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Main Author:	Carlos Adrián Pérez-Martínez
Format:	Artículo científico
Language:	es
Published:	Instituto Mexicano del Seguro Social 2020
Subjects:	Medicina 19 COVID Pandemias Trombocitopenia Infecciones por Coronavirus
Online Access:	https://www.redalyc.org/articulo.oa?id=457769376026 https://www.redalyc.org/journal/4577/457769376026/ https://www.redalyc.org/journal/4577/457769376026/html/ https://www.redalyc.org/journal/4577/457769376026/457769376026.epub https://www.redalyc.org/journal/4577/457769376026/movil https://doi.org/10.24875/RMIMSS.M20000147
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Trombocitopenia inmune secundaria a COVID-19: reporte de un caso Carlos Adrián Pérez-Martínez Brandon Enrique Casados-Rodríguez Fernando Padilla-Santamaría Medicina 19 COVID Pandemias Trombocitopenia Infecciones por Coronavirus Introducción: el virus del SARS-CoV-2, el cual surgió a finales de 2019 en la provincia de Wuhan, China, ha mostrado un espectro amplio de manifestaciones, algunas de las cuales comparte con algunos trastornos autoinmunes. La asociación del SARS-CoV-2 con la trombocitopenia inmune (TIP) es hasta ahora poco entendida, pues todavía no se conocen los mecanismos que expliquen la compleja relación entre estos dos estados protrombóticos. Caso clínico: se presenta el caso de una mujer de 66 años, sin antecedentes crónicos, que acudió al Servicio de Urgencias por sintomatología respiratoria. Se realizó prueba de reacción en cadena de la polimerasa con transcriptasa reversa, la cual fue positiva para SARS-CoV-2. En los estudios de laboratorio se encontró trombocitopenia aislada que se protocolizó, por lo que se descartaron otras causas de esta y se diagnosticó TIP secundaria a COVID-19. Se inició tratamiento con esteroides intravenosos y se obtuvo una respuesta completa. Conclusiones: la asociación de TIP y COVID-19 es hasta ahora poco clara y plantea retos en el tratamiento. Los esteroides continúan siendo de primera elección con la indicación de disminuir su dosis y duración a las mínimas necesarias. Otros tratamientos de segunda línea plantean más dudas que respuestas en el contexto de esta pandemia. 2020 artículo científico 0443-5117 https://www.redalyc.org/articulo.oa?id=457769376026 https://www.redalyc.org/journal/4577/457769376026/ https://www.redalyc.org/journal/4577/457769376026/html/ https://www.redalyc.org/journal/4577/457769376026/457769376026.epub https://www.redalyc.org/journal/4577/457769376026/movil https://doi.org/10.24875/RMIMSS.M20000147 es http://www.redalyc.org/revista.oa?id=4577 Revista Médica del Instituto Mexicano del Seguro Social application/pdf Instituto Mexicano del Seguro Social Revista Médica del Instituto Mexicano del Seguro Social (México) Num.2 Vol.58

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// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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