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INTRODUCTION: Turf-Toe includes a wide variety of traumatic injuries of the metatarsophalangeal joint of the first toe (MTF1). It is a potentially severe injury and there is no consensus for surgical management. The objective of this case report was to describe a patient with traumatic Turf-Toe injury grade III with a sesamoid fracture treated surgically. CLINICAL CASE: 24-year-old male with motorcycle fall with hyperflexion of the MTF1 joint, presented pain, edema and functional limitation; the radiographs showed soft tissue edema, lateral displacement of lateral sesamoid with fracture. Traumatic Turf-Toe was established. The ultrasound of the MTF1 joint showed breakage of the plantar plate and collateral ligaments. Patient was surgically managed with sesamoid reduction and plantar plate repair; postoperative evolution was satisfactory. At 8 weeks the patient was assessed with the AOFAS forefoot scale, obtaining 82 points, SF-12 with 87% and VAS of two and returned to his daily activities. CONCLUSION: We describe a patient with traumatic Turf Toe grade III injury, not related to sports practice; first report in the literature of the use of ultrasound in the evaluation of patients with lesion of the metatarso-phalangic joint of the first toe.
INTRODUCCIÓN: Turf-Toe incluye una gran variedad de lesiones traumáticas de la articulación metatarsofalángica del primer dedo del pie (MTF1). Es una lesión potencialmente grave y no existe consenso para el manejo quirúrgico. El objetivo de este reporte fue describir el caso de un paciente con lesión Turf-Toe traumática grado III con fractura sesamoidea tratado quirúrgicamente. CASO CLÍNICO: Masculino de 24 años con caída de motocicleta con hiperflexión de la articulación MTF1 presentó dolor, edema y limitación funcional; las radiografías mostraron edema de tejidos blandos, desplazamiento lateral de sesamoideo lateral con fractura. Se estableció el diagnóstico de Turf-Toe traumático. En el ultrasonido de la articulación MTF1, se demostró rotura de la placa plantar y ligamentos colaterales. Se manejó quirúrgicamente con reducción del sesamoideo y reparación de la placa plantar. La evolución postoperatoria fue satisfactoria; a las ocho semanas el paciente fue valorado con escala AOFAS de antepié obteniendo 82 puntos, SF-12 con 87% y EVA de 2 y retornó a sus actividades cotidianas. CONCLUSIÓN: Describimos un paciente con lesión Turf-Toe traumática grado III, no relacionada con la práctica deportiva. Primer reporte en la literatura del uso del ultrasonido en la evaluación de pacientes con lesión de la articulación metatarso-falángica del primer dedo del pie.
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Traumatismos em Atletas , Traumatismos do Pé , Articulação Metatarsofalângica , Adulto , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Humanos , Masculino , Radiografia , Dedos do Pé/lesões , Adulto JovemAssuntos
Colágeno Tipo VII/genética , Epidermólise Bolhosa Distrófica/genética , Dermatopatias Vesiculobolhosas/genética , Adulto , Vesícula/patologia , Criança , Análise Mutacional de DNA , Epidermólise Bolhosa Distrófica/sangue , Epidermólise Bolhosa Distrófica/patologia , Feminino , Genes Recessivos , Humanos , Masculino , Mutação , Peru/epidemiologia , Polimorfismo de Nucleotídeo Único/genética , Dermatopatias Vesiculobolhosas/patologiaRESUMO
BACKGROUND: To determine an exploratory estimation of the strength of type 2 diabetes mellitus (T2DM) and hypertension diagnoses as risk indicators for missing teeth in a sample of Mexican adults. MATERIALS AND METHODS: A comparative cross-sectional study of sixty adult patients in a health center in Mexico included as dependent variable, the number of missing teeth (and having a functional dentition) and as independent variables, diagnoses for diabetes or hypertension, age, sex, maximum level of schooling, and tobacco use. Of the 60 participants, 20 were diagnosed with T2DM, 13 with hypertension, and 27 were otherwise diagnosed as healthy in their most recent medical checkup. A negative binomial regression (NBR) model was generated. RESULTS: Mean age was 50.7 ± 16.2 and 50.0% were women. Mean number of missing teeth was 4.98 ± 4.17. In the multivariate NBR model, we observed that individuals with T2DM had higher risk of more missing teeth (incidence rate ratios [IRRs] = 3.13; 95% confidence interval [CI] = 2.09-4.69), followed by those with hypertension (IRRs = 2.63; 95% CI = 1.77-3.90). In addition, participants with current tobacco use were significantly more likely to have suffered tooth loss (P < 0.05) than those who were never smokers or former smokers, just like older participants (P < 0.05). CONCLUSIONS: T2DM and hypertension are independently associated with higher experience of missing teeth in an open adult population in Mexico. Future studies with a more sophisticated epidemiological design and encompassing a more detailed landscape of chronic diseases, type and length of use of long-term medications, and patterns of dental care use are needed to better delineate these associations.
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Diabetes Mellitus Tipo 2/etnologia , Hipertensão/etnologia , Perda de Dente/epidemiologia , Adulto , Idoso , Estudos Transversais , Assistência Odontológica , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Fumar/epidemiologiaRESUMO
Resumen ANTECEDENTES: la hipercloremia es la causa más frecuente de acidosis metabólica en pacientes en estado crítico. La diferencia sodio-cloro (Na+-Cl-) y el índice cloro/sodio (Cl-/Na+) pueden valorar de manera simple el papel de la hipercloremia en las alteraciones ácido-base. OBJETIVO: determinar si la diferencia sodio-cloro y el índice cloro/ sodio medidos a las 24 horas de ingreso son predictores de mortalidad a 30 días en pacientes con choque séptico. MATERIAL Y MÉTODO: estudio de cohorte prospectivo, longitudinal, descriptivo y analítico. Se incluyeron los pacientes con diagnóstico de choque séptico según las Guías de la Campaña Sobreviviendo a la Sepsis del año 2012, ingresados a la Unidad de Cuidados Intensivos en el periodo comprendido de junio del 2015 a junio de 2016. RESULTADOS: el análisis multivariado mostró que la diferencia Na+-Cl- menor de 31 mEq/L incrementa el riesgo de muerte en los pacientes con choque séptico a 30 días, OR 15.26 (IC95% 1.56-148.49) p=0.019. CONCLUSION: la disminución de la diferencia Na+-Cl- por debajo de 31 mEq/L condicionada por hipercloremia incrementa el riesgo de muerte a 30 días en el paciente con choque séptico.
Abstract BACKGROUND: Hyperchloremia is the most common cause of metabolic acidosis in critically ill patients. The sodium-chloride difference (Na+-Cl-) and chloride/sodium ratio (Cl-/Na+) may simply evaluate the role of hyperchloremia in acid-base disturbances. OBJECTIVE: To determine if sodium-chloride difference and chloride/ sodium ratio measured at 24 h of admission are mortality predictors at 30 days in patients with septic shock. MATERIAL AND METHOD: A prospective cohort, longitudinal, descriptive and analytic study was done including patients diagnosed with septic shock according to the guidelines of the Surviving Sepsis Campaign in 2012, admitted to the Intensive Care Unit in the period comprising from June 2015 to June 2016. RESULTS: The multivariate analysis showed that the Na+-Cl- difference less than 31 mEq/L increases the risk of death in patients with septic shock at 30 days, OR 15.26 (95% CI 1.56-148.49) p=0.019. CONCLUSION: The decrease in the Na+-Cl- difference below 31 mEq/L conditioned by hyperchloremia increases the risk of death at 30 days in the patient with septic shock.
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Abstract: The information system on chronic diseases is an electronic system that was recently established in Mexico to monitor new cases and cumulative chronic diseases that are increasing. The aim of this study was to evaluate the qualitative and quantitative consistency of the electronic record of diseases such as diabetes, obesity, hypertension and dyslipidemia, in contrast to what was found in the medical records through a validation system exprofeso data. It followed up on 3,293 diseases recorded and compared with the pathologies registered in the files, these were higher than the records (n = 4,188). It was found that there is an electronic sub-register of diseases recorded in medical units with a differential in the quality standards of care. Our results reveal that to increase the effectiveness of electronic health information it is required a mechanism of annual or biennial review by a systematic validation and based on clinical records. This system also enables validation mechanisms and promotes greater adherence to treatment in the management of chronic diseases, contributing to quality improvement and cost containment in health.
Resumen: El sistema de información en enfermedades crónicas, es un sistema electrónico que se estableció en México recientemente para el monitoreo de los casos nuevos y acumulados de enfermedades crónicas que van en aumento. El objetivo de este estudio fue evaluar la consistencia cualitativa y cuantitativa del registro electrónico de enfermedades como la diabetes, obesidad, hipertensión arterial y dislipidemias, en contraste con lo encontrado en el expediente clínico a través de un sistema de validación de datos exprofeso. Se dio seguimiento a 3,293 patologías registradas y se compararon con las patologías registradas en los expedientes las cuales fueron mayores a los registros en los expedientes (n = 4,188). Se encontró que existe un sub-registro electrónico de las enfermedades registradas en las unidades médicas con un diferencial en los estándares de calidad de la atención. Nuestros resultados dejan ver que para incrementar la efectividad de un sistema de información electrónica en salud se requiere de un mecanismo de revisión anual o bianual a través de una validación sistematizada y basada en los expedientes clínicos. Este sistema de validación también permite y promueve mecanismos de mayor adherencia al tratamiento en el manejo de las enfermedades crónicas contribuyendo a mejoras en la calidad y en la contención de costos en salud.
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Rotavirus (RV) is the primary etiologic agent of severe gastroenteritis in human infants. Although two attenuated RV-based vaccines have been licensed to be applied worldwide, they are not so effective in low-income countries, and the induced protection mechanisms have not been clearly established. Thus, it is important to develop new generation vaccines that induce long lasting heterotypic immunity. VP6 constitutes the middle layer protein of the RV virion. It is the most conserved protein and it is the target of protective T-cells; therefore, it is a potential candidate antigen for a new generation vaccine against the RV infection. We determined whether targeting the DEC-205 present in dendritic cells (DCs) with RV VP6 could induce protection at the intestinal level. VP6 was cross-linked to a monoclonal antibody (mAb) against murine DEC-205 (αDEC-205:VP6), and BALB/c mice were inoculated subcutaneously (s.c.) twice with the conjugated containing 1.5 µg of VP6 in the presence of polyinosinic-polycytidylic acid (Poly I:C) as adjuvant. As controls and following the same protocol, mice were immunized with ovalbumin (OVA) cross-linked to the mAb anti-DEC-205 (αDEC-205:OVA), VP6 cross-linked to a control isotype mAb (Isotype:VP6), 3 µg of VP6 alone, Poly I:C or PBS. Two weeks after the last inoculation, mice were orally challenged with a murine RV. Mice immunized with α-DEC-205:VP6 and VP6 alone presented similar levels of serum Abs to VP6 previous to the virus challenge. However, after the virus challenge, only α-DEC-205:VP6 induced up to a 45% IgA-independent protection. Memory T-helper (Th) cells from the spleen and the mesenteric lymph node (MLN) showed a Th1-type response upon antigen stimulation in vitro. These results show that when VP6 is administered parenterally targeting DEC-205, it can induce protection at the intestinal level at a very low dose, and this protection may be Th1-type cell dependent.
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Antígenos CD/genética , Antígenos CD/imunologia , Antígenos Virais/genética , Antígenos Virais/imunologia , Proteínas do Capsídeo/genética , Proteínas do Capsídeo/imunologia , Lectinas Tipo C/genética , Lectinas Tipo C/imunologia , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/imunologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/imunologia , Rotavirus/imunologia , Adjuvantes Imunológicos , Animais , Anticorpos Antivirais/sangue , Linfócitos T CD4-Positivos/imunologia , Citocinas/imunologia , Células Dendríticas/imunologia , Proteínas de Escherichia coli/imunologia , Feminino , Humanos , Memória Imunológica , Camundongos Endogâmicos BALB C , Antígenos de Histocompatibilidade Menor , Poli I-C/administração & dosagem , Poli I-C/imunologia , Rotavirus/patogenicidade , Infecções por Rotavirus/imunologia , Infecções por Rotavirus/virologia , Células Th1/imunologia , Eliminação de Partículas ViraisRESUMO
The mosquito Aedes aegypti is the main vector of Dengue and Yellow Fever flaviviruses. The organophosphate insecticide temephos is a larvicide that is used globally to control Ae. aegypti populations; many of which have in turn evolved resistance. Target site alteration in the acetylcholine esterase of this species has not being identified. Instead, we tracked changes in transcription of metabolic detoxification genes using the Ae. aegypti 'Detox Chip' microarray during five generations of temephos selection. We selected for temephos resistance in three replicates in each of six collections, five from Mexico, and one from Peru. The response to selection was tracked in terms of lethal concentrations. Uniform upregulation was seen in the epsilon class glutathione-S-transferase (eGST) genes in strains from Mexico prior to laboratory selection, while eGSTs in the Iquitos Peru strain became upregulated after five generations of temephos selection. While expression of many carboxyl/cholinesterase esterase (CCE) genes increased with selection, no single esterase was consistently upregulated and this same pattern was noted in the cytochrome P450 monooxygenase (CYP) genes and in other genes involved in reduction or oxidation of xenobiotics. Bioassays using glutathione-S-transferase (GST), CCE and CYP inhibitors suggest that various CCEs instead of GSTs are the main metabolic mechanism conferring resistance to temephos. We show that temephos-selected strains show no cross resistance to permethrin and that genes associated with temephos selection are largely independent of those selected with permethrin in a previous study.
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Aedes/genética , Resistência a Inseticidas , Inseticidas/farmacologia , Seleção Genética , Temefós/farmacologia , Aedes/efeitos dos fármacos , Aedes/crescimento & desenvolvimento , Aedes/metabolismo , Animais , Perfilação da Expressão Gênica , Larva/efeitos dos fármacos , Larva/genética , Larva/metabolismo , México , Análise de Sequência com Séries de Oligonucleotídeos , Peru , Reação em Cadeia da Polimerase em Tempo Real , Transcrição GênicaRESUMO
This communication revises the state of the art concerning antivenoms against snakes, spiders and scorpions. An overview of the historical facts that preceded the therapeutic use of antibodies is mentioned. A brief list of the major protein components of these venomous animals is revised with a short discussion of what is known on the proteomic analysis of their venoms, but the emphasis is placed on the type of antivenoms available commercially, including pertinent literature and addresses of the companies that prepare these antivenoms. The final section revises and discusses current research on the field and new potential applications that are being developed geared at obtaining new therapeutic antibodies or fragments of antibodies for neutralization of toxic components of venomous animals.
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Antivenenos/análise , Proteômica/métodos , Venenos de Escorpião/toxicidade , Venenos de Serpentes/toxicidade , Venenos de Aranha/toxicidade , Animais , Antivenenos/imunologia , Cromatografia Líquida de Alta Pressão , Humanos , Imunoglobulina G/química , Camundongos , Proteoma , Proteínas Recombinantes/química , Venenos de Escorpião/análise , Escorpiões , Venenos de Serpentes/análise , Venenos de Aranha/análise , AranhasRESUMO
Objetivo: Comparar los efectos de las técnicas Kinésicas Respiratorias agrupadas en cuatro protocolos de tratamiento (K1, K2, K3 Y PVA) en lactantes y preescolares hospitalizados con afecciones respiratorias, usando un diseño cuasiexperimental, longitudinal prospectivo. Método: Se evaluó a 80 niños, edad promedio de 14.3 meses (SD 12.3) con diagnóstico de Síndrome Bronquial Obstructivo (SBO) y Bronconeumonía (BNM) entre el primer y tercer día de hospitalización. El efecto de la Kinesiterapia Respiratoria (KTR) fue medido en cada paciente a través del Índice Kinésico de Carga de Trabajo Ventilatorio (IKCTV), ejecutado por un único evaluador (KA) al inicio y al final de un turno de 12 horas. Cada protocolo fue definido tanto en la metodología de las técnicas como en el número de atenciones. Cada uno de los protocolos fue seleccionado al azar y aplicado por otro kinesiólogo (KB). Resultados: No se encontraron diferencias estadísticamente significativas al comparar las variables biomédicas de los pacientes evaluados. Los resultados muestran un descenso, una mantención y un incremento en el puntaje final del IKCTV en el 57.5%, 27.5% y un 15% de los pacientes, respectivamente. Tampoco existieron diferencias estadísticamente significativas al comparar la efectividad de los protocolos de tratamiento entre sí. Conclusión: No existió asociación directa entre cantidad de atenciones de KTR, el Protocolo de tratamiento y la disminución en el 1 KCTV.
Objective: Compare the effects of the different techniques dealing with chest physical therapy (CPT) grouped in four treatment protocols (K1, K2, K3, PVA) in infants and preschool children that were hospitalized with respiratory infection, using a prospective longitudinal experimental design. Method: 80 children were assessed, with an average age of 13.8 months (SD 11.8) with a diagnosis of obstructive bronchial syndrome and pneumonia between the first and third day of hospitalization. The effects of CPT measured through the Physical Therapy Index of Ventilatory Work Load (PTIVWL), performed by a single therapist (KA) before and after the therapy in a 12-hour shift. The treatment was grouped in form of protocols; they differed in the methodology of the techniques and number of applications of the therapy. The protocol, chosen randomly, was applied by a different therapist (KB) who didn't know the previous evaluations. Results: There was no statistically significant difference in the biomedical variables of the assessed patients. The results show a decrease of the PTIVWL final score in the 57.5% of patients, maintenance in the 27.5% and increase in the 15% in the PTIVWL. Similarly, there was no statistically significant difference between the four protocols of treatment. Conclusion: There was no relationship between the number of CPT.
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Humanos , Lactente , Pré-Escolar , Infecções Respiratórias/fisiopatologia , Infecções Respiratórias/reabilitação , Terapia Respiratória/métodos , Terapia por Exercício/métodos , Doença Aguda , Criança Hospitalizada , Protocolos Clínicos , Estudos Longitudinais , Estudos Prospectivos , Resistência das Vias Respiratórias/fisiologia , Ventilação Pulmonar/fisiologiaRESUMO
Background: Depression is common among women, specially during breeding. Aim: To characterize post-partum depression in a group of women attending a primary health care clinic and its relationship to quality of life. Material and methods: The sample included women meeting criteria for Major Depression, with a child of up to 11 months old. Exclusion criteria included the presence of psychosis, history of mania, alcohol abuse, illegal drug use, high suicide risk, and receiving mental health care in the last three months. Structured interviews used were the Edinburgh postpartum depression scale (EPDS), Mini International Neuropsychiatric Interview (MINI), Medical Outcomes Study Questionnaire (SF-36) and questions about incapacity and health care use. Results: The sample included 159 women with a median age of 27 years (range: 16-43 years). Thirty three percent were married, 30.8% lived in common law marriage, 9.4% were divorced, and 26.4% were single. Most (89.3%) were housewives, 31% were students, and 6.9% were employed. The average score on the EPDS was 17 points (S.D. 4.2). The average SF-36 somatic score was 42.7 points (S.D. 8.2), and the emotional score was 30.3 (D.S. 0.3). The relation between the average score on the EPDS and the somatic and emotional scores was statistically significant (p=0.000-0.006). Conclusions: Most women were mildly to moderately depressed. Their depression was associated with a marked impairment of activities of daily living. These findings add to the evidence suggesting that depression is associated with marked disability cultures, even when the depression is mild to moderate.
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Adulto , Feminino , Humanos , Lactente , Gravidez , Depressão Pós-Parto/psicologia , Transtorno Depressivo Maior/psicologia , Qualidade de Vida/psicologia , Depressão Pós-Parto/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Avaliação da Deficiência , Indicadores Básicos de Saúde , Entrevista Psicológica , Estado Civil , Atenção Primária à Saúde , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Fatores de TempoRESUMO
The health of 22 free-ranging adult rheas (Rhea americana) examined and sampled during a translocation/reintroduction project and six juvenile rheas kept in semicaptivity was investigated, and details of their haematology and plasma biochemistry are presented. Serological testing for antibodies to infectious agents was negative for infectious laryngotracheitis, avian adenovirus, avian influenza, avian reovirus, infectious bursal disease, infectious bronchitis virus, paramyxovirus types 1, 2, and 3, fowlpox and Salmonella Pullorum. Antibodies to Chlamydophila species were found in 25 of 27 of the birds, and 22 of 25 had antibodies to Aspergillus species. Ova of gastrointestinal nematodes of the genus Capillaria were identified, and the anoplocephalid cestode Monoecocestus cf rheiphilus was identified in R americana for the first time.
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Doenças das Aves/epidemiologia , Doenças Transmissíveis/veterinária , Nível de Saúde , Reiformes , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Antifúngicos/sangue , Anticorpos Antivirais/sangue , Argentina/epidemiologia , Aspergillus/imunologia , Doenças das Aves/diagnóstico , Análise Química do Sangue/veterinária , Chlamydophila/imunologia , Doenças Transmissíveis/epidemiologia , Fezes/parasitologia , Contagem de Leucócitos/veterináriaRESUMO
La Depresión es una enfermedad que se ha ido transformando en un gran problema de salud pública. Para poder tratarla efectivamente se requiere de un acabado conocimiento de los factores etiológicos, de su evolución y de la efectividad de los diferentes tratamientos disponibles actualmente. Durante los últimos años se ha reconocido que la Depresión es una enfermedad crónica y que parte de dicha cronicidad se debe a una deficiente liberación de los síntomas con los tratamientos actuales. Esto último ha hecho que pongamos nuestra atención en los síntomas residuales de la depresión. El siguiente artículo tiene como objetivo mostrar la importancia de los síntomas residuales y su tratamiento .
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Humanos , Depressão/diagnóstico , Recidiva/prevenção & controle , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologiaRESUMO
Se realizó un estudio comparativo de biodisponibilidad, para evaluar la bioequivalencia entre dos formulaciones de claritromicina en suspensión de 250 mg/5 mL, una nacional (Pre-Clar(R)), y el innovador del mercado (Klaricid(R)). En ambos casos, se administró una dosis de 500 mg. Se utilizó un ensayo microbiológico para determinar las concentraciones plasmáticas del antimicrobiano. El ensayo está basado en la correlación entre la inhibición del crecimiento bacteriano y la concentración plasmática de claritromicina. Un total de 12 voluntarios, jóvenes sanos, participaron y completaron el protocolo del estudio, el cual fue aprobado por el Comité de Ética de la Facultad de Medicina de la Universidad de Chile. Los parámetros farmacocinéticos de concentración plasmática máxima (Cmáx), tiempo de vida media (t1/2), área bajo la curva concentraciones plasmáticas versus tiempo, desde cero a infinito (ABC0-Ñ) y la constante de velocidad de absorción (Kabs), no mostraron diferencias estadísticamente significativas entre los productos utilizados. De acuerdo a los criterios recomendados por la FDA y sobre la base de nuestros resultados, se concluye que las formulaciones en suspensión pediátrica de 250 mg/5 mL Pre-Clar® y Klaricid® son bioequivalentes asumiéndose que tendrán igual eficacia clínica.
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Claritromicina , Claritromicina/sangue , Equivalência Terapêutica , Disponibilidade Biológica , Chile , Macrolídeos/farmacocinética , Macrolídeos/farmacologia , Macrolídeos/sangue , SuspensõesRESUMO
The objective of this article is to correlate a new biochemical method called fetal fibronectin (fFN) found in cervico-vaginal secretions (CVS) in pregnant woman with the presence or not of preterm labor. In this paper the patients studied had pregnancies of 24 up to 37 weeks of pregnancy. The were free of symptoms and without risk factors for preterm labor. The cervico-vaginal specimen was taken with special equipment designed for this purpose (Adeza Biomedical Collection Kit). The laboratory processed this for immunoassay. A positive fFN was considered above 0.05 microgram/dl. There were 263 patients enrolled for this study. Of these 232 had fFN negative (89%) and 31 were positive (12%). The weeks of gestation at birth were 38.6 for the negative group and 34.4 for the positive group (p < 0.0001). Only 5 neonates from the negative group were born before 37 weeks of gestation (2.2%) and in the positive fFN group this occurred in 22 case (71%) (p < 0.0001). The average weight at birth for the negative fibronectin group was 3152 g. for the positive group (p < 0.0001). The neonatal morbidity was more frequent and respiratory distress syndrome was more severe in the positive fibronectin group in comparison with the negative fFN with a significant p. The same tendency was observe with the Apgar score < 7 at 1 and 5 minutes (more frequent in the positive group) (p < 0.0001). The was one neonatal death in the negative group (0.43%) and 5 in the positive group (16%) p = 0.0001. The sensibility and positive predicitive value of positive fFN for the prediction of preterm labor was 81.4 and 71 respectively and the specificity and negative predictive value for negative fFN was 96.1 and 97.8. Finally the RR for prematurity when the fFN was positive on SCV was 32.9. The presence fFN in cervical-vaginal secretion between 24 and 37 weeks of gestation seems to be a good indicator of preterm labor. In this study positive results correlate with less weeks of pregnancy and lees weight at birth. Also with higher with more morbidity and mortality. These findings give the obstetrician a better chance of an opportune diagnosis with adequate treatment and improve perinatal results.
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Colo do Útero/metabolismo , Feto/química , Fibronectinas/análise , Trabalho de Parto Prematuro/diagnóstico , Complicações na Gravidez/diagnóstico , Vagina/metabolismo , Adulto , Colo do Útero/química , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Vagina/química , Esfregaço VaginalRESUMO
The outcome of 32 pregnancies in renal allograft recipients is reported. The mean age at the time of conception was 27.3 years (range, 20 to 37) with an average interval of 47 months from the time of transplantation to conception (range, 2 to 163). Twenty-nine patients received the graft from a living related donor, one from a living no related donor an 2 from cadaver donors. All patients continued their immunosuppressive regimen during pregnancy and only 6 patients were taking cyclosporine A. Hypertension during pregnancy was observed in 10 patients (31%), superimposed preeclampsia in 4 (14%), preterm labor in 4 (14%) and premature rupture of membranes in 2 (7%). Twenty-eight pregnancies resulted in 28 liveborn infants and there were 4 miscarriages. Cesarean section was performed in 17 cases and 11 had vaginal delivery. Intrauterine growth retardation was observed in 4 cases (14%), fetal distress in 2 (7%) and one neonatal death due to multiple malformations. There was not significative impairment of renal function in this group.
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Transplante de Rim , Mortalidade Materna , Complicações na Gravidez , Cesárea , Ciclosporina/uso terapêutico , Feminino , Retardo do Crescimento Fetal , Humanos , Hipertensão Renal/tratamento farmacológico , Imunossupressores/uso terapêutico , Trabalho de Parto Prematuro , Pré-Eclâmpsia , Gravidez , Resultado da Gravidez , Imunologia de Transplantes , Transplante HomólogoRESUMO
The immune thrombocytopenic purpura (ITP) is an immunological disease associated with pregnancy; it is difficult to control when there is not an adequate response to the treatment mainly with prednisone (refractory). When this problem occurs there are other ways to treat it: monthly pulses of dexamethasone (oral or intravenously), administration of gamma globulin or anti D and occasionally to perform a splenectomy. Three cases of refractory ITP and pregnancy are presented using different treatment in each case: Case 1 hyperimmune gammaglobulin; case 2 platelets by transfusion and in case number 3 monthly dexamethasone oral pulses. In the case treated with hyperimmune gammaglobulin the maternal response was acceptable but neonatal demise occurred due to hemorrhage; in the treated with platelets transfusion, there were maternal and fetal deaths; the best results were obtained with the administration of dexamethasone monthly, in this way we were able to reach the term of the pregnancy with good results for mother and neonate. The importance of early diagnosis is imperative and initiating the adequate treatment that according to our results would be dexamethasone pulses; the use of hyperimmune gammaglobulin in restricted due to high cost, and the platelets transfusion would be indicated only in cases of severe thrombocythopenia, imminence of hemorrhage or if a surgical procedure has to be done. An extensive review of the literature is done.
Assuntos
Complicações na Gravidez/imunologia , Púrpura Trombocitopênica Idiopática/imunologia , Adulto , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Feminino , Humanos , Prednisona/uso terapêutico , Gravidez , Complicações na Gravidez/terapia , Púrpura Trombocitopênica Idiopática/terapia , Esplenectomia , gama-Globulinas/uso terapêuticoRESUMO
Twins, specially those of monochorionic and monoamniotic pregnancies, are exposed to many perinatal risks and complications. The objective of this study was to evaluate the usefulness of ultrasonographic determination of the chorionicity of human placental by counting the number of layers in amniotic membranes. Thirty-eight patients with twin pregnancies were studied prospectively. The ultrasonographic evaluation of membranes layers was made only once, between the weeks and 16 and 30 of pregnancy. When two layers were identified, the placentation was determined as monochorionic, and when four layers were seen, the diagnosis of bichorionic placentation was made. The type of chorionicity was confirmed by histologic study of the placenta. With ultrasound, the chorionicity was correctly determined in 36 out of 38 cases, for a total predictive value of 94.6%. The capacity for diagnosing bichorionic (4 layers) placentation was 100% (22/22) and 87.6% (14/16) for monochorionic (2 layers) placentation. The ultrasonographic evaluation of the amniotic membranes number is an efficient method to recognize the chorionicity of placenta and constitutes an useful and simple method giving important information in perinatal prognosis.
Assuntos
Córion/diagnóstico por imagem , Gravidez Múltipla , Ultrassonografia Pré-Natal , Feminino , Idade Gestacional , Humanos , Placentação , Gravidez , Estudos Prospectivos , GêmeosRESUMO
Respiratory distress syndrome is a common morbidity in a infants of diabetic mother however there is a controversy in the literature about apparition of lung maturity in this infants. However this reports have not got a control group. Lung maturity tests were prospectively studied, obtained by amniocentesis at 37 weeks of gestation, in 47 patients: twenty diabetics (studied group) and 27 healthy pregnant women (control group). All the pregnancies were solved by cesarean section. The values of lung maturity tests were related to presence of respiratory morbidity in neonates (respiratory distress syndrome: RDS). Five of 49 infants had some kind of respiratory morbidity. The incidence of RDS was 10.2%. Four of 5 infants with RDS belonged to the diabetic group, which gives us an incidence of 20% versus only one of the 29 healthy infants (3.7%). This difference is statistically significant, p < 0.0001. Four infants had false positive lung maturity tests (Od, L/S), three of them (two with severe metabolic meladjustment) occurred in the study group, with alteration of L/S ratio (3/20 = 15%). There was no false positive in PG (specificity 100%) in both group. The 3 lung maturity tests had a specificity of a hundred per cent in the control group). This study shows that the presence of PG in amniotic fluid of diabetic pregnant women confirms maturity with a very low risk to develop RDS. Finally, when the metabolic control of the diabetic is not appropriate, the L/S ratio may give false positive results in 15% of cases, which is quite important.
Assuntos
Maturidade dos Órgãos Fetais , Pulmão/embriologia , Gravidez em Diabéticas , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Amniocentese , Cesárea , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Fatores de RiscoRESUMO
The presence of oligohydramnios evaluated by accumulation or major pool technique in pre-term PMR is strongly correlated with maternal and perinatal infection. The objective of this study is to evaluate the usefulness of amniotic fluid volume rate (AFVR) in prediction of maternal and fetal-neonatal infection in patients with PMR before 37 weeks. Thirty patients with PMR were prospectively studied. AFVR was done in all the patients at the time of arrival and they were managed conservatively. None of them had utero-inhibitors and only antibiotics were used after chord clamping. In absence of intrauterine infection corticotherapy was allowed. The results of AFVR were correlated with maternal infection (chorioamnioitis) and perinatal (possible neonatal sepsis or neonatal sepsis). Twenty three out of 30 patients (76.6%) had a AFVR less than or equal to 5.0 cm. (Oligohydramnios) and seven (30.4%) showed a greater rate than 5.0 cm. The earliest pregnancy was 26.5 weeks and the greatest 34.4 weeks. Out of the total of patients 13 (43.3%) had chorioamnioitis and all correspond to the group with AFVI smaller or equal to 5.0 cm. In the group with oligohydramnios were 15 neonates (65.2%) with neonatal infection (six possible sepsis and nine neonatal sepsis). All neonates with positive cultures also corresponded to the group with smaller AFVR; the comparison among the cases with oligohydramnios with infection and the ones that had normal AFVR without infection has statistical significance (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Líquido Amniótico/fisiologia , Ruptura Prematura de Membranas Fetais/diagnóstico , Oligo-Hidrâmnio , Complicações Infecciosas na Gravidez/diagnóstico , Peso ao Nascer , Feminino , Ruptura Prematura de Membranas Fetais/complicações , Idade Gestacional , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Gravidez Prolongada , PrognósticoRESUMO
El presente es un estudio prospectivo, para evaluar la técnica de anestesia general balanceada con Tramadol Clorhidrato al 0.1 por ciento vía endovenosa por infusión más Halotano al 1 por ciento vía inhalatoria; realizado en el Departamento de Anestesiología y Reanimación del Hospital General Nacional Dos de Mayo entre los meses de Agosto a Diciembre de 1993. El trabajo incluyó 50 pacientes entre los 16 y 70 años, previamente seleccionados, donde 27 (54 por ciento) fueron de sexo masculino y 23 (46 por ciento) de sexo femenino; los cuales fueron sometidos a diferentes tipos de cirugía, entre ellos: Cirugía Abdominal: 29 (58 por ciento), Traumatológica: 7 (14 por ciento), Ginecológica: 5 (10 por ciento), Otorrinolaringológica: 1 (2 por ciento). La mayoría fueron de cirugía electiva y algunos de cirugía de emergencia. Estos pacientes estaban incluidos dentro de ASA I y II. Se observó que las variaciones de funciones vitales (PAS, PAD,PAM Y FC) no fueron significativos tanto entre los basales, inducción y durante el transoperatorio. El tiempo operatorio varió entre menos de 1 hora hasta las 5 horas. Un gran porcentaje despertó entre los 30 y los 60 minutos post-operatorio, con un despertar de buena calidad con sedación óptima y analgesia residual importante, concluyendo que el 100 por ciento de casos presentaron analgesia residual de moderada a intensa por lo menos hasta cerca de las 6 horas post-operatorios. Aunque no se encontró una relación causa-efecto específica entre los efectos secundarios y la técnica tanto quirúrgica como anestésica, se presentaron náuseas en 13 pacientes, 5 llegaron al vómito, diaforesis: 7, retención uribnaria: 3, bradicardia: 1, depresión respiratoria: 1. Efectos secundarios de escasa incidencia clínica y reversibles en todos los casos. Debemos resaltar que estos efectos secundarios se presentaron de manera independiente de la dosis de Tramadol aplicados. Podemos concluir que ésta técnica anestésica, produce un adecuado balance analgésico-quirúrgico que hace llevadera la cirugía, además de continuar con un adecuado despertar y analgesia residual importante.