Conventional office blood pressure measurements and unattended automated office blood pressure compared with home self-measurement and 24-h ambulatory blood pressure monitoring.

OBJECTIVE: To assess whether automated office blood pressure (BP) (AOBP) measurement is a better method for measuring BP in the office than conventional techniques and an alternative to out-of-office BP measurements: home-self BP (HSBP) or ambulatory BP monitoring (ABPM). METHODS: We conducted a cross-sectional study of 74 patients and compared AOBP with the conventional technique using a mercury sphygmomanometer and with both out-to-office BP measurements: HSBP of 7 days (three measurements in the morning, afternoon, and night) and daytime ABPM. In addition, we compared BP values obtained using HSBP and ABPM to determine their level of agreement. We used ANOVA to compare means, Bland-Altman, and intraclass correlation coefficients (ICC) for concordance. RESULTS: BP values obtained by the two office methods were similar: conventional 147.2/85.0 mmHg and AOBP 146.0/85.5 mmHg ( P > 0.05) with good agreement (ICC 0.85). The mean SBP differences between AOBP and HSBP ( P < 0.001) and between AOBP and ABPM ( P < 0.001) were 8.6/13.0 mmHg with limits of agreement of -21.2 to 38.5 and -18.4 to 44.3 mmHg, respectively. The average SBP values obtained by HSBP were 4.3 mmHg higher than those obtained by ABPM ( P < 0.01). CONCLUSION: Our study showed good agreement and concordance between the two office methods as well between the two out-to-office methods, although there was a significant difference in the mean SBP between the HSBP and ABPM. Moreover, AOBP was not comparable to either HSBP or ABPM; therefore, the estimation of out-to-office BP using AOBP is not supported.

[Maternal risk factors associated to stillbirth in a public hospital at West of Mexico]. / Factores de riesgo materno asociados a muerte fetal en nacimientos pretérmino en un hospital público del occidente de México.

INTRODUCTION: Mortality rates in preterm births and stillbirth are high. OBJECTIVE: To identify maternal risk factors relating to stillbirth in preterm infants. MATERIAL AND METHODS: We conducted a cross-sectional, analytic study of 1,022 newborns between 20 and 36 weeks of gestation, from September 2004 to August 2005. Stillbirth was defined as fetal death prior to expulsion or extraction from the mother. Data was collected prospectively by directly interviewing the pregnant women and from the medical chart. The dependent variable was stillbirth and the independent ones were the maternal risk factors. Associations were evaluated by logistic regression. RESULTS. One thousand and twenty-four (1,024) preterm births were detected in a total of 14,882 births (6.9%/year). One hundred and fifty-two (152) were stillborn and 870 were live births. The fetal mortality rate was 10.3 per 1,000 live births. The least common maternal factors associated to stillbirth included: urinary tract infection (22/152, 14% vs. 224/869, 26%, p = 0.020), PMR > 24 h (18/152, 12% vs. 172/869, 20%, p = 0.020) and cesarean delivery (24/138, 17% vs. 344/719, 48%, p < 0.001). The crude odd risk ratios for stillbirth included spontaneous preterm delivery (OR 4.38, CI95% 2.70-7.17) and deficient prenatal care (OR 2.64, CI95% 1.83-3.82). By multivariate analysis, stillbirth predictors included: spontaneous preterm delivery (OR 4.00, CI 95% 2.61-6.61) and deficient prenatal care (OR 2.54, CI 95% 1.78-3.62). CONCLUSION: Deficient prenatal care was the only statistically significant and clinically coherent variable predicting stillbirth.

[Teenage pregnancy as a risk factor for fetal abuse]. / Embarazo en adolescentes como factor de riesgo para maltrato fetal.

OBJECTIVE: To identify if pregnancy in adolescence is a risk factor for fetal abuse. MATERIAL AND METHOD: A case-control study of 333 mothers that made fetal abuse and its controls, was made between October 2005 and May 2006 at the Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca. The fetal abuse was considered when the prenatal attention was deficient and was documented illicit drugs or physics violence to the mother. The fetal abuse was documented by means of a direct interview to the mother. Was realized a descriptive analyze of different forms of fetal abuse. The odds ratio was calculated for association between adolescent mother and fetal abuse. RESULTS: The prenatal attention was deficient in 284 (69.7%), illicit drugs abuse in 100 (24.5%) and physics violence to the mother en 69 (20.7%). The adolescent mothers had more deficient prenatal attention that adult mothers (54 vs. 37.7%), used more illicit drugs (25.6 vs. 16.6%) and received more physics violence (4.9 vs. 2.8%). The pregnancy in adolescent was associated with fetal abuse OR: 1.9 (95% CI: 1.39-2.71). CONCLUSIONS: The pregnancy in adolescent is a risk factor to fetal abuse and the form more frequent was the deficient prenatal attention.

Airway anomalies in the oculoauriculofrontonasal syndrome.

Oculoauriculofrontonasal syndrome was the subset of patients with oculo-auriculo-vertebral spectrum and frontonasal malformation. Radiographic evidence of tracheal duplication was documented in a male infant with oculoauriculofrontonasal syndrome. Although previously unreported in oculoauriculofrontonasal syndrome, airway anomalies in our case can be attributed to the oculo-auriculo-vertebral component of the oculoauriculofrontonasal syndrome.

Defectos del tubo neural altos y bajos al nacer en el Hospital Civil Juan I. Menchaca / Upper and lower neural tube defect at birth in the Hospital Civil Juan I. Menchaca

Objetivo: determinar la prevalencia de los Defectos del Tubo Neural (DTN) altos y bajos al nacer, y la frecuencia de exposición a gripe, anticonceptivos y analgésicos durante el primer trimestre de embarazo.Introducción: los defectos del tubo neural se encuentran asociados a factores genéticos y ambientales. Aunque ya se han identificado a varios de ellos, se hipotetiza que los defectos del tubo neural altos tienen diferente etiología de los bajos.Material y método: se realizó un estudio descriptivo transversal simple. Se incluyeron a todos los recién nacidos (RN) vivos o muertos con defectos del tubo neural, con peso mayor de 500 g y/o más de 20 semanas de gestación que nacieron entre enero de 1989 y marzo de 1997 en el Hospital Civil Dr. Juan I. Menchaca. Se consideraron para su estudio, variables demográficas, frecuencia de exposición a gripe, anticonceptivos y analgésicos así como las características del recién nacido.Resultados: de 56,926 nacimientos 166 presentaron defectos del tubo neural. La prevalencia general promedio de DTN en el hospital fue de 25 x 10,000 RN; los DTN altos tuvieron prevalencia de 18.8 x 10,000 RN, mientras que los DTN bajos fue de 10.4 x 10,000 RN.La anencefalia fue la malformación más frecuente de los DTN altos con una tasa de 14 x 10,000; y el mielomeningocele en el grupo con DTN bajos con una tasa de 6.5 x 10,000. La ingesta de acetaminofén fue tres veces mayor en el grupo con DTN alto. La presencia de gripe y uso de anticonceptivos no presentó grandes diferencias entre uno y otro grupo de malformados. El peso, talla y edad gestacional de los RN con DTN altos fueron menores y nacieron principalmente por vía vaginal; mientras que los recién nacidos con DTN bajos lo hicieron por cesárea.Discusión: se encontraron algunas diferencias entre los DTN altos y bajos, sobre todo en la frecuencia de mielocele y mielomeningocele, en la ingesta de acetaminofén y en la forma de resolución de los partos.