RESUMEN
BACKGROUND: Identification of optimal surgical site antisepsis preparations may reduce cesarean-related surgical site infections. Two recently published investigations examined efficacy of chlorhexidine-alcohol and iodine-alcohol preparations. No previous randomized controlled trial has compared chlorhexidine-alcohol to povidone-iodine aqueous scrub and paint in reduction of cesarean-related surgical site infection. OBJECTIVE: The purpose of the study was to determine if chlorhexidine-alcohol would result in fewer surgical site infections than povidone-iodine when used as skin antisepsis preparation prior to cesarean delivery. STUDY DESIGN: This study was a single-center pragmatic randomized controlled trial at an urban tertiary care institution to compare chlorhexidine-alcohol 26-mL single-step applicator to povidone-iodine aqueous scrub and paint 236-mL wet skin tray as preoperative skin antiseptic preparation for women undergoing cesarean delivery. Patients were eligible for study participation if they could provide informed consent in English or Spanish, were ≥18 years of age, did not have clinical chorioamnionitis, were unlikely to be lost to follow-up, and had no sensitivities to chlorhexidine, betadine, or iodine. Treatment was assigned by computer-generated simple 1:1 randomization immediately before skin preparation. The primary outcome was surgical site infection occurring within 30 days of cesarean delivery including ≥1 of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions. Analysis was by intent to treat. Categorical outcomes were compared using Fisher exact test. The Wilcoxon rank-sum test was performed for continuous outcomes. This trial was institutional review board approved and registered at ClinicalTrials.gov (NCT02202577). RESULTS: In all, 932 subjects (461 assigned to chlorhexidine-alcohol, 471 assigned to povidone-iodine) were randomized from February 2013 through May 2016. Rate of follow-up evaluation after 30 days was 99% (455) in the chlorhexidine-alcohol group and 97% (455) in the povidone-iodine group. Surgical site infection occurred in 29 (6.3%) of the chlorhexidine-alcohol group and 33 (7.0%) in the povidone-iodine group (P = .38). The rates of individual components of the primary outcome were as follows: superficial surgical site infection (4.6% v 5.5%; P = .55), deep surgical site infection (0.0% v 0.4%; P = .50), and endometritis (1.7% v 1.1%; P = .42) in chlorhexidine-alcohol vs povidone-iodine arms, respectively. All results were similar in per protocol analysis. CONCLUSION: Preoperative antiseptic skin preparation with chlorhexidine-alcohol 26-mL single-step applicator before cesarean did not result in less frequent surgical site infection when compared with povidone-iodine aqueous scrub and paint 236-mL wet skin preparation tray. Povidone-iodine should still be considered as acceptable for preoperative surgical site antisepsis for cesarean delivery.
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Antiinfecciosos Locales/uso terapéutico , Cesárea , Clorhexidina/uso terapéutico , Povidona Yodada/uso terapéutico , Cuidados Preoperatorios , Infección de la Herida Quirúrgica/prevención & control , Adulto , Endometritis/epidemiología , Femenino , Humanos , Embarazo , Infección de la Herida Quirúrgica/epidemiología , Adulto JovenRESUMEN
BACKGROUND/AIMS: The aim of this study was to assess the combined effects of exercise and dietary glycemic load on insulin resistance in older obese adults. METHODS: Eleven men and women (62 +/- 2 years; 97.6 +/- 4.8 kg; body mass index 33.2 +/- 2.0) participated in a 12-week supervised exercise program, 5 days/week, for about 1 h/day, at 80-85% of maximum heart rate. Dietary glycemic load was calculated from dietary intake records. Insulin resistance was determined using the euglycemic (5.0 mM) hyperinsulinemic (40 mU/m(2)/min) clamp. RESULTS: The intervention improved insulin sensitivity (2.37 +/- 0.37 to 3.28 +/- 0.52 mg/kg/min, p < 0.004), increased VO(2max) (p < 0.009), and decreased body weight (p < 0.009). Despite similar caloric intakes (1,816 +/- 128 vs. 1,610 +/- 100 kcal/day), dietary glycemic load trended towards a decrease during the study (140 +/- 10 g before, vs. 115 +/- 8 g during, p < 0.04). The change in insulin sensitivity correlated with the change in glycemic load (r = 0.84, p < 0.009). Four subjects reduced their glycemic load by 61 +/- 8%, and had significantly greater increases in insulin sensitivity (78 +/- 11 vs. 23 +/- 8%, p < 0.003), and decreases in body weight (p < 0.004) and plasma triglycerides (p < 0.04) compared to the rest of the group. CONCLUSION: The data suggest that combining a low-glycemic diet with exercise may provide an alternative and more effective treatment for insulin resistance in older obese adults.
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Carbohidratos de la Dieta , Ejercicio Físico/fisiología , Índice Glucémico , Resistencia a la Insulina/fisiología , Obesidad/terapia , Anciano , Índice de Masa Corporal , Terapia Combinada/estadística & datos numéricos , Diabetes Mellitus/prevención & control , Dieta , Femenino , Técnica de Clampeo de la Glucosa , Humanos , Lípidos/sangre , Masculino , Obesidad/complicaciones , Obesidad/fisiopatología , Consumo de Oxígeno , Aptitud FísicaRESUMEN
Exercise improves glucose metabolism and delays the onset and/or reverses insulin resistance in the elderly by an unknown mechanism. In the present study, we examined the effects of exercise training on glucose metabolism, abdominal adiposity, and adipocytokines in obese elderly. Sixteen obese men and women (age = 63 +/- 1 yr, body mass index = 33.2 +/- 1.4 kg/m2) participated in a 12-wk supervised exercise program (5 days/wk, 60 min/day, treadmill/cycle ergometry at 85% of heart rate maximum). Visceral fat (VF), subcutaneous fat, and total abdominal fat were measured by computed tomography. Fat mass and fat-free mass were assessed by hydrostatic weighing. An oral glucose tolerance test was used to determine changes in insulin resistance. Exercise training increased maximal oxygen consumption (21.3 +/- 0.8 vs. 24.3 +/- 1.0 ml.kg(-1).min(-1), P < 0.0001), decreased body weight (P < 0.0001) and fat mass (P < 0.001), while fat-free mass was not altered (P > 0.05). VF (176 +/- 20 vs. 136 +/- 17 cm2, P < 0.0001), subcutaneous fat (351 +/- 34 vs. 305 +/- 28 cm2, P < 0.03), and total abdominal fat (525 +/- 40 vs. 443 +/- 34 cm2, P < 0.003) were reduced through training. Circulating leptin was lower (P < 0.003) after training, but total adiponectin and tumor necrosis factor-alpha remained unchanged. Insulin resistance was reversed by exercise (40.1 +/- 7.7 vs. 27.6 +/- 5.6 units, P < 0.01) and correlated with changes in VF (r = 0.66, P < 0.01) and maximal oxygen consumption (r = -0.48, P < 0.05) but not adipocytokines. VF loss after aerobic exercise training improves glucose metabolism and is associated with the reversal of insulin resistance in older obese men and women.
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Glucemia/metabolismo , Ejercicio Físico/fisiología , Resistencia a la Insulina/fisiología , Obesidad/fisiopatología , Adiposidad/fisiología , Factores de Edad , Prueba de Esfuerzo , Terapia por Ejercicio , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Grasa Intraabdominal/química , Leptina/sangre , Masculino , Persona de Mediana Edad , Obesidad/patología , Consumo de Oxígeno/fisiología , Triglicéridos/sangre , Pérdida de PesoRESUMEN
High-risk pregnancy is the most common clinical association with antiphospholipid antibodies; the principal manifestations are pregnancy loss and early preeclampsia. Membership in this family of antibodies is continually growing and includes antibodies against a variety of phospholipids, phospholipid-protein complexes, and phospholipid-binding proteins. The current information in the literature is inadequate to clearly implicate a subgroup of antiphospholipid antibodies or a particular pathophysiologic mechanism as being responsible for poor pregnancy outcomes. It is clear, however, that prevalent diagnostic tests for LA and aCL are extremely useful to identify many of these patients, but are inadequate for diagnosis of all patients with autoimmune pregnancy loss or to elucidate the pathophysiology. Many patients who present clinically with autoimmune-like pregnancy complications currently are negative in tests for LA or aCL, but have antibodies against annexin V, phosphatidylserine, or other relevant antigens. The greatest risk for a complicated pregnancy is conveyed by a subgroup of antibodies that affect the normal function of placental trophoblast. As clinical laboratory tests designed to detect more members of the antiphospholipid antibody family become available, understanding of this complicated disease (APS) will increase.
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Aborto Habitual/etiología , Síndrome Antifosfolípido/complicaciones , Infertilidad Femenina/etiología , Aborto Habitual/diagnóstico , Aborto Habitual/inmunología , Adulto , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/inmunología , Autoanticuerpos/efectos adversos , Autoanticuerpos/inmunología , Femenino , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/inmunología , Diagnóstico PrenatalRESUMEN
OBJECTIVE: To develop a more accurate ultrasound birth weight (BW) model using neonatal anthropometric measurements. STUDY DESIGN: Two hundred thirty-one newborns were evaluated. Measurements included weight; head, chest, and abdominal circumferences (umbilicus and liver), humerus, and femur lengths. Infants were randomly assigned into two groups (G(1) and G(2)). Anthropometric measurements that are obtainable by ultrasound were generated from G(1). Stepwise regression and a bootstrap analysis were used to create the prediction models. The models were validated using G(2). RESULTS: The final stepwise regression model included FL and circumferences of the head, chest, and abdomen. The correlations were: G(1): R(2)=0.91, p<0.001; G(2): R(2)=0.90 p<0.001. There was no difference between derived and actual BW in G(1) (p=0.42) or G(2) (p=0.28). The mean absolute percent error between the prediction model and actual BW was 3.8%. CONCLUSION: Neonatal anthropometric models are strongly predictive of actual BW. This model will be tested prospectively using ultrasound to predict fetal weight.