Acute liver failure: Management update and prognosis.

Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival.

La cardiología nuclear en la pandemia COVID-19 / Nuclear Cardiology in the COVID-19 pandemic

La infección por SARS-CoV-2 tiene una relación muy importante con la patología cardiovascular. Desde el inicio de la pandemia se objetivó una relación estrecha entre la comorbilidad cardiovascular y un peor pronóstico de los pacientes COVID-19. El estudio de la fisiopatología de la infección por SARS-CoV-2 y la enfermedad cardiovascular sugieren varias hipótesis concomitantes: el daño miocárdico directo por el virus, la hipoxemia secundaria a la insuficiencia respiratoria, la respuesta inflamatoria a la infección y/o los fenómenos tromboembólicos. El daño cardiovascular se puede manifestar en la fase aguda de la infección con cuadros de infarto agudo de miocardio, miocarditis, arritmias…, durante esta fase los procedimientos de Cardiología Nuclear no han tenido un papel determinante en el diagnóstico y manejo de estos pacientes. En cambio, en la fase subaguda de la infección y en el síndrome del COVID post-agudo la Cardiología Nuclear parece ofrecer luz a lo que sucede en el sistema cardiovascular en esta fase de la enfermedad. La pandemia de la COVID-19 ha representado un gran reto para los sistemas de salud constatándose una reducción importante de pruebas diagnósticas no urgentes con el objetivo de disminuir el riesgo de transmisión a pacientes y personal sanitario. La Cardiología Nuclear no ha sido una excepción. Además de la priorización de pruebas urgentes/preferentes y las medidas generales de screening, higiene y distancia, los principales organismos y sociedades científicas de Medicina Nuclear y Cardiología Nuclear han elaborado recomendaciones y guías para su práctica segura introduciendo notables cambios en los protocolos SPECT de perfusión miocárdica (AU)

SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias..., during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease. The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocol (AU)

[Nuclear Cardiology in the COVID-19 pandemic]. / La cardiología nuclear en la pandemia COVID-19.

SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias..., during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease.The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocols.

Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. / Evaluación psicosocial para trasplante hepático: una guía breve para gastroenterólogos.

Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.

SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. / Guía SEOM-SERAM-SEMNIM sobre el empleo de las técnicas de imagen funcional y molecular en el cáncer de pulmón no microcítico avanzado.

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.

SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer.

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision-making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.

Platypnea-orthodeoxia syndrome: Importance of patient position for correct diagnosis at the time of (99m)Tc-MAA injection.

A 65-year-old male presented with unexplained hypoxia that became exacerbated by an upright posture (platypnea-orthodeoxia syndrome) secondary to hepatopulmonary syndrome (HPS). A (99m)Tc-macroaggregated albumin pulmonary perfusion scan revealed a right to left shunt of 29% in the sitting position, which had not been previously detected when the radiotracer injection was performed with the patient in supine position, nor was it diagnosed using another non-invasive imaging method (transthoracic contrast echocardiography and angio-CT). A transesophageal echocardiography was contraindicated due to the presence of esophageal varices. The administration of the radiopharmaceutical in sitting position for the study of the pulmonary perfusion allowed us to confirm the presence of the shunt and consider the patient a candidate for liver transplantation.

[Vestibular schwannoma]. / Schwannoma vestibular.

The vestibular schwannoma is a benign intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve or cranial nerve VIII. It comprises 8-10% of all intracranial neoplasms in adults. It originates in the vestibular portion of the cranial nerve VIII and it is located in the cerebellopontine angle. This disorder is characterized by ipsilateral hearing loss, tinnitus, disturbed sense of balance and altered gait, facial numbness, muscle weakness or ipsilateral paralysis. This report presents the magnetic resonance imaging of a patient with this rare condition.

[Morning glory syndrome]. / Síndrome de Morning Glory.

In 1970, Kindier described the morning glory syndrome. This syndrome is a congenital abnormality of the optic nerve with unilateral presence and very low incidence. It is characterized by an enlarged optical disc, deep excavation, presence of traces of radial glia, and arrangement of retinal vascularization. This report describes the fundoscopic image in a patient with morning glory syndrome.

Caracterización del binomio adulto mayor-familiar de convivencia / Characterization of binomial older adult-relative of coexistence

Introducción: El incremento de población adulto mayor exige responsabilidad sanitaria y familiar para que el aumento en años de vida sea de vida saludable. Objetivo: Identificar las características del adulto mayor y del familiar de convivencia como base para las acciones. Metodología: Estudio descriptivo; transversal con 96 binomios adulto mayor-familiar de convivencia. Cuestionario de datos biográficos y de salud para el adulto mayor y datos socios demográficos para el familiar; aplicados mediante entrevista en los hogares. Se utilizó el Programa Estadístico SPSS Versión 17. Resultados: Relación significativa en edad y sexo entre adultos mayores y familiares de convivencia. Media de edad 70 y 45; sexo; mujeres 59.4% y 67.7%; casados o en unión libre 56.3% y 72.9%; respectivamente. Familiar de convivencia hijo/a (54 %) y esposo/a (32%) mayoría mujeres con bajo nivel de escolaridad (65%) y ocupación labores del hogar (64%). La convivencia es favorable para la salud porque hay un mayor control de las conductas de riesgo. Relevancia de las características del binomio adulto mayor-familiar de convivencia para las acciones de promoción y prevención en los hogares; orientadas a fortalecer la relación y desarrollar habilidad en la atención al adulto mayor.

Abstract Nurses have sensitivity, knowledge and experience to attend the binomial older adult-relative of coexistence in family context. The purpose of the study was to identify characteristics of the older adult and the relative of coexistence as base to plan actions. The study was descriptive, cross-sectional with 96 binomials adult major-relative of greater coexistence. Biographical data and health questionnaire for the older adult and demographic data for the relative applied by means of interview in the homes. We used the statisti-cal program SPSS version 17. Age and sex had significant relation between older adults and relatives of coexistence. Age average, 70 and 45; woman, 59. 4% and 67.7%; ma-rried, 56.3% and 72.9, respectively. Relative of coexistence was child (54%) and wife or husband (32%), majority were woman with low level of education (65%) and occupation of the household work (64%).The coexistence is favorable for the health because there is a greater control of the risk conducts. Relevance of the characteristics of the binomial older adult-relative of coex-istence for promotion and prevention actions in the homes, oriented to fortify the relation and to develop ability in the at-tention to the older adult.

Delayed lung maturation of foetus of diabetic mother rats develop with a diminish, but without changes in the proportion of type I and II pneumocytes, and decreased expression of protein D-associated surfactant factor.

Newborn children of diabetic mothers have an increased morbidity and mortality because of respiratory distress syndrome. We study lung histogenesis during intrauterine development of offspring of diabetic Sprague-Dawley rats at 18, 19 and 21 days of gestation (DG). Pregnant rats were grouped into diabetic (streptozotocin-induced), citrate, and control groups; five female and five male offspring were selected randomly from each group at 18, 19 and 21 DG, and a biopsy of the lung was taken and processed in paraffin for histological examination. The biopsy for the transmission electron microscopy (TEM) analysis was taken at 21 days. A delay in alveolization of the offspring at 18, 19 and 21 days of the diabetic group was observed, which was confirmed at TEM level, and also less quantity of protein D associated to surfactant in diabetic group was detected (P < 0.001). The foetuses of the diabetic group presented a delay in lung histogenesis and in differentiation of the type II pneumocytes cells, but conserved the proportion with a decrease in 50% of pneumocytes, accompanied by a diminish of protein D associated to surfactant factor.

Satisfacción con el cuidado de Enfermería del adulto mayor hospitalizado / Satisfaction with the nursing healthcare on hospitalizaed older adults

Los adultos mayores hospitalizados son un grupo vulnerable que requiere cuidado de Enfermería de calidad; esta conlleva satisfacción valorada a través de: relación Enfermera-paciente, comunicación efectiva, información oportuna y habilidad técnica profesional. Para identificar satisfacción de adultos mayores con cuidado de Enfermería se realizó un estudio descriptivo transversal con 45 adultos mayores hospitalizados en Medicina Interna y Cirugía de dos instituciones de salud. Mediante entrevista se aplicó una escala de Likert de 23 reactivos con cinco categorías: De completo acuerdo (5) a total desacuerdo (1). A mayor puntuación mayor satisfacción. Procesamiento y análisis con programa estadístico SPSS. Resultados: Edad media 71 años, escolaridad media 6 años. Completo acuerdo: Enfermera agradable con el paciente (62.2%), debería ser más atenta (60.0%), se siente mejor al platicar con ella (75.6%), le explica en lenguaje sencillo (73.3%), brinda información sobre exámenes (68.9%). Total desacuerdo: Le molesta cuando la Enfermera le habla como si fuera niño (60.0%). Alta puntuación (85%) en evaluación general de satisfacción con el cuidado de Enfermería. Coincidente con estudios previos en que a mayor edad mayor satisfacción con el cuidado de Enfermería.

Older adults hospitalized are a vulnerable group that require quality nursing care ; this imply satisfaction valued through patient-nursing relationship, effective communication and information and professional technical competence. In order to identify older adults' satisfaction with nursing care it was carried out a transactional descriptive study with 45 hospitalized older adults in medical and surgical wards of two health institutions. Through interview it was applied a Likert scale of 23 items and five categories: Complete agree (5) to total disagree (1). Instrument was translated and validated , it was obtained Cronbach's alpha coefficient from .78 (12). Results. Age mean 71, years of school mean 6. Complete agree: Nursing pleasant with patient (62.2%), she should be more attentive with patient (60.0%), the patient feels better when nurse talks with him(75.6%), nurse explains to patient in sample language (73.3%), nurse gives information about exams (68.9%). Total disagree: Patient gets angry when nurse talks him like a child (60.0%). High score (85%) in general evaluation about satisfaction with nursing care. This study is coincident with previous studies about to higher age higher satisfaction with nursing care.

Apoplejía hipofisaria como presentación de recurrencia de craneofaringioma / Pituitary apoplexy as the presenting symptom of a recurrent craniopharyngionma

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A calculating alliance.

PIP: This article discusses the effects of the alliance between the Church and the Argentine state on women's reproductive rights. Several commentators have criticized how President Carlos Menem used the campaign against abortion for his own political interest. He issued a presidential decree on antiabortion campaign--the Day of the Unborn Child. This decree was announced on December 8, 1998, and the day of observance is March 25 of every coming year. Although the Argentine government does not have a law that explicitly regulates family planning method for the last two decades, many Argentines find the action of the president selfish. The initiation of this presidential decree was the culmination of Menem's manipulation of church and state to secure clerical support for his political regime. Even if statistics is providing him with data concerning the effects of unclear reproductive health laws, he and the church still has chosen not to focus on reproductive rights exclusively, but have concerned themselves primarily with other social and economic issues. While Menem uses the Vatican's pro-life rhetoric and his presidential power to protect fetal life, Argentines will have to contend with the existing Menem policies, which compromise the health of women and children.^ieng

[Frequency of external congenital abnormalities in abortions]. / Frecuencia de malformaciones congénitas externas en abortos.

The purpose of this study was to calculate the incidence of external birth defects found in 1,650 aborted fetuses studied from September 1978 to February 1983 at the Department of Gynecology and Obstetrics of the University Hospital "Dr. José Eleuterio González" of the U.A.N.L. Medical School. Ninety five of fetuses had external birth defects and 85 had abnormalities in annexes. The Fisher exact test was applied to find the relationship between these abnormalities; no relationship was found. 67.4% had only one birth defect; 32.1% showed several defects. Those defects which were lethal constituted 67%, the majority being of the central nervous system. Defects found in the abdominal wall took second place in frequency followed by abnormalities in either extremity and ear defects. The birth defects seen in early gestational ages differ from those seen in live newborn babies. It is important to carry out morphological and teratological studies, not only in newborns but also during the embrion and fetal periods.

[Congenital malformations in live-born neonates]. / Malformaciones congénitas en recién nacidos vivos.

A retrospective study on the incidence and prevalence of congenital malformations in living newborns registered during a period of two years (1987-1988) at the University Hospital "Dr. José Eleuterio González" in Monterrey, Nuevo León was conducted. The data was tabulated based on the classification codes established by the World Health Organization (WHO), grouped according to organs and systems and by sex. Of a total of 9,675 living newborns registered, 224 (2.31%) had a congenital malformation: 102 males, 121 females and one of undetermined sex. The greatest incidence corresponded to the central nervous system, following in descending order the cardiovascular and muscular-skeletal systems, cleft lip and palate, digestive system, genitalia, chromosomic anomalies, respiratory and urinary systems and congenital cataracts. The prevalence of congenital malformations in our population is similar to that reported in other countries with respect to neural tube defects. Muscular-skeletal and multiple malformations were less frequent than seen in other hospitals.

[Do children take their milk at the dilution that you indicated]. / Toman los niños la leche a la dilución que usted indica?

The experiment was plotted with the purpose of discovering the variability of the measurements of powder milk and refined cane sugar. With this idea in mind, a plastic measurement contained in a commercial lactic product and teaspoon were used. With the results obtained from the dehydrated milk measured by 3 groups of 25 mothers and one of 25 nurses and those corresponding to 10 mothers and 5 nurses who measured the cane sugar, a speculation arose on the eventual significance these findings might have on the state of nutrition of the infants.