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Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.
Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.
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The study aims to test if Ecuadorean coffee's symbolic and material contents agree with the instrumental analysis and grading protocols. We studied the relationship between the chemical composition and the organoleptic characteristics of eight non-specialty and six specialty coffee samples. Firstly, the study addresses the grading following the Specialty Coffee American Association (SCAA) method. The second stage focuses on the qualitative composition of the coffee brews employing GC-MS and caffeine concentrations using HPLC. Then, we employed statistical tools such as Cohen's concordance coefficients, dissimilarity dendrograms, and linear correlations between the chemical compounds in the beverage and the attributes' scores. The grading panel consisted of 6 semi-trained-testers who would assess if the primary cultural capital can provide a criterion to identify specialty coffee. The variety of compounds allowed the evaluators to distinguish between commercial and specialty coffees. However, the composition analysis identified molecules that would imply greater gradation in the tasting, a prevision that was not reflected in the results. Finally, we confirmed that basic training could create cultural capital to distinguish non-specialties from specialty coffees through their chemistry and organoleptic attributes.
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Euthanasia is a subject of permanent discussion everywhere, mainly about its ethical appropriateness and about its legalization in different countries. This debate includes many ethical, legal, social, political, spiritual, religious, and public health issues. A relevant problem is the frequent misunderstanding that many have about the meaning of the terms and concepts used in different ethical and clinical end of life settings. Many views and even texts are affected by such mistakes, rendering a constructive discussion almost impossible. The goal of this article is to contribute to an improvement of the social and legislative discussion about euthanasia through an elucidation of the main terms and notions linked to this topic. We present definitions and explanations for euthanasia, assisted suicide, withdrawal or foregoing of therapy, treatment rejection, palliative sedation, dignified death and others.
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Humanos , Eutanásia , Suicídio Assistido , Cuidados Paliativos , Princípios MoraisAssuntos
Bronquiolite , Cuidados Críticos , Bronquiolite/terapia , Colômbia , Hospitalização , Humanos , América LatinaRESUMO
We report the most comprehensive clinical and molecular characterization of XLH patients performed in Chile. We show high prevalence of musculoskeletal burden and pain, associated with significantly impaired physical capacity and quality of life, with many relevant complications presenting more frequently than previously reported in cohorts from developed countries. INTRODUCTION: Our current understanding of the clinical presentation and natural history of X-linked hypophosphatemia (XLH) comes mainly from cohorts from developed countries, with limited data on the clinical and genetic abnormalities of XLH patients in South America. OBJECTIVE: To describe the clinical, biochemical, and molecular presentation of patients with XLH in Chile. METHODS: Patients with XLH referred by endocrinologist throughout Chile were included. Demographic data and clinical presentation were obtained from a clinical interview. Surveys were applied for quality of life (QoL), pain, and functionality. FGF23 was measured by ELISA, and genetic testing was performed. Imaging studies were conducted to assess skeletal and renal involvement. RESULTS: We included 26 patients, aged 2-64 years, from 17 unrelated Chilean families. All pediatric patients but only 40% of adults were receiving conventional therapy, while 65% of all patients had elevated alkaline phosphatase. All patients had mutations in PHEX, including 5 novel variants. Radiographic skeletal events (RSE) and enthesopathies in adults were frequent (34% and 85%, respectively). The duration of treatment was associated with fewer RSE (p < 0.05). Most adults reported pain and impaired QoL, and 50% had impaired physical capacity. The number of enthesopathies was associated with worse pain and stiffness scores (p < 0.05). CONCLUSION: Chilean patients with XLH have a high prevalence of musculoskeletal burden associated with pain and impaired physical capacity and QoL, especially in adults who were generally undertreated. These data identify a significant unmet need, inform our understanding of the current status of patients, and can guide care for XLH patients in similarly socioeconomically defined countries.
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Raquitismo Hipofosfatêmico Familiar , Qualidade de Vida , Adulto , Criança , Chile/epidemiologia , Raquitismo Hipofosfatêmico Familiar/epidemiologia , Raquitismo Hipofosfatêmico Familiar/genética , Fator de Crescimento de Fibroblastos 23 , Testes Genéticos , Humanos , MutaçãoRESUMO
Euthanasia is a subject of permanent discussion everywhere, mainly about its ethical appropriateness and about its legalization in different countries. This debate includes many ethical, legal, social, political, spiritual, religious, and public health issues. A relevant problem is the frequent misunderstanding that many have about the meaning of the terms and concepts used in different ethical and clinical end of life settings. Many views and even texts are affected by such mistakes, rendering a constructive discussion almost impossible. The goal of this article is to contribute to an improvement of the social and legislative discussion about euthanasia through an elucidation of the main terms and notions linked to this topic. We present definitions and explanations for euthanasia, assisted suicide, withdrawal or foregoing of therapy, treatment rejection, palliative sedation, dignified death and others.
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Eutanásia , Suicídio Assistido , Humanos , Princípios Morais , Cuidados PaliativosRESUMO
Globally, the greenhouses' farming area comprises 500 000 ha, and they efficiently produce more than half of the vegetables consumed around the world. Nevertheless, high-yield crops tend to be incredibly energy-intensive. This study proposes designing and building a coupled geothermal heat pump for a 470 m2 greenhouse in the Andean zone conditions addressing a requirement of 15 °C at night and 30 °C during the day. Firstly, the study determined the energy potential of the solar and geothermal sources employing actual measurements and contrasting the results with theoretical models. Then, it developed an energy balance in the greenhouse to size the geothermal heat pump using the vapor compression cycle. Finally, the comprehensive system was built and evaluated through the Leveled Cost of Heat (LCOH). The operation requires a potential of 29.56 and 65.76 kW for heating and cooling; this is technically feasible when running the system with a heating flow driven by an optimized temperature ramp of 1.64 °C h-1. Also, the capacity factor (CF) shows that a lifespan between 12 to 14 years is required to reach acceptable LCOH when CF is as low as 0.45. Financially, it is necessary to foster customs exemptions to make it competitive versus more traditional sources such as electricity and LPG since the main components of the heat pump and the geothermal exchanger are not produced locally and represent nearly 70 % of the upfront costs.
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In Ecuador, the net energy contribution of biofuels is unknown or unnoticed. To address this issue, we determined the Energy Return on Investment (EROI) for bioethanol and biodiesel. The selection of raw materials relied on their productive capacity, export and import records, and historical yields. Consequently, the scope included three raw materials for ethanol (sugar cane, corn, and forest residues) and four for biodiesel (African palm, pinion, bovine fat, and swine fat). Using a method based on the Life Cycle Analysis (LCA) of each biofuel, we assessed the entire production chain through statistical processing of primary and secondary information. Then we calculated the calorific values in the laboratory, compared energy inputs/outputs, and finally obtained the energetic returns. EROIs for bioethanol were: 1.797 for sugarcane, 1.040 for corn, and 0.739 for wood. The results for biodiesel were: 3.052 for African palm, 2.743 for pinion, 2.187 for bovine fat, and 2.891 for swine fat. These values suggest feasibility only for sugarcane in the case of ethanol. In contrast, biodiesel has better prospects because all the feedstocks analyzed had EROIs higher than two. Nevertheless, biodiesel is not available for trading in Ecuador because energy policy has overlooked systems based on higher energy return. Future studies should consider more comprehensive variables such as climate change, land use, and water management.
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BACKGROUND: The nasopharynx is a known gateway for some mycobacterial species such as Mycobacterium bovis and M. leprae. M. tuberculosis can cross lymphoepithelial barriers in vitro, but its ability to colonise the nasopharyngeal mucosa in vivo has not been established. OBJECTIVE: To determine if M. tuberculosis can be transiently detected in nasopharyngeal mucosa of tuberculosis (TB) contacts as a preliminary step in the development of tuberculous infection. DESIGN: Exploratory study conducted among asymptomatic household contacts of pulmonary TB cases. A chest X-ray, QuantiFERON(®) TB-Gold or tuberculin skin test and a bilateral nasopharyngeal swab for Xpert(®) MTB/RIF and mycobacterial culture were performed at baseline and repeated 8-12 weeks later. RESULTS: Eighty-nine contacts were enrolled a median of 9 days after the diagnosis of the index case. At baseline, 29.9% were positive for latent tuberculous infection and one subject (1.1%) had a positive Xpert in the nasopharyngeal swab with a normal chest X-ray, negative QuantiFERON and negative induced sputum. After 12 weeks' follow-up, this subject developed a new cough and upper lobe infiltrates and M. tuberculosis grew in sputum. No other cases of active TB were detected at follow-up. CONCLUSION: The detection of M. tuberculosis DNA in the nasopharyngeal mucosa of contacts is an infrequent event that in this instance preceded the development of pulmonary TB. Its pathogenic role requires further investigation.
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DNA Bacteriano/isolamento & purificação , Tuberculose Latente/diagnóstico , Mucosa/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Nasofaringe/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mycobacterium bovis/isolamento & purificação , Escarro/microbiologia , Teste Tuberculínico , Adulto JovemRESUMO
Las plaquetas o trombocitos son fragmentos citoplasmáticos irregulares, pequeños derivados de los megacariocitos. Poseen un rol fundamental en la hemostasia y en la reparación de tejidos, esta última desarrollada mediante la liberación de factores de crecimiento contenidos en sus gránulos ante estímulos como la injuria tisular. El plasma rico en plaquetas (PRP) consiste en un concentrado de plaquetas obtenido mediante centrifugación de sangre del propio paciente. Se utilizó inicialmente como compactante y sellante de implantes óseos en cirugía maxilofacial y dental. Actualmente, se ha hecho más conocido como alternativa terapéutica en lesiones de deportistas de alto rendimiento. Los exitosos resultados han provocado la expansión de su uso en otras áreas como la dermatología, estética facial y más recientemente la reumatología. El uso de PRP en osteoartritis ha demostrado ser efectiva aliviando el dolor y mejorando la funcionalidad, sin embargo, la diversidad de protocolos utilizados ha dificultado la estandarización del tratamiento.
Platelets or thrombocytes are irregular, small cytoplasmic fragments derived from megakaryocytes. They have a fundamental role in hemostasis and tissue repair, the latter developed by the release of growth factors contained in their granules to stimuli such as tissue injury. Platelet-rich plasma (PRP) consists of a platelet concentrate obtained by centrifugation of the patients own blood. It was initially used as a compactor and sealant of bone implants in maxillofacial and dental surgery. It has now become better known as a therapeutic alternative in high-performance sports injuries. The successful results have led to the expansion of its use in other areas such as dermatology, facial aesthetics and more recently rheumatology. The use of PRP in osteoarthritis has been shown to be effective in relieving pain and improving functionality, however the diversity of protocols used has made difficult the standardization of treatment.
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Humanos , Plasma Rico em Plaquetas/fisiologia , Doenças Reumáticas/terapia , Osteoartrite/terapiaRESUMO
ANTECEDENTES: Los niños nacidos entre las 34 0/7 y 36 6/7 semanas se denominan prematuros tardíos (PT), constituyen 5-7% de los nacidos y poseen mayor morbimortalidad que los niños de término. OBJETIVO: Analizar las causas de partos PT en nuestra institución. Comparar morbilidad neonatal de nacidos PT y de término. MÉTODOS: Estudio de cohorte retrospectivo. Se revisan registros de nacimientos entre enero de 2009 y diciembre de 2012 identificando los nacidos vivos entre las 34 0/7 y 36 6/7 y entre las 39 0/6 y 40 6/7 semanas. Se identifica grupo clínico de parto prematuro al que pertenecen. Se compara frecuencia de resultados perinatales de nacidos PT y de término completo. RESULTADOS: En el período estudiado nacieron 8.890 niños vivos. Tasa de partos PT fue 7,49% (n = 666). El 64,11% fue por causa idiopática o asociado a rotura de membranas y 35,89% por indicación médica. Dentro del grupo de indicaciones médicas un 19,25% de interrupciones no están basadas en evidencia y ninguna puramente electiva. Los PT, comparados con niños de término, tienen más riesgo de hospitalización y morbilidad neonatal; este riesgo es mayor a menor edad gestacional. CONCLUSIONES: En nuestro hospital 1 de cada 5 PT pudo haber nacido a una edad gestacional mayor, lo que podría haber evitado los riesgos perinatales asociados. Se sugiere que las instituciones de salud analicen las causas de interrupciones del embarazo en el grupo de PT, lo que podría ser un indicador de calidad obstétrica.
BACKGROUND: Children born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants. Represent 5 to 7% of live births and they are at higher risk of morbidity and mortality than term infants. OBJECTIVE: To analyze causes of late preterm births in our institution. To compare neonatal morbidity in late-preterm and term infants. METHODS: A retrospective cohort study. Birth records between January 2009 and December 2012 were reviewed identifying live births between 34 0/7 and 36 6/7 and between 39 0/6 and 40 6/7 weeks of gestation. Clinical group of preterm labor to which they belong was identified. Frequency of perinatal outcomes of late-preterm and term infants were compared. RESULTS: In the period under study there were 8890 live birth. The late-preterm birth rate was 7.49% (n = 666); 64.11% of them was idiopathic in cause or associated with rupture of membranes and 35.89% was for medical indication. In the group of medical indications 19.25% of the interruptions were not based on evidence and none were purely elective. Late-preterm infants have higher risk of hospitalization and neonatal morbidity than term infants; this risk is higher at earlier gestational ages. CONCLUSIONS: In our hospital 1 in 5 late-preterm birth could have been born at higher gestational age, preventing perinatal risks. It is suggested that health institutions analyze causes of interruption of pregnancy in the late-preterm group, which could constitute an indicator of obstetric quality.
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Humanos , Feminino , Gravidez , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro , Resultado da Gravidez , Chile , Causalidade , Estudos Retrospectivos , Estudos de Coortes , Morbidade , Idade Gestacional , Nascido Vivo , Doenças do Prematuro/etiologia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/epidemiologiaRESUMO
Antecedentes: El 10 por ciento de las mujeres postmenopáusicas con sangrado uterino anormal (SUA) tendrán cáncer de endometrio. Se recomienda efectuar una biopsia endometrial en toda mujer postmenopáusica con SUA y grosor endometrial ecográfico >5 mm. Estudios recientes sugieren que el uso de un valor menor (3 mm) mejora la capacidad diagnóstica de la ecografía. En mujeres postmenopáusicas asintomáticas se ha sugerido efectuar biopsia endometrial si se detecta un endometrio >11mm. Objetivo: Determinar la capacidad diagnóstica de la ecografía para detectar cáncer de endometrio, utilizando los valores de corte de 3 y 5 mm en mujeres posmenopáusicas sintomáticas y de 11 mm en mujeres postmenopáusicas asintomáticas. Método: Revisión retrospectiva de biopsias de endometrio e historia clínica de mujeres atendidas en la Red de Salud UC (2007-2012). Resultados: Se analizó 132 casos, 63,6 por ciento presentaron SUA. Hubo 17 casos de cáncer de endometrio (12,9 por ciento), con un grosor endometrial promedio de 18 mm, el 8 por ciento presentó SUA. En mujeres sintomáticas la sensibilidad para el diagnóstico de cáncer de endometrio fue de 100 por ciento y de 93 por ciento para valores de corte 3 y 5 mm respectivamente. En mujeres asintomáticas, el punto de corte 11 mm, tuvo una sensibilidad de 50 por ciento y una especificidad de 65 por ciento para el diagnóstico de cáncer de endometrio. Conclusión: Recomendamos efectuar biopsia endometrial a toda mujer postmenopáusica con SUA y endometrio >3 mm. En postmenopáusicas sin SUA, no recomendamos la evaluación ecográfica endometrial de rutina.
Introduction: 10 percent of postmenopausal women with abnormal uterine bleeding (AUB) have endometrial cancer. Endometrial biopsy is recommended in all postmenopausal women with AUB and endometrial thickness >5 mm on ultrasound. Recent studies suggest that the use of a lower value (3 mm) improves the ability of ultrasound to detect endometrial cancer. In asymptomatic postmenopausal women, endometrial biopsy is recommended if the endometrial thickness is >11mm. Objective: To determine the diagnostic accuracy of ultrasound for detecting endometrial cancer, using a cutoff value of 3 and 5 mm in symptomatic and 11 mm in asymptomatic postmenopausal women. Methods: Retrospective review of endometrial biopsies and clinical history of women attending UC Health Network (2007-2012). Results: 132 cases were analyzed, 63.6 percent had AUB. There were 17 cases of endometrial cancer (12.9 percent), with a mean endometrial thickness of 18 mm. 88 percent of women with endometrial cancer had SUA. In symptomatic women the sensitivity for the diagnosis of endometrial cancer was 100 percent and 93 percent using a cutoff value of 3 and 5 mm respectively. In asymptomatic women, the cutoff value of 11 mm, had a sensitivity of 50 percent and a specificity of 65 percent for endometrial cancer. Conclusion: We recommend endometrial biopsy in all postmenopausal women with AUB and endometrial thickness >3 mm. In postmenopausal women without AUB we do not recommend routine endometrial ultrasound evaluation.
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Humanos , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Neoplasias do Endométrio , Pós-Menopausa , Ultrassonografia , Biópsia , Metrorragia/etiologia , Neoplasias do Endométrio/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Introduction: Breast cancer diagnosis and treatment had evolved over the past quarter century. From self-examination to mammography as main suspicion tool and from radical to conservative surgery plus radiotherapy as prefered treatment. The aim of this review was to assess the evolution of presentation and local management of breast cancer at a Chilean radio-oncology center. Materials and Methods: We analyzed 1.204 breast cancer patients who received postoperative irradiation on two four-years periods. The first period included 223 patients and coincides with the introduction of mammography and conservative surgery. The second included 981 patients managed according to current guidelines. The variables analyzed were type of clinical suspicion, time between clinical suspicion and diagnosis confirmation, type of surgery, histology and tumor size. Data were obtained from medical records and analyzed using STATA 12. Results: In the second period mammographic suspicion reached 39.8 percent. Time between clinical suspicion and histological diagnosis was reduced to 50 percent, the proportion of tumors larger than 2 cm was reduced from 61 to 45 percent, the proportion of DCIS was tripled from 6 to 18 percent, use of conservative surgery has an absolute increase of 28 percent. All of these differences were statistically significant (p < 0.01). Conclusion: The introduction of mammography and conservative management allowed early diagnosis of breast cancer in the analyzed population.
Introducción: El enfrentamiento del cáncer de mama evolucionó en el último cuarto de siglo desde el autoexamen a la mamografía como herramienta de sospecha y desde el tratamiento con cirugía radical a la cirugía conservadora más radioterapia. El objetivo de esta revisión fue evaluar la evolución de la presentación y manejo local del cáncer de mama en un centro de radio-oncología. Materiales y Método: Se analizaron 1.204 pacientes con cáncer de mama que recibieron irradiación post-operatoria en dos períodos de cuatro años. El primer período incluyó 223 pacientes y coincide con la introducción de mamografía y cirugía conservadora. El segundo incluyó 981 pacientes manejadas según el estándar actual. Las variables analizadas fueron: forma de sospecha, tiempo entre sospecha y confirmación diagnóstica, tipo de cirugía, histología y tamaño tumoral. Los datos fueron obtenidos de fichas clínicas y analizados con STATA 12. Resultados: Al comparar el segundo período con el primero se evidenció un aumento absoluto del 39,8 por ciento de la sospecha por mamografía, disminución a la mitad del tiempo entre sospecha y diagnóstico histológico, reducción de la proporción de tumores mayores a 2 cm de 61 a 45 por ciento, triplicación en la proporción de carcinoma ductal in situ de 6 a 18 por ciento y aumento absoluto de 28 por ciento del uso de cirugía conservadora. Todas estas diferencias fueron estadísticamente significativas (p < 0,01). Conclusión: En el grupo analizado la introducción de mamografía y manejo conservador se asoció a un aumento de sospecha y diagnóstico precoz del cáncer de mama.
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Humanos , Feminino , Mastectomia Segmentar , Neoplasias da Mama/cirurgia , Neoplasias da Mama , Autoexame de Mama , Evolução Clínica , Invasividade Neoplásica/prevenção & controle , Mamografia , Neoplasias da Mama/radioterapiaRESUMO
OBJECTIVE: High sodium (HS) diet is associated with hypertension (HT) and insulin resistance (IR). We evaluated whether HS diet was associated with a dysregulation of cortisol production and metabolic syndrome (MetS). PATIENTS AND MEASUREMENTS: We recruited 370 adults (18-85 years, BMI 29·3 ± 4·4 kg/m(2) , 70% women, 72% HT, 61% MetS). HS diet (urinary sodium >150 mEq/day) was observed in 70% of subjects. We measured plasma hormones, lipid profile, urinary free cortisol (UFC) and cortisol tetrahydrometabolites (THM). RESULTS: Urinary sodium was correlated with UFC (r = +0·45, P < 0·001), cortisol THM (r = +0·41, P < 0·001) and inversely with adiponectin, HDL and aldosterone, after adjusting by age, gender and BMI. Subjects with high, compared with adequate sodium intake (50-149 mEq/day) had higher UFC (P < 0·001), THM (P < 0·001), HOMA-IR (P = 0·04), HT (81% vs 50%, P < 0·001), MetS (69% vs 41%, P < 0·001) and lower adiponectin (P = 0·003). A multivariate predictive model adjusted by confounders showed a high discriminative capacity for MetS (ROC curve 0·878) using four clinical variables: HS intake [OR = 5·6 (CI 2·3-15·3)], HOMA-IR [OR 1·7 (1·3-2·2)] cortisol THM [OR 1·2 (1·1-1·4)] and adiponectin [OR = 0·9 (0·8-0·9)], the latter had a protective effect. CONCLUSIONS: High sodium diet was associated with increased urinary cortisol and its metabolites. Also, HS diet was associated with HT, insulin resistance, dyslipidaemia and hypoadiponectinaemia, even when adjusting by confounding variables. Further, we observed that high salt intake, IR and higher cortisol metabolites, alone or combined in a clinical simple model, accurately predicted MetS status, suggesting an additive mechanism in obesity-related metabolic disorders.
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Hidrocortisona/urina , Resistência à Insulina , Síndrome Metabólica/epidemiologia , Sódio na Dieta/efeitos adversos , Adiponectina/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aldosterona/urina , Glicemia/análise , Índice de Massa Corporal , Estudos de Coortes , Feminino , Glucocorticoides/metabolismo , Glucocorticoides/urina , Humanos , Hidrocortisona/metabolismo , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Razão de Chances , Sódio na Dieta/urina , Adulto JovemRESUMO
La isoinmunización eritrocitaria feto-materna se define como la presencia de anticuerpos maternos dirigidos contra antígenos presentes en los glóbulos rojos fetales. Los anticuerpos maternos pueden atravesar la barrera placentaria y provocar hemólisis de los glóbulos rojos fetales produciendo anemia hemolítica e hiperbilirrubinemia, características de la enfermedad hemolítica perinatal (EHP). La principal causa de EHP es la incompatibilidad ABO, seguida de la isoinmunización por RhD; esta última ha disminuido su incidencia dado el amplio uso de inmunoglobulina anti D. Sin embargo, el glóbulo rojo tiene más de 400 antígenos, muchos de ellos (>50) capaces de producir isoinmunización y EHP. En este artículo, revisamos la evidencia y proponemos un algoritmo de manejo y seguimiento de las embarazadas con isoinmunización por anticuerpos irregulares. En la isoinmunización por anticuerpos irregulares, los títulos de anticuerpos maternos no se correlacionan con la gravedad de la enfermedad. La anemia en la EHP por anticuerpos anti-Kell es secundaria a una supresión de la eritroblastosis fetal a diferencia del resto de los sistemas que producen anemia hemolítica. Recomendamos efectuar tamizaje de todas las pacientes en el control prenatal, solicitando grupo sanguíneo, Rh y test de Coombs indirecto. En las pacientes Rh (+) con test de Coombs indirecto positivo es necesario identificar los anticuerpos irregulares. En caso de tener isoinmunización por anticuerpos irregulares con riesgo de EHP, derivar a una unidad de alto riesgo obstétrico para realizar seguimiento de la aparición de anemia fetal midiendo de modo seriado el peak sistólico de la arteria cerebral media. Si se detecta anemia fetal, debemos planificar una cordocentesis para confirmar el diagnóstico y tratar la anemia.
The fetomaternal erythrocyte isoimmunization is defined as the presence of maternal antibodies directed against antigens present in fetal red blood cells. Maternal antibodies can cross the placenta and cause hemolysis of fetal red blood cells causing hyperbilirubinemia and hemolytic anemia, known as perinatal hemolytic disease (PHD). The main cause of PHD is ABO incompatibility, followed by RhD isoimmunization. The latter has decreased its incidence since the widespread use of anti-D immunoglobulin. However, the red cell has more than 400 antigens; many of them (>50) can lead to isoimmunization and PHD. In this article, we review the evidence and propose an algorithm for the management and monitoring of pregnant women with irregular antibodies isoimmunization. In the isoimmunization by irregular antibodies, maternal antibody titers do not correlate with the severity of the disease. Anemia in PHD by anti-Kell is secondary to suppression of fetal erythroblastosis unlike other systems that produce hemolytic anemia. We suggest the screening of all patients in the prenatal control with blood group, Rh and indirect Coombs test. In the Rh (+) patients with positive indirect Coombs test, irregular antibodies should be identified. In case of immunization by irregular antibodies in risk of PHD, the women should be referred to a high-risk obstetrics where the appearance of fetal anemia should be seek by measuring systolic peak of middle cerebral artery. If anemia is detected full confirmation of diagnosis and treatment should be effected by cordocentesis.
Assuntos
Humanos , Feminino , Gravidez , Eritroblastose Fetal/diagnóstico , Eritroblastose Fetal/terapia , Isoimunização Rh/diagnóstico , Isoimunização Rh/terapia , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Central obesity has a higher risk of the metabolic syndrome (MetS) and cardiovascular diseases. It is estimated by measuring waist circumference (WC) and waist-to-hip ratio (WHR), which are operator-dependent. The present study aimed to validate a body composition monitor (BCM) as a tool for estimating visceral adipose tissue (VAT), as well as to assess its capacity to predict the MetS and its correlation with anthropometric parameters. METHODS: We measured WC, WHR and body mass index (BMI) in 60 recruited subjects. BCM estimated VAT (1-30 points). Body composition and resting energy expenditure (REE) were compared with bioelectrical impedance analysis (BIA) and indirect calorimetry, respectively. VAT was estimated by BCM (range 1-30 points), We evaluated the capability of VAT, WC, BMI and WHR to predict the MetS by ATP-III criteria. RESULTS: The mean (SD) age of subjects was 36.8 (12.9) years, 80% were female, and 47% had the MetS. Body composition and REE estimated by BCM had a significant correlation with BIA (r = 0.85-0.91, P< 0.001) and REE (r = 0.86, P < 0.001), respectively, even after adjusting by sex. VAT estimation by BCM was positively correlated with WC (r = 0.75, P< 0.001) and WHR (r = 0.61, P < 0.001). The area under the receiver operator characteristic curves to predict the MetS was 0.93 for VAT, 0.81 for WC, 0.76 for WHR and 0.74 for BMI. VAT ≥10 points had a sensitivity of 100% and a specificity of 82% for predicting the MetS. CONCLUSIONS: VAT estimation by BCM efficiently predicts the MetS and correlates with anthropometric parameters of central obesity. Its routine use could facilitate cardiovascular risk estimation and follow-up in overweight and obese patients in ambulatory practice.
Assuntos
Composição Corporal , Índice de Massa Corporal , Gordura Intra-Abdominal , Síndrome Metabólica/diagnóstico , Obesidade Abdominal/diagnóstico , Circunferência da Cintura , Relação Cintura-Quadril , Tecido Adiposo , Adulto , Antropometria , Metabolismo Basal , Calorimetria Indireta , Impedância Elétrica , Feminino , Humanos , Masculino , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Adulto JovemRESUMO
Antecedentes: la diabetes mellitus gestacional (DMG) se asocia a mayor riesgo materno y perinatal. El manejo habitual de ésta patología es la dieta, el ejercicio y la insulina. Los hipoglicemiantes orales (HGO) son una terapia emergente para el tratamiento de la DMG. Objetivos: realizar una revisión sistemática de toda la evidencia tipo I disponible acerca del uso de HGO para tratamiento de DMG y realizar un metaanálisis de los resultados maternos y perinatales significativos. Resultados: diez estudios cumplieron criterios de selección. Tres estudios comparaban metformina vs insulina, cuatro gliburide vs insulina y tres metformina vs gliburide. Los estudios no encontraron diferencias significativas en control glicémico ni en complicaciones perinatales entre metformina vs insulina, gliburide vs insulina y metformina vs gliburide. Nuestro metaanálisis mostró que la glicemia de ayuno es significativamente menor (DM 1,74; IC95 por ciento 0,383,10) y la glicemia postprandial a las 2 horas es significativamente mayor en el grupo insulina vs HGO (DM -2,97; IC95 por ciento -27,24 a -5,36). Nuestro metaanálisis muestra que la incidencia de fetos grandes para edad gestacional fue significativamente menor en el grupo metformina vs gliburide (OR 0,38; IC95 por ciento 0,18-0,78). El fracaso del tratamiento con gliburide fue significativamente menor que con metformina (27,6 por ciento vs 38,5 por ciento, p<0,0001; IC95 por ciento 1,21-1,60). Conclusión: los HGO son un tratamiento seguro y efectivo para DMG. Recomendamos gliburide (glibenclamida) para el tratamiento de las pacientes con DMG que fracasan su control glicémico con dieta y ejercicio, por no cruzar la placenta, tener menor tasa de fallo y ser igualmente efectiva que metformina.
Background: gestational diabetes mellitus (GDM) is associated to a higher maternal and perinatal risk. Usually GDM is controlled with diet, exercise and insulin. Oral hypoglycaemic agents (OHA) are an emergent therapy for the treatment of GDM. Objectives: conduct a systematic review of all class I evidence available regarding the use of OHA for GDM treatment, and perform a metaanalysis of significant maternal and perinatal outcomes. Results: ten studies accomplished inclusion criteria. Three studies compared metformin to insulin, four compared glyburide to insulin and three compared metformin to glyburide. Studies showed no significant differences in glycaemic control or perinatal complications, between metformin and insulin, between glyburide and insulin, or between metformin and glyburide. Our metaanalysis comparing OHA to insulin shows significantly lower fasting blood glucose (MD 1.74; 95 percent IC 0.38-3.10) and larger 2-hr postprandial glucose in the insulin group compared to OHA groups (MD -2.97; 95 percent IC -27.24-5.36). Our metaanalysis comparing shows a significantly lower incidence of large for gestational age in the metformin vs. gliburide group (OR 0.38; 95 percent IC 0.18-0.78). Failure of treatment was significantly lower using gliburide than metformin (27.6 percent vs. 38.5 percent, p<0.0001; 95 percent IC 1.21-1.60). Conclusion: OHA are a safe and effective treatment for GDM. We recommend the use of glyburide (glibenclamide) in GDM patients that fail to obtain glycemic control with diet and exercise, since glyburide does not crosses the placental barrier, has a lower rate of treatment failure and is equally affective as metformin.
Assuntos
Humanos , Feminino , Gravidez , Diabetes Gestacional/tratamento farmacológico , Glibureto/administração & dosagem , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Metformina/administração & dosagem , Administração Oral , Glibureto/uso terapêutico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Metformina/uso terapêuticoRESUMO
Objetivo: análisis crítico de estudios clínicos randomizados para determinar si el suplemento con L-arginina mejora el resultado perinatal en pacientes embarazadas en riesgo o que presenten patologías como parto prematuro, síndrome hipertensivo del embarazo o restricción de crecimiento fetal intrauterino. Métodos: se realizó una búsqueda bibliográfica en base de datos Pubmed, Tripdatabase y una multibúsqueda en el Sistema de Bibliotecas de la Pontificia Universidad Católica de Chile con posterior análisis crítico de los estudios seleccionados. Resultados: se seleccionaron 14 estudios clínicos randomizados; 4 de ellos corresponden a estudios de L-arginina en hipertensión gestacional, 5 estudios de L-arginina en preeclampsia, 1 estudio de L-arginina en parto prematuro, 1 estudio de L-arginina en hipertensión crónica y 4 estudios de L-arginina en restricción de crecimiento intrauterino. Solo dos de los estudios son de buena calidad metodológica, pero uno de ellos estudia un resultado intermedio y no clínicamente relevante. El resultado más promisorio muestra que el uso de L-arginina asociada a vitaminas antioxidantes reduce significativamente la incidencia de preeclampsia en mujeres de riesgo (antecedente personal o familiar de preeclampsia). Conclusiones: no se ha demostrado la efectividad de la suplementación antenatal con L-arginina para mejorar el resultado perinatal en embarazadas en riesgo o que presentan patologías como parto prematuro, síndrome hipertensivo del embarazo o restricción de crecimiento fetal. Se requieren estudios de buen diseño que permitan conclusiones definitivas.
Objective: critical analysis of randomized clinical trials to determine whether supplementation with L-arginine improves perinatal outcome in pregnant patients at risk or presenting conditions such as preterm labor, hypertensive disorders or intrauterine fetal growth restriction. Methods: we performed a literature search in Pubmed, Tripdatabase and multisearch in the Library System of the Pontifical Catholic University of Chile to further critical analysis of selected studies. Results: We selected 14 randomized trials, 4 of them are for studies of L-arginine in gestational hypertension, 5 studies of L-arginine in preeclampsia, one study of L-arginine in preterm labor, one study of L-arginine in chronic hypertension and 4 studies of L-arginine in intrauterine growth restriction. Only two of the studies were of good methodological quality, but one these studies analyzes an intermediate result that is not clinically relevant. The most promising result shows that the use of L-arginine associated with antioxidant vitamins significantly reduced the incidence of preeclampsia in women at risk (personal or family history of preeclampsia). Conclusions: is not shown the effectiveness of antenatal supplementation with L-arginine to improve perinatal outcome in pregnant women at risk or with pathological conditions such as premature labor, hypertensive disorders and fetal growth restriction. More studies of good design are needed to allow definitive conclusions.