrient-dense foods and food groups. The linear programming results provide an evidence-based strategy in designing interventions to improve the quality of Filipino complementary diets.

Organochlorine Pesticides (OCPs) in raft mussels coming from Galician rías.

This survey gives an overview of the range of organochlorine pesticides (OCPs) α and γ-HCH (lindane), HCB, pp´-DDE, pp´-DDD, op´-DDT, pp´-DDT, aldrin, dieldrin, endrin, isodrin and trans-nonachlor in raft mussels cultivated in several polygons of the Galician Rías (Ares-Betanzos, Muros-Noia, Arousa, Pontevedra and Vigo) during the period 1998-2014. A significant number of OCPs were detected, but the levels found were generally low, mainly in the recent samplings (2010-2014). The levels of ∑DDs (sum of DDTs and its metabolites, pp´-DDE and pp´-DDD) ranged between 0.22 ng/g dry weight (dw) in samples from the Ría of Pontevedra and 46.4 ng/g dw in mussels from the Ría of Arousa. Both aldrin and endrin were not detected or were below the analytical limits of detection. With regard to other pesticides, dieldrin is the major compound, followed by γ-HCH, isodrin, α-HCH and transnonachlor. Significant ANOVA regressions indicated variations in levels of some OCPs with the biological parameters (lipid, condition index and shell length). Univariate and multivariate analysis of OCP levels revealed no significant differences between Rías. Temporal trends showed an important decline of OCPs in the studied samples during the period 1998-2014.

Estudio de la interferencia por hemólisis en la determinación de bilirrubina total / Hemolysis interference study in determination of total bilirubin / Estudo da interferência por hemólise na determinação de bilirrubina total

La hemólisis es una causa frecuente de rechazo de muestras que genera un sesgo negativo en la determinación de bilirrubina total (BT). Los objetivos de este trabajo fueron determinar el grado de hemólisis (GH) para reemplazar la inspección visual subjetiva, establecer la magnitud de su interferencia y conocer la concentración inicial de hemoglobina a partir de la cual se produce interferencia clínicamente relevante (ICR). Se recolectaron sueros con diferentes concentraciones de BT. Se preparó un hemolizado para generar distintas concentraciones de interferente. Se cuantificó la BT mediante el método de diclorofenildiazonio en los sueros con las diferentes concentraciones de hemoglobina y se determinó GH midiendo absorbancia a 578 nm. Se consideró ICR cuando se superó la máxima inexactitud deseable. Para cada nivel de BT se determinó la concentración de hemoglobina máxima aceptable (CHbmáx aceptable) por sobre la cual se considera ICR. La Abs578 permitió definir cuatro GH (GH1, GH2, GH3 y GH4). A partir de los interferogramas se determinó la CHbmáx aceptable para cada nivel de BT; ésta mostró un aumento lineal con la BT. A partir de 14,8 mg/dL de BT no se encontró ICR en los rangos estudiados. El GH permite tomar conductas objetivas ante muestras hemolizadas según el algoritmo propuesto.

Hemolysis is a common cause for rejection of samples that generates a negative bias in total bilirubin (TB) determination. The objectives of this study were to determine the hemolysis degree (HD) to replace the subjective visual inspection, to establish the extent of their interference and to meet the initial hemoglobin concentration from which clinically relevant interference (CRI) occurs. Sera was collected at different TB concentrations.Hemolysate was prepared to generate different concentrations of interfering. TB was quantified by dichlorophenyldiazonium method in sera with several hemoglobin concentrations, and DH was determined by measuring absorbance at 578 nm (Abs578). CRI was considered when it exceeded the maximum desirable inaccuracy. For each TB level, the maximum acceptable concentration of hemoglobin (CHbmáx acceptable) above which ICR is considered was determined.The Abs578 made it possible to define four DH (DH1, DH2, DH3 and DH4). The CHbmax acceptable was determined for each level of TB from the interferograms; it showed a linear increase with TB. From 14,8 mg/dL BT, CRI was not found in the ranges studied. The DH makes it possible to have objective behaviours in hemolyzed samples according to the proposed algorithm.

A hemólise é uma causa frequente de rejeição de amostras que gera um viés negativo na determinação da bilirrubina total (BT). Os objetivos deste estudo foram: determinar o grau de hemólise (GH) para substituir a inspeção visual subjetiva, estabelecer a extensão da sua interferência e conhecer a concentração inicial de hemoglobina a partir da qual ocorre a interferência clinicamente relevante (ICR). Foram coletados soros com diferentes concentrações de BT. Um hemolisado foi preparado para gerar diferentes concentrações de interferente. Foi quantificada a BT pelo método de diclorofenil diazônio nos soros com as diferentes concentrações de hemoglobina e foi determinado o GH medindo a absorvância a 578 nm (Abs578). ICR foi considerada quando se superou a máxima inexatidão desejável. Para cada nível de BT foi determinada a concentração de hemoglobina máxima aceitável (CHbMax aceitável) acima da qual é considerada ICR. A Abs578 permitiu definir quatro GH (GH1, GH2, GH3 e GH4). A partir dos interferogramas se determinou a CHbMax aceitável para cada nível de BT; ela apresentou um aumento linear com a BT. A partir de 14,8 mg/dL de BT, a ICR não foi encontrada nos intervalos estudados. O GH permite ter condutas objetivas diante de amostras hemolisadas de acordo com o algoritmo proposto.

Geographical distribution and time trends of polychlorinated biphenyls in raft mussel from Galician coast (1998-2013).

PCBs were analyzed in raft mussels cultured in several polygons from Galician Rías (Rías of Ares-Betanzos, Muros-Noia, Arousa, Pontevedra and Vigo) during the period 1998-2013. The main aim of this work is study the quality of culture marine environment in relation to PCBs compounds. We report the results of a monitoring. The mean levels of ΣPCBs (ten congeners) ranged from 7.41 to 59.50ngg(-1)dw. The isomer concentrations in the Mytilus galloprovincialis cultured in raft were in the order hexachlorobiphenyls>pentachlorobiphenyls>tetrachlorbiphenyls>trichlorobiphenyls. Some biological parameters of mussel were also investigated (shell length, lipid content and condition index) in order to know their influence on ability of PCBs accumulation. ANOVA analysis confirms that levels of most of congeners had a significant relation (p<0.05) with shell length. The geographical patterns and temporal variations of PCBs were also investigated. Principal Component Analysis (PCA) showed differences between geographic areas (Rías) in the distribution of PCBs levels. Samples coming from Rías of Vigo and Ares-Betanzos presented the highest levels of PCBs and samples from Rías of Arousa and Muros-Noia had the lowest levels of these compounds. Time trends (linear regressions) showed a decline of levels of PCB congeners along the period 1998-2013.

Lipodistrofia congénita generalizada en un paciente con anomalía de Dandy Walker / Congenital generalized lipodystrophy in pacient with Dandy Walker anomaly

La asociación entre la lipodistrofia congénita generalizada y la anomalía de Dandy Walker no es habitual. Se reporta el caso de una niña de 1 año de edad que ingresa al hospital a los 4 meses por riesgo social, con diagnóstico de anomalía de Dandy Walker. Durante su internación, se evidencia en forma progresiva aspecto acromegaloide, facies triangular, hirsutismo, lipoatrofia, hipertrofia muscular, clitoromegalia, distensión abdominal con hepatomegalia progresiva e hpertrigliceridernia. Se arriba así al diagnóstico clínico de lipodistrofia congénita generalizada. Se revisan los aspectos clínicos y el seguimiento interdisciplinario para la detección oportuna de insulinorresistencia y diabetes, pubertad precoz, miocardiopatía, entre otras. Respecto de la anomalía de Dandy Walker, se realizan controles evolutivos en búsqueda de la aparición de signos de hipertensión endocraneana. Por el carácter autosómico recesivo de la lipodistrofia congénita generalizada, es importante realizar el asesoramiento genético a los padres.

The objective of this study is to describe the unexpected association between the congenital generalized lipodystrophy (CGL) and Dandy Walker anomaly. We report the case of a 1-year-old infant who was hospitalized at her fourth month of life with Dandy Walker anomaly diagnosis and an increased social risk. During her hospitalization, she developed progressively: acromegaloid aspect, triangular fascia, hirsutism, lipoatrophy, muscle hypertrophy, clitoromegaly, abdominal distention, progressive hepatomegaly, and hypertriglyceridemia. This led to the clinical diagnosis of congenital generalized lipodystrophy. Importance shouldbe given to the examination of clinical aspects as well as the interdisciplinary follow-up for proper detection of insulin resistance and diabetes, early puberty, cardiomyopathy, among others. In case of Dandy Walker anomaly, it should be checked the evolution to search intracranial hypertension signs. Due to its autosomal recessive nature, it is important to provide genetic counseling to the parents.

Lipodistrofia congénita generalizada en un paciente con anomalía de Dandy Walker / Congenital generalized lipodystrophy in pacient with Dandy Walker anomaly

La asociación entre la lipodistrofia congénita generalizada y la anomalía de Dandy Walker no es habitual. Se reporta el caso de una niña de 1 año de edad que ingresa al hospital a los 4 meses por riesgo social, con diagnóstico de anomalía de Dandy Walker. Durante su internación, se evidencia en forma progresiva aspecto acromegaloide, facies triangular, hirsutismo, lipoatrofia, hipertrofia muscular, clitoromegalia, distensión abdominal con hepatomegalia progresiva e hpertrigliceridernia. Se arriba así al diagnóstico clínico de lipodistrofia congénita generalizada. Se revisan los aspectos clínicos y el seguimiento interdisciplinario para la detección oportuna de insulinorresistencia y diabetes, pubertad precoz, miocardiopatía, entre otras. Respecto de la anomalía de Dandy Walker, se realizan controles evolutivos en búsqueda de la aparición de signos de hipertensión endocraneana. Por el carácter autosómico recesivo de la lipodistrofia congénita generalizada, es importante realizar el asesoramiento genético a los padres.(AU)

The objective of this study is to describe the unexpected association between the congenital generalized lipodystrophy (CGL) and Dandy Walker anomaly. We report the case of a 1-year-old infant who was hospitalized at her fourth month of life with Dandy Walker anomaly diagnosis and an increased social risk. During her hospitalization, she developed progressively: acromegaloid aspect, triangular fascia, hirsutism, lipoatrophy, muscle hypertrophy, clitoromegaly, abdominal distention, progressive hepatomegaly, and hypertriglyceridemia. This led to the clinical diagnosis of congenital generalized lipodystrophy. Importance shouldbe given to the examination of clinical aspects as well as the interdisciplinary follow-up for proper detection of insulin resistance and diabetes, early puberty, cardiomyopathy, among others. In case of Dandy Walker anomaly, it should be checked the evolution to search intracranial hypertension signs. Due to its autosomal recessive nature, it is important to provide genetic counseling to the parents.(AU)

[Congenital generalized lipodystrophy in a patient with Dandy Walker anomaly]. / Lipodistrofia congénita generalizada en un paciente con anomalía de Dandy Walker.

The objective of this study is to describe the unexpected association between the congenital generalized lipodystrophy (CGL) and Dandy Walker anomaly. We report the case of a 1-year-old infant who was hospitalized at her fourth month of life with Dandy Walker anomaly diagnosis and an increased social risk. During her hospitalization, she developed progressively: acromegaloid aspect, triangular fascia, hirsutism, lipoatrophy, muscle hypertrophy, clitoromegaly, abdominal distention, progressive hepatomegaly, and hypertriglyceridemia. This led to the clinical diagnosis of congenital generalized lipodystrophy. Importance should be given to the examination of clinical aspects as well as the interdisciplinary follow-up for proper detection of insulin resistance and diabetes, early puberty, cardiomyopathy, among others. In case of Dandy Walker anomaly, it should be checked the evolution to search intracranial hypertension signs. Due to its autosomal recessive nature, it is important to provide genetic counseling to the parents.

Lipodistrofia congénita generalizada en un paciente con anomalía de Dandy Walker. / [Congenital generalized lipodystrophy in a patient with Dandy Walker anomaly].

The objective of this study is to describe the unexpected association between the congenital generalized lipodystrophy (CGL) and Dandy Walker anomaly. We report the case of a 1-year-old infant who was hospitalized at her fourth month of life with Dandy Walker anomaly diagnosis and an increased social risk. During her hospitalization, she developed progressively: acromegaloid aspect, triangular fascia, hirsutism, lipoatrophy, muscle hypertrophy, clitoromegaly, abdominal distention, progressive hepatomegaly, and hypertriglyceridemia. This led to the clinical diagnosis of congenital generalized lipodystrophy. Importance should be given to the examination of clinical aspects as well as the interdisciplinary follow-up for proper detection of insulin resistance and diabetes, early puberty, cardiomyopathy, among others. In case of Dandy Walker anomaly, it should be checked the evolution to search intracranial hypertension signs. Due to its autosomal recessive nature, it is important to provide genetic counseling to the parents.

Organochlorine pesticide levels in Ensis siliqua (Linnaeus, 1758) from Ría de Vigo, Galicia (N.W. Spain): influence of season, condition index and lipid content.

Levels of organochlorine pesticides (OCPs), including ΣDDTs, γ-HCH, HCB, aldrin, isodrin, trans-nonachlor, heptachlor and dieldrin, were determined in the razor clam, Ensis siliqua, collected monthly from February 2003 to April 2004 from the Islas Cíes in Ría de Vigo (Galicia, Spain). The sum of DDTs ranged from 2.17 to 26.9 ng g(-1) dry weight (dw). Principal component analysis showed seasonal trends in the levels of some OCPs (γ-HCH and dieldrin). Pearson correlations (p < 0.05) were observed between OCP levels and the biometric parameters of condition index and body lipids.

Tratamiento endovascular de un aneurisma poplíteo con anatomía desfavorable / Endovascular treatment of a popliteal aneurysm with unfavourable anatomy

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Microwave-assisted solvent extraction and gas chromatography ion trap mass spectrometry procedure for the determination of persistent organochlorine pesticides (POPs) in marine sediment.

Microwave-assisted solvent extraction of persistent organochlorine pesticides (POPs) in marine sediment was developed and optimized by means of two-level factorial designs. Six variables (microwave power, extraction time and temperature, amount of sample, solvent volume, and sample moisture) were considered as factors in the optimization process. The results show that the amount of sample to be extracted and solvent volume are statistically significant for the overall recovery of the studied pesticides, although compromise conditions have to be established with the object of avoiding overpressure in closed vessels. After extraction, a clean up step including the use of a silica cartridge was performed prior to chromatographic determination in order to remove interferences. The optimized procedure was compared to conventional Soxhlet extraction. The MS-MS ion preparation mode was applied to improve the sensitivity and selectivity of the chromatographic technique.

Possible influence of lipid content on levels of organochlorine compounds in mussels from Galicia coast (Northwestern, Spain). Spatial and temporal distribution patterns.

Influence of lipid content of mussel on levels of organochlorine compounds (polychlorinated biphenyls [PCBs] and OC pesticides) has been studied. Mussel samples coming from three sites in Galicia coast (Northwestern, Spain), Moaña and Cangas C from Ría de Vigo and Barallobre from Ría de Ferrol, collected monthly in the period from November 2000 to October 2001, have been analysed. Organochlorine compounds, PCBs (IUPAC nos. 31, 28, 52, 101, 118, 153, 105, 138, 156 and 180) and OC pesticides (pp'-DDE, op'-DDT, pp'-DDT, aldrin, isodrin and endrin) have been extracted by means of Soxhlet and determined by using gas chromatography (electron capture detector [ECD]) and gas chromatography-mass spectrometry. Statistical analysis has been performed using the SPSS statistical package. Few compounds were correlated with lipid content (Pearson product-moment correlation); for samples coming from Barallobre, only the individual PCBs 31, 28, 52 (tri- and tetrachlorinated biphenyls) and 180 (heptachlorinated biphenyl) presented a significant correlation; for Moaña samples, two cyclodiene pesticides, endrin and isodrin, presented a slight significant correlation with lipid content. From these results, it is deduced that the normalization of the concentration of organochlorine compounds to the lipid content is not necessary, in this way, avoiding possible error sources associated to the analytical determination of the lipid contentor reproductive status of mussel. Multivariate techniques (PCA) have been employed in order to study spatial and temporal distribution patterns of organochlorine compounds. The great differences found in studied samples are mainly related to spatial distribution: separations between estuarine bays (samples coming from Ría de Vigo and Ría de Ferrol) and between rural and urban zones (samples coming from Moaña and Cangas C and samples from Barallobre, respectively).

Afasia global sin hemiparesia / Global aphasia without hemiparesis

Se presenta tres casos de afasia global sin hemiparesia consecutivos a desórdenes vasculares cerebrales embólicos. Los estudios de tomografía axial computarizada mostraron infartos únicos en la región perisilviana izquierda con afectación predominante de la corteza. En base a los casos de este trabajo y la revisión de la bibliografía se concluye que la afasia global sin hemiparesia encontrada desde el comienzo de la afección se debe a embolias cerebrales, pero también puede ser causada por otros mecanismos fisiopatológicos. Los síntomas en algunos casos resultan de infartos separados, uno en el área de Broca y otro en el área de Wernicke, pero en otros pacientes los síntomas se relacionan a infartos únicos que comprometen principalmente las zonas corticales perisilvianas, dejando relativamente indemnes los territorios subcorticales, especialmente la cápsula interna