Resumen Introducción. En becerras prepúberes, la Kisspeptina-10 ha estimulado la secreción de las hormonas luteinizante (LH) y folículo estimulante (FSH), y en vacas posparto amamantando ha estimulado la secreción de LH sin evidencia de inducir la ovulación. Objetivo. Inducir la ovulación con Kisspeptina-10 u hormona liberadora de gonadotropinas (GnRH), en vacas productoras de carne en condiciones subtropicales de México. Materiales y métodos. El estudio se realizó en la región nororiente del estado de Puebla durante los años 2020 al 2021, con 252 vacas cruzadas Bos taurus x Bos indicus. El protocolo de sincronización estral consistió en la aplicación de un dispositivo intravaginal impregnado con progesterona (1,9 g) y la inyección intramuscular de 2 mg de benzoato de estradiol (día 0). El día siete se removió el dispositivo intravaginal y de inmediato las vacas fueron inyectadas vía intramuscular con 0,150 mg de D-cloprostenol. Al día siguiente (día ocho), las vacas fueron inyectadas vía intramuscular con 1 mg de benzoato de estradiol. Entre 52 y 56 horas posteriores al retiro del dispositivo intravaginal (día nueve), las vacas se inyectaron vía intramuscular con GnRH o Kisspeptina-10. Las vacas se asignaron a cuatro tratamientos: T1, 100 µg de GnRH (control positivo), T2, T3 y T4 500 µg, 1000 µg y 1500 µg de Kisspeptina-10, respectivamente. La ovulación se detectó mediante ultrasonografía a los cuatro días post-tratamiento. La variable de respuesta evaluada fue la tasa de ovulación. Los datos se analizaron mediante modelos lineales generalizados y se aplicó una función liga logit. Resultados. Las tasas de ovulación obtenidas con T1 y T4 fueron iguales estadísticamente (99,9 %; p>0,05) y mayores (p<0,05) que las logradas con T2 (98,5 %) y T3 (88,4 %), estas dos últimas fueron iguales estadísticamente (p>0,05). Conclusión. La Kisspeptina-10 1500 µg fue tan efectiva como la GnRH para inducir la ovulación.

Abstract Introduction. In prepubertal heifers, Kisspeptin-10 has stimulated the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and in postpartum lactating cows, it has stimulated LH secretion without evidence of inducing ovulation. Objective. To induce ovulation using Kisspeptin-10 or gonadotropin-releasing hormone (GnRH) in beef-producing cows under subtropical conditions in Mexico. Materials and methods. The study was conducted in the northeastern region of the state of Puebla uring the years 2020 to 2021, with 252 Bos taurus x Bos indicus cows. The estrous synchronization protocol involved the insertion of an intravaginal device impregnated with progesterone (1.9 g) and intramuscular injection of 2 mg of estradiol benzoate (day 0). On day seven, the intravaginal device was removed, and cows were immediately intramuscularly injected with 0.150 mg of D-cloprostenol. On the following day (day eight), Kisspeptin-10 was as effective as GnRH in inducing ovulation. 56 hours after the removal of the intravaginal device (day nine), cows were intramuscularly injected with GnRH or Kisspeptin-10. Cows were assigned to four treatments: T1, 100 µg of GnRH (positive control), T2, T3, and T4 with 500 µg, 1000 µg, and 1500 µg of Kisspeptin-10, respectively. Ovulation was detected via ultrasonography four days post-treatment. The response variable evaluated was the ovulation rate. Data were analyzed using generalized linear models with a logit link function. Results. Ovulation rates obtained with T1 and T4 were statistically equal (99.9%; p>0.05) and higher (p<0.05) than those achieved with T2 (98.5%) and T3 (88.4%), with the latter two being statistically equal (p>0.05). Conclusion. Kisspeptin-10 1500 µg was as effective as GnRH in inducing ovulation.

Resumen Introducción: Aunque la vena subclavia ofrece ventajas significativas sobre otros abordajes para el acceso venoso central guiado por ultrasonido, no se considera la primera opción en la población pediátrica, principalmente debido a su proximidad con la pleura y la arteria subclavia. Objetivo: Evaluar las características sonoanatómicas de la vena subclavia y sus estructuras adyacentes utilizando el abordaje supraclavicular en la población pediátrica. Materiales y métodos: Estudio observacional de corte transversal durante el periodo intraoperatorio, desde junio de 2021 hasta marzo de 2022. Participaron niños ASA I, II y III sometidos a procedimientos quirúrgicos no emergentes bajo anestesia general. Se realizaron las imágenes bajo anestesia general, utilizando un transductor lineal de alta frecuencia para identificar la vena subclavia y medir características anatómicas. Resultados: Se reclutaron 67 niños, con una mediana de 6 años (RIQ 2-12 años), predominando el sexo masculino (61 %). La mediana de peso fue de 22 kg (RIQ12,2-34 kg) y la de estatura fue de 115 cm (RIQ 88-142 cm). Las mediciones del vaso mostraron una distancia media de la piel al vaso de 0,70 cm (DE: 0,18 cm) y una de la piel a la pleura de 1,31 cm (DE: 0,28 cm). El diámetro de la vena tuvo una mediana de 0,49 cm (RIQ 0,40-0,63 cm). El ángulo hipotético de aproximación al vaso presentó una media de 22,09 grados (DE: 4,37 grados), mientras que el ángulo de aproximación a la pleura fue de 39 grados (DE: 5,31 grados). No se documentó la visualización simultánea de la arteria y la vena en ninguna de las ventanas sonoanatómicas registradas. Las pruebas indicaron una diferencia promedio de 0,61 cm en la profundidad del vaso respecto a la pleura, y 16,91 grados menos en el ángulo de aproximación al vaso comparado con el ángulo pleural (p < 0,001). Conclusiones: Mediante esta técnica, el abordaje supraclavicular para punción de la vena subclavia en niños es seguro y viable, con una distancia promedio de la piel al vaso de 0,70 cm, minimizando el riesgo de punción pleural. Se requieren estudios adicionales para optimizar esta técnica en la población pediátrica.

Abstract Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population.

Resumen Introducción: La anestesia espinal se realiza mediante palpación de superficies para la identificación de los espacios intervertebrales lumbares. En adultos mayores el procedimiento presenta mayor dificultad debido a los cambios degenerativos de la columna vertebral asociados a la edad. Objetivo: Evaluar cuál técnica de anestesia espinal garantiza una mayor tasa de éxito entre la guiada por ultrasonido (US) y la guiada por reparos anatómicos (RA) en adultos mayores. Métodos: Estudio observacional de cohorte prospectivo en pacientes con indicación de suministro de anestesia subaracnoidea independientemente de la intervención quirúrgica, llevado a cabo en el Hospital Universitario del Valle y la Fundación Hospital San José Buga. En un lapso de 12 meses se recolectaron datos durante la realización de la punción, según decisión del anestesiólogo tratante, guiada por US vs. RA. Resultados: En total se evaluaron 80 pacientes entre hombres y mujeres, mayores de 65 años, con edad media de 78,50±9,04. El número de punciones, así como de redireccionamientos, fue significativamente menor en el grupo guiado por US. Adicionalmente, se observó que en el grupo guiado por RA, el 37,5 % no coincidía con el sitio demarcado con el espacio real de punción confirmado con US (p<0,001). Podría ser la causa de un bloqueo inadecuado o de complicaciones de la punción intradural. Conclusiones: La técnica de anestesia neuroaxial guiada por US en adultos mayores podría facilitar el bloqueo neuroaxial al primer intento de punción.

Abstract Introduction: Spinal anesthesia requires palpation of surfaces in order to identify the intervertebral spaces in the lumbar spine. In elderly individuals, the procedure is more challenging due to age-related degenerative changes in the spine. Objective: To determine which technique between ultrasound (US) guidance or the use of anatomical landmarks to guide spinal anesthesia ensures a higher success rate in elderly patients. Methods: prospective observational cohort study in patients with an indication to receive subarachnoid anesthesia, regardless of the type of surgical intervention, carried out at Hospital Universitario del Valle and Fundación Hospital San José Buga. Data were collected over a 12-month period at the time of making the puncture. The treating anesthetists were free to choose between US guidance or the use of anatomical landmarks. Results: Overall, 80 patients were assessed, including men and women over 65 years of age (mean 78.5±19.04). The number of punctures as well as needle redirections were significantly lower in the US-guided group. Additionally, in the group in which anatomical landmarks were used to guide the puncture, the marked site did not coincide with the actual puncture site confirmed with US in 37.5% of cases (p<0.001). This could result in inadequate block or complications associated with intradural puncture. Conclusions: US-guided neuroaxial anesthesia in elderly individuals could facilitate success on the first attempt.

Abstract Objective Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. Data sources A PubMed search was conducted using the key terms “ascariasis complications” and “hepatobiliary ascariasis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. Summary of findings Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. Conclusion The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides. emergencies endemic patients ascariasis. . ascariasis” metaanalyses, metaanalyses meta analyses, analyses meta-analyses trials reports 2023 complication treat biliary hepatic appendicitis Meckels Meckel s diverticulitis granulomas obstruction childhood fails needed lumbricoides 202 20 2

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. Objective To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. Methods A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. Results Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. Study limitations The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. Conclusions The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life. (HS nodules fistulas fibrosis life condition IHS4. IHS4 IHS . (IHS4) case surgical created four 12 2 immunobiologicals SOSHS SOS one (IHS4 1 (IHS

Abstract Only 2% of malignant tumor lesions in the pancreas represented metastatic lesions. Endoscopic biliopancreatic ultrasonography, with the possibility of guided biopsy, is one of the main diagnostic methods currently available for lesions in the pancreas. A case of a male patient with a history of small cell carcinoma of the lung with findings of a tumor lesion in the pancreas corresponding to metastasis was described.

Resumen Tan solo el 2% de las lesiones tumorales malignas en el páncreas representan lesiones metastásicas. La ultrasonografía endoscópica biliopancreática, con posibilidad de biopsia guiada, es uno de los principales métodos diagnósticos disponibles actualmente para las lesiones en el páncreas. Se describe el caso de un paciente masculino con antecedente de carcinoma de células pequeñas de pulmón con hallazgos de lesión tumoral en el páncreas correspondiente a metástasis.

Resumen Introducción: El amniocele es una hernia del saco amniótico a través de un defecto en la pared del útero, el cual puede deberse a ruptura uterina, secundario a daños preexistentes, anomalías uterinas o en un útero sin cicatrices. Caso clínico: Presentamos el caso de una paciente de 37 años, con antecedente de dos partos por cesárea, a quien en la semana 25,5 de embarazo se le diagnostica por ecografía amniocele en la pared anterior de útero contenido por la vejiga, además de signos ecográficos de acretismo placentario. La posterior realización de resonancia magnética confirma el diagnóstico. Se realiza manejo expectante con estancia continua intrahospitalaria estricta. Resolución obstétrica a las 34 semanas por cesárea, con extracción fetal por fondo uterino sin complicaciones, con posterior realización de histerectomía con placenta in situ. Conclusiones: Este reporte de caso ilustra la importancia de la identificación temprana de esta condición por ser una complicación infrecuente, pero de grave pronóstico fetomaterno en ausencia de atención inmediata.

Abstract Introduction: Amniocele is a hernia of the amniotic sac through a defect in the uterine wall, which can be caused by uterine rupture secondary to preexisting damage, uterine anomalies, or a scarless uterus. Case report: We present a case of a 37-year-old patient with a history of two previous cesarean deliveries. At 25.5 weeks of gestation, the diagnosis of amniocele in the anterior uterine wall, contained by the bladder, along with ultrasound signs of placenta accreta, was confirmed through ultrasound. Subsequent magnetic resonance imaging further confirmed the diagnosis. Expectant management with strict continuous intrahospital stay was implemented. Obstetric resolution was achieved at 34 weeks through cesarean delivery, with uncomplicated fetal extraction through the uterine fundus. Subsequently, a hysterectomy was performed with the placenta left in situ. Conclusions: This case report illustrates the importance of early identification of this condition due to its infrequent but serious feto-maternal prognosis in the absence of immediate attention.

RESUMEN Introducción: La enfermedad metastásica a tiroides corresponde a 2% de las malignidades tiroideas en series de autopsias. Hasta el 50% de las metástasis se deben a carcinoma de células renales (Ree). Estas pueden ocurrir varios años después del diagnóstico o la nefrectomía. La presentación aislada en la glándula tiroides es rara. Presentación caso clínico: Presentamos el caso de una mujer de 68 años con historia de Ree manejada con nefrectomía y linfadenectomía retroperitoneal. Tras 7 años libre de síntomas notó la aparición de una masa sobre la región tiroidea. La ultrasonografía reportó nódulos tiroideos bilaterales. Por el antecedente oncológico y la afirmación de síntomas durante la deglución se le realizó tiroidectomía total. El reporte histopatológico fue compatible con metástasis de Ree. Discusión: La literatura muestra que el tiempo medio de metástasis a tiroides en pacientes con Ree es 92 meses. La mayoría de los pacientes son asintomáticos. Se recomienda la tiroidectomía total para prevenir progresión de la enfermedad con impacto favorable en la supervivencia. Conclusión: En los pacientes con nódulos tiroideos y antecedente de Ree se debe sospechar enfermedad metastásica.

ABSTRACT Introduction: Metastatic disease of the thyroid corresponds to 2% of thyroid malignancies in autopsy series. Up to 50% of metastases are due to renal cell carcinoma (Ree). These can occur several years after diagnosis or nephrectomy. An isolated presence in the thyroid gland is rare. Clinical case presentation: We present the case of a 68-year-old woman with a history of Ree managed with nephrectomy and retroperitoneal lymphadenectomy. After 7 years free of symptoms, she noticed a mass over the thyroid region. Ultrasonography reported bilateral thyroid nodules. Due to the oncologic history and the affirmation of symptoms during swallowing, a full thyroidectomy was performed. The histopathological report was compatible with Ree metastasis. Discussion: The literature shows that the median time for thyroid metastasis in patients with Ree is 92 months. Most patients are asymptomatic, and a full thyroidectomy is recommended to prevent disease progression with a favorable impact on Survival. Conclusion: In patients with thyroid nodules and a history of Ree, metastasis should be suspected.

Abstract Broad ligament pregnancy is a rare form of abdominal pregnancy that corresponds to 1 percent of ectopic pregnancies. It has a high maternal mortality rate, and its diagnosis can represent a clinical challenge. We report a case of a 29-year-old woman, G2P0, pregnant of 21 weeks who was submitted to surgery due to hemoperitoneum that resulted from a ruptured extra uterine pregnancy. Broad ligament pregnancy diagnosis was made intraoperatively and the broad ligament along with fetus, placenta and fallopian tube were excised.

Resumo A gravidez do ligamento largo é uma forma rara de gravidez abdominal e corresponde a 1 por cento das gestações de localização ectópica. Esta entidade tem uma elevada taxa de mortalidade materna e o seu diagnóstico pode representar um desafio. Apresenta-se o caso de uma mulher de 29 anos, G2P0, grávida de 21 semanas submetida a cirurgia em contexto de hemoperitoneu por rotura de gravidez extrauterina. O diagnostico de gravidez do ligamento largo foi realizado intraoperatoriamente com remoção do mesmo, juntamente com o feto, placenta e trompa de Falópio.

RESUMEN Introducción: Durante el embarazo varios factores pueden interactuar sobre el organismo en formación. Parte de los cuidados prenatales se centran en detectar desviaciones del crecimiento fetal. Objetivo: Describir las variables biométricas fetales primarias y la asociación de las enfermedades maternas con la condición trófica del recién nacido. Método: Se realizó un estudio cuantitativo, observacional, analítico y retrospectivo, con una población de 5432 y una muestra de 4131 gestantes, seleccionada por muestreo no probabilístico, intencional, por criterios. Los datos fueron obtenidos del registro de consultas de genética desde enero de 2013 hasta octubre de 2018. Para el análisis estadístico se utilizó el test de Kruskal Wallis, la prueba post hoc de Dunn-Bonferroni, ji cuadrado y V de Cramer. Resultados: Prevaleció el incremento de las medianas de las variables biométricas, según la condición trófica y semana gestacional, predominó la significación estadística, al igual que las diferencias significativas en todos los contrastes dos a dos realizados. Las gestantes de peso adecuado preponderaron en cada condición al nacer, los recién nacidos pequeños se relacionaron con los trastornos hipertensivos durante el embarazo, la sepsis vaginal y la diabetes mellitus mientras que los recién nacidos grandes predominaron en madres con la glucemia alterada y anemia. Conclusiones: Las mediciones biométricas y las fórmulas de estimación del peso fetal pueden advertir las desviaciones del crecimiento fetal y la condición trófica al nacer. Las variables maternas se relacionaron con la condición trófica del recién nacido.

ABSTRACT Introduction: During pregnancy several factors can interact on the developing organism. Part of prenatal care focuses on detecting deviations in fetal growth. Objective: Describe the primary fetal biometric variables and the association of maternal diseases with the trophic condition of the newborn. Method: A quantitative, observational, analytical and retrospective study was carried out, with a population of 5432 and a sample of 4131 pregnant women, selected by non-probabilistic, intentional sampling, by criteria. The data were obtained from the registry of genetic consultations from January 2013 to October 2018. For statistical analysis, the Kruskal Wallis test, the Dunn-Bonferroni post hoc test, chi-square and Cramer's V were used. Results: The increase in the medians of the biometric variables prevailed, according to the trophic condition and gestational week, the statistical significance predominated, as did the significant differences in all the two-to-two contrasts carried out. Pregnant women of adequate weight predominated in each condition at birth, small newborns were related to hypertensive disorders during pregnancy, vaginal sepsis and diabetes mellitus, while large newborns predominated in mothers with altered glycemia and anemia. Conclusions: Biometric measurements and fetal weight estimation formulas can warn of deviations in fetal growth and trophic condition at birth. Maternal variables were related to the trophic condition of the newborn.

ABSTRACT Foundation: Ultrasonography of the diameter of the optic nerve sheath has been used as a non-invasive measure of intracranial pressure. One of the deficiencies stated is the non-existence of a standard value that suggests the limit between normality and intracranial hypertension. Objective: Determine the diameter of the optic nerve sheath using ultrasound in healthy volunteers. Methods: A multi-population ecological study was conducted on 160 healthy volunteers who met the inclusion criteria. Three ultrasonographic measurements were performed in B mode in each eye, the average was taken as the final value. The variables studied were: age, sex, skin color and diameter of the optic nerve sheath. The percentage, mean, median, limit and standard were calculated. With a reference value at the 95% confidence interval. The relationship between the variables was determined by simple logistic regression analysis with the SPSS 22.0 statistical package. Results: That diameter of the optic nerve sheath, in the subjects, was quantified between 4.62 - 4.80 mm and 4.66 - 4.83 mm for the right and left eyes respectively. In the simple linear regression analysis, only sex was associated with the value of the diameter of the optic nerve sheath (p= 0.000). Conclusions: In a population of healthy volunteers, the value of the diameter of the optic nerve sheath was similar to other descriptions, with differences between sex, which suggests taking this variable into consideration when making the measurement.

RESUMEN Fundamento: La ultrasonografía del diámetro de la vaina del nervio óptico ha sido utilizada como medidor no invasivo de la presión intracraneal. Una de las deficiencias enunciadas resulta, la no existencia de un valor estándar, que sugiera el límite entre la normalidad y la hipertensión intracraneal. Objetivo: Determinar el diámetro de la vaina del nervio óptico mediante ecografía en voluntarios sanos. Métodos: Se realizó un estudio ecológico de poblaciones múltiples en 160 voluntarios sanos que cumplieron con los criterios de inclusión. Se realizaron 3 mediciones ultrasonográficas en modo B en cada ojo, se tomó como valor final el promedio. Las variables estudiadas fueron: edad, sexo, color de la piel y diámetro de la vaina del nervio óptico. Se calculó el porcentaje, media, mediana, límite y estándar. Con un valor de referencia al 95 % del intervalo de confianza. La relación entre las variables se determinó mediante análisis de regresión logística simple con el paquete estadístico de SPSS 22.0. Resultados: El diámetro de la vaina del nervio óptico, en los sujetos, se cuantificó entre 4,62 - 4,80 mm y 4,66 - 4,83 mm para los ojos derecho e izquierdo respectivamente. Al análisis de regresión lineal simple, solo el sexo se asoció al valor del diámetro de la vaina del nervio óptico (p= 0,000). Conclusiones: En una población de voluntarios sanos el valor del diámetro de la vaina del nervio óptico fue similar a otras descripciones, con diferencias entre el sexo, lo cual sugiere tomar en consideración esta variable al hacer la medición.

Resumo Introdução: A trombocitemia essencial (TE) é uma condição pouco comum e assintomática na maioria dos casos. No entanto, podem surgir sintomas como cefaleias, síncope, vertigem, dor torácica, eritromelalgia e distúrbios visuais transitórios. Os eventos hemorrágicos e tromboembólicos são os grandes riscos desta patologia. O objetivo da partilha deste caso clínico é alertar para uma patologia rara que pode passar despercebida e causar eventos potencialmente graves. Descrição do caso: Sexo feminino, 43 anos, raça caucasiana, antecedentes de hepatite B crónica, sem antecedentes cirúrgicos nem medicação habitual, incluindo método contracetivo hormonal. Recorreu a consulta com queixas de enfartamento precoce, dispepsia e epigastralgia com três dias de evolução, negando alterações do trânsito intestinal, características das fezes, náuseas ou vómitos. Exame físico e endoscopia digestiva alta recente sem alterações de relevo. Foi consultado o estudo analítico que a utente realizava regularmente no hospital, verificando-se que o valor do número de plaquetas se encontrava consistentemente a rondar os 500.000/uL desde há três anos. Pediu-se ecografia abdominal que descrevia trombose parcial da veia porta e do seu ramo esquerdo. A doente foi medicada com enoxaparina 60 mg 12h/12 h. Foi realizado angio-TC abdominal, estudo pró-trombótico e estudo genético e iniciou varfarina 5 mg 1x/dia, inicialmente sobreposta com enoxaparina 60 mg 12/12h. O angio-TC viria a confirmar a trombose da veia porta e confirmou-se positiva a mutação JAK2 V617F. Assumido o diagnóstico de TE e iniciado tratamento citorredutor com hidroxiureia 500 mg em dias alternados. Comentário: Este caso chama a atenção pelo excesso de plaquetas secundário à TE, ainda que ligeiramente acima do valor de referência, ter originado uma trombose da veia porta. Pretende-se alertar os médicos de família para a importância de realizar um estudo atento, valorizando pequenas variações sustentadas fora dos intervalos da normalidade e fazer uma referenciação correta e atempada quando necessário.

Abstract Introduction: Essential thrombocythemia (ET) is an asymptomatic rare condition in most cases. Nonetheless, symptoms like headache, syncope, vertigo, thoracic pain, erythromelalgia, and transient visual disturbances may surge. The major concerns of this pathology are hemorrhagic and thromboembolic events. The aim of sharing this case report is to alert for the existence of this rare pathology that can go unnoticed and cause potentially serious events. Case description: Female, 43-year-old, Caucasian. Background of chronic B hepatitis, without surgical background nor usual medication, including the contraceptive pill. She appealed to a medical appointment with an early feeling of fullness when eating, dyspepsia, and epigastric pain in the last three days. She denied changes in intestinal habits, feces characteristics, nausea, or vomiting. Physical examination and recent upper endoscopic study were normal. The hospital medical record was examined, verifying that platelet levels were consistently rounding 500,000/uL for the past three years. An abdominal ultrasonography was requested, and it described a partial portal vein and left branch thrombosis. The patient started enoxaparin 60 mg every 12 hours. It was conducted an abdominal angiotomography, prothrombotic, and genetic study, including the JAK2 V617F mutation. The patient started warfarin 5 mg one time daily, initially overlaid with enoxaparin 60 mg 12h/12h. The abdominal angiotomography would confirm the portal vein thrombosis and the JAK2 V617F mutation study was positive. It was assumed the diagnosis of ET and was initiated cytoreductive therapy with hydroxyurea 500 mg on alternated days. Comment: This case report shows that the excessive platelet count, secondary to ET, even if slightly above the reference value, caused a portal vein thrombosis. We aim to alert family physicians to the importance of doing a careful study, valuing little sustained variations out of the normal intervals, and referring correctly and promptly when necessary.

Introduction Muscle mass assessment of critically ill patients is essential to be part of the nutritional diagnosis in hospital care. Thus, the evaluation of more specific techniques for that purpose is needed. The present study aimed to investigate the association of quadriceps muscle thickness (QMT), measured by ultrasound (US), with the nutritional status of critically ill patients in a referral high-complexity trauma care hospital. Methods A cross-sectional observational study was conducted in the intensive care units (ICUs) in a tertiary hospital in Brazil. The sample comprised 30 critically ill trauma patients admitted between February and March 2022. The methodology involved evaluating muscle mass and comparing nutritional status through mid-upper arm circumference measurements and US assessments. Specifically, the QMT was quantified using US at a predefined site between the iliac crest and the proximal border of the patella. Results The Kruskal-Wallis test indicated variability in QMT between the nutritional status groups, with statistical significance reached after excluding the overweight group (H(2) = 7.532, p = 0.023). The moderate malnutrition group exhibited notably lower QMT. Sensitivity analyses using bootstrap and Monte Carlo methods showed moderate trends toward significance. A positive correlation was found between QMT and mid-upper arm circumference adequacy (p &lt; 0.05), demonstrating fair to moderate correlation (rs = 0.531). Conclusion Significant changes in QMT were detected by ultrasound assessment in moderate malnutrition patients compared to patients of other nutritional statuses. Ultrasound may be a valuable technique for monitoring muscle integrity in critically ill patients.

ABSTRACT Introduction: The clinical, etiological, anatomical and pathophysiological classification (CEAP) standardizes the manifestations of lower limb venous disease. Objetive: To investigate the association between insufficient venous systems and the clinical classification of CEAP. Method: A quantitative, cross-sectional, analytical, correlational design was carried out. Non-probability sampling for convenience. Sample size was 136 lower limbs from 71 patients. Chi-square, Monte Carlo and Odd ratio (OR) statistical tests were used with 95% confidence intervals through bivariate logistic regression (p<0.05). Results: 71.8% were female, average age of 66.1. The most frequent insufficient venous system was the superficial one (61.7%). 100% of the dilated great saphenous veins (GSV) had insufficiency. The most frequent CEAP clinical class was C2: 44.9%); 35.1% of C1 (telangiectasia) had an insufficient venous system and 50% of C2 had GSV insufficiency (p=0.227). There was an association between insufficiency of the superficial and deep venous systems and the CEAP clinical classification (p=<0.001). The deep venous system was associated with severe chronic venous disease of the lower limbs OR (6.04) with 95% CI (1.02-35.73) and p=0.047. Conclusions: An association was evident between the insufficiency of the superficial and deep venous systems with the clinical classification of CEAP. One third of lower limbs with C1 (telangiectasias) had an insufficient venous system.

RESUMEN Introducción: La clasificación clínica, etiológica, anatómica y fisiopatológica (CEAP) estandariza las manifestaciones de la enfermedad venosa de miembros inferiores. Objetivo: Investigar la asociación entre los sistemas venosos insuficientes y la clasificación clínica del CEAP. Método: Se realizó una investigación tipo cuantitativa, transversal, con diseño analítico, correlacional. El muestreo es no probabilístico por conveniencia. El tamaño de muestra fue136 miembros inferiores de 71 pacientes. Se utilizó las pruebas estadísticas de Chi-cuadrado, Monte Carlo y Odd ratio (OR) con intervalos de confianza del 95 %, mediante regresión logística bivariada (p<0,05). Resultados: El 71,8 % fue femenino con edad media de 66,1. El sistema venoso insuficiente más frecuente fue el superficial: 61,7 %. El 100% de las venas safenas mayores (VSM) dilatadas tenían insuficiencia. La clase clínica CEAP más frecuente fue la C2: 44,9 %; el 35,1 % de C1 (telangiectasia) tenían un sistema venoso insuficiente; el 50 % de C2, insuficiencia de la VSM (p=0,227). Hubo una asociación entre la insuficiencia de los sistemas venosos superficial y profundo y la clasificación clínica del CEAP (p=<0,001). El sistema venoso profundo estuvo asociado a la enfermedad venosa crónica de miembros inferiores grave OR (6,04) con IC95 % (1,02-35,73) y p=0,047. Conclusiones: Se evidenció una asociación entre la insuficiencia de los sistemas venosos superficial y profundo con la clasificación clínica del CEAP. Un tercio de los miembros inferiores con C1 (telangiectasias) tenían un sistema venoso insuficiente.