El índice neutrófilo/linfocito como predictor de morbilidad y mortalidad en neumonía por influenza / The neutrophil/lymphocyte index as a predictor of morbidity and mortality in pneumonia due to influenza

Resumen: OBJETIVO: Demostrar si el índice neutrófilo/linfocito predice la mortalidad en pacientes con neumonía tipo influenza. MATERIAL Y MÉTODO: Estudio de casos y controles, observacional, analítico, transversal, retrospectivo y retrolectivo que incluyó pacientes con neumonía por influenza que padecieron neumonía aguda grave de 2009 a 2017. Se calculó APACHE II, SMART COP y el índice neutrófilo/linfocito (INL). Se determinó supervivencia mediante Kaplan y Meier, para la asociación entre INL y mortalidad, APACHE II, SMART COP y comorbilidades se usó χ2 y razón de momios (RM), así como correlación entre APACHE II, SMART COP e INL. RESULTADOS: Se incluyeron 69 pacientes. La RM entre el INL y la mortalidad fue de 0.174 (p = 0.533; IC95% 0.274 a 2.08). Hubo asociación significativa entre el INL y componentes del síndrome metabólico en pacientes vivos. No hubo diferencia en la supervivencia entre INL mayor o menor de 7. Correlación positiva entre APACHE II e INL de 0.4295 (p = 0.0002; IC95% 0.00 a 0.063). CONCLUSIONES: Existe asociación entre el INL y el síndrome metabólico en pacientes vivos, así como correlación positiva con APACHE II. No hay asociación entre el INL y mortalidad. El punto de corte del INL se desplazó cuatro puntos comparado con otras poblaciones.

Abstract: OBJECTIVE: To demonstrate if neutrophil/lymphocyte index predicts mortality in patients with influenza-like pneumonia. MATERIAL AND METHOD: A case-control, observational, analytical, cross-sectional, retrospective and retrolective study with patients with influenza like pneumonia who developed severe acute pneumonia from 2009 to 2017. APACHE II, SMART COP and neutrophil lymphocyte index (INL) were calculated. Survival was determined by Kaplan and Meier, for the association between INL and mortality, APACHE II, SMART COP and comorbidities was used χ2 and odds ratio (OR), as well as correlation between APACHE II, SMART COP and INL. RESULTS: There were included 69 patients. OR between the INL and mortality was of 0.174 (p = 0.533, IC95% 0.274-2.08). There was significant association between INL and components of the metabolic syndrome in living patients. There was no difference in survival between INL greater or less than 7. Positive correlation between APACHE II and INL of 0.4295 (p = 0.0002, IC95% 0.00 to 0.063). CONCLUSIONS: There is an association between INL and metabolic syndrome in liv- ing patients, as well as a positive correlation with APACHE II. There is no association between INL and mortality. The cutoff point of the INL shifted 4 points compared to other populations.

Hematomas hepáticos subcapsulares posparto en síndrome HELLP / Postpartum subcapsular hepatic hematomas in HELLP syndrome

Resumen: El síndrome HELLP es una complicación del embarazo que puede ser mortal cuando sobreviene hematoma hepático subcapsular o ruptura hepática, su tratamiento puede ser conservador, embolización de la arteria hepática, drenaje quirúrgico e incluso trasplante hepático. Se comunica el caso de una paciente de 37 años de edad, multípara, que tuvo preeclampsia y en el posparto hematomas hepáticos subcapsulares que requirió inicialmente manejo conservador, posteriormente embolización supraselectiva de la arteria hepática derecha y finalmente laparotomía exploradora con drenaje de hematomas y colecistectomía abierta por necrosis vesicular, así como vigilancia por hematomas hepáticos residuales posquirúrgicos. Fue egresada estable en términos cardiohemodinámicos y respiratorios. Establecer de forma oportuna el diagnóstico y tratamiento del hematoma hepático subcapsular en pacientes con síndrome HELLP puede disminuir la mortalidad; la vigilancia clínica, bioquímica y con estudios de imagen es importante.

Abstract: Hellp syndrome is a complication of pregnancy that can be fatal when subcapsular hepatic hematoma or hepatic rupture occurs, its management can be conservative or can include embolization of the hepatic artery, surgical drainage and even liver transplantation. This paper reports the case of a 37-year-old multiparous patient who presented preeclampsia and in the postpartum hepatic subcapsular hematomas that initially required conservative management, later supraselective embolization of the right hepatic artery and finally exploratory laparotomy with drainage of hematomas and open cholecystectomy due to vesicular necrosis, as well as surveillance for post-surgical residual hepatic hematomas. She was discharged stable in cardiohemodynamic and respiratory terms. The timely diagnosis and treatment of subcapsular hepatic hematoma in patients with HELLP syndrome can reduce mortality; clinical, biochemistry and imaging studies monitoring are important.

Effect of inter-renal aortic coarctation-induced hypertension on function and expression of vascular α(1A)- and α(1D)-adrenoceptors.

We investigated the effect of inter-renal aortic coarctation on the function and expression of vascular α(1A)- and α(1D)-adrenoceptors and plasma angiotensin II (ATII) in rats. Male Wistar rats, either sham operated (SO), or with aortic coarctation for 7 (AC7) and 14 days (AC14) were used for agonist-induced pressor responses in vehicle (physiological saline)- and antagonist-treated anesthetized animals, immunoblot analysis (α(1A)- and α(1D)-adrenoceptor in aorta and caudal arteries), and immunoassay (plasma ATII). The α(1D)-adrenoceptor antagonist, BMY-7378 (BMY) blocked noradrenaline-induced responses in the order SO > AC7 â‰« AC14; in contrast, the α(1A)-adrenoceptor antagonist RS-100329 (RS), produced a marginal shift to the right of the dose-response curve to noradrenaline, along with a strong decrease of the maximum pressor effect in the order SO > AC7 = AC14. The potency of the α(1A)-adrenoceptor agonist A-61603 increased in rats with AC14, and responses were inhibited by RS in the order AC14 > AC7 > SO. In aorta, α(1D)-adrenoceptor protein increased in AC7 and decreased in AC14; α(1A)-adrenoreceptor protein increased in the caudal artery of AC7 and returned to control values in AC14. Plasma ATII increased in AC7 and AC14, compared with SO rats. These results suggest an early and direct relationship between ATII and α(1D)-adrenoreceptors in the development of hypertension in this experimental model.

[Prevalence of chronic urticaria of autoimmune origin at the Regional Hospital Adolfo López Mateos]. / Prevalencia de urticaria crónica de origen autoinmunitario en el Hospital Regional Adolfo López Mateos.

BACKGROUND: Chronic urticaria is a common skin disorder characterized by recurrent, transitory, itchy wheals with individual lesions lasting less than 24 hours and affecting patients for six weeks or longer. In adults it has been shown that approximately 40% of the patients with chronic urticaria have autoimmune urticaria. OBJECTIVE: To determine the prevalence of autoimmune urticaria in adults with chronic urticaria. PATIENTS AND METHOD: We studied adult patients with chronic urticaria by means of autologous serum skin test (ASST), and by antinuclear and antithyroid (antityroglobulin, antiperoxidase) antibodies. We compared them with a group matched by sex and age. RESULTS: We included 68 patients: 34 cases (patients with chronic urticaria) and 34 controls (healthy individuals). In the cases we found high levels of TSH (p = 0.003) and positive autologous serum skin test (p = 0.04), while in the controls we observed a statistically significant difference of the levels of antithyroid antibodies (p = 0.002). The prevalence of autoantibodies (antithyroid or by autologous serum) was present in 55 and 44% of the patients with chronic urticaria. CONCLUSION: Autoimmunity is one of the most common causes of chronic urticaria; it may explain the pathogenesis in half of the studied cases.