<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092024000800664</article-id>
<article-id pub-id-type="doi">10.35366/120013</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Relación de la hiperreflexia con los biomarcadores antiangiogénicos y proangiogénicos (sFlt-1, PlGF) en preeclampsia con criterios de severidad y eclampsia]]></article-title>
<article-title xml:lang="en"><![CDATA[Relationship of hyperreflexia with antiangiogenic and proangiogenic biomarkers (sFlt-1, PlGF) in preeclampsia with severity criteria and eclampsia]]></article-title>
<article-title xml:lang="pt"><![CDATA[Relação da hiperreflexia com os biomarcadores antiangiogênicos e proangiogênicos (sFlt-1, PlGF) na pré-eclâmpsia com critérios de gravidade e eclâmpsia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zúñiga Ramírez]]></surname>
<given-names><![CDATA[Aldo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montelongo]]></surname>
<given-names><![CDATA[Felipe de Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Suárez Suárez]]></surname>
<given-names><![CDATA[Araceli]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Galindo Ayala]]></surname>
<given-names><![CDATA[Jonathan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrera Morales]]></surname>
<given-names><![CDATA[Blanca Estela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Calderón Magallán]]></surname>
<given-names><![CDATA[Nancy Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Instituto de Salud del Estado de México Hospital General Las Américas]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital General de Zona 197 ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital General Regional No. 196 ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto de Salud del Estado de México Laboratorio Estatal de Salud Pública ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>8</numero>
<fpage>664</fpage>
<lpage>668</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092024000800664&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092024000800664&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092024000800664&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[resumen está disponible en el texto completo]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  preeclampsia is a syndrome that presents after the 20th week of gestation and is characterized by arterial hypertension and proteinuria, or hypertension with organ dysfunction. Symptoms include visual disturbances, headache, abdominal pain, thrombocytopenia and liver dysfunction, resulting from microangiopathy in organs such as the brain, liver, kidneys and placenta. Widespread endothelial dysfunction causes these signs and in the neurological setting, hyperreflexia may indicate neuronal damage in the cerebral cortex due to cytotoxic edema, which can lead to clonus and seizures. The «Las Americas General Hospital and Intensive Care Scale» helps to assess deep osteotendinous reflexes in these patients. During pregnancy, placentation requires angiogenesis for an adequate vascular network. An imbalance between proangiogenic factors (such as VEGF and PlGF) and antiangiogenic factors (such as sFlt-1) can cause endothelial dysfunction and preeclampsia. Although these biomarkers are useful in predicting disease, their relationship with neurological manifestations such as hyperreflexia in severe preeclampsia or eclampsia has not been studied.  Objective:  to determine whether there is association with the presence of hyperreflexia and its degrees with levels of sFlt-1, PlGF and sFlt-1/PlGF ratio in preeclampsia with severity criteria and eclampsia.  Material and methods:  a prospective and analytical study was performed in the intensive care unit of Hospital General «Las Americas» which was carried out from August 31, 2023 to April 5, 2024, included the measurement of serum levels of sFlt-1 and PlGF, and the evaluation of osteotendinous reflexes using a validated scale. Blood samples were processed in a central laboratory and results were obtained in approximately 48 hours. Data were analyzed with SPSS using medians and statistical tests, such as Kruskal-Wallis, to determine the relationship between biomarkers and hyperreflexia.  Results:  ninety-six patients were included, of whom 63 had preeclampsia with severity criteria; all received magnesium sulfate treatment. 88.5% showed elevated sFlt-1 levels and 84.2% had increased or severe hyperreflexia. The median sFlt-1 in patients with severe hyperreflexia was 2186 pg/ml, indicating a positive relationship between sFlt-1 and hyperreflexia. Although the cutoff value for the sFlt-1/PlGF ratio varied with gestational weeks, no significance was found in the values measured in the study. The Kruskal-Wallis test showed a significant difference (p = 0.018) between sFlt-1 levels and degree of hyperreflexia, confirming that higher sFlt-1 levels are associated with higher degree of hyperreflexia.  Conclusions:  hyperreflexia in preeclampsia is associated with endothelial dysfunction, cerebral perfusion problems, and high sFlt-1 levels. Knowing this relationship may help to improve the evaluation and management of preeclampsia, making osteotendinous reflex scanning a useful tool at any level of medical care.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  a pré-eclâmpsia é uma síndrome que ocorre após a 20ª semana de gestação e se caracteriza por hipertensão arterial e proteinúria, ou hipertensão com disfunção orgânica. Os sintomas incluem distúrbios visuais, cefaleia, dor abdominal, trombocitopenia e disfunção hepática, resultantes de microangiopatia em órgãos como cérebro, fígado, rins e placenta. A disfunção endotelial generalizada causa esses sinais e, no quadro neurológico, a hiperreflexia pode indicar dano neuronal no córtex cerebral devido ao edema citotóxico, que pode levar a clônus e convulsões. A «Escala do Hospital Geral Las Américas e Terapia Intensiva» ajuda a avaliar os reflexos osteotendinosos profundos nesses pacientes. Durante a gravidez, a placentação requer angiogênese para uma rede vascular adequada. Um desequilíbrio entre fatores pró-angiogênicos (como VEGF e PlGF) e fatores antiangiogênicos (como sFlt-1) pode causar disfunção endotelial e pré-eclâmpsia. Embora estes biomarcadores sejam úteis para prever a doença, a sua relação com manifestações neurológicas como a hiperreflexia na pré-eclâmpsia grave ou na eclâmpsia não foi estudada.  Objetivo:  determinar se existe uma associação entre a presença de hiperreflexia e os seus graus com os níveis de sFlt-1, PlGF e o rácio sFlt-1/PlGF na pré-eclâmpsia com critérios de gravidade e na eclâmpsia.  Material e métodos:  foi realizado um estudo prospectivo e analítico na unidade de terapia intensivos do Hospital Geral «Las Américas» de 31 de agosto de 2023 a 5 de abril de 2024, incluindo a medição dos níveis séricos de sFlt-1 e PlGF, e a avaliação dos reflexos osteotendinosos utilizando uma escala validada. As amostras de sangue foram processadas em laboratório central e os resultados foram obtidos em aproximadamente 48 horas. Os dados foram analisados no SPSS por meio de medianas e testes estatísticos, como Kruskal-Wallis, para determinar a relação entre biomarcadores e hiperreflexia.  Resultados:  foram incluídas 96 pacientes, das quais 63 apresentavam pré-eclâmpsia com critérios de gravidade, todas recebendo tratamento com sulfato de magnésio. 88.5% apresentaram níveis elevados de sFlt-1 e 84.2% apresentaram hiperreflexia aumentada ou grave. A mediana do sFlt-1 em pacientes com hiperreflexia grave foi de 2186 pg/ml, indicando uma relação positiva entre sFlt-1 e hiperreflexia. Embora o valor de corte para a relação sFlt-1/PlGF tenha variado com as semanas de gestação, não foi encontrada significância nos valores medidos no estudo. O teste de Kruskal-Wallis mostrou diferença significativa (p = 0.018) entre os níveis de sFlt-1 e o grau de hiperreflexia, confirmando que níveis mais elevados de sFlt-1 estão associados a um maior grau de hiperreflexia.  Conclusão:  a hiperreflexia na pré-eclâmpsia está associada à disfunção endotelial, problemas de perfusão cerebral e níveis elevados de sFlt-1. Conhecer essa relação pode ajudar a melhorar a avaliação e o manejo da pré-eclâmpsia, tornando o exame dos reflexos tendinosos profundos uma ferramenta útil em qualquer nível de atendimento médico.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[preeclampsia]]></kwd>
<kwd lng="es"><![CDATA[preeclampsia con criterios de severidad]]></kwd>
<kwd lng="es"><![CDATA[eclampsia]]></kwd>
<kwd lng="es"><![CDATA[sFlt-1]]></kwd>
<kwd lng="es"><![CDATA[PlGF]]></kwd>
<kwd lng="es"><![CDATA[relación sFlt-1/PlGF]]></kwd>
<kwd lng="es"><![CDATA[hiperreflexia]]></kwd>
<kwd lng="en"><![CDATA[preeclampsia]]></kwd>
<kwd lng="en"><![CDATA[preeclampsia with severity criteria]]></kwd>
<kwd lng="en"><![CDATA[eclampsia]]></kwd>
<kwd lng="en"><![CDATA[sFlt-1]]></kwd>
<kwd lng="en"><![CDATA[PlGF]]></kwd>
<kwd lng="en"><![CDATA[sFlt-1/PlGF ratio]]></kwd>
<kwd lng="en"><![CDATA[hyperreflexia]]></kwd>
<kwd lng="pt"><![CDATA[pré-eclâmpsia]]></kwd>
<kwd lng="pt"><![CDATA[pré-eclâmpsia com critérios de gravidade]]></kwd>
<kwd lng="pt"><![CDATA[eclâmpsia]]></kwd>
<kwd lng="pt"><![CDATA[sFlt-1]]></kwd>
<kwd lng="pt"><![CDATA[PlGF]]></kwd>
<kwd lng="pt"><![CDATA[relação sFlt-1/PlGF]]></kwd>
<kwd lng="pt"><![CDATA[hiperreflexia]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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