metricas
covid
Buscar en
Medicina Clínica
Toda la web
Inicio Medicina Clínica Síndrome hemolítico urémico en puérpera con preeclampsia sin criterios de gr...
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Carta al Editor
Síndrome hemolítico urémico en puérpera con preeclampsia sin criterios de gravedad
Uremic hemolytic syndrome in puerperal with non-severe pre-eclampsia
Marta Avella Marcos
Autor para correspondencia
mavella@hsjdbcn.es

Autor para correspondencia.
, María Dolores Gómez-Roig, Eduardo Gonzalez-Bosquet
Servicio de Ginecología y Obstetricia, Hospital Sant Joan de Déu, BCNatal, Barcelona Barcelona. España
Leído
4
Veces
se ha leído el artículo
0
Total PDF
4
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S0025775323001161"
  "issn" => "00257753"
  "doi" => "10.1016/j.medcli.2023.01.026"
  "estado" => "S300"
  "fechaPublicacion" => "2023-06-23"
  "aid" => "6214"
  "copyright" => "Elsevier España, S.L.U.. Todos los derechos reservados"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Med Clin. 2023;160:e17-e18"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S2387020623002139"
      "issn" => "23870206"
      "doi" => "10.1016/j.medcle.2023.06.003"
      "estado" => "S300"
      "fechaPublicacion" => "2023-06-23"
      "aid" => "6214"
      "copyright" => "Elsevier España, S.L.U."
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Med Clin. 2023;160:e17-e18"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "Uremic hemolytic syndrome in puerperal with non-severe pre-eclampsia"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e17"
            "paginaFinal" => "e18"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "S&#237;ndrome hemol&#237;tico ur&#233;mico en pu&#233;rpera con preeclampsia sin criterios de gravedad"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Marta Avella Marcos, Mar&#237;a Dolores G&#243;mez-Roig, Eduardo Gonzalez-Bosquet"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Marta"
                "apellidos" => "Avella Marcos"
              ]
              1 => array:2 [
                "nombre" => "Mar&#237;a Dolores"
                "apellidos" => "G&#243;mez-Roig"
              ]
              2 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "Gonzalez-Bosquet"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "es" => array:9 [
          "pii" => "S0025775323001161"
          "doi" => "10.1016/j.medcli.2023.01.026"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "es"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323001161?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002139?idApp=UINPBA00004N"
      "url" => "/23870206/0000016000000012/v1_202306191131/S2387020623002139/v1_202306191131/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0025775323001483"
    "issn" => "00257753"
    "doi" => "10.1016/j.medcli.2023.02.018"
    "estado" => "S300"
    "fechaPublicacion" => "2023-06-23"
    "aid" => "6223"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Clin. 2023;160:e19-e20"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
      "titulo" => "Infecci&#243;n urinaria por <span class="elsevierStyleItalic">Streptococcus thoraltensis</span>"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e19"
          "paginaFinal" => "e20"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Urinary tract infection by <span class="elsevierStyleItalic">Streptococcus thoraltensis</span>"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ingrid Eunice Salazar Brise&#241;o, Mario Alberto Ley Soler, Oscar Sosa Hern&#225;ndez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Ingrid Eunice"
              "apellidos" => "Salazar Brise&#241;o"
            ]
            1 => array:2 [
              "nombre" => "Mario Alberto"
              "apellidos" => "Ley Soler"
            ]
            2 => array:2 [
              "nombre" => "Oscar"
              "apellidos" => "Sosa Hern&#225;ndez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2387020623002140"
        "doi" => "10.1016/j.medcle.2023.02.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002140?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323001483?idApp=UINPBA00004N"
    "url" => "/00257753/0000016000000012/v1_202306120952/S0025775323001483/v1_202306120952/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0025775323001100"
    "issn" => "00257753"
    "doi" => "10.1016/j.medcli.2023.02.011"
    "estado" => "S300"
    "fechaPublicacion" => "2023-06-23"
    "aid" => "6209"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Clin. 2023;160:e15-e16"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
      "titulo" => "Respuesta"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e15"
          "paginaFinal" => "e16"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Reply"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Pablo Ruiz Sada, Lara Palacios Garc&#237;a, Aitziber Echeverria Echeverria"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Pablo"
              "apellidos" => "Ruiz Sada"
            ]
            1 => array:2 [
              "nombre" => "Lara"
              "apellidos" => "Palacios Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "Aitziber"
              "apellidos" => "Echeverria Echeverria"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2387020623002115"
        "doi" => "10.1016/j.medcle.2023.02.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002115?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323001100?idApp=UINPBA00004N"
    "url" => "/00257753/0000016000000012/v1_202306120952/S0025775323001100/v1_202306120952/es/main.assets"
  ]
  "es" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
    "titulo" => "S&#237;ndrome hemol&#237;tico ur&#233;mico en pu&#233;rpera con preeclampsia sin criterios de gravedad"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Sr&#46; Editor&#44;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e17"
        "paginaFinal" => "e18"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Marta Avella Marcos, Mar&#237;a Dolores G&#243;mez-Roig, Eduardo Gonzalez-Bosquet"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Marta"
            "apellidos" => "Avella Marcos"
            "email" => array:1 [
              0 => "mavella@hsjdbcn.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Mar&#237;a Dolores"
            "apellidos" => "G&#243;mez-Roig"
          ]
          2 => array:2 [
            "nombre" => "Eduardo"
            "apellidos" => "Gonzalez-Bosquet"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Ginecolog&#237;a y Obstetricia&#44; Hospital Sant Joan de D&#233;u&#44; BCNatal&#44; Barcelona Barcelona&#46; Espa&#241;a"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Uremic hemolytic syndrome in puerperal with non-severe pre-eclampsia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El s&#237;ndrome hemol&#237;tico ur&#233;mico at&#237;pico &#40;SHUa&#41; se caracteriza por presentar anemia hemol&#237;tica no autoinmune&#44; trombocitopenia y fallo renal agudo&#46; Es una variante de la microangiopat&#237;a tromb&#243;tica&#44; causado por una excesiva activaci&#243;n del complemento microvascular<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nuestro objetivo al presentar este caso es alertar sobre el infradiagn&#243;stico de esta enfermedad y sus consecuencias&#44; as&#237; como proveer herramientas para un correcto diagn&#243;stico diferencial&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Presentamos el caso de una primigesta de 34 a&#241;os de 34&#44;2 semanas de gestaci&#243;n &#40;sg&#41; con preeclampsia leve&#59; el feto mostraba un crecimiento intrauterino restringido tipo 1&#46; No constaban antecedentes personales&#44; quir&#250;rgicos ni obst&#233;tricos de inter&#233;s&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ingres&#243; para inducci&#243;n al parto debido a unos factores angiog&#233;nicos de 300&#46; Al d&#237;a siguiente&#44; a las 34&#44;3<span class="elsevierStyleHsp" style=""></span>sg&#44; se realiz&#243; ces&#225;rea de recurso por inducci&#243;n fallida&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A las 2<span class="elsevierStyleHsp" style=""></span>h de la intervenci&#243;n la paciente present&#243; una hemorragia posparto que se resolvi&#243; con medidas farmacol&#243;gicas&#44; estando hemodin&#225;micamente estable en todo momento&#46; Se realiz&#243; hemograma de control a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; objetiv&#225;ndose anemia con valores de LDH aumentados&#44; trombocitopenia&#44; leucocitosis moderada&#44; perfil renal alterado con perfil hep&#225;tico normal&#46; El an&#225;lisis de sangre a las 24<span class="elsevierStyleHsp" style=""></span>h presentaba&#58; hemoglobina 6&#44;6<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;12-16<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;&#44; hematocrito 19&#37; &#40;36-46&#37;&#41;&#44; plaquetas 25&#46;000&#47;mm<span class="elsevierStyleSup">3</span> &#40;150-500&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; leucocitos 18&#46;000&#47;mm<span class="elsevierStyleSup">3</span> &#40;4-5-13&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; creatinina 1&#44;52<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;0&#44;6-1&#44;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; En la siguiente anal&#237;tica de seguimiento se evidenci&#243; un empeoramiento de los par&#225;metros contempl&#225;ndose C3 y C4 disminuidos&#46; Se orient&#243; el caso como s&#237;ndrome hemol&#237;tico ur&#233;mico &#40;SHU&#41; &#40;trombocitopenia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>anemia hemol&#237;tica<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>fallo renal&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se ampli&#243; el estudio a&#241;adiendo ADAMS 13&#44; Shiga toxina y mult&#237;meros de factor Von Willebrand con resultados en rangos dentro de la normalidad&#44; descartando SHU t&#237;pico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se inici&#243; tratamiento con un anticuerpo monoclonal que inhibe la activaci&#243;n del complemento C5 &#40;eculizumab&#41;&#46; Previamente al inicio del f&#225;rmaco se administraron vacunas contra g&#233;rmenes encapsulados y profilaxis antibi&#243;tica con amoxicilina 500<span class="elsevierStyleHsp" style=""></span>mg&#47;12 para prevenir la infecci&#243;n debido a una disminuci&#243;n de la inmunidad ante la administraci&#243;n de dicho f&#225;rmaco&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La paciente present&#243; una sustancial mejor&#237;a cl&#237;nica y anal&#237;tica y dada la estabilidad de las constantes en planta se decidi&#243; el alta a domicilio con seguimiento en la unidad y con el servicio de Nefrolog&#237;a&#46; Se realizaron test gen&#233;ticos de manera ambulatoria destacando anticuerpos anti-FH positivos a t&#237;tulo d&#233;bil y presentando una mutaci&#243;n de plasmin&#243;geno y polimorfismos de riesgo&#46; Se decidi&#243; tratamiento cada 2 semanas con eculizumab y revaloraci&#243;n a los 6 meses&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En cuanto al SHU se ha clasificado en t&#237;pico y at&#237;pico&#44; siendo el primero frecuente en ni&#241;os y es causado por infecciones ent&#233;ricas&#46; El SHU at&#237;pico se asocia a pacientes con mutaciones en el sistema del complemento y suele requerir un desencadenante<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> como hipertensi&#243;n maligna&#44; septicemia e infecciones&#44; enfermedades autoinmunes&#44; gestaci&#243;n&#44; s&#237;ndrome de HELLP o puerperio&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El diagn&#243;stico diferencial de la microangiopat&#237;a durante la gestaci&#243;n incluye&#58; p&#250;rpura trombocitop&#233;nica tromb&#243;tica &#40;PTT&#41;&#44; SHU&#44; coagulaci&#243;n intravascular diseminada&#44; preeclampsia&#44; eclampsia y s&#237;ndrome de HELLP &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; En nuestro caso la sospecha cl&#237;nica se inclinaba hacia un SHU o un HELLP incompleto&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">El tratamiento de esta enfermedad&#44; seg&#250;n la bibliograf&#237;a&#44; se basa en dos l&#237;neas&#58; la plasmaf&#233;resis y el eculizumab&#46; La revisi&#243;n sistem&#225;tica de Gupta et al&#46; concluye que las mujeres tratadas con eculizumab ten&#237;an tasas m&#225;s altas de remisi&#243;n con menos casos de fallo renal y di&#225;lisis persistente<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3-5</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se ha objetivado que los antecedentes de complicaciones obst&#233;tricas&#44; incluyendo la preeclampsia&#44; hemorragia posparto y muerte fetal&#44; en el desarrollo del SHU o de cualquier microangiopat&#237;a son frecuentes&#46; Por ello&#44; la limitaci&#243;n para realizar el diagn&#243;stico diferencial de esta enfermedad tiene un alto grado de dificultad&#44; dado que puede coexistir con otras complicaciones obst&#233;tricas y el tratamiento precoz es vital&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Consideraciones &#233;ticas</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se ha informado a la paciente y se ha obtenido la firma del consentimiento informado&#46; Se ha garantizado la protecci&#243;n de la privacidad en todo momento&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financiaci&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">No ha habido financiaci&#243;n&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicto de intereses</span><p id="par0075" class="elsevierStylePara elsevierViewall">En este trabajo no ha habido ning&#250;n conflicto de inter&#233;s&#46; Los autores declaran que no hay objetivos financieros&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Consideraciones &#233;ticas"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Financiaci&#243;n"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicto de intereses"
        ]
        3 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preeclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HELLP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PTT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SHU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#237;gado graso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muy com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muy com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ntomas neurol&#243;gicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muy com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trombocitopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hem&#243;lisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperbilirrubinemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transaminasemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Com&#250;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#233;ficit ADAMTS13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30-100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90-100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trimestre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;<span class="elsevierStyleSup">o</span> o 3&#46;<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posnatal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;<span class="elsevierStyleSup">o</span> o 3&#46;<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagn&#243;stico diferencial</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic sensitivity of extended renal and hematologic criteria to define hemolytic uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Balestracci"
                            1 => "L&#46;M&#46; Battaglia"
                            2 => "I&#46; Toledo"
                            3 => "S&#46;M&#46; Martin"
                            4 => "I&#46; Puyol"
                            5 => "L&#46; Beaudoin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5546/aap.2021.eng.238"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Argent Pediatr&#46;"
                        "fecha" => "2021"
                        "volumen" => "119"
                        "paginaInicial" => "238"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34309299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical uraemic haemolytic syndrome in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;A&#46; P&#233;rez-Calatayud"
                            1 => "J&#46;C&#46; Briones-Gardu&#241;o"
                            2 => "M&#46;D&#46;P&#46; &#193;lvarez-Goris"
                            3 => "R&#46; S&#225;nchez Zamora"
                            4 => "A&#46;A&#46; Torres Aguilar"
                            5 => "R&#46;E&#46; Mendoza-Morales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Cir&#46;"
                        "fecha" => "2016"
                        "volumen" => "84"
                        "paginaInicial" => "344"
                        "paginaFinal" => "349"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Where are we with haemolytic uremic syndrome&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Cavero"
                            1 => "M&#46; Alonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;&#46;"
                        "fecha" => "2018"
                        "volumen" => "151"
                        "paginaInicial" => "329"
                        "paginaFinal" => "335"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical Hemolytic-Uremic Syndrome&#58; An Update on Pathophysiology&#44; Diagnosis&#44; and Treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Raina"
                            1 => "V&#46; Krishnappa"
                            2 => "T&#46; Blaha"
                            3 => "T&#46; Kann"
                            4 => "W&#46; Hein"
                            5 => "L&#46; Burke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ther Apher Dial&#46;"
                        "fecha" => "2019"
                        "volumen" => "23"
                        "paginaInicial" => "4"
                        "paginaFinal" => "21"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy-Associated Atypical Hemolytic Uremic Syndrome&#58; A Systematic Review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Gupta"
                            1 => "S&#46; Govindappagari"
                            2 => "R&#46;M&#46; Burwick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AOG.0000000000003554"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol&#46;"
                        "fecha" => "2020"
                        "volumen" => "135"
                        "paginaInicial" => "46"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31809447"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/00257753/0000016000000012/v1_202306120952/S0025775323001161/v1_202306120952/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "66430"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Cartas al Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00257753/0000016000000012/v1_202306120952/S0025775323001161/v1_202306120952/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323001161?idApp=UINPBA00004N"
]
Información del artículo
ISSN: 00257753
Idioma original: Español
Datos actualizados diariamente
año/Mes Html Pdf Total
2023 Julio 2 0 2
2023 Junio 2 0 2

Siga este enlace para acceder al texto completo del artículo

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos