Perinatologia y Reproduccion Humana最新文献

Congenital intrathoracic stomach is a very rare condition, and requires prompt recognition and adequate medical and surgical management. The main differential diagnosis for this condition includes a true congenital short oesophagus and hiatal hernia. The case is presented of a newborn with radiology images highly suggestive of an intrathoracic stomach. Emphasis is placed on the perinatal monitoring plays a role of upmost importance in the detection, follow-up, and prompt management of these types of patients.

Introduction

The United States Center for Disease Control and Prevention (CDC) estimates a chlamydial infection prevalence of 5% in adolescents. Colonisation by Mycoplasma is estimated to be between 5% and 75%, and by Ureaplasma from 35% to 90%.

The objective was to describe the frequency of atypical infections in newborns admitted to a tertiary hospital, as well as risk factors and clinical manifestations.

Material and methods

A retrospective, descriptive study was conducted between January and December 2015. All newborns with a positive culture or PCR for an atypical germ during hospital stay were included.

Results

A total of 75 (19%) positive cultures/PCR were observed out of a total of 388 samples. Mean maternal age was 28.7, and 25% presented with PROM (premature rupture of membranes) > 18 h, with chorioamnionitis in 9.3% of cases. The mean birth weight was 1478 g and the mean gestational age was 31 weeks. Mechanical ventilation was required in 56% of patients. Mean hospital stay was 60 days, and eosinophilia was present in 60% of cases. Conjunctivitis and pneumonia were the recognised pathologies caused by atypical microbes. There were 18 cases of conjunctivitis, all of them caused by chlamydia trachomatis (23%). Sixty-four (85.3%) cases of pneumonia were diagnosed, of which 75% were caused by chlamydia, 22% by Ureaplasma, and Mycoplasma in 3% of cases. Seven patients presented with pneumonia and conjunctivitis.

Conclusion

Of the study population, 23% presented with conjunctivitis and 85% had pneumonia. Chlamydia trachomatis was the most frequently isolated microbe (75%). Eosinophilia was associated in 60% of cases.

Objective

To establish the prognostic usefulness of cervicovaginal fluid concentrations of matrix metalloproteinase-9 in the second trimester for the prediction of preterm delivery.

Materials and method

A case-control study was conducted on 613 pregnant women attending the Dr. Urquinaona Central Hospital, Maracaibo, Venezuela. Group A (n = 52) women with preterm birth and group B (n = 561) women with term birth, (control group) of pregnant women who had term deliveries. The cervicovaginal concentrations of matrix metalloproteinase-9 were compared between the 2 groups.

Results

The mean gestation age at measurement of cervicovaginal concentrations of matrix metalloproteinase-9 was 26.2 ± 1.1 weeks in Group A, and 25.9 ± 1.1 weeks in Group B (P = ns). There were no significant differences in maternal age, body mass index, or history of pre-term labour. Cervicovaginal matrix metalloproteinase-9 concentrations were higher in Group A (252.6 ± 104.1 ng/mL) than in Group B (214.7 ± 120.9 ng/mL; P< .0285). A cut-off value of 180 ng/mL had an under the curve value of 0.59, with a sensitivity of 75.0%, specificity of 41.1%, positive predictive value of 10.5%, and negative predictive value of 94.6%.

Conclusion

Cervicovaginal matrix metalloproteinase-9 concentrations in second trimester are elevated in pregnant women, who later had pre-term delivery, but are not useful for predicting this.

Roberto Caldeyro-Barcia was born in Montevideo in 1921, and studied medicine graduating as medical physician in 1947. He was accepted as associate investigator at the Instituto de Fisiologia under Professor Hermogenes Alvarez, who was working on the effect of uterine activity on the foetal cardiac pulse during delivery. The amniotic pressure was registered by the use of a small catheter introduced inside the amniotic cavity. Thereby, Dr. Caldeyro-Barcia proposed to introduce a micro-catheter directly into the uterine muscle to obtain more specific information on the uterus contraction and its effect on foetal heart activity. It was observed that heart pulse was decreased in those cases of hypoxia. These decreases were called DIP I and II. Therefore, the theory was that during delivery hypoxia had a deleterious action on foetal oxygenation, which was registered and graduated as “Montevideo units”. Two years later Eduard H. Hon working in Yale University confirmed these findings, and it was the beginning of foetal heart beat monitoring during delivery in the whole world. Dr. Caldeyro-Barcia was presented worldwide with research awards. Moreover, he became the Director of the South-American Centre of Perinatology and President of the International Gynaeco-Obstetrics Federation. He was very fond of Mexico, a place that he visited several times, and had a close and warm relationship with Luis Castelazo-Ayala. Dr. Caldeyro-Barcia was considered an accomplished scientist, an exemplary mentor, and a leader in perinatology.

Introduction

The use of steroids in the post-natal period is a common practice, although it is still controversial in neonatology due to its association with adverse effects and risk of neurodevelopment sequelae.

Material and methods

A retrospective, observational, analytical study was conducted including patients weighing less than 1500 g that received a steroid protocol for extubation between 2008 and 2010 and compared with a control group. Neurodevelopment was evaluated using the Bayley II scale at one and two years of age, as well as an analysis of the demographic variables and morbidity.

Results

A total of 132 patients were included, with 46 in the study group and 86 in the control group. No differences were found in the demographic variables, although the length of stay was significantly longer in the study group. An increased risk for arterial hypertension, grade II intraventricular haemorrhage, Patent Ductus Arteriosus, bronchopulmonary dysplasia, and retinopathy was found in the study group. There was no difference as regards blindness, hearing loss, cerebral palsy, and leukomalacia. At 2 years of age an increase in the risk for mild mental development impairment was found in the control group and increased risk for significant delay in psychomotor development in the study group.

Conclusions

Post-natal low dose steroids are effective to accomplish extubation in patients that are ventilation dependent. Significant psychomotor development changes were found at 2 years of age, with no evidence of leukomalacia or cerebral palsy.

Stem cells are known for their capacity for self-renewal and produce various cell lines (cell differentiation). Due to these 2 factors, stem cells are classified according to their potential in totipotent, pluripotent, multipotent, and unipotent stem cells, and according to their site of origin are classified as induced embryonic, adult, and pluripotent stem cells. The scientific and medical advances in the study of stem cells has generated considerable interest in society, due to the variety of cells that can be generated for a wide range of medical treatments, ranging from the cure of diabetes mellitus, to cell therapies for neural diseases. The following literature review aims to present an overview of the research and medical application of stem cells, highlighting some of the diseases which stem cell therapy could offer new areas of medical and scientific research and new hope for patients.

Objective

To compare plasma vascular 8-isoprostane concentrations in pregnant women with pre-eclampsia and eclampsia.

Material and methods

Patients attending the Hospital Central Dr. Urquinaona in Maracaibo, Venezuela, were selected. The study included 30 patients with mild pre-eclampsia (group A), 30 patients with severe pre-eclampsia (group B), and 30 patients with eclampsia (group C). A control group was also included, consisting of 30 healthy pregnant women (group D) of similar age and body mass index to studied groups. Only nulliparous patients were included. Plasma samples were collected for the 8-isoprostane determination from all patients before delivery, and in the studied groups immediately after diagnosis.

Results

Statistically significant differences were found in gestational age between groups B and C compared with the control group (p < .05). Higher values of plasma 8-isoprostane were observed in severe pre-eclampsia patients (366.0 ± 29.7 pg/mL), as well as in eclampsia patients (354.2 ± 26.9 pg/mL). Lower values were found in mild pre-eclampsia patients (302.2 ± 31.6 pg/mL). The studied groups had significantly higher values of plasma 8-isoprostane compared with controls (209.3 ± 19.1 pg/mL; p < .05). Linear regression analysis found that the factor that was significantly associated with 8-isoprostane concentrations was the 24-h urine protein level (p < .05).

Conclusion

Eclampsia and pre-eclampsia patients had higher plasma 8-isoprostane concentrations than healthy normotensive pregnant women.

Objective

To identify modifications foetal cardiac function in pre-eclampsia patients treated with nitroglycerin patches.

Method

The sample consisted of 50 pre-eclampsia nulliparous patients with pregnancies of more than 25 weeks who attended the obstetric emergency service at Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. Maternal haemodynamic changes and cardiac functions by M-mode, pulsed-wave, and tissue Doppler echocardiography were evaluated. Treatment consisted of 5 mg transdermal nitroglycerin patches, applied in the anterior thoracic and lumbar region of patients for 12 hours (total time of 48 hours). After 24 hours and 48 hours of treatment beginning, maternal haemodynamic and foetal echocardiography variables were evaluated. All parameters were evaluated in each patient.

Results

Mean age of patients was 24.4 ± 3.9 years-old, and mean gestational age at beginning of research was 33.2 ± 1.7 weeks. Treatment with nitroglycerin patches produced significant reduction in maternal blood pressure and a significant increase in maternal heart rate in both periods of evaluation (p < .0001). There were observed no changes in general foetal echocardiographic findings, echocardiographic findings in both ventricles and tissue Doppler values after 24 hours and 48 hours of treatment compared with values previous to treatment (p = ns).

Conclusion

The use of transdermal nitroglycerin patches in pre-eclampsia patients did not produce significant changes in foetal cardiac function.

There is a risk of spreading multiple microorganisms in the hospital environment, with the possibility of the development nosocomial infections. The surfaces can contribute to cross-contamination through the hands of health professionals and the instruments that could be contaminated when they come into contact with those surfaces.

Objective

To evaluate the effectiveness of 6% sodium hypochlorite versus a disinfectant solution of bromine-chloro-dimethyl-hydantoin to eliminate pathogens on the surfaces of different hospital environments.

Materials and methods

A prospective, cross-sectional, analytical, and comparative study was designed to evaluate the effectiveness of the cleaning of surfaces in hospital areas with 6% sodium hypochlorite at various dilutions.

Results

Samples were taken from a total of 21 surfaces of different areas. In the surfaces disinfected with the solution bromine-chloro-dimethyl-hydantoin, and sodium hypochlorite, several microorganisms grew in 13/21, and 9/21, respectively, before the disinfection process. After application of disinfectants, the microorganisms grew in 0/21, and 2/21 surfaces, respectively, which was non-significant.

Conclusions

The two surface disinfectants were effective, and there were no differences between their disinfecting effectiveness.