Background: Acute appendicitis diagnosis is still challenging and is established with clinical history, physical exam, laboratory tests, and imaging studies. It´s crucial to analyze the blood biometry with physiopathological asses and not with a statistical approach for establishing diagnostic items. The interaction between neutrophils with monocytes is noticeable in the blood biometry, so its relationship could be explained as directly proportional to the neutrophils count because of cellular recruitment and inversely proportional to the monocyte count because of cellular migration. Methods: A retrospective, transversal and analytic study was conducted, admission blood biometry of all patients (n=160) that went through appendectomy in Pemex´s North Central Hospital between 2014 and 2019 were dissected. Statistical correlation between sensibility and likelihood ratio of granulocyte/monocyte ratio (GMR), leucocyte elevation, and left shift of neutrophil count were contrasted. IBM® SPSS© statistical software performed the statistical analysis. Results: GMR (1.00) sensitivity showed to be superior to leukocytosis (0.785) and percentage neutrophils (0.846). the same for the negative likelihood ratios (LR-) calculated for GMR (0.00), leukocytosis (0.59) and percentage of neutrophils (0.579). Conclusions:  GMR showed higher sensibility for detecting immune response in a patient with suspected acute appendicitis compared to leucocyte elevation and left shift of neutrophil count or both.

Deep endometriosis (DE) is an uncommon cause of bowel obstruction; preoperative diagnosis is a challenging task due to its rarity and pathological confirmation. Surgery is the appropriate treatment and complications are common. A 26-year-old Latin female was admitted to emergency department with 72 hours history of abdominal pain associated with inability to pass stool or gas, vomiting and nausea. Abdominal distention and pain without acute abdomen signs. Laboratory tests reported normal. Abdominal contrast-enhanced computed tomography showed distal small bowel obstruction. Patient underwent exploratory laparotomy with segmental resection bearing ileal strictures and Brook´s ileostomy was performed. Postoperative course of patient was uneventful and after pathology report treatment with dienogest was established. DE remains challenging entity to treat, medical treatment can reduce symptoms, but surgical resection is required. Bowel resection is reserved for mayor stenosis lesions. Anastomotic leakage is frequent. Surgery represents the definitive treatment for bowel obstruction by DE. Resection improves pain and intestinal symptoms. Recurrence, stenosis, and anastomotic leakage rates vary across the studies. Surgical and medical treatment should be considered.

Invasive aspergillosis is a severe illness described in immune-compromised and critically ill non-immuno-compromised patients. Aspergillosis and COVID-19 co-infection cases harbor multiple unfavorable prognostic factors, with a 44% mortality versus 19% without aspergillosis. We presented the case of a 61-year-old man known with hypertension, diabetes, and smoking that went through COVID-19 infection, during the convalescent period presented multiple hemoptoic events due to A. fumigatus mycotic pseudoaneurysm, successfully resolved by selective angioembolization. Selective angioembolization is an effective alternative for high surgical risk due to comorbidities in the treatment of pulmonary mycotic aneurism.