Hemorrhagic Shock Research Articles

Does early transfusion of cold-stored whole blood reduce the need for component therapy in civilian trauma patients? A systematic review.

Civilian acute trauma care has advanced in recent decades; however, traumatic injury remains the leading cause of death in individuals aged 15 to 29 years in the United States and worldwide. Uncontrolled hemorrhage is the leading preventable cause of death in trauma patients, with up to half of these deaths occurring before reaching a medical facility. The timely application of hemorrhage control measures is critical to enhance the survivability of trauma patients and is one of the major challenges faced by medical providers in austere environments. The purpose of this review is to explore if early resuscitation with cold-stored whole blood therapy reduces the need for component therapy in the first 24 hours postinjury in the civilian population. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic literature search in Medline, EMBASE, and Transfusion Evidence Library for studies reporting data on 24-hour blood product usage in trauma patients in hemorrhagic shock receiving initial therapy with whole blood. Two reviewers independently performed the selection of eligible studies. Of a total of 2,150 identified studies, 11 studies (n = 4,792) met the inclusion criteria. There was heterogeneity in the study design, interventions, and outcomes. Seven studies reported a statistically significant decrease in 24-hour transfusion requirements in the whole blood intervention group in comparison with the control component therapy group. Three studies reported no significant difference between the two groups. One of the studies reported an increase in 24-hour transfusion requirements in the whole blood group. Overall, there appears to be a decrease in component therapy use following initial resuscitation with whole blood in trauma patients with hemorrhagic shock. However, further research is needed to address this important practical question (PROSPERO registration no. CRD42023422173). Systematic Review; Level IV.

A machine learning-based Coagulation Risk Index predicts acute traumatic coagulopathy in bleeding trauma patients.

Acute traumatic coagulopathy (ATC) is a well-described phenomenon known to begin shortly after injury. This has profound implications for resuscitation from hemorrhagic shock, as ATC is associated with increased risk for massive transfusion (MT) and mortality. We describe a large-data machine learning-based Coagulation Risk Index (CRI) to test the early prediction of ATC in bleeding trauma patients. Coagulation Risk Index was developed using continuous vital signs (VSs) available during the first 15 minutes after admission at a single trauma center over 4 years. Data to compute the CRI were derived from continuous features of photoplethymographic and electrocardiographic waveforms, oximetry values, and blood pressure trends. Two groups of patients at risk for ATC were evaluated: critical administration threshold and patients who received an MT. Acute traumatic coagulopathy was evaluated in separate models and defined as an international normalized ratio (INR) >1.2 and >1.5 upon arrival. The CRI was developed using 2 years of cases for training and 2 years for testing. The accuracy of the models is described by area under the receiver operator curve with 95% confidence intervals. A total of 17,567 patients were available for analysis with continuous VS data, 52.8% sustained blunt injury, 30.2% were female, and the mean age was 44.6 years. The ability of CRI to predict ATC in critical administration threshold patients was excellent. The true positive and true negative rates were 95.6% and 88.3%, and 94.9% and 89.2% for INR >1.2 and INR >1.5, respectively. The CRI also demonstrated excellent accuracy in patients receiving MT; true positive and true negative rates were 92.8% and 91.3%, and 100% and 88.1% for INR >1.2 and INR >1.5, respectively. Using continuous VSs and large-data machine learning capabilities, the CRI accurately predicts early ATC in bleeding patients. Clinical application may guide early hemostatic resuscitation. Extension of this technology into the prehospital setting could provide earlier treatment of ATC. Retrospective, Prognostic Study; Level III.

Excessive hydrogen sulfide-induced activation of NMDA receptors in the colon participates in anxiety- and compulsive-like behaviors in a rodent model of hemorrhagic shock and resuscitation

ObjectiveHemorrhagic shock and resuscitation (HSR) cause inflammatory responses in the gastrointestinal tract and is associated with substantial morbidity and mortality rates. Hydrogen sulfide (H2S), a gasotransmitter with pleiotropic activity, exhibits anti-inflammatory benefits at physiological levels. However, deleterious effects are observed when its concentration increases. In this investigation, we employed a mouse model of HSR to examine the effects of an H2S scavenger on the gastrointestinal tract and brain, with emphasis on N-Methyl-d-Aspartate (NMDA) receptor function. MethodsMice were immediately administered dl-propargylglycine (PAG) intragastrically as an H2S scavenger after HSR exposure. The O-maze and buried beads tests were used to assess compulsive- and anxiety-like behaviors. Pathological changes in the intestine were evaluated at 24 and 30 days after HSR. Subsequently, at 30 days after HSR, we examined electrophysiological and pathological changes in the amygdala. ResultsWithin 24 h of HSR exposure, animals treated with PAG showed significantly lower colonic injury. Additionally, compared to the HSR-treated mice 30 days after HSR, the PAG-treated mice displayed reduced buried beads, increased open-arm time, lower blood levels of Diamine Oxidase (DAO) and considerably improved ZO-1 intensity, a stronger association between the delta rhythm phase and beta activity amplitude, and lower neuroinflammatory response in the amygdala. MK-801, an NMDA receptor inhibitor, significantly reversed H2S-induced intestinal and cerebral injury. ConclusionThis experimental data suggests that H2S-induced excessive activation of NMDA receptors contributes to anxiety- and compulsive-like behaviors caused by HSR.

Hereditary gluten enteropathy in irish setters: evaluation of external parameters, clinical symptoms and fatal risks

Aim. Determine the features of appearance, clinical signs and fatal risks in Irish setters with hereditary gluten enteropathy. Methods. The methods used were observation, eye examination, clinical examination, autopsy, histological. Results. It has been established that in hereditary gluten enteropathy in Irish setters there are violations of the parameters of appearance, weak ability to train, fulminant and chronic forms of damage to the intestinal wall by type of enteropathy, anaphylactic reactions and cerebral disorders. In the dead setters, the causes of death were hypovolemic shock due to intestinal bleeding and combined critical injuries of the brain, heart and lungs. Conclusions. Violations of the parameters of appearance in setters with hereditary gluten enteropathy led to their unsuitability for hunting. Dietary therapy with the exclusion of feed containing cereals was effective in stabilizing the condition of sick setters. Setters with hereditary gluten enteropathy are at risk of developing fatal cardiovascular, pulmonary, and cerebral insufficiency. The validity of the spread of hereditary gluten enteropathy in Irish setters depends on the accounting of the results of multi-year studies by a multidisciplinary group of specialists.

Fluid resuscitation strategy in patients with placenta previa accreta: a retrospective study.

Obstetric hemorrhage is the leading cause of maternal death worldwide. Placenta previa accreta is one of the major direct causes of postpartum hemorrhage, accounting for two-thirds of obstetric hemorrhage cases. Fluid resuscitation is a life-saving procedure for patients suffering from massive hemorrhage. This study aims at evaluating the risk factors of massive hemorrhage and appropriate fluid resuscitation strategy in patients with placenta previa accreta. This study retrospectively analyzed the risk factors for massive hemorrhage, clinical characteristics, and perinatal outcomes of patients with placenta previa accreta. Maternal noninvasively evaluated hemodynamic indicators, including maternal heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and shock index, were collected and analyzed at nine time points, from the administration of anesthesia until the end of procedures, in patients diagnosed with placenta previa accreta and receiving different fluid supply volumes. Complicated with placenta increta/percreta and gestational age of delivery later than 37 weeks are two independent risk factors of massive hemorrhage in patients with placenta previa accreta. A total of 62.27% (170/273) patients diagnosed with placenta increta/percreta had massive hemorrhage, significantly higher than those diagnosed with placenta previa accreta (5.88%, 6/102). Patients delivered after 37 weeks of gestation had significantly higher ratios (86.84%, 99/114) of massive hemorrhage compared with those delivered between 36 and 36+6 weeks of gestation (35.39%, 63/178). Maternal SBP, DBP, and MAP started to decrease immediately after the baby was delivered and reached a relatively stable trough state at 15-30 min after delivery. No statistical differences were found in hemodynamic indicators, the occurrence of hypotension, or in-hospital days after the procedure among the transfusion volumes < 30 ml/kg, 30-80 ml/kg, and ≥ 80 ml/kg groups. Patients with a suspected diagnosis of placenta previa accreta should plan to deliver before 37 weeks of gestation. The ability to identify concurrent placenta increta/percreta should be improved to schedule a reasonably rapid perioperative plan. Restrictive fluid resuscitation could achieve good effects in maintaining hemodynamic stability in patients with placenta previa accreta. A time period of 15-30 min after delivery is the critical stage for fluid resuscitation.

The Association of Calcium Derangements With 24-Hour Outcomes in the Deployed Combat Setting.

Calcium derangements remain poorly characterized in the combat trauma population. We describe the incidence of emergency department (ED) calcium derangements, associated physiologic derangements, and 24-hour mortality from the deployed combat setting. We analyzed adult casualties from 2007 to 2023 from the DoD Trauma Registry for U.S. military, U.S. contractor, and coalition casualties that had at least 1 ionized calcium value documented in the ED at a Role 2 or Role 3 military treatment facility. We constructed a series of multivariable logistic regression models to test for the association of hypocalcemia and hypercalcemia with physiological derangements, blood product consumption, and survival. Vital signs and other laboratory studies were based on the concurrent ED encounter. There were 941 casualties that met inclusion for this analysis with 26% (245) having at least 1 calcium derangement. Among those, 22% (211) had at least 1 episode of hypocalcemia and 5% (43) had at least 1 episode of hypercalcemia in the ED. The vast majority (97%, 917) received calcium at least once. Median composite injury severity scores were lower among those with no calcium derangement (8 versus 17, P < .001). Survival was higher during the total hospitalization (98% versus 93%) among those with calcium derangements but similar at 24 hours (99% versus 98%, P = .059). After adjusting for confounder, any hypocalcemic measurement was associated with an elevated international normalized ratio (odds ratio 1.94, 95% CI 1.19-3.16), acidosis (1.66, 1.17-2.37), tachycardia (2.11, 1.42-3.15), hypotension (1.92, 1.09-3.38), depressed Glasgow coma scale (3.20, 2.13-4.81), elevated shock index (2.19, 1.45-3.31), submassive transfusion (3.97, 2.60-6.05), massive transfusion (4.22, 2.66-6.70), supermassive transfusion (3.65, 2.07-6.43), and all hospital stay mortality (2.30, 1.00-5.29). Comparatively, any hypercalcemic measurement was associated with acidosis (2.96, 1.39-6.32), depressed Glasgow coma scale (4.28, 1.81-10.13), submassive transfusion (3.40, 1.37-8.43), massive transfusion (6.25, 2.63-14.83), and supermassive transfusion (13.00, 5.47-30.85). Both hypocalcemia and hypercalcemia in the ED were associated with physiological derangements and blood product use, with a greater extent observed in those with hypocalcemia compared to those with hypercalcemia. Prospective studies are underway to better explain and validate these findings.

Hemorrhagic shock secondary to ruptured hypogastric artery pseudoaneurysm. A rare complication of colorectal anastomotic leakage

Hemorrhagic shock secondary to ruptured hypogastric artery pseudoaneurysm. A rare complication of colorectal anastomotic leakage

Effect of SGLT2 inhibitors on kidney function of type 2 diabetes patients during Ramadan: A systematic review.

SGLT2 inhibitors are known for their osmotic diuretic effect, and their use by Muslim patients with type 2 diabetes during the fasting month of Ramadan may pose an increased risk of volume depletion, potentially impacting renal function. We conducted a systematic review registered on PROSPERO (registration number CRD42020204582) of studies published between 2013 and January 2023, sourced from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The study selection criteria included controlled studies that reported the use of SGLT2 inhibitors (SGLT2i) by fasting adult type 2 diabetes patients and provided data on creatinine or estimated glomerular filtration rate (eGFR) as outcomes. Two prospective observational studies, encompassing a total of 359 participants, of which 197 utilized SGLT2 inhibitors, were identified. Our findings indicated that the use of SGLT2 inhibitors during Ramadan did not result in a significant alteration in eGFR. In one study by Hassanein et al., the mean changes in eGFR for the SGLT2i group, as compared to the non-SGLT2i group, were -1.2 ± 19.4 and 3.1 ± 14.8, respectively (p = 0.06). In a study by Shao et al., the least squares mean changes for eGFR in the SGLT2i group, compared to the non-SGLT2i group, were -6.0 ± 1.5 (95% CI, -8.9 to -3.1) and -4.2 ± 1.6 (95% CI, -7.3 to -1.1), respectively (p = 0.39). Despite the limited number of observational studies available, our analysis suggests that the use of SGLT2 inhibitors by type 2 diabetes patients during Ramadan does not appear to significantly impact kidney function.

Liposome‐encapsulated hemoglobin rescues hemorrhagic shock heart through anti‐ischemic and anti‐arrhythmogenic effects on myocardium in repetitive 65% bleeding rat model

Liposome‐encapsulated hemoglobin rescues hemorrhagic shock heart through anti‐ischemic and anti‐arrhythmogenic effects on myocardium in repetitive 65% bleeding rat model

Cardiovascular events in crush syndrome: on-site therapeutic strategies and pharmacological investigations.

Crush syndrome often occurs after severe crush injury caused by disasters or accidents, and is associated with high mortality and poor prognosis. Cardiovascular complications, such as cardiac arrest, hypovolemic shock, and hyperkalemia-related cardiac dysfunction, are the primary causes of on-site death in crush syndrome. Prehospital evaluation, together with timely and correct treatment, is of great benefit to crush syndrome patients, which is difficult in most cases due to limited conditions. Based on current data and studies, early fluid resuscitation remains the most important on-site treatment for crush syndrome. Novel solutions and drugs used in fluid resuscitation have been investigated for their effectiveness and benefits. Several drugs have proven effective for the prevention or treatment of cardiovascular complications in crush syndrome, such as hypovolemic shock, hyperkalemia-induced cardiac complications, myocardial ischemia/reperfusion injury, ventricular dysfunction, and coagulation disorder experimentally. Moreover, these drugs are beneficial for other complications of crush syndrome, such as renal dysfunction. In this review, we will summarize the existing on-site treatments for crush syndrome and discuss the potential pharmacological interventions for cardiovascular complications to provide clues for clinical therapy of crush syndrome.

Prognostic Value of Shock Index Creatinine in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Introduction: Shock index (SI) and its derivatives have been reported to have prognostic value in various cardiovascular diseases. This study aims to ascertain the utility of shock index creatinine (SIC) in predicting mid-term mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods: We conducted a retrospective analysis of 555 patients with severe AS who underwent TAVR from April 2016 to March 2023. SIC was calculated as (SI × 100) – estimated creatinine clearance (CCr). The primary endpoint was all-cause mortality during the follow-up period, and secondary endpoints included in-hospital complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. Patients were stratified into two groups based on the optimal cutoff value determined by the receiver-operating characteristic (ROC) curve. Cox regression analysis was employed to identify independent predictors of all-cause mortality. Additionally, restricted cubic spline (RCS) was deployed to illustrate the relationship between SIC and mortality risk. The predictive performance of risk scores was evaluated using the area under the ROC curve (AUC). Results: Over a mean follow-up period of 21.5 months, there were 51 cases of all-cause mortality. Patients with a high SIC, identified by a cutoff of 16.5, exhibited a significantly higher cumulative all-cause mortality compared to those with a low SIC (18.3% vs. 5.2%, p < 0.001; adjusted HR = 2.188; 95% CI 1.103–4.341, p = 0.025). Patients with a high SIC were older (p = 0.002) and exhibited a higher prevalence of frailty (p < 0.001). Furthermore, they exhibited a heightened probability of moderate or severe mitral regurgitation (p < 0.001), tricuspid regurgitation (p < 0.001), and pulmonary hypertension (p < 0.001) compared to those with a low SIC. In terms of perioperative complications, acute kidney injury (10.1% vs. 3.9%, p = 0.008) and bleeding (13.6% vs. 6.7%, p = 0.014) were more prevalent in patients with a high SIC. The RCS demonstrated a positive correlation between SIC and all-cause mortality rate. Furthermore, incorporating high SIC into the STS score improved its predictive value for 1-year all-cause mortality (AUC: 0.731 vs. 0.649, p = 0.01). Conclusion: Patients with a high SIC are more likely to experience frailty and cardiac damage and exhibit an increased in-hospital and mid-term mortality rate. SIC may provide additional information for risk stratification of patients undergoing TAVR.

Tranexamic acid stops hyperfibrinolysis in dogs with hemorrhagic shock: a randomized, controlled clinical trial

Tranexamic acid stops hyperfibrinolysis in dogs with hemorrhagic shock: a randomized, controlled clinical trial

Whole Blood Assay with Dual Co-Stimulation for Antigen-Specific Analysis of Host Immunity to Fungal and Viral Pathogens.

Rapid and resource-efficient sample processing, high throughput, and high robustness are critical for effective scientific and clinical application of advanced antigen-specific immunoassays. Traditionally, such immunoassays, especially antigen-specific T-cell analysis by flow cytometry or enzyme-linked immunosorbent spot assays, often rely on the isolation of peripheral blood mononuclear cells. This process is time-consuming, subject to many pre-analytic confounders, and requires large blood volumes. Whole blood-based assays provide a facile alternative with increased pre-analytic robustness and lower blood volume requirements. Furthermore, whole blood-based assays allow for the preservation of inter-cellular interactions that are not captured by assays using isolated cell subsets. Recently, a refined whole blood immunoassay with dual anti-CD28 and anti-CD49d co-stimulation for comprehensive analysis of both antigen-specific T-cell functions and complex intercellular interactions in response to various fungal and viral antigens has been proposed. This protocol provides guidance for the preparation of stimulation tubes, blood stimulation, and downstream sample processing for flow cytometry, cytokine secretion assays, and transcriptional analyses. This includes a validated and functionally equivalent, previously unpublished, low-volume protocol (250 µL) to make flow cytometric and cytokine-based T-cell monitoring more accessible for studies in pediatric patients or preclinical studies in small animals (e.g., mice). Altogether, these protocols provide a versatile toolbox for complex antigen-specific immune analysis in both clinical and translational research settings.

Hemorragia digestiva grave debido a ectasia vascular de yeyuno

Introduction: bleeding from the small bowel represents 5% of all cases of gastrointestinal (GI) bleeding and is mainly due to vascular malformations. Diagnosis is made by capsule endoscopy, although it depends on the patient´s condition as well as capsule endoscopy availability. Case report: a 22-year-old female patient presenting with hematochezia leading to hypovolemic shock and cardiorespiratory arrest, with negative upper and lower GI endoscopies. Given the impossibility of accessing capsule endoscopy, a surgical intervention was performed which identified jejunal vascular ectasia.

ĐẶC ĐIỂM DỊCH TỄ LÂM SÀNG, CẬN LÂM SÀNG BỆNH SỐT XUẤT HUYẾT DENGUE Ở TRẺ EM TẠI BỆNH VIỆN SẢN NHI NGHỆ AN

Dengue hemorrhagic fever is rising in many localities nationwide, including Nghe An. The movement of people carrying the Dengue virus increases the risk of an outbreak. The study aimed to describe dengue's epidemiological, clinical and paraclinical characteristics in children. The results show that children living in rural areas have a higher infection rate than those in urban areas; the disease frequency is mainly in the rainy season from August to December. There are 50% of children hospitalized in the early stages of the disease. The danger of the disease is that common clinical symptoms are joint pain and muscle fatigue; tired, abdominal pain in the liver area, and enlarged liver; Hemorrhagic manifestations, of which subcutaneous bleeding is the most common; 4.7% had symptoms of shock due to dengue fever; 31.3% had a platelet count reduced below 50.109/l. Subclinical liver enzymes (GOT, GPT) increased mainly at mild and moderate levels. Dengue IgM and Dengue NS1Ag tests appeared in 3 stages of the disease; Dengue IgG only appeared in the later stages, in which the recovery phase accounts for the highest rate. Dengue hemorrhagic fever can have clinical manifestations ranging from mild to severe, with complications of hypovolemic shock that can potentially lead to cardiovascular collapse, severe organ failure shock or severe bleeding. If not detected and treated promptly, it can lead to death, especially in children. Keywords: Dengue hemorrhagic fever; children; Nghe An Obstetrics and Pediatrics Hospital.

MASSIVE HEMORRHAGE DUE TO RUPTURE OF A RIGHT ILIAC ANEURYSM REVEALING BEHCET'S DISEASE: A CASE REPORT FROM THE FESTOC CENTER IN BAMAKO

INTRODUCTION: Behçet's disease is a chronic inflammatory disorder. It is clinically characterized by oral and genital aphthoses; skin lesions and systemic manifestations. Arterial aneurysms are defined as a loss of parallelism of the arterial walls, localized to an arterial segment, and corresponding to an increase of at least 50% of the normal arterial diameter. We report a case of Behcet's disease revealed by a ruptured aneurysm of the right primitive iliac artery. OBSERVATION: This was a 44-year-old patient with no known history, referred for management of a right inguinal mass that had progressively increased in volume and had been evolving for about 1 month. On admission, the physical examination revealed conjunctival pallor, a pulsatile right inguinal mass approximately 10 cm in diameter, and a suppurating sore on the scrotum. Doppler ultrasound of the lower limbs revealed an aneurysm of the right common iliac artery. The aneurysm ruptured during the short preparation period for surgery, resulting in cataclysmic hemorrhage. This prompted manual compression and the transfusion of several packed red blood cells. During transport to the OR, the patient experienced hemorrhagic shock and altered consciousness, prompting the administration of drugs (noradrenaline) and emergency orotracheal intubation. The aneurysm was controlled upstream and downstream by approaching the right primitive iliac artery, followed by dissection and clamping after general heparinization. The common femoral artery was then approached and checked. Surgical exploration revealed numerous clots which were evacuated, revealing a large neck extending over 7 cm. The procedure involved reconstruction of the common femoral artery with a patch saphenous graft and excision of the necrotic tissue. The post-operative course was marked by suppuration of the surgical wound, which progressed well with appropriate antibiotics and local care. CONCLUSION: Arterial involvement in Behçet's disease manifests as arterial thrombosis or, more frequently, aneurysm. This is due to inflammation of the media, intima and vasa vasorum. Their management can be envisaged in our context.

Pharmaceutical Interventions for the Management of Hemorrhagic Shock in Hepatic Surgery: An Experimental Swine Model Outcome.

Introduction During abdominal trauma or major hepatic surgery, the liver can be subjected to hypoxic conditions due to hemorrhage, leading to various degrees of ischemic injury to hepatocytes. Hemorrhagic shock, a critical and life-threatening condition, often complicates hepatic surgery due to massive blood loss, resulting in inadequate tissue perfusion and oxygenation. The challenge in managing hemorrhagic shock in hepatic surgery is heightened by the liver's unique blood supply and its crucial role in coagulation. Effective treatment requires a multifaceted approach, including surgical intervention, blood transfusions, and pharmaceutical therapy to stabilize hemodynamics and promote coagulation. Additionally, reperfusion of the liver after resuscitation can cause severe injury through inflammatory and oxidative pathways, potentially leading to multiple organ dysfunction. This study examines the effectiveness of combining standard fluid therapy with antioxidants (bucillamine and valproic acid) in mitigating oxidative stress and reducing hepatocyte damage in the context of hemorrhagic shock. Method Thirty male swine were randomly divided into four groups as follows: Group A (n=6/control group), Group B (n=8), Group C (n=8), and Group D (n=8). A resection of the left liver lobe was performed, followed by the controlled loss of a specific volume of blood until the mean arterial pressure dropped to between 30 and 40 mmHg. The animals were maintained in this state of hypovolemic shock for 50 minutes, followed by IV administration of fluids. Additionally, pharmaceutical agents were administered to Groups B (bucillamine), C (valproic acid), and D (combination of bucillamine and valproic acid). The experiment lasted six hours in total. Results The study showed that animals treated with pharmaceutical agents like bucillamine and valproic acid and their combination demonstrated significantly reduced serum levels of protein carbonyls (PCs) and thiobarbituric acid reactive substances (TBARS) compared to the control group. Furthermore, histological evaluation of liver tissues revealed that treated animals showed reduced histopathological signs of injury, suggesting that the pharmaceutical agents not only lowered biochemical markers of oxidative stress but also provided a protective effect against liver damage in the context of hemorrhagic shock. Conclusion These findings suggest that incorporating antioxidant therapy into resuscitation protocols may offer substantial benefits in mitigating hepatic damage associated with hemorrhagic shock. This approach could potentially improve outcomes in clinical settings where oxidative stress plays a critical role in injury progression by better understanding the pathophysiology of this complex and dynamic process.

Epidemiological Study and Seropositivity in Viral Panel Testing Among Corneal Tissue Donors.

Corneal tissue is a critical component for vision restoration through transplantation, yet the availability of suitable corneal tissue is limited. This limitation results in long waiting lists and high demand, especially in countries with lower donation rates compared to global benchmarks. In Mexico, the corneal donation rate remains significantly behind other Latin American countries and leading nations such as Spain. Understanding the characteristics of corneal tissue donors is essential for improving donation practices and addressing the shortage of available tissues. This descriptive retrospective study analyzed electronic medical records of cadaveric corneal donors at the General Regional Hospital 1 of the Mexican Social Security Institute of Querétaro from January 2022 to December 2023. Donors were included based on criteria such as age (2-85 years) and known cause of death. Exclusion criteria included age outside the specified range, neoplastic diseases, active systemic infections, and prior ocular surgeries. Serological testing for human immunodeficiency virus (HIV), Venereal Disease Research Laboratory (VDRL), coronavirus disease 2019 (COVID-19), hepatitis B virus (HBV), and hepatitis C virus (HCV was performed to assess viral reactivity. Statistical analyses were conducted usingIBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), summarizing data with descriptive statistics. The study included 185 corneal donors with a mean age of 56.34 years. The majority were male (109; 58.9%), and the leading causes of death were cardiogenic shock (34; 18.4%), hypovolemic shock (31; 16.8%), and acute respiratory failure (30; 16.2%). Exclusion due to positive serological tests included seven donors (3.8%) for HIV and seven (3.8%) for SARS-CoV-2. A total of 16 donors (8.6%) were excluded due to positive results in the viral serological panel. The most common comorbidities were chronic kidney disease (36; 19.5%), type 2 diabetes mellitus (28; 15.1%), and systemic hypertension (31; 16.8%). The study highlights a predominantly male donor profile with a mean age of 56.34 years and emphasizes cardiogenic shock as a leading cause of death. The notably higher seropositivity rate of 8.6% for various viral infections compared to international reports indicates a need for improved health interventions and screening processes. The focus on cardiovascular and respiratory causes of death underscores regional health issues affecting donation patterns. To address the organ and tissue donation shortfall, it is crucial to enhance coordination within donation teams and increase public awareness, given the significant gap in donation rates compared to leading countries.

Cornual Ectopic Pregnancy Rupture Early Diagnosis and Treatment: A Case Report

Cornual pregnancy is a severe form of ectopic pregnancy, comprising 2-4% of such cases and presenting a mortality rate 6-7 times higher than typical ectopic pregnancies. It is often confused with interstitial pregnancy which arises from the implantation of the gestational sac in the myometrium’s proximal part. Diagnosis and treatment are challenging and considered medical emergencies due to potential for significant maternal haemorrhage. This is a case report of a 26-year-old woman in hypovolemic shock due to a ruptured ectopic pregnancy, confirmed via ultrasound and treated with emergency laparotomy, revealing a left corneal ectopic pregnancy, which was successfully repaired.

Rupture of liver myelolipoma in a patient who underwent mitral valve replacement 16 years ago: A case report.

Myelolipoma is a rarely encountered benign tumour of the liver. Patients may be asymptomatic or may present with clinical signs such as silent hepatomegaly, pain in the right upper quadrant of the abdomen, and anorexia. The patient, who had a history of mitral valve replacement, had been on warfarin for 16 years. The pain, which began in the right upper quadrant of the abdomen two days ago, has since spread to the entire abdomen. The patient, who was in hypovolemic shock, underwent an exploratory laparotomy with a preliminary diagnosis of bleeding. During the procedure, a ruptured mass in the liver was incidentally discovered. Histopathological and immunohistochemical examinations revealed that the mass consisted of fat and bone marrow cells, leading to a definitive diagnosis of myelolipoma. To the best of our knowledge, this is the first reported case of spontaneous rupture of a liver myelolipoma in the literature.