Effects of Climate Change on the Distribution of Prosthechea mariae (Orchidaceae) and within Protected Areas in Mexico.

The impact of climate change on the distribution of native species in the Neotropics remains uncertain for most species. Prosthechea mariae is an endemic epiphytic orchid in Mexico, categorized as threatened. The objective of this study was to assess the effect of climate change on the natural distribution of P. mariae and the capacity of protected areas (PAs) to safeguard optimal environmental conditions for the species in the future. Historical records were obtained from herbaria collections and through field surveys. We utilized climate variables from WorldClim for the baseline scenario and for the 2050 period, using the general circulation models CCSM4 and CNRM-CM5 (RCP 4.5). Three sets of climate data were created for the distribution models, and multiple models were evaluated using the kuenm package. We found that the species is restricted to the eastern region of the country. The projections of future scenarios predict not only a substantial reduction in habitat but also an increase in habitat fragmentation. Ten PAs were found within the current distribution area of the species; in the future, the species could lose between 36% and 48% of its available habitat within these PAs. The results allowed for the identification of locations where climate change will have the most severe effects, and proposals for long-term conservation are addressed.

Electrically evoked stapedial reflex threshold and behavioral method usefulness in the cochlear implant programming in pediatric population.

OBJETIVE: To determine the utility of the electrically evoked stapedial reflex test (ESRT) and behavioral method in the CIs programming as an objective method to identify MCL levels in the CIs programming in pediatric patients. METHOD: Cross-sectional cohort study that included 20 pediatric patients with postlingual deafness and CI unilateral. They were performed clinical history, tympanometry, ESRT and by free field audiometry, before and after programming modifications according to MCL levels obtained by ESRT were performed. ESRT threshold was assessed with individual 300 ms stimuli on the 12 electrodes and recorded through manual decay. Likewise, the maximum comfort threshold (MCL) of each electrode was obtained through a behavioral analysis. RESULTS: No significant differences were found between the ESRT and behavioral method in MCLs levels in each of the electrodes evaluated. In addition, the correlation coefficients were significant and located in a range of 0.55-0.81, higher in electrodes 7, 8, and 9 (r = 0.77, 0.76, and 0.81, respectively). However, the median hearing threshold established by the ESRT was significantly lower compared to the behavioral threshold (36.0 vs. 47.0 dB, p < 0.0001), regardless of age (p = 0.249) or the etiology of hearing loss (p = 0.292). The difference between the tests was in the number of times to do it, the ESRT was done once and the behavioral on average 4 ± 1 times. CONCLUSION: Similar MCL thresholds were obtained in both ESRT and behavioral test, establishing that both methods are reliable for use in pediatric patients; however, ESRT allows shortening the time to achieve normal hearing and language acquisition thresholds in a more optimal time.

Use of Artificial Intelligence in the Search for New Information Through Routine Laboratory Tests: Systematic Review.

Background: In recent decades, the use of artificial intelligence has been widely explored in health care. Similarly, the amount of data generated in the most varied medical processes has practically doubled every year, requiring new methods of analysis and treatment of these data. Mainly aimed at aiding in the diagnosis and prevention of diseases, this precision medicine has shown great potential in different medical disciplines. Laboratory tests, for example, almost always present their results separately as individual values. However, physicians need to analyze a set of results to propose a supposed diagnosis, which leads us to think that sets of laboratory tests may contain more information than those presented separately for each result. In this way, the processes of medical laboratories can be strongly affected by these techniques. Objective: In this sense, we sought to identify scientific research that used laboratory tests and machine learning techniques to predict hidden information and diagnose diseases. Methods: The methodology adopted used the population, intervention, comparison, and outcomes principle, searching the main engineering and health sciences databases. The search terms were defined based on the list of terms used in the Medical Subject Heading database. Data from this study were presented descriptively and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; 2020) statement flow diagram and the National Institutes of Health tool for quality assessment of articles. During the analysis, the inclusion and exclusion criteria were independently applied by 2 authors, with a third author being consulted in cases of disagreement. Results: Following the defined requirements, 40 studies presenting good quality in the analysis process were selected and evaluated. We found that, in recent years, there has been a significant increase in the number of works that have used this methodology, mainly because of COVID-19. In general, the studies used machine learning classification models to predict new information, and the most used parameters were data from routine laboratory tests such as the complete blood count. Conclusions: Finally, we conclude that laboratory tests, together with machine learning techniques, can predict new tests, thus helping the search for new diagnoses. This process has proved to be advantageous and innovative for medical laboratories. It is making it possible to discover hidden information and propose additional tests, reducing the number of false negatives and helping in the early discovery of unknown diseases.

Foxp3 Silencing with Antisense Oligonucleotide Improves Immunogenicity of an Adjuvanted Recombinant Vaccine against Sporothrix schenckii.

BACKGROUND: In recent years, there has been great interest in developing molecular adjuvants based on antisense oligonucleotides (ASOs) targeting immunosuppressor pathways with inhibitory effects on regulatory T cells (Tregs) to improve immunogenicity and vaccine efficacy. We aim to evaluate the immunostimulating effect of 2'OMe phosphorothioated Foxp3-targeted ASO in an antifungal adjuvanted recombinant vaccine. METHODS: The uptake kinetics of Foxp3 ASO, its cytotoxicity and its ability to deplete Tregs were evaluated in murine splenocytes in vitro. Groups of mice were vaccinated with recombinant enolase (Eno) of Sporothix schenckii in Montanide Gel 01 adjuvant alone or in combination with either 1 µg or 8 µg of Foxp3 ASO. The titers of antigen-specific antibody in serum samples from vaccinated mice (male C57BL/6) were determined by ELISA (enzyme-linked immunosorbent assay). Cultured splenocytes from each group were activated in vitro with Eno and the levels of IFN-γ and IL-12 were also measured by ELISA. The results showed that the anti-Eno antibody titer was significantly higher upon addition of 8 µM Foxp3 ASO in the vaccine formulation compared to the standard vaccine without ASO. In vitro and in vivo experiments suggest that Foxp3 ASO enhances specific immune responses by means of Treg depletion during vaccination. CONCLUSION: Foxp3 ASO significantly enhances immune responses against co-delivered adjuvanted recombinant Eno vaccine and it has the potential to improve vaccine immunogenicity.

Cutting force measurement: Hand tool instrumentation used in slaughterhouses - a systematic review.

Workers' intensive use of hand tool cutting in the meat packing industry is a risk factor for occupational health, mainly by mechanical compression of tissues in the upper limbs, which can cause Work-Related Musculoskeletal Disorders (WMSDs). This systematic review aimed to identify the characteristics and measured variables of instrumented knives and determine how they should be designed. The review process and article extractions occurred through an analysis of the (article) titles, keywords and abstracts, followed by reading the full texts by two reviewers independently. Searches were conducted in Medline, Web of Science, Science Direct, Scopus, Ebsco and Engineering Village for articles published in peer-reviewed journals from January 2000 to March 2019, in the English language. The result of (the) search included 1289 potentially eligible studies, with 894 duplicated/triplicated/quadruplicated articles that were excluded, resulting in 404 remaining articles of which 33 were considered eligible, with 36 additional articles, totaling 69 evaluated full texts. After the review, none of the 14 analyzed studies, were rated as having good methodological quality. In addition, four types of instrumented knives were used. Data acquisition was performed in both laboratory and meat processing plants. It is noteworthy that only one knife was submitted to a validation process and that the articles did not provide complete technical information about the knives. The result demonstrated that the cutting force varies within and between subjects, tasks, plants and blade finishings. All knives used some type of electrical connection via cable or wires. Of the articles found, none considered the influences that the workers are subject to when they do not use the same tool daily for data acquisition. Therefore, the development of different types of instrumented knives, with wireless data transmission and more rigorous studies are necessary to expand the knowledge of the cutting force and development of WMSD in slaughterhouse workers who perform meat cutting.

Highly selective recovery of medium chain carboxylates from co-fermented organic wastes using anion exchange with carbon dioxide expanded methanol desorption.

The aim of this work was to recover a mixture of carboxylates ranging from 2 to 7 carbon atoms using a strong anion exchange resin, followed by desorption with CO2-expanded methanol. Medium chain carboxylates hexanoate and heptanoate adsorbed better than acetate, and the corresponding medium chain carboxylic acids desorbed easier than acetic acid. Consequently, hexanoate and heptanoate were concentrated up to 14.6 and 20.7 times, respectively. These findings will enable effective separation and purification of the produced carboxylic acids. Notably, the presence of inorganic ions in the sample, such as chloride, decreased the adsorption affinity compared to a synthetic mixture only of carboxylates.

Exertion Perception When Performing Cutting Tasks in Poultry Slaughterhouses: Risk Assessment of Developing Musculoskeletal Disorders.

Brazil is the leader in poultry meat exports, in which most products are in the form of cuts. This study analyzed the exertion perception of poultry slaughterhouses workers when performing cutting tasks, as well as the influence of knife sharpness on the risk of developing musculoskeletal disorders by Occupational Repetitive Action (OCRA) method. Participants (n = 101) from three slaughterhouses were asked to rate their perceived exertion on the Borg scale during the cutting task when the knife was well and poorly sharpened. The OCRA results showed that the score for cutting with a dull knife was greater (43.57 ± 13.51) than with a sharp knife (23.79 ± 3.10) (p < 0.001). Consequently, there was a significant increase in the risk level of acquiring upper-limb work-related musculoskeletal disorders (UL-WMSD) by using a "poorly sharpened" knife (29%; p < 0.001; Borg scale 2-8). Thus, maintaining well-sharpened knives for optimal performance of the cutting task (fewer technical actions) is suggested, as well as including knife sharpening in the standard operating procedure to reduce musculoskeletal disorders.

Calcium Alginate as a Novel Sealing Agent for Colloidosomes.

We report on the preparation of colloidosomes formed with a poly(methyl methacrylate-co-butyl acrylate) latex shell, sealed using calcium alginate as a novel nontoxic and biodegradable sealing agent. The aim is to encapsulate enzymes in detergent formulations. The proposed method, with vegetable oil as the continuous phase, avoids the use of harmful organic solvents. Allura Red has been used as a water-soluble dye, in the core, to analyze the influence of variables such as sodium alginate and latex concentrations on the sealing and release profiles. After formation, the capsules were dispersed in either water or propylene glycol. The capsules have been examined using optical, confocal, and scanning electron microscopies. Working with the highest sodium alginate concentration and latex volume, the encapsulation efficiency is between 60 and 80%. Propylene glycol enables a better dispersion of the capsules compared with water. Dye release data have been fitted to exponential and Michaelis-Menten-type equations, leading to kinetic parameters that allow the simulation of the release process.

Progress in the Use of Antisense Oligonucleotides for Vaccine Improvement.

: Antisense oligonucleotides (ASOs) are synthetically prepared short single-stranded deoxynucleotide sequences that have been validated as therapeutic agents and as a valuable tool in molecular driving biology. ASOs can block the expression of specific target genes via complementary hybridization to mRNA. Due to their high specificity and well-known mechanism of action, there has been a growing interest in using them for improving vaccine efficacy. Several studies have shown that ASOs can improve the efficacy of vaccines either by inducing antigen modification such as enhanced expression of immunogenic molecules or by targeting certain components of the host immune system to achieve the desired immune response. However, despite their extended use, some problems such as insufficient stability and low cellular delivery have not been sufficiently resolved to achieve effective and safe ASO-based vaccines. In this review, we analyze the molecular bases and the research that has been conducted to demonstrate the potential use of ASOs in vaccines.

CYP3A5*3 and CYP2C8*3 variants influence exposure and clinical outcomes of tacrolimus-based therapy.

Aim: The influence of variants in pharmacokinetics-related genes on long-term exposure to tacrolimus (TAC)-based therapy and clinical outcomes was investigated. Patients & methods: Brazilian kidney recipients were treated with TAC combined with everolimus (n = 178) or mycophenolate sodium (n = 97). The variants in CYP2C8, CYP2J2, CYP3A4, CYP3A5, POR, ABCB1, ABCC2, ABCG2, SLCO1B1 and SLCO2B1 were analyzed. Main results:CYP3A5*3/*3 genotype influenced increase in TAC concentration from week 1 to month 6 post-transplantation (p < 0.05). The living donor and CYP2C8*3 variant were associated with reduced risk for delayed graft function (OR = 0.07; 95% CI = 0.03-0.18 and OR = 0.45; 95% CI = 0.20-0.99, respectively, p < 0.05). Conclusion: The CYP3A5*3 variant is associated with increased early exposure to TAC. Living donor and CYP2C8*3 variant seem to be protective factors for delayed graft function in kidney recipients.

Amorphous Carbon Chips Li-Ion Battery Anodes Produced through Polyethylene Waste Upcycling.

Remediation process produces high-value functional material from low-cost or valueless waste feedstock. Current research demonstrates an innovative solvothermal approach to effectively react sulfuric acid on polyethylene (PE) chains, modifying the PE at a moderate temperature. In this process, the polymer undergoes a cross-linking step above 120 °C, whereas above 500 °C, it transforms into turbostratic carbon structures. Scanning electron micrographs confirmed the free-standing carbon sheet architecture. Raman spectroscopy and X-ray diffraction verified the amorphous/disordered sp2/sp3 hybrid carbon structure in the produced carbons. A high Brunauer-Emmett-Teller surface area of 752.3 and 673.5 m2/g for low-density PE-derived carbon (LDPE-C) and high-density PE-derived carbon (HDPE-C), respectively, was recorded. Thermogravimetric analysis analysis established a total mass retention of 50 and 46% for LDPE and HDPE, respectively, from sulfonated materials. Li-ion battery composite anode comprising LDPE-C and HDPE-C, with a binder and a carbon additive (vs lithium), produced 230 and 350 mA h/g specific capacities for LDPE-C and HDPE-C, respectively, when cycled at room temperature at C/5 rate. Elevated temperature (50 °C) battery cycling produced 290 and 440 mA h/g specific capacities for LDPE-C and HDPE-C, respectively, at C/5 rate. On the basis of the literature survey, this is the first report, which demonstrates that a solvothermal sulfonation process followed by thermal treatment successfully converts waste LDPE and HDPE plastic bags to functional energy-storing carbons.

Efficacy of hydrodynamic interleukin 10 gene transfer in human liver segments with interest in transplantation.

Different diseases lead, during their advanced stages, to chronic or acute liver failure, whose unique treatment consists in organ transplantation. The success of intervention is limited by host immune response and graft rejection. The use of immunosuppressant drugs generally improve organ transplantation, but they cannot completely solve the problem. Also, their management is delicate, especially during the early stages of treatment. Thus, new tools to set an efficient modulation of immune response are required. The local expression of interleukin (IL) 10 protein in transplanted livers mediated by hydrodynamic gene transfer could improve the organ acceptance by the host because it presents the natural ability to modulate the immune response at different levels. In the organ transplantation scenario, IL10 has already demonstrated positive effects on graft tolerance. Hydrodynamic gene transfer has been proven to be safe and therapeutically efficient in animal models and could be easily moved to the clinic. In the present work, we evaluated efficacy of human IL10 gene transfer in human liver segments and the tissue natural barriers for gene entry into the cell, employing gold nanoparticles. In conclusion, the present work shows for the first time that hydrodynamic IL10 gene transfer to human liver segments ex vivo efficiently delivers a human gene into the cells. Indexes of tissue protein expression achieved could mediate local pharmacological effects with interest in controlling the immune response triggered after liver transplantation. On the other hand, the ultrastructural study suggests that the solubilized plasmid could access the hepatocyte in a passive manner mediated by the hydric flow and that an active mechanism of transportation could facilitate its entry into the nucleus. Liver Transplantation 23:50-62 2017 AASLD.

Mujeres jóvenes con infección por VIH adquirida por transmisión vertical: expectativas de tener hijos no infectados / Young women with HIV infection acquired by vertical transmission: expectations of having uninfected children

Introduction: Pediatric antiretroviral therapy (ART), changed the prognosis of the disease, allowing young women infected by vertical transmission (TV) to be pregnant without risk for their fetus of acquiring this infection. Aim: To describe the clinical-immune status in pregnant women that acquired HV by vertical transmission, treatments received, monitoring of pregnancy and newborn characteristics. Material and Methods: A protocol was performed, evaluating clinical and immunological parameters during pregnancy, ART used, protocol preventing vertical transmission (PPTV), and follow up of children to 18 months of age. Results: Of 358 HIV-positive patients vertically infected, five women became pregnant, between 14 and 24 years old. Pregnancies were controlled in clinical/immune-stage N2 C3. They had received two to five therapies. Full PPTV was performed in all binomials. Pre-natal undetectable viral loads ranged from 4,700 ARN copies/mL. Five living children were born by Caesarean section, four of them with 37 weeks of completed gestation and one of them with 34 weeks of gestation. All received zidovudine (AZT) for 6 weeks. CD4 at 72 hours of life ranged from 48% to 74.6%. All children were born uninfected with HIV. Only two had mild anemia. Conclusions: Expectations of HIV mothers vertically infected to have healthy children are similar to those infected by horizontal transmission, using PPTV

Introducción: La terapia anti-retroviral en pediatría (TARV), cambió el pronóstico de la enfermedad, permitiendo embarazarse a mujeres jóvenes infectadas por transmisión vertical (TV). Objetivos: Conocer las características clínico-inmunológicas de las mujeres embarazadas, tratamientos recibidos, condición al embarazo y seguimiento de sus recién nacidos. Material y Método: Se efectuó un protocolo, evaluando etapas clínico-inmunológicas en el embarazo, TARV usadas, protocolo de prevención de transmisión vertical (PPTV) y seguimiento de los niños hasta 18 meses. Resultados: De 358 pacientes con infección por VIH adquirida por TV, cinco mujeres se embarazaron, con edades entre 14 a 24 años, embarazos que fueron controlados por el equipo de salud, encontrándose en etapa clínico-inmunológica N2 a C3. Habían recibido dos a cinco esquemas de TARV. Se efectuó PPTV completo en todos los binomios. Las cargas virales previas al parto fluctuaron entre indetectable y 4.700 copias ARN/ml. Nacieron por cesárea cinco niños vivos, cuatro de término y uno con 34 semanas de gestación. Todos recibieron zidovudina (AZT) durante seis semanas. Los CD4 a las 72 h de vida fluctuaron entre 48 y 74,6%. Ninguno de los niños adquirió la infección por VIH en forma vertical. Sólo dos presentaron anemia leve. Conclusiones: Las expectativas de madres con infección por VIH de adquisición vertical de tener hijos sanos son semejantes a las infectadas por transmisión horizontal, al usar PPTV.

Pancreatitis aguda asociada a balón intragástrico / Acute pancreatitis associated with the intragastric balloon

No disponible

[Young women with HIV infection acquired by vertical transmission: Expectations of having uninfected children]. / Mujeres jóvenes con infección por VIH adquirida por transmisión vertical: Expectativas de tener hijos no infectados.

INTRODUCTION: Pediatric antiretroviral therapy (ART), changed the prognosis of the disease, allowing young women infected by vertical transmission (TV) to be pregnant without risk for their fetus of acquiring this infection. AIM: To describe the clinical-immune status in pregnant women that acquired HV by vertical transmission, treatments received, monitoring of pregnancy and newborn characteristics. MATERIAL AND METHODS: A protocol was performed, evaluating clinical and immunological parameters during pregnancy, ART used, protocol preventing vertical transmission (PPTV), and follow up of children to 18 months of age. RESULTS: Of 358 HIV-positive patients vertically infected, five women became pregnant, between 14 and 24 years old. Pregnancies were controlled in clinical/immune-stage N2 C3. They had received two to five therapies. Full PPTV was performed in all binomials. Pre-natal undetectable viral loads ranged from 4,700 ARN copies/mL. Five living children were born by Caesarean section, four of them with 37 weeks of completed gestation and one of them with 34 weeks of gestation. All received zidovudine (AZT) for 6 weeks. CD4 at 72 hours of life ranged from 48% to 74.6%. All children were born uninfected with HIV. Only two had mild anemia. CONCLUSIONS: Expectations of HIV mothers vertically infected to have healthy children are similar to those infected by horizontal transmission, using PPTV.

Impact of Single Nucleotide Polymorphisms (SNPs) on Immunosuppressive Therapy in Lung Transplantation.

Lung transplant patients present important variability in immunosuppressant blood concentrations during the first months after transplantation. Pharmacogenetics could explain part of this interindividual variability. We evaluated SNPs in genes that have previously shown correlations in other kinds of solid organ transplantation, namely ABCB1 and CYP3A5 genes with tacrolimus (Tac) and ABCC2, UGT1A9 and SLCO1B1 genes with mycophenolic acid (MPA), during the first six months after lung transplantation (51 patients). The genotype was correlated to the trough blood drug concentrations corrected for dose and body weight (C0/Dc). The ABCB1 variant in rs1045642 was associated with significantly higher Tac concentration, at six months post-transplantation (CT vs. CC). In the MPA analysis, CT patients in ABCC2 rs3740066 presented significantly lower blood concentrations than CC or TT, three months after transplantation. Other tendencies, confirming previously expected results, were found associated with the rest of studied SNPs. An interesting trend was recorded for the incidence of acute rejection according to NOD2/CARD15 rs2066844 (CT: 27.9%; CC: 12.5%). Relevant SNPs related to Tac and MPA in other solid organ transplants also seem to be related to the efficacy and safety of treatment in the complex setting of lung transplantation.

Proyecto manejos integral en la DM tipo 1. Acuerdo en el manejo integral del paciente con diabetes mellitus tipo 1 / MIPDI-1 project. Agreement on the integrated management of patients with type 1 diabetes mellitus

INTRODUCCIÓN: El control glucémico inadecuado en la diabetes mellitus tipo 1 (DM1) se asocia al desarrollo de graves complicaciones, por lo que resulta necesario el seguimiento estrecho de la enfermedad, integrando tanto la participación de los profesionales sanitarios como la del paciente. OBJETIVO: Revalidar aspectos reseñados por expertos previamente, para establecer el estándar de actuación para el correcto manejo del paciente con DM1. MATERIAL Y MÉTODO: La Sociedad Española de Diabetes, la Sociedad Española de Endocrinología y Nutrición, y la Sociedad Española de Endocrinología Pediátrica han promovido entre sus asociados la valoración del grado de acuerdo y consistencia con 62 recomendaciones seleccionadas de la bibliografía, mediante un estudio Delphi multicéntrico nacional en 2013. RESULTADOS: Participaron 164 médicos especialistas en la DM1 de todas las comunidades autonómicas españolas, completando todo el proceso 150. No hubo ningún desacuerdo, considerándose consistente el acuerdo en 5 aseveraciones de carácter general, en 9 referidas al tratamiento insulínico y en 7 al seguimiento y gestión del paciente con DM1. CONCLUSIONES: No se ha discrepado de ninguna de las afirmaciones expresadas por expertos anteriores, si bien no todas han sido ratificadas. Se considera tan importante el control glucémico basal como el posprandial, relacionándose el control glucémico inadecuado con las alteraciones vasculares, nefropatía, polineuropatía y retinopatía. Se precisa contar con insulinas de efecto predecible y similar a la fisiológica como ocurre con los análogos de insulina. Es fundamental la educación diabetológica, el autocontrol, así como el seguimiento coordinado, multidisciplinario y personalizado para cada paciente

INTRODUCTION: Inadequate glycemic control in type 1 diabetes mellitus (DM1) is associated with the development of serious complications, so close monitoring of the disease is necessary, integrating the participation of both health professionals and the patient. OBJECTIVE: Revalidate aspects previously identified by experts, to set the performance standard for the proper management of patients with DM1. MATERIAL AND METHODS: The Spanish Society of Diabetes, the Spanish Society of Endocrinology and Nutrition, and the Spanish Society of Pediatric Endocrinology promoted among their members to assess the degree of agreement and consistency with 62 selected recommendations from the literature, by a national multicenter study Delphi in 2013. RESULTS: A total of 164 medical specialists in DM1 of all Spanish autonomous communities, completing the entire process 150. There were no disagreements, considering consistent agreements on 5 general assertions, 9 relating to insulin therapy and 7 monitoring and management aspects of patients with DM1. CONCLUSIONS: None disagreed with any statements expressed by previous experts, although not all have been ratified. It's considered so important basal and posprandial glycemic control, interacting inadequate glycemic control with vascular disorders, nephropathies, polyneuropathies and retinopathies. It's required insulin with a predictable and similar effect to the physiological as with insulin analogues. Diabetes education, self-control and the coordinated, multidisciplinary and personalized monitoring for each patient is essential

[Rupture of splenic artery pseudoaneurysm: an unusual cause of upper gastrointetinal bleeding]. / Ruptura de pseudoaneurisma de la arteria esplénica: una causa poco frecuente de hemorragia digestiva alta.

BACKGROUND: Bleeding from a pancreatic pseudocyst is a severe complication after pancreatitis that can lead to a massive gastrointestinal blood loss. Pseudocyst rupture into the stomach is an unusual complication. CLINICAL CASE: We report the case of a 34-year-old woman with a history of alcoholism and a pancreatic pseudocyst. One year after follow-up of her pseudocyst, she arrived at the emergency room with an episode of upper gastrointestinal bleeding. An upper digestive endoscopy showed active bleeding in the subcardial fundus, which could not be endoscopically controlled. Abdominal angio-CT confirmed the diagnosis of a splenic artery pseudoaneurysm in close contact with the back wall of the stomach, as well as a likely fistulization of it. The patient was urgently operated and a distal splenopancreatectomy and fistulorrhaphy was performed. CONCLUSION: The rupture of a splenic artery pseudoaneurysm may rarely present as upper gastrointestinal bleeding. This may be lethal if not urgently treated.

Antecedentes: tras una pancreatitis, el sangrado de un pseudoquiste pancreático es una complicación grave que puede conducir a una hemorragia digestiva masiva. La ruptura de ese pseudoquiste en el estómago es rara. Caso clínico: se comunica el caso de una paciente femenina de 34 años de edad, con antecedentes de alcoholismo y un pseudoquiste pancreático. Después de abandonar el estudio y seguimiento del pseudoquiste pancreático un año más tarde reingresó de urgencia debido a un cuadro de hemorragia digestiva alta. En una endoscopia del tubo digestivo alto se encontró sangrado activo en la región del fundus gástrico, que no pudo controlarse. La angio-tomografía axial computada abdominal confirmó el diagnóstico de pseudoaneurisma de la arteria esplénica, en íntimo contacto con la pared posterior del estómago y quizá fistulizado al mismo. La paciente se intervino con carácter urgente realizándose esplenopancreatectomía distal y fistulorrafia. Conclusión: en raras ocasiones la ruptura de un pseudoaneurisma de la arteria esplénica puede iniciarse como una hemorragia digestiva alta, que puede ser letal si no es tratada con urgencia.