Polycystic ovary syndrome with feasible equivalence to overweight as a risk factor for non-alcoholic fatty liver disease development and severity in Mexican population.

INTRODUCTION AND OBJECTIVES: Polycystic ovary syndrome (PCOS) is the most common endocrinology disorder in women of reproductive age; these patients have a higher risk of suffering from non-alcoholic fatty liver disease (NAFLD). We determine the frequency of NAFLD in Mexican patients with PCOS and matched-controls. PATIENTS AND METHODS: Cross-sectional study, with 98 women of 18-44 years old. Rotterdam 2003 criteria integrated PCOS diagnosis. Those with significant alcohol consumption, chronic liver disease, use of steatogenic drugs, and pharmacological PCOS treatment or fertility protocol were excluded. Controls were matched in a 1:1 ratio by age and body mass index (BMI). The presence of NAFLD was determined by transient elastography performed by a single experienced operator. RESULTS: A total of 98 female volunteers at reproductive age were recruited. NAFLD denoted markedly higher in patients with than without PCOS at 69.3% vs. 34.6%, respectively. Compared to controls, PCOS patients had a significantly higher risk of NAFLD (OR=4.26, 95% CI 1.83-9.93). Severe steatosis was the most frequent NAFLD stage between women with PCOS and NAFLD. Patients with hyperandrogenism have a significantly higher mean CAP 277.83dB/m than controls without hyperandrogenism 191.57dB/m. NAFLD prevalence was 84.3% in PCOS patients with phenotype A, while in another phenotype, it was 41.1%. CONCLUSIONS: PCOS is an independent risk factor for NAFLD development. NAFLD screening needs to be considered in all PCOS patients independently of BMI, except in PCOS patients without hyperandrogenism and BMI<25.

Tuberculosis pélvica y antecedente de embarazo. Reporte de caso / Pelvic tuberculosis and pregnancy antecedent. Case report

Resumen A lo largo del tiempo, la tuberculosis ha sido un problema de salud pública. La Organización Mundial de la Salud reporta anualmente alrededor de 8 millones de casos nuevos y 3 millones de muertes. En México se estima que anualmente prevalecen cerca de 64,000 casos de esta enfermedad gue puede afectar diferentes órganos con presentaciones clínicas gue simulan otras patologías. Se presenta el caso de una paciente de 22 años de edad con antecedente de embarazo normo evolutivo y parto vaginal 4 meses antes sin complicaciones, gue inició su cuadro clínico en el puerperio con presencia de tos en accesos gue remitió un mes posterior acompañado de síndrome de desgaste, pérdida de peso, dolor abdominal difuso, diarrea y fiebre. Recibió múltiples tratamientos sin mejoría, ingresó a nuestro hospita con cuadro de síndrome abdominal agudo y se le realizó laparotomía exploradora con hallazgos de abdomen congelado, engrosamiento de peritoneo parietal, adherencias fijas, colecciones en hueco pélvico, con material purulento caseoso, blanquecino, poco fétido, tejido friable, presencia de granulomas en asas de intestino; se realizó histerectomía subtotal abdominal con ooforectomía bilateral, la evolución posquirúrgica fue lenta hacia la mejoría tras corroborar por reporte histopatológico y cultivo el diagnóstico de tuberculosis pélvica e iniciar tratamiento específico.

Abstract Tuberculosis has been overtime public health problem. The World Health Organization reports annually about 8 million new cases and 3 million deaths. In Mexico, an estimation of around 64,000 prevalent cases of this disease are reported annually. Tuberculosis can affect different organs with clinica presentations that mimic other diseases. A patient presents a history of normal pregnancy and vaginal delivery without complications for 4 months. The clinical picture begins in the postpartum period with the presence of cough accesses registered a month later accompanied by fatigue, weight loss, diffuse abdominal pain, diarrhea and fever syndrome. She received multiple treatments without improvement. She was ad missioned to our hospital and an acute abdomen laparotomy was performed with findings of abdominal frozen thickened parietal peritoneum, fixed adhesions, collections of pelvic cavity with whitish, slightly fetid pus, friable tissue, presence of granulomas in bowel loop. A subtotal abdominal hysterectomy with bilateral oophorectomy was performed. The postoperative evolution showed a slow improvement after the reportand was corroborated bya histopathological diagnosis of pelvic tuberculosis culture and the initiation of a specific treatment.

[Metastatic choriocarcinoma associated with Wunderlich syndrome: case report and literature review]. / Coriocarcinoma metastásico asociado con síndrome de Wunderlich: presentación de un caso y revisión de la bibliografía.

Choriocarcinoma is a rare condition, with an incidence of 1 in 30 to 40,000 pregnancies in the United States and Europe. In Mexico it is reported in 1 in 10,000 pregnancies. Wunderlich syndrome is a spontaneous perirenal hematoma, a very rare entity. This paper reports the case of a young patient with a history of molar pregnancy one year prior to admission, valuation due to fainting, generalized headache, spontaneous pain in the right flank and data of hypovolemic shock. Computed tomography reported right perirenal hematoma, normal uterus, two annexes with data of tecaluteinic cysts, beta human chorionic gonadotropin greater than 200,000 IU/mL. Patient was stabilized with crystalloid, blood products and right adrenal artery embolization. It was corroborated the brain, mediastinum and abdomen metastases. She was sent to a third level hospital, starting holocraneal radiotherapy, she had retroperitoneal bleeding and died a week later.