Validación de un instrumento para evaluar el nivel de conocimiento en la aplicación de fórceps obstétrico / Validation of an instrument to assess the level of knowledge about the application of obstetric forceps

Resumen OBJETIVO: Diseñar y validar un instrumento para evaluar el nivel de conocimiento en la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, tipo validación de un instrumento. El primer constructo se desarrolló con base en el marco teórico; el cuestionario fue objeto de análisis por parte de un grupo de expertos que se basaron en la metodología Delphi. Se obtuvo un constructo de 20 preguntas y se emprendió un estudio para evaluar la pertinencia del instrumento. La confiabilidad se evaluó con el coeficiente de Kuder-Richardson, prueba Kaiser-Meyer-Olkin y de esfericidad de Bartlett. Los datos se procesaron en el programa SPSS versión 21. RESULTADOS: El instrumento se aplicó a 66 médicos residentes con media de edad de 28.5 ± 0.7 años. El coeficiente de Kuder-Richardson fue 0.608. Las pruebas de Kaiser-Meyer-Olkin y Bartlett mostraron que se trató de un instrumento multidimensional. CONCLUSIONES: Se obtuvo un instrumento válido, confiable y multidimensional para determinar el nivel de conocimientos en relación con la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia.

Abstract OBJECTIVE: To design and validate an instrument to assess the level of knowledge of Salinas forceps application in Gynecology and Obstetrics residents. MATERIALS AND METHODS: Descriptive, cross-sectional, validation-type study of an instrument. The first construct was developed based on the theoretical framework; the questionnaire was analyzed by a group of experts based on the Delphi methodology. A construct of 20 questions was obtained and a study was undertaken to assess the relevance of the instrument. Reliability was evaluated with the Kuder-Richardson coefficient, Kaiser-Meyer-Olkin test and Bartlett's sphericity test. The data were processed in SPSS version 21. RESULTS: The instrument was applied to 66 resident physicians with a mean age of 28.5 ± 0.7 years. The Kuder-Richardson coefficient was 0.608. The Kaiser-Meyer-Olkin and Bartlett tests showed that it was a multidimensional instrument. CONCLUSIONS: A valid, reliable and multidimensional instrument was obtained to determine the level of knowledge in relation to the application of Salinas forceps in Gynecology and Obstetrics residents.

ESR1 and PGR gene promoter methylation and correlations with estrogen and progesterone receptors in ductal and lobular breast cancer.

The aim of this work was to analyze methylation of the promoter sites of the ESR1 and PGR genes and to determine correlations with immunohistochemical expression of estrogen and progesterone receptors in ductal and lobular breast cancers. An observational, descriptive, molecular study was conducted on 20 ductal and 20 lobular breast cancer samples with immunohistochemical determination of estrogen and progesterone receptor expression. The methylation analysis of ESR1 and PGR promoter sites was carried-out by methylation-specific PCR. For correlation analysis, Kendall's tau coefficient was determined. Positive correlations were found between estrogen and progesterone receptors, estrogen receptor and unmethylated progesterone receptor, progesterone receptor, and unmethylated progesterone receptor. Negative correlations were found between estrogen receptor and methylated progesterone receptor, progesterone receptor and methylated progesterone receptor, methylated and unmethylated estrogen receptor, and methylated and unmethylated progesterone receptor. The results suggest that methylation of promoter sites of ESR1 and PGR is a relatively uncommon event in ductal and lobular breast cancer, and also suggest that the determination of epigenetic states of ESR1 and PGR could represent an alternative or complement to the histopathological expression analysis.

Doppler ultrasound evaluation in preeclampsia.

BACKGROUND: Worldwide preeclampsia (PE) is the leading cause of maternal death and affects 5 to 8% of pregnant women. PE is characterized by elevated blood pressure and proteinuria. Doppler Ultrasound (US) evaluation has been considered a useful method for prediction of PE; however, there is no complete data about the most frequently altered US parameters in the pathology. The aim of this study was to evaluate the uterine, umbilical, and the middle cerebral arteries using Doppler US parameters [resistance index (RI), pulsatility index (PI), notch (N), systolic peak (SP) and their combinations] in pregnant women, in order to make a global evaluation of hemodynamic repercussion caused by the established PE. RESULTS: A total of 102 pregnant Mexican women (65 PE women and 37 normotensive women) were recruited in a cases and controls study. Blood velocity waveforms from uterine, umbilical, and middle cerebral arteries, in pregnancies from 24 to 37 weeks of gestation were recorded by trans-abdominal examination with a Toshiba Ultrasound Power Vision 6000 SSA-370A, with a 3.5 MHz convex transducer. Abnormal general Doppler US profile showed a positive association with PE [odds ratio (OR) = 2.93, 95% confidence interval (CI) = 1.2 - 7.3, P = 0.021)], and a specificity and predictive positive value of 89.2% and 88.6%, respectively. Other parameters like N presence, RI and PI of umbilical artery, as well as the PI of middle cerebral artery, showed differences between groups (P values < 0.05). CONCLUSION: General Doppler US result, as well as N from uterine vessel, RI from umbilical artery, and PI from umbilical and middle cerebral arteries in their individual form, may be considered as tools to determine hemodynamic repercussion caused by PE.

No association between polymorphisms/haplotypes of the vascular endothelial growth factor gene and preeclampsia.

BACKGROUND: Preeclampsia (PE) is the first worldwide cause of death in pregnant women, intra-uterine growth retardation, and fetal prematurity. Some vascular endothelial grown factor gene (VEGF) polymorphisms have been associated to PE and other pregnancy disturbances. We evaluated the associations between VEGF genotypes/haplotypes and PE in Mexican women. METHODS: 164 pregnant women were enrolled in a case-control study (78 cases and 86 normotensive pregnant controls). The rs699947 (-2578C/A), rs1570360 (-1154G/A), rs2010963 (+405G/C), and rs25648 (-7C/T), VEGF variants were discriminated using Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR-RFLP) methods or Taqman single nucleotide polymorphism (SNP) assays. RESULTS: The proportions of the minor allele for rs699947, rs1570360, rs2010963, and rs25648 VEGF SNPs were 0.33, 0.2, 0.39, and 0.17 in controls, and 0.39, 0.23, 0.41, and 0.15 in cases, respectively (P values > 0.05). The most frequent haplotypes of rs699947, rs1570360, rs2010963, and rs25648 VEGF SNPs, were C-G-C-C and C-G-G-C with frequencies of 0.39, 0.21 in cases and 0.37, 0.25 in controls, respectively (P values > 0.05) CONCLUSION: There was no evidence of an association between VEGF alleles, genotypes, or haplotypes frequencies and PE in our study.

[Perinatal mortality at Hospital de Ginecoobstetricia No. 23 of Monterrey, Nuevo León, 2002-2006 period]. / Mortalidad perinatal en el Hospital de Ginecoobstetricia núm. 23 de Monterrey, Nuevo León (2002 a 2006).

BACKGROUND: Perinatal period begins at 22 gestational weeks and ends seven days after birth. Perinatal mortality is an important quality indicator of the obstetric and pediatric care available, and representative of the population's health service. OBJECTIVE: To know fetal, early neonatal, and perinatal dead rates, and them main mortality causes. PATIENTS AND METHODS: Descriptive and retrospective study at IMSS's no. 32 UMAE (Monterrey, Nuevo León, México), from January 2002 to December 2006. Mortality rates during fetal and perinatal, or neonatal periods, were estimated per 1,000 births or 1,000 live born, respectively. RESULTS: There were 1,681 deaths: 747 stillbirths and 934 neonatal. Two hundred and nineteen (29.3%) stillbirths had 22 to 27 gestational weeks, and 528 (70.6%) had 28. Three hundred and sixty neonatal deaths (38.5%) occurred before 27th gestational week, 320 (34.2%) between weeks 28th and 35th, and 254 (27.1%) after 36 weeks of pregnancy. Seven hundred and sixty four neonates died within 0 to 6 days of life, and 170 (18%) between seventh to 28th days of life. Fetal, neonatal, early neonatal, and late neonatal mortality rates were 7.2 in 1,000 births, 9.08 in 1,000 live born, 7.42 in 1,000 live born, and 1.65 in 1,000 births, respectively, and overall perinatal mortality rate was 14.58 in 1,000 births. CONCLUSIONS: Stillbirth, early neonatal, and perinatal mortality rates of this study were under national mean. Main mortality causes (70%) were congenital defects and prematurity.

[Ambulatory treatment of prolonged pregnancy with prostaglandin E2 gel]. / Embarazo de 41 semanas o mayor. Manejo ambulatorio con gel de prostaglandina E2.

BACKGROUND: the rutinary labor induction with prostaglandin E2 (PGE2) in pregnancy at 41 weeks has showed a fetal benefit without an increase in maternal morbidity or cesarean delivery. OBJECTIVE: to show that the ambulatory management of prolonged pregnancy with PGE2 gel decreases the cesarean delivery and prenatal morbidity rates. METHODS: quasiexperimetal study of patients with an accurate dated pregnancy of 41 weeks and beyond were analyzed. The women were divided in two groups of 196 each one. In the treated group, the endocervical application of PGE2 was followed by cardiotocographic control. If there was no reason to interrupt the pregnancy they were evaluated twice a week. Perinatal outcomes, mode of delivery and indications for cesarean section were assessed in both groups. RESULTS: there was a decrease in rate of cesarean delivery in treated group, 43 % versus 54 % in control group (p < 0.05). Apgar score at 1 and 5 minute showed no difference, but there were two intrauterine deaths in control group. The indications for cesarean surgery were the same in both groups and there was a case of tachysystole in each one. CONCLUSION: we concluded that decrease in the rate of cesarean deliveries without increments of fetal and maternal morbidity in this study, point to a secure management choice with PGE2 in ambulatory patients.