Background: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. Aim: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. Materials and Methods: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. Results: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29][30][31][32][33][34][35][36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14][15][16][17][18][19][20][21][22][23][24][25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29][30][31][32][33][34] weeks. Neonatal median hospitalization length was 4 days, with 18% of neonatal deaths. Conclusions: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential. (Rev Med Chile 2019; 147: 709-717)
.Frecuentemente secundaria a procesos mieloproliferativos o leucemias agudas, pueden asociarse a un Síndrome de hiperviscosidad y/o a un Síndrome de lisis tumoral constituyendo urgencias oncológicas. Existe un fenómeno menos conocido que se puede presentar en los pacientes con hiperleucocitosis. Ésta es la alteración espuria de los gases arteriales, específi camente la disminución de la presión arterial de oxígeno (P a 0 2 ) en ausencia de síntomas o signos de hipoxia y sin correlación con la Oximetría de pulso del paciente. Este fenómeno se denomina hipoxemia espuria. Esta alteración, de no ser considerada, puede llevar a una interpretación errónea de la condición del paciente, derivando en tratamientos agresivos y potencialmente dañinos.Presentamos un caso clínico de hipoxemia espuria. Caso clínicoPaciente hombre de 67 años, con antecedentes de etilismo crónico. Cinco semanas antes del ingreso presentó súbitamente hipoacusia bilateral. El día del ingreso presentó paresia braquio-crural derecha de instalación brusca, asociada a compromiso cualitativo de conciencia, por lo cual fue llevado a Urgencia del Hospital Dr. Sótero del Río.Al examen físico se constató vigil, desorientado, con Glasgow 14 (V 4 M 6 O 4 ); hemodinámicamente estable, afebril, polipneico (30/min); bien hidratado y perfundido, sin cianosis, muy enfl aquecido. Examen pulmonar con crepitaciones bibasales simétricas; corazón con ruidos rítmicos en dos tiempos, sin soplos; abdomen blando, depresible,
Intensified insulin therapy plus antineuritic medication is more effective than antineuritics alone in painful diabetic neuropathy (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025 (Rev Méd Chile 2006; 134: 1507-15).
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