Enfermedad de Crohn: hemorragia fatal en paciente con 19.3 semanas de gestación. Reporte de un caso y revisión de la literatura mundial / Cohn's disease: Fatal haemorrhage in patient at 19.3 weeks of pregnancy. Case report and review of the world literature

La enfermedad de Crohn (EC) es un padecimiento que afecta al 0,3% de las pacientes gestantes; la hemorragia fatal es un evento raro que complica a estas pacientes. El propósito de este artículo es reportar un caso fatal de EC ocasionado por hemorragia intraabdominal y revisar la literatura mundial. Paciente de 20 años de edad, primigesta con feto vivo de 19.3 semanas, ingresa al Servicio de Urgencias con dolor intraabdominal e hipotensión arterial sistémica; se realiza laparotomía exploradora donde encuentran hemoperitoneo de 2.000 ml y feto vivo intrauterino. El sitio de sangrado activo no se detecta, por lo que se procede al empaquetamiento intraabdominal. Por persistir datos de hipotensión arterial sistémica, realizan tomografía axial computarizada premortem, en esta detectan datos de persistencia de sangrado intraabdominal y programan laparotomía de urgencia. Antes de ingresar a cirugía, fallece la paciente. El estudio histológico muestra lesiones compatibles con EC. Como conclusión, la EC durante el embarazo afecta al 0,3% de las pacientes. La perforación intestinal con hemorragia severa y muerte de la paciente es una complicación no reportada en la literatura mundial

Crohn's disease (CD) affects 0.3% of pregnant women and can infrequently cause fatal bleeding. We report a fatal case of intra-abdominal haemorrhage caused by CD and review the world literature on the topic. A 20-year-old primigravida with a live fetus of 19.3 weeks was admitted to the accident and emergency department with intra-abdominal pain and systemic hypotension. Exploratory laparotomy was performed, revealing a hemoperitoneum of 2,000 ml and a live intrauterine fetus. The site of bleeding was not detected and intraabdominal packing was performed. Due to persistent systemic hypertension, premortem computed tomography was carried out, revealing the persistence of intra-abdominal bleeding. Emergency laparotomy was scheduled but the patient died before entering the operating theatre. Histological examination showed lesions consistent with CD. As a conclusion, CD during pregnancy affects 0.3% of patients. Intestinal perforation with fatal bleeding has not previously been reported in the world literature

Characterization of silver nanoparticles synthesized on titanium dioxide fine particles.

Silver nanoparticles with a narrow size distribution were synthesized over the surface of two different commercial TiO(2) particles using a simple aqueous reduction method. The reducing agent used was NaBH(4); different molar ratios TiO(2):Ag were also used. The nanocomposites thus prepared were characterized using transmission electron microscopy (TEM), scanning transmission electron microscopy (STEM), scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), x-ray photoelectron spectroscopy (XPS), x-ray diffraction (XRD), dynamic light scattering (DLS) and UV-visible (UV-vis) absorption spectroscopy; the antibacterial activity was assessed using the standard microdilution method, determining the minimum inhibitory concentration (MIC) according to the National Committee for Clinical Laboratory Standards. From the microscopy studies (TEM and STEM) we observed that the silver nanoparticles are homogeneously distributed over the surface of TiO(2) particles and that the TiO(2):Ag molar ratio plays an important role. We used three different TiO(2)Ag molar ratios and the size of the silver nanoparticles is 10, 20 and 80 nm, respectively. It was found that the antibacterial activity of the nanocomposites increases considerably comparing with separated silver nanoparticles and TiO(2) particles.