Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap.

BACKGROUND: Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the SCIP flap. METHODS: This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24 minutes after indocyanine green (ICG) lymphography injection. Standardized procedures were implemented for all participants in both hospitals. RESULTS: The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the SCIP flap were oriented toward the inguinal lymph node (ILN). However, the left SCIP zone lymphatic vessels were directed opposite to the ILN. CONCLUSION: The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was toward the ILN, although only single-side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.

Prenatal Stress as a Risk Factor for Maternal-Foetal Morbidity: A Longitudinal Study.

Pregnancy is one of the most complex periods in a woman's life, not only because of the biological changes involved but also because of the psychological aspects. Stress during pregnancy refers to the concerns and distress that arise during pregnancy and that can be assessed by means of psychological and physiological scales. The aim of this study was to analyse prenatal stress and to evaluate its consequences on the health of both the mother and the foetus. A descriptive longitudinal study was carried out on a sample of 398 pregnant women being followed up during their entire pregnancy, who gave birth at the Punta de Europa University Hospital in Algeciras (Spain) between September 2021 and August 2023. The Prenatal Distress Questionnaire (PDQ) was used, as well as serum cortisol levels in each trimester of pregnancy and birth experience using the Childbirth Experience Questionnaire in its validated Spanish version, CEQ-E. Demographic and obstetric variables were included. One of the main findings was that experiencing more stress in late pregnancy had a negative impact on obstetric outcomes. Women who had higher levels of prenatal distress had higher blood cortisol levels and increased risk of having a caesarean section at delivery. A significant negative correlation was also found between stress and Apgar test values in the first minute of life. It is concluded that interventions promoted by the health system that provide comprehensive prenatal care contribute to decreased stress as perceived by these pregnant women, thus reducing the risk of maternal and foetal morbidity.

[End of the use of masks in public spaces during the COVID-19 pandemic: impact on the mental health of pregnant women]. / Fin del uso de la mascarilla en espacios públicos durante la pandemia por la COVID-19: impacto en la salud mental de las mujeres embarazadas.

OBJECTIVE: COVID-19 has affected the entire population, generating a greater impact on certain vulnerable groups, such as pregnant women. The aim of this study was to evaluate the levels of fear and anxiety regarding the COVID-19 disease in pregnant women, using the AMICO_Pregnant scale, in the final phase of the health crisis caused by the disease, marked by the relaxation of isolation measures in public spaces. METHODS: A descriptive cross-sectional study using the self-reported questionnaire AMICO_Pregnant was developed between March 24 and April 18, 2022. This was followed by a univariate and bivariate statistical analysis of the data collected. RESULTS: A total of 479 surveys of pregnant women of different gestational ages were obtained. The bivariate analysis showed statistical significance in the AMICO_Pregnant scale score about several variables over the previous year: contact with the disease (p=0.025); number of previous pregnancies (p=0.019); changes in the birth plan (p=0.001); and vaccination status (p=0.01). CONCLUSIONS: The COVID-19 pandemic has impacted pregnant women's mental health, producing a negative effect on emotions. The research carried out shows a statistically significant relationship between the levels of fear and anxiety in pregnant women and factors such as the number of previous pregnancies, contact with the previous disease, vaccination level or expectations regarding the delivery or birth plan.

OBJECTIVE: La COVID-19 ha afectado a toda la población, generando un mayor impacto en determinados grupos vulnerables, como es el caso de las mujeres gestantes. El objetivo de este estudio fue evaluar los niveles de miedo y ansiedad a la COVID-19 en la mujer gestante, mediante la escala AMICO_Gestante, en la fase final de la crisis sanitaria causada por dicha enfermedad, marcada por el relajamiento de las medidas de aislamiento en espacios públicos. METHODS: Se realizó un estudio transversal descriptivo mediante el uso de cuestionario autoinformado AMICO_Gestante, desarrollado entre el 24 de marzo y el 18 de abril de 2022. Tras ello, se ejecutó un análisis estadístico univariado y bivariado de los datos recogidos. RESULTS: Se obtuvieron un total de 479 encuestas de mujeres gestantes de diferente edad gestacional. El análisis bivariado mostró significación estadística en la puntuación de la escala AMICO_Gestante en relación con varias variables en relación al año anterior: contacto con la enfermedad (p=0,025); número de embarazos previos (p=0,019); cambios en el plan de parto (p=0,001); y estado vacunacional (p=0,01). CONCLUSIONS: La pandemia por la COVID-19 tiene un impacto en la salud mental de la mujer gestante, produciendo un efecto negativo en las emociones. La investigación realizada muestra una relación estadísticamente significativa entre los niveles de miedo y ansiedad en la mujer gestante y factores como el número de embarazos previos, el contacto con la enfermedad previa, el nivel de vacunación o las expectativas en relación al plan de parto o nacimiento.

Fin del uso de la mascarilla en espacios públicos durante la pandemia por la COVID-19: impacto en la salud mental de las mujeres embarazadas / End of the use of masks in public spaces during the COVID-19 pandemic: impact on the mental health of pregnant women

Background: COVID-19 has affected the entire population, generating a greater impact on certain vulnerable groups, such as pregnant women. The aim of this study was to evaluate the levels of fear and anxiety regarding the COVID-19 disease in pregnant women, using the AMICO_Pregnant scale, in the final phase of the health crisis caused by the disease, marked by the relaxation of isolation measures in public spaces. Methods: A descriptive cross-sectional study using the self-reported questionnaire AMICO_Pregnant was developed between March 24 and April 18, 2022. This was followed by a univariate and bivariate statistical analysis of the data collected. Results: A total of 479 surveys of pregnant women of different gestational ages were obtained. The bivariate analysis showed statistical significance in the AMICO_Pregnant scale score about several variables over the previous year: contact with the disease (p=0.025); number of previous pregnancies (p=0.019); changes in the birth plan (p=0.001); and vaccination status (p=0.01). Conclusions: The COVID-19 pandemic has impacted pregnant women’s mental health, producing a negative effect on emotions. The research carried out shows a statistically significant relationship between the levels of fear and anxiety in pregnant women and factors such as the number of previous pregnancies, contact with the previous disease, vaccination level or expectations regarding the delivery or birth plan.(AU)

Fundamentos: La COVID-19 ha afectado a toda la población, generando un mayor impacto en determinados grupos vulnerables, como es el caso de las mujeres gestantes. El objetivo de este estudio fue evaluar los niveles de miedo y ansiedad a la COVID-19 en la mujer gestante, mediante la escala AMICO_Gestante, en la fase final de la crisis sanitaria causada por dicha enfermedad, marcada porel relajamiento de las medidas de aislamiento en espacios públicos. Métodos: Se realizó un estudio transversal descriptivo mediante el uso de cuestionario autoinformadoAMICO_Gestante, desarrollado entre el 24 de marzo y el 18 de abril de 2022. Tras ello, se ejecutó un análisis estadístico univariado y bivariado de los datos recogidos. Resultados: Se obtuvieron un total de 479 encuestas de mujeres gestantes de diferente edad gestacional. El análisis bivariado mostró significación estadística en la puntuación de la escala AMICO_Gestante en relación con varias variables en relación al año anterior: contacto con la enfermedad (p=0,025); número de embarazos previos (p=0,019); cambios en el plan de parto (p=0,001); y estado vacunacional (p=0,01). Conclusiones: La pandemia por la COVID-19 tiene un impacto en la salud mental de la mujer gestante, produciendo un efecto negativo en las emociones. La investigación realizada muestra una relación estadísticamente significativa entre los niveles de miedo y ansiedad en la mujer gestante y factores como el número de embarazos previos, el contacto con la enfermedad previa, el nivel de vacunación o las expectativas en relación al plan de parto o nacimiento.(AU)

Assessment of Levels of Anxiety and Fear of Covid-19 in a Population of Pregnant Women in Spain.

Objective: The aim of the study was to assess the levels of fear and anxiety in the particularly vulnerable population group of women during pregnancy. Methods: Cross-sectional study between March 2022 and July 2022 involving 978 pregnant women aged 16 to 50 years. It was carried out based on the scale for the assessment of fear and anxiety in pregnant women (AMICO_Pregnant) and the collection of sociodemographic data. Normality analysis was performed prior to univariate and bivariate statistical analysis. Results: The sample was composed of a total of 978 pregnant women. The mean of the AMICO_Pregnant scale was intermediate (5.04 points; SD=2.36). The bivariate analysis showed a statistically significant relationship between the AMICO_Pregnant scale and the following variables: vaccination schedule status, contact with the disease, weeks of gestation, altered delivery or birth plan. Conclusion: Women with pregnancies closer to term, with no contact with the disease, without a complete vaccination schedule, or who had undergone changes in their delivery or birth plans, showed higher levels of fear and anxiety.

Adaptation and psychometric study of the scale for the measurement of fear and anxiety of COVID-19 disease in pregnant women (AMICO_Pregnant).

Objective: The aim of this research was to adapt and explore the psychometric properties of a specific scale to assess the levels of fear and anxiety of COVID-19 disease in pregnant women. Methods: An adaptation phase, by a panel of experts, and a psychometric descriptive cross-sectional study were carried out on the final version of the 16-item, self-administered AMICO_Pregnant scale. Univariate and bivariate analyses were carried out, followed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The consistency of the scale was assessed using the Omega coefficient and Cronbach's Alpha. Results: With a sample of 1,013 pregnant women living in Spain and over 18 years of age, the mean age was 33 years. The scale showed a bifactor structure (anxiety and fear) that was confirmed with good fit parameters. Reliability was assessed in terms of internal consistency by calculating Cronbach's Alpha coefficient (0.95) and McDonald's Omega coefficient (0.94) as indicators of robustness of the scale's reliability. Conclusion: The AMICO_Pregnant scale of 16 items with scores ranging from 1 to 10 is a valid and reliable tool to assess levels of anxiety and fear of COVID_19 in Spanish pregnant women. Pregnant women have shown moderate levels of anxiety and fear regarding the COVID_19 disease in the final phase of the pandemic.

Fear and Anxiety in Pregnant Women During the COVID-19 Pandemic: A Systematic Review.

Objectives: The aim of this study was to explore the impact of the 2020-2022 pandemic on the levels of fear and anxiety in pregnant women and to identify risk and protective factors. Methods: A systematic review was conducted. Electronic databases were consulted for studies published between January 2020 and August 2022. The methodological quality was assessed using a critical appraisal tool for non-randomised studies. Results: Seventeen studies were included in the review. A high prevalence of levels of fear and anxiety were observed. Risk factors such as unplanned pregnancy, poor support from partners, or intolerance of uncertainty were identified for high levels of fear. Regarding anxiety, risk factors such as maternal age, social support, financial status, or concern about being able to maintain antenatal follow-ups were identified. Conclusion: The COVID-19 pandemic had a significant impact on the mental health of pregnant women through increased levels of fear and anxiety. It has not been possible to establish a relationship between significant factors such as gestational age or health emergency control measures with high levels of fear or anxiety.

Popliteal Vascular Lymph Node Resection in the Rabbit Hindlimb for Secondary Lymphedema Induction.

Lymphedema is a common condition often associated with cancer and its treatment, which leads to damage to the lymphatic system, and current treatments are mostly palliative rather than curative. Its high incidence among oncologic patients indicates the need to study both normal lymphatic function and pathologic dysfunction. To reproduce chronic lymphedema, it is necessary to choose a suitable experimental animal. Attempts to establish animal models are limited by the regenerative capacity of the lymphatic system. Among the potential candidates, the rabbit hindlimb is easy to handle and extrapolate to the human clinical scenario, making it advantageous. In addition, the size of this species allows for better selection of lymphatic vessels for vascularized lymph node resection. In this study, we present a procedure of vascular lymph node resection in the rabbit hindlimb for inducing secondary lymphedema. Anesthetized animals were subjected to circumferential measurement, patent blue V infiltration, and indocyanine green lymphography (ICG-L) using real-time near-infrared fluorescence, a technique that allows the identification of single popliteal nodes and lymphatic channels. Access to the identified structures is achieved by excising the popliteal node and ligating the medial and lateral afferent lymphatics. Special care must be taken to ensure that any lymphatic vessel that joins the femoral lymphatic system within the thigh without entering the popliteal node can be identified and ligated. Postoperative evaluation was performed at 3, 6, and 12 months after induction using circumferential measurements of the hindlimb and ICG-L. As demonstrated during follow-up, the animals developed dermal backflow that was maintained until the 12th month, making this experimental animal useful for novel long-term evaluations in the management of lymphedema. In conclusion, the approach described here is feasible and reproducible. Additionally, during the time window presented, it can be representative of human lymphedema, thus providing a useful research tool.

Swine Models of Aneurysmal Diseases for Training and Research.

Large animal models, specifically swine, are widely used to research cardiovascular diseases and therapies, as well as for training purposes. This paper describes two different aneurysmal swine models that may help researchers to study new therapies for aneurysmal diseases. These aneurysmal models are created by surgically adding a pouch of tissue to carotid arteries in swine. When the model is used for research, the pouch must be autologous; for training purposes, a synthetic pouch suffices. First, the right external jugular vein (EJV) and right common carotid artery (CCA) must be surgically exposed. The EJV is ligated and a vein pouch fashioned from a short segment. This pouch is then sutured to an elliptical arteriotomy performed in the CCA. Animals must be kept heparinized during model creation, and local vasodilators may be used to decrease vasospasms. Once the suture is completed, correct blood flow should be inspected, checking for bleeding from the suture line and vessel patency. Finally, the surgical incision is closed by layers and an angiography performed to image the aneurysmal model. A simplification of this aneurysmal carotid model that decreases invasiveness and surgical time is the use of a synthetic, rather than venous, pouch. For this purpose, a pouch is tailored in advance with a segment of a polytetrafluoroethylene (PTFE) prosthesis, one end of which is sutured close using polypropylene vascular suture and sterilized prior to surgery. This "sac" is then attached to an arteriotomy performed in the CCA as described. Although these models do not reproduce many of the physiopathological events related to aneurysm formation, they are hemodynamically similar to the situation found in the clinical setting. Therefore, they can be used for research or training purposes, allowing physicians to learn and practice different endovascular techniques in animal models that are close to the human system.

Autophagy modulation in animal models of corneal diseases: a systematic review.

Autophagy is an intracellular catabolic process implicated in the recycling and degradation of intracellular components. Few studies have defined its role in corneal pathologies. Animal models are essential for understanding autophagy regulation and identifying new treatments to modulate its effects. A systematic review (SR) was conducted of studies employing animal models for investigations of autophagy in corneal diseases. Studies were identified using a structured search strategy (TS = autophagy AND cornea*) in Web of Science, Scopus, and PubMed from inception to September 2019. In this study, 230 articles were collected, of which 28 were analyzed. Mouse models were used in 82% of the studies, while rat, rabbit, and newt models were used in the other 18%. The most studied corneal layer was the epithelium, followed by the endothelium and stroma. In 13 articles, genetically modified animal models were used to study Fuch endothelial corneal dystrophy (FECD), granular corneal dystrophy type 2 (GCD2), dry eye disease (DED), and corneal infection. In other 13 articles, animal models were experimentally induced to mimic DED, keratitis, inflammation, and surgical scenarios. Furthermore, in 50% of studies, modulators that activated or inhibited autophagy were also investigated. Protective effects of autophagy activators were demonstrated, including rapamycin for DED and keratitis, lithium for FECD, LYN-1604 for DED, cysteamine and miR-34c antagomir for damaged corneal epithelium. Three autophagy suppressors were also found to have therapeutic effects, such as aminoimidazole-4-carboxamide-riboside (AICAR) for corneal allogeneic transplantation, celecoxib and chloroquine for DED.

Animal models used to study direct peripheral nerve repair: a systematic review.

OBJECTIVE: Peripheral nerve repair is required after traumatic injury. This common condition represents a major public health problem worldwide. Recovery after nerve repair depends on several factors, including the severity of the injury, the nerve involved, and the surgeon's technical skills. Despite the precise microsurgical repair of nerve lesions, adequate functional recovery is not always achieved and, therefore, the regeneration process and surgical techniques are still being studied. Pre-clinical animal models are essential for this research and, for this reason, the focus of the present systematic review (according to the PRISMA statement) was to analyze the different animal models used in pre-clinical peripheral nerve repair studies. DATA SOURCES: Original articles, published in English from 2000 to 2018, were collected using the Web of Science, Scopus, and PubMed databases. DATA SELECTION: Only preclinical trials on direct nerve repair were included in this review. The articles were evaluated by the first two authors, in accordance with predefined data fields. OUTCOME MEASURES: The primary outcomes included functional motor abilities, daily activity and regeneration rate. Secondary outcomes included coaptation technique and animal model. RESULTS: This review yielded 267 articles, of which, after completion of the screening, 49 studies were analyzed. There were 1425 animals in those 49 studies, being rats, mice, guinea pigs, rabbits, cats and dogs the different pre-clinical models. The nerves used were classified into three groups: head and neck (11), forelimb (8) and hindlimb (30). The techniques used to perform the coaptation were: microsuture (46), glue (12), laser (8) and mechanical (2). The follow-up examinations were histology (43), electrophysiological analysis (24) and behavioral observation (22). CONCLUSION: The most widely used animal model in the study of peripheral nerve repair is the rat. Other animal models are also used but the cost-benefit of the rat model provides several strengths over the others. Suture techniques are currently the first option for nerve repair, but the use of glues, lasers and bioengineering materials is increasing. Hence, further research in this field is required to improve clinical practice.

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery.

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many areas of biomedical research due to its cost-effectiveness and its translation to humans. This protocol describes a method to create a preclinical free skin flap model in rats with ischemia-reperfusion injury. The described 3 cm x 6 cm rat free skin flap model is easily obtained after the placement of several vascular ligatures and the section of the vascular pedicle. Then, 8 h after the ischemic insult and completion of the microsurgical anastomosis, the free skin flap develops the tissue damage. These ischemia-reperfusion injury-related damages can be studied in this model, making it a suitable model for evaluating therapeutic agents to address this pathophysiological process. Furthermore, two main monitoring techniques are described in the protocol for the assessment of this animal model: transit-time ultrasound technology and laser speckle contrast analysis.

Incidence of intraepithelial fallopian tube neoplasias in mexican women over 40 years of age that underwent elective hysterectomy.

AIMS: The incidence of intraepithelial neoplasia in the fallopian tubes of women over 40 years of age who had undergone elective hysterectomy was assessed at the Aguascalientes Women's Hospital. METHODS: An observational, prospective, descriptive study was carried out at the Aguascalientes Women's Hospital on female patients over 40 years of age who underwent elective hysterectomy between July and October 2017. In these 4 months, 85 patients underwent elective hysterectomy. RESULTS: In this study, 85 patients who received a hysterectomy for non-oncological reasons were analyzed. Salpinx alterations compatible with intraepithelial neoplasia in the Fallopian tubes were found in 2.4% of the patients studied. CONCLUSIONS: The incidence of intraepithelial neoplasia in the fallopian tubes of high-risk patients at the Aguascalientes Women's Hospital is 2.4%. Prophylactic salpingectomy is a simple procedure and has the potential to decrease the risk of high-grade ovarian cancer. In premenopausal patients, total abdominal hysterectomy with bilateral salpingectomy should be the procedure most often performed.

Adipose-Derived Stem Cells Ameliorate Ischemia-Reperfusion Injury in a Rat Skin Free Flap Model.

BACKGROUND: Ischemia-reperfusion (I/R) injury is inevitable during free tissue transfers. When the period of ischemia exceeds the tissue tolerance, it causes necrosis and flap failure. The aim of this study was to investigate the effects of adipose-derived stem cells (ASCs) embedded in a collagen type I scaffold on the survival of free skin flaps to counteract I/R injury. METHODS: Left superficial caudal epigastric skin flaps (3 × 6 cm) were performed in 28 Wistar rats that were divided into four groups. The flaps elevated in the animals of the control group did not suffer any ischemic insult, and the vascular pedicle was not cut. All other flaps were subjected to 8 hours of ischemia prior to revascularization: I/R control group (8 hours of ischemia), I/R scaffold group (8 hours of ischemia + collagen type I scaffold), and I/R scaffold-ASCs group (8 hours of ischemia + collagen type I scaffold with rat ASCs embedded). Transit-time ultrasound blood flow measurements were performed. After 7 days, the areas of flap survival were measured and tissues were stained with hematoxylin/eosin and Masson's trichrome stain for histological analysis. RESULTS: The mean percentage flap survival area was significantly higher in the ASCs-treated flaps (I/R scaffold-ASCs group) compared with the ischemic controls (I/R control group and I/R scaffold group). Higher vascular proliferation and lower severity of necrosis and inflammatory changes were seen histologically in the samples of the ASCs-treated group. No significant difference in blood flow was detected between groups. CONCLUSION: Subcutaneous administration of ASCs embedded on a collagen type I scaffold reduces tissue damage after I/R injury in microvascular free flaps.

Utilidad y eficacia de la clasificación de Robson para disminuir la tasa de cesáreas / Utility and efficacy of Robson's classification to reduce the rate of cesareas

Resumen Objetivo: Evaluar la eficacia y utilidad de la clasificación de Robson en la reducción de la práctica de cesáreas. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y de corte transversal efectuado en pacientes de nivel socioeconómico medio y bajo atendidas entre enero y diciembre de 2016 en un hospital de segundo nivel. Para clasificar a las pacientes, según sus características obstétricas, se aplicó el modelo de Robson. Resultados: Se estudiaron 374 pacientes embarazadas; de ellas 91 (24.3%) terminaron la gestación mediante cesárea. Los grupos de Robson con mayor contribución al porcentaje de cesáreas fueron: grupo 1 con 50.5%, grupo 2 con 29.8% y grupo 10 con 8.7%. El grupo 5 reportó que 62.7% de los embarazos terminaron mediante parto. El 89.8% de las pacientes ingresó con trabajo de parto espontáneo. Las principales indicaciones de cesárea fueron, en el grupo 1, trabajo de parto estacionario; en el grupo 2, cesárea iterativa y en el grupo 10, feto pretérmino. Conclusiones: La aplicación del modelo de clasificación de Robson es útil y práctica para identificar los grupos de pacientes en los que es posible disminuir el porcentaje de cesáreas.

Abstract Objective: Evaluate the effectiveness and usefulness of the Robson classification to reduce the practice of cesarean sections. Materials and methods: Observational, descriptive, retrospective and cross section was made in patients of medium and low socioeconomic status attended between January and December 2016 in a second level hospital. For classify the patients, according to their obstetric characteristics, the model of Robson was applied. Results: 374 pregnant patients were studied; in 91 (24.3%) the pregnancy ended by caesarean section. The Robson groups with the greatest percentage contribution of caesarean sections were: group 1 with 50.5%, group 2 with 29.8% and group 10 with 8.7%. Group 5 reported that 62.7% of pregnancies ended by delivery; 89.8% of the patients was admitted with spontaneous labor. The main Cesarean indications were, in group 1, stationary labor; at group 2, iterative caesarean section and group 10, preterm fetus. Conclusions: The application of the Robson classification model is useful and practice to identify groups of patients in who it is possible to decrease the percentage of cesareans.

Hematoma subcapsular hepático en síndrome de HELLP: reporte de dos casos / Hepatic subcapsular hematoma in HELLP syndrome. Report of 2 cases

Resumen OBJETIVO Reportar el tratamiento clínico-quirúrgico y en la unidad de cuidados intensivos obstétricos de dos pacientes con síndrome de HELLP y hematoma subcapsular hepático. CASO CLINICO A Paciente de 29 años en curso de las 36.1 semanas de embarazo, con ausencia de movimientos fetales, choque hipovolémico, desprendimiento prematuro de placenta normoinserta y óbito. Hemoperitoneo de 2000 mL y hematoma subcapsular del lóbulo hepático izquierdo. Se le colocó un empaquetamiento Miculicz durante 48 horas. Permaneció en la unidad de cuidados intensivos durante nueve días. Reporte de tomografía axial computada de hematoma subcapsular hepático. CASO CLINICO B Paciente de 15 años, con embarazo de 38.6 semanas, dolor epigástrico y lumbar, bradicardia fetal y síndrome de HELLP. Hemoperitoneo de 300 cc, feto de 2400 g, Apgar 1-5, desprendimiento de placenta del 100%, hematoma hepático subcapsular contenido por el ligamento triangular sin necesidad de empaquetamiento. Atención en la unidad de cuidados intensivos obstétricos durante tres días. Reporte de tomografía axial computada de hematoma hepático subcapsular. CONCLUSIÓN El síndrome de HELLP puede originar complicaciones hepáticas graves, como: rotura hepática o hematoma subcapsular roto o no roto. La mortalidad es de 18 a 86% en caso de rotura del hematoma. Las pacientes deben tratarse en hospitales de tercer nivel. La intervención temprana, la atención multidisciplinaria, el soporte hemodinámico y el seguimiento con estudios de imagen son decisivos para reducir su elevada morbilidad y mortalidad.

Abstract OBJECTIVE Report clinical-surgical management and in the Obstetric Intensive Care Unit of the HELLP Syndrome and hepatic subcapsular hematoma of two clinical cases. CLINICAL CASE A 29 years of age, 36.1 weeks of gestation, absence of fetal movements, hypovolemic shock, premature detachment of normoinserta placenta, stillbirth. Hemoperitoneum finding of 2000 mL and subcapsular hematoma of the left hepatic lobe; Miculicz packaging is placed for 48 hours. Management in the Obstetric Intensive Care Unit for 9 days. Computed Axial Tomography reports hepatic subcapsular hematoma. CLINICAL CASE B 15 years of age, 38.6 weeks of gestation, pain in the hypogastrium and lumbar region, fetal bradycardia and HELLP syndrome; hemoperitoneum finding of 300 cc, product of 2,400 gr, Apgar 1-5, placental abruption of 100%, hepatic subcapsular hematoma contained by triangular ligament without the need for packaging. Management in the Obstetric Intensive Care Unit for 3 days. Computed Axial Tomography reports hepatic subcapsular hematoma. CONCLUSION The HELLP syndrome can present serious hepatic complications such as ruptured hepatic or subcapsular hematoma. Mortality is 18 to 86% in case of hematoma rupture. They require management in highly complex centers. Early intervention, multidisciplinary management, hemodynamic support and follow-up with imaging studies are essential to reduce their high morbidity and mortality.

Mesenchymal Stem Cell-Derived Exosomes: Immunomodulatory Evaluation in an Antigen-Induced Synovitis Porcine Model.

Synovitis is an inflammatory process associated with pain, disability, and discomfort, which is usually treated with anti-inflammatory drugs or biological agents. Mesenchymal stem cells (MSCs) have been also successfully used in the treatment of inflammatory-related diseases such as synovitis or arthritis. In the last years, the exosomes derived from MSCs have become a promising tool for the treatment of inflammatory-related diseases and their therapeutic effect is thought to be mediated (at least in part) by their immunomodulatory potential. In this work, we aimed to evaluate the anti-inflammatory effect of these exosomes in an antigen-induced synovitis animal model. To our knowledge, this is the first report where exosomes derived from MSCs have been evaluated in an animal model of synovitis. Our results demonstrated a decrease of synovial lymphocytes together with a downregulation of TNF-α transcripts in those exosome-treated joints. These results support the immunomodulatory effect of these exosomes and point out that they may represent a promising therapeutic option for the treatment of synovitis.

Evaluation of antigen-induced synovitis in a porcine model: Immunological, arthroscopic and kinetic studies.

BACKGROUND: Synovitis is an inflammation-related disease linked to rheumatoid arthritis, osteoarthritis, infections and trauma. This inflammation is accompanied by immune cells infiltration which initiates an inflammatory response causing pain, discomfort and affecting the normal joint function. The treatment of synovitis is based on the administration of anti-inflammatory drugs or biological agents such as platelet rich plasma and mesenchymal stem cells. However, the evaluation and validation of more effective therapies of synovitis requires the establishment of clinically relevant animal models. RESULTS: In this study, Large White pigs were pre-immunized to evaluate an antigen-induced synovitis. The immune monitoring of synovial fluids in this model allowed us the identification of IL-12p40 and T cell subsets as immune biomarkers. Moreover, the evolution of synovitis was performed by arthroscopic procedures and kinetic analysis. In summary, this paper describes an animal model of antigen-induced synovitis to be used in the evaluation of anti-inflammatory therapies. CONCLUSIONS: The novelty of this paper lies in the development of a clinically relevant model of synovitis which permits the simultaneous evaluation of synovitis from an immunological, surgical and kinetic point of view.

Clinical and epidemiological features of extrapulmonary tuberculosis in a high incidence region.

OBJECTIVE: To describe the clinical features of extrapulmonary tuberculosis (EXPTB) and to evaluate epidemiological data to search for potential explanations for its high frequency in the state of Aguascalientes, Mexico. MATERIALS AND METHODS: Clinical records of all patients with tuberculosis seen in Aguascalientes in 2008 were reviewed, and official databases were analyzed. RESULTS: EXPTB comprised 60.5% of the 86 cases evaluated, being lymph nodes the main site affected. Patients with EXPTB were younger and more obese than subjects with pulmonary tuberculosis (PTB). One third of cases in either group had diabetes, a frequency much higher than expected. Epidemiological analysis showed that PTB incidence, but not EXPTB incidence, decreases as geographical altitude increases, and had a descendent trend from 1997 to 2011. CONCLUSIONS: The lower frequency of PTB (due to its inverse relationship with altitude and its descendent trend in last years) might explain the high frequency of EXPTB. Obesity appeared to protect against developing pulmonary involvement, and diabetes was more frequent than expected among PTB and EXPTB cases.