Surrogate indices of insulin resistance using the Matsuda index as reference in adult men-a computational approach.

Background: Overweight and obesity, high blood pressure, hyperglycemia, hyperlipidemia, and insulin resistance (IR) are strongly associated with non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disease, stroke, and cancer. Different surrogate indices of IR are derived and validated with the euglycemic-hyperinsulinemic clamp (EHC) test. Thus, using a computational approach to predict IR with Matsuda index as reference, this study aimed to determine the optimal cutoff value and diagnosis accuracy for surrogate indices in non-diabetic young adult men. Methods: A cross-sectional descriptive study was carried out with 93 young men (ages 18-31). Serum levels of glucose and insulin were analyzed in the fasting state and during an oral glucose tolerance test (OGTT). Additionally, clinical, biochemical, hormonal, and anthropometric characteristics and body composition (DEXA) were determined. The computational approach to evaluate the IR diagnostic accuracy and cutoff value using difference parameters was examined, as well as other statistical tools to make the output robust. Results: The highest sensitivity and specificity at the optimal cutoff value, respectively, were established for the Homeostasis model assessment of insulin resistance index (HOMA-IR) (0.91; 0.98; 3.40), the Quantitative insulin sensitivity check index (QUICKI) (0.98; 0.96; 0.33), the triglyceride-glucose (TyG)-waist circumference index (TyG-WC) (1.00; 1.00; 427.77), the TyG-body mass index (TyG-BMI) (1.00; 1.00; 132.44), TyG-waist-to-height ratio (TyG-WHtR) (0.98; 1.00; 2.48), waist-to-height ratio (WHtR) (1.00; 1.00; 0.53), waist circumference (WC) (1.00; 1.00; 92.63), body mass index (BMI) (1.00; 1.00; 28.69), total body fat percentage (TFM) (%) (1.00; 1.00; 31.07), android fat (AF) (%) (1.00; 0.98; 40.33), lipid accumulation product (LAP) (0.84; 1.00; 45.49), leptin (0.91; 1.00; 16.08), leptin/adiponectin ratio (LAR) (0.84; 1.00; 1.17), and fasting insulin (0.91; 0.98; 16.01). Conclusions: The computational approach was used to determine the diagnosis accuracy and the optimal cutoff value for IR to be used in preventive healthcare.

A longitudinal study of free leptin index in pre-eclamptic pregnancies.

The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the aim of our study was to investigate the FLI in mild pre-eclamptic pregnancies in a nested case-control study within a prospective observational study. Circulating levels of leptin and sOB-R levels rise significantly during pregnancy in healthy (p < 0.05) (n = 46) and pre-eclamptic pregnancies (p < 0.05) (n = 20). Serum levels of leptin were significantly higher in pre-eclamptic compared to healthy pregnancies at second and third trimesters of pregnancy (p < 0.05). Additionally, serum levels of sOB-R were significantly lower in pre-eclamptic pregnancies during the second and third trimesters of pregnancy compared to healthy pregnancies (p < 0.05). Moreover, we found that FLI did not vary significantly during pregnancy in healthy women (p > 0.05), while it increases in pre-eclamptic pregnancies (p < 0.05). Indeed, FLI was significantly higher at second and third trimesters of pregnancy in pre-eclamptic compared to healthy pregnancies (p < 0.05). In addition, FLI was significantly higher in the luteal phase compared with the follicular phase of the menstrual cycle in eumenorrheic women (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed the ability of leptin (AUC = 0.72) and FLI (AUC = 0.67) as a reliable predictor for mild pre-eclampsia during the second trimester of pregnancy. In conclusion, our findings show that FLI were significantly increased in mild pre-eclamptic pregnancies and allowed us to hypothesize that this rise might alter leptin bioavailability and bioactivity which might lead to the sympathetic hyperactivity and the hypertensive disorders during pregnancy.

Study of the Ghrelin/LEAP-2 Ratio in Humans and Rats during Different Phases of Pregnancy.

The Liver-Expressed Antimicrobial Peptide 2 (LEAP-2) has emerged as an endogenous GHS-R antagonist and blunts the orexigenic action of ghrelin. This study aimed to determine the Ghrelin/LEAP-2 ratio in humans and rats during pregnancy. In humans, we conducted a nested case-control study within an observational prospective cohort. Healthy and mild preeclamptic pregnant women were studied at each trimester of gestation and three months postpartum. In addition, a group of non-pregnant women was studied into the follicular and luteal phases of the menstrual cycle. Furthermore, Ghrelin/LEAP-2 ratio was investigated in non-pregnant rats and at different periods of rat pregnancy. Human and rat serum ghrelin and LEAP-2 levels were determined using the commercially available ELISA kits. The Ghrelin/LEAP-2 ratio peak around the second trimester of gestation in healthy pregnant women (p < 0.05). Additionally, there were no statistically significant differences in Ghrelin/LEAP-2 ratio between healthy and preeclamptic pregnant women at each trimester of gestation (p > 0.05). The Ghrelin/LEAP-2 ratio in pregnant rat reached the peak around mid-gestation with a similar pattern to the human pregnancy. LEAP-2 was visualized by immunohistochemistry in human term placenta and rat placentas on days 12, 16 and 21 of pregnancy. In conclusion, this study provides the first evidence of a Ghrelin/LEAP-2 ratio peak around the half-way point of pregnancy onwards during human and rat pregnancy, and it might be associated with increased rates of weight gain during pregnancy. Thus, this study suggests that LEAP-2 and Ghrelin/LEAP-2 ratio might play an important role in maternal physiology adaptation of weight gain during pregnancy.

Maternal Fibroblast Growth Factor 21 Levels Decrease during Early Pregnancy in Normotensive Pregnant Women but Are Higher in Preeclamptic Women-A Longitudinal Study.

(1) Background: Fibroblast growth factor 21 (FGF-21) is an endocrine factor involved in glucose and lipid metabolism that exerts pleiotropic effects. The aim of this study was to investigate the serum FGF-21 profile in healthy and mild preeclamptic pregnant women at each trimester of pregnancy; (2) Methods: Serum FGF-21 levels were determined by ELISA in a nested case-control study within a longitudinal cohort study that included healthy (n = 54) and mild preeclamptic (n = 20) pregnant women, women at three months after delivery (n = 20) and eumenorrheic women during the menstrual cycle (n = 20); (3) Results: FGF-21 levels were significantly lower in the mid-luteal phase compared to the early follicular phase of the menstrual cycle in eumenorrheic women (p < 0.01). Maternal levels of FGF-21 were significantly lower in the first and second trimesters and peaked during the third trimester in healthy pregnant women (p < 0.01). Serum levels of FGF-21 in healthy pregnant were significantly lower in the first and second trimester of pregnancy compared with the follicular phase of the menstrual cycle and postpartum (p < 0.01). Serum FGF-21 levels were significantly higher in preeclamptic compared to healthy pregnant women during pregnancy (p < 0.01); (4) Conclusions: These results suggest that a peak of FGF-21 towards the end of pregnancy in healthy pregnancy and higher levels in preeclamptic women might play a critical role that contributes to protecting against the negatives effects of high concentrations of non-esterified fatty acids (NEFA) and hypertensive disorder. Furthermore, FGF-21 might play an important role in reproductive function in healthy eumenorrheic women during the menstrual cycle.

Pelvic abscess mistaken for malignant ovarian tumor in a postmenopausal woman. case report

ABSTRACT Introduction: Tubo-ovarian abscesses are rare in postmenopausal women. They have been associated with benign gynecological conditions such as endometriosis, uterine polyp or leiomyoma, and malignant diseases such as endometrial adenocarcinoma, epithelial and non-epithelial malignant ovarian tumors, squamous cell carcinoma of the cervix, and adenocarcinoma of the colon. Their presentation represents a diagnostic and therapeutic challenge for clinicians. Case report: A 72-year-old female patient was admitted with a 3-day history of abdominal pain and distension, fever, irritative urinary symptoms and urinary retention. Lab tests on admission showed elevated white blood cells and neutrophils count, and CA-1 25 at 222 U/mL. Ultrasound and magnetic resonance imaging revealed a solid retrouterine cystic mass of 15 cm. Suspecting tumor versus tubo-ovarian abscess, a tomography-directed biopsy was performed, finding foul-smelling purulent material. An exploratory laparotomy was performed with intraoperative findings of solid-cystic retrouterine pelvic mass with purulent content, adhesions, and inflammatory involvement of the uterine tubes. Pathology reported ovarian fibroma and tubo-ovarian abscess. The patient evolved satisfactorily in the postoperative period and in the subsequent follow-up appointments. Conclusions: The reported case illustrates how a possibility of ovarian cancer with peritoneal carcinomatosis can actually be a benign condition (tubo-ovarian abscess) that responds well to medical-surgical treatment. Diagnostic imaging and tumor markers are helpful in differentiating a malignant ovarian disease from a benign process.

RESUMEN Introducción. Los abscesos tubo-ováricos son poco frecuentes en la posmenopausia y se asocian con patologías ginecológicas benignas como endometriosis, pólipo endometrial o leiomioma uterino, y con patologías malignas como adenocarcinoma de endometrio, tumores malignos epiteliales y no epiteliales de ovario, carcinoma escamocelular de cérvix y adenocarcinoma de colon. Su presentación representa un reto diagnóstico y terapéutico para el médico. Presentación del caso. Paciente femenina de 72 años, quien consultó por cuadro clínico de tres días de evolución consistente en dolor y distensión abdominal asociados a fiebre y síntomas urinarios irritativos y retención urinaria. Los exámenes de ingreso mostraron leucocitosis con neutrofilia y CA-125 en 222 U/mL El ultrasonido y la resonancia magnética evidenciaron una masa retrouterina solido-quística de 15 cm. Ante sospecha de tumor versus absceso tubo-ovárico, se realizó biopsia dirigida por tomografía mediante la cual se encontró material purulento fétido. Se practicó laparotomía que confirmó masa pélvica retrouterina sólido-quística con contenido purulento, adherencias y compromiso inflamatorio de las trompas uterinas. El resultado de patología informó fibroma ovárico y absceso tubo-ovárico. La paciente evolucionó de satisfactoriamente en el posoperatorio y en los controles posteriores. Conclusiones. El caso reportado ilustra cómo, en ocasiones, un posible diagnóstico de car-cinomatosis por cáncer de ovario puede ser realmente una patología benigna (absceso tubo-ovárico) que responde bien a un tratamiento médico-quirúrgico. Las imágenes diagnósticas y los marcadores tumorales son de gran ayuda para diferenciar una patología ovárica maligna de un proceso benigno.

Maternal Serum Angiopoietin-Like 3 Levels in Healthy and Mild Preeclamptic Pregnant Women.

Objective: Angiopoietin-like protein 3(ANGPTL3) is an important regulator of lipoprotein metabolism in the fed state by inhibiting the enzyme lipoprotein lipase in oxidative tissues. However, the possible role of ANGPTL3 throughout gestation and its relationship with hormonal and biochemical variables are still unknown. The aim of this study was to determinate serum ANGPTL3 level in healthy non-pregnant women, during healthy and preeclamptic pregnancy and postpartum. Methods: Serum ANGPTL3 was analyzed by enzyme-linked immunosorbent assay (ELISA), in a prospective cohort of healthy pregnant women (n = 52) and women with mild preeclampsia (n = 21), and women at three months postpartum (n = 20) and healthy non-pregnant women (n = 20). The results obtained were correlated with biochemical, hormonal and anthropometric variables and insulin resistance indices. Results: Levels of ANGPTL3 were not different between the follicular and the luteal phases of the cycle in healthy non-pregnant women. There was a significant reduction in serum ANGPTL3 levels from the first to the third trimester in healthy pregnant women compared with healthy non-pregnant and postpartum women (p <0.01). ANGPTL3 levels do not differ significantly during the three trimesters of pregnancy neither in healthy women nor in preeclamptic women. The serum levels of ANGPTL3 in women who developed preeclampsia are not statistically different from those observed in healthy pregnant women in each trimester of pregnancy. A significant lineal positive correlation was observed between serum ANGPTL3 levels and triglyceride (P =0.0186, r =0.52), very low-density lipoprotein cholesterol (P =0.0224, r =0.50), and total cholesterol levels (P =0.0220, r =0.50) in healthy non-pregnant women (P 0.05). Besides, there were no significant correlations between serum ANGPTL3 and body mass index (BMI), high-density lipoprotein cholesterol, glucose, insulin, leptin, or HOMA-IR (P >0.05). Conclusions: We describe for the first time the profile of ANGPTL3 throughout pregnancy and postpartum as well as and discussed about explore their potential contribution interactions with lipoprotein metabolism throughout pregnancy and postpartum. Thus, low levels of ANGPTL3 during pregnancy might favor lipid uptake in oxidative tissues as the main maternal energy source, while may helping to preserve glucose for use by the fetus and placenta.

Terapia hormonal en la menopausia y cánceres diferentes al cáncer de mama. Riesgos y beneficios / Hormonal therapy in menopause and cancers other than breast cancer. Risks and benefits

Introducción: La terapia hormonal es el tratamiento de elección para la sintomatología vasomotora, así como para los síntomas y signos asociados con el síndrome urogenital. Utilizada dentro de la ventana terapéutica, la terapia hormonal en la menopausia reduce el riesgo cardiovascular y las fracturas por osteoporosis posmenopáusica. Hay abundante literatura en relación con la asociación entre terapia hormonal en la menopausia y cáncer de mama; sin embargo, la información sobre los riesgos y beneficios de la terapia hormonal en la menopausia en relación con otras neoplasias malignas es menos conocida. Este artículo resume los riesgos y beneficios de la terapia hormonal en pacientes con neoplasias malignas diferentes al cáncer de mama. Métodos: Revisión narrativa, no sistemática, de la literatura, que incluye artículos originales y revisiones sistemáticas publicadas. Resultados: Se resumen los principales hallazgos de los riesgos y beneficios de la terapia hormonal de reemplazo en pacientes con neoplasias diferentes al cáncer de mama, incluyendo neoplasias de los sistemas digestivo, respiratorio y nervioso, así como neoplasias malignas hematológicas, de la glándula tiroides, el ovario y el endometrio. Conclusiones: La relación entre la terapia hormonal en la menopausia y las neoplasias malignas es un campo de investigación activa. Considerando la calidad de la evidencia primaria de una buena parte de los estudios incluidos en revisiones sistemáticas encontradas, las dificultades metodológicas derivadas de la baja incidencia de las neoplasias malignas estudiadas y los resultados controversiales, el médico debe tener una actitud crítica ante los hallazgos y estar atento a nuevas pruebas científicas acerca de las asociaciones entre la terapia hormonal y diferentes tipos de cáncer.

Introduction: Menopausal Hormone therapy is the treatment of choice for vasomotor symptoms, as well as for the symptoms and signs associated with urogenital syndrome. Used within the therapeutic window, menopausal hormone therapy reduces cardiovascular risk and fractures due to postmenopausal osteoporosis. There is abundant literature regarding the association between menopausal hormone therapy and breast cancer; however, information about the risks and benefits of hormone therapy in menopause in relation to other malignant neoplasms is less known. This article summarizes the risks and benefits of hormonal therapy in patients with malignant neoplasms other than breast cancer. Methods: Narrative, non-systematic review of the literature, which includes original articles and published systematic reviews. Results: This article summarized the main findings in the literature about the risks and benefits of hormone replacement therapy in patients with neoplasms other than breast cancer, including digestive, respiratory and nervous system neoplasms, as well as, hematological, thyroid gland, ovary and endometrium malignancies. Conclusions: The relationship between menopausal hormone therapy and malignant neoplasms is an active field of research. Considering the quality of the primary evidence of a group of studies included in the systematic reviews found, the methodological difficulties derived from the low incidence of the malignancies studied, and the controversial results, physicians must adopt a critical attitude towards the findings and be attentive to new scientific evidence about the associations between hormonal therapy and different types of cancer.

Triglycerides/Glucose and Triglyceride/High-Density Lipoprotein Cholesterol Indices in Normal and Preeclamptic Pregnancies: A Longitudinal Study.

Metabolic changes have been correlated with adverse pregnancy outcomes. The aim of the present study is to determine the TyG and TG/HDL-c indices in a cohort of healthy pregnant (n = 142), preeclamptic (n = 18), and healthy nonpregnant women (n = 56). Preeclamptic women were selected from the same cohort. Pregnant women were followed during three periods of pregnancy and postpartum. The results showed a significant increase in the values of TyG and TG/HDL-c (p < 0.01) as pregnancy progresses, without significant differences between healthy and preeclamptic women. TyG and TG/HDL-c indices are significantly low in nonpregnant and three months' postpartum women when compared with each gestational period studied. TyG and TG/HDL-c indices are positively correlated with HOMA-IR in the early and middle pregnancy (p < 0.05). Multiple linear regression using the TyG and TG/HDL-c indices as dependent variables showed that TyG index was significantly associated with HOMA-IR, gestational age, HDL-c, TC, LDL, fasting insulin, and mean BP (p < 0.001); meanwhile, TG/HDL-c index was only associated with HOMA-IR (p < 0.0242) and gestational age (p < 0.001). In conclusion, the TyG and TG/HDL-c indices could be useful in monitoring insulin resistance during pregnancy.

Niveles séricos del factor neurotrófico derivado del cerebro durante la gestación normal y la preeclampsia / Serum Levels of Brain Derived Neurotrophic Factor during Normal Pregnancy and Preeclampsia

Introducción. La preeclampsia (PE) es una de las principales causas de mortalidad materna y perinatal en el mundo, aparece en la segunda mitad de la gestación y actualmente no hay marcadores que la detecten en forma temprana. Dadas las propiedades angiogénicas del factor neurotrófico derivado del cerebro (BDNF) y la disfunción endotelial de los vasos sanguíneos presente en la PE, se ha propuesto una posible asociación entre el BDNF y PE. Objetivo. Determinar si existe asociación entre niveles séricos de BDNF durante el embarazo y la preeclampsia. Materiales y métodos. Estudio de cohorte prospectivo longitudinal. Se seleccionaron 13 pacientes quienes desarrollaron PE y 31 gestantes de curso normal. Se midieron variables antropométricas y niveles de BDNF, glicemia, insulina y perfil lipídico en la gestación temprana, media y tardía. Se practicó un modelo de regresión logística para verificar si los niveles de BDNF, en conjunto con otras variables, pueden explicar el desarrollo de PE. Resultados. Los niveles de BDNF no variaron significativamente entre el grupo de gestantes que desarrollaron preeclampsia y las que no: en gestación temprana 25.3 y 23.3ng/ml, en gestación media 28 y 24.7ng/ml y en gestación tardía 25.4 y 27.4ng/ml, respectivamente. Se hallaron diferencias entre los dos grupos en el peso, la insulina y la evaluación del modelo homeostático (HOMA). Se encontró asociación entre niveles de BDNF y peso e IMC y glucemia en las gestantes que no desarrollaron PE. Se practicó un modelo de regresión logística en el que la PE se explicó mejor con variables como IMC, PAS y HOMA, pero no con BDNF. Conclusiones. El BDNF puede participar en la regulación del peso corporal y el metabolismo de la glucosa en mujeres gestantes, pero el nivel de BDNF, solo o en conjunto con otras variables, no puede explicar la preeclampsia.

Introduction. Preeclampsia (PE) is one of the major causes of maternal and perinatal mortality in the world. PE appears during the second half of pregnancy and there are currently no markers for its early detection. Given the angiogenic properties of brain derived neurotrophic factor (BDNF) and the endothelial dysfunction of blood vessels that occurs during PE, an association between BDNF and PE has been proposed. Objective. To determine if there is an association between BDNF serum levels and PE during pregnancy. Materials and Methods. Prospective longitudinal cohort study. 13 patients who developed PE and 31 patients with normally coursing pregnancies were selected. Anthropometric variables, BDNF serum levels, glycemia, insulin and lipid profile in early, mid-term and late pregnancies were measured. Results. No significant differences were observed in BDNF levels between women who developed PE and those who did not; in early pregnancy the levels were 25.3 and 23.3 ng/ml, for mid-term pregnancy 28 and 24.7 ng/ml and for late pregnancy 25.4 and 27.4 ng/ml for PE and normal pregnancy, respectively. An association between BDNF and weight and BMI and serum glucose was found in women who did not develop PE. A logistic regression model was carried out where PE was better explained through variables such as BMI, SBP and homoeostasis model assessment (HOMA), however BDNF was not taken into account here. Conclusions. BDNF might have a role in regulating body weight and glucose metabolism in pregnant women but there is no evidence to suggest that BDNF alone or in combination with other variables can account for PE.

Sobre la enseñanza en las Facultades de Medicina. Universidad Nacional de Colombia / On teaching Medicine at universities. Universidad Nacional de Colombia

En este texto se presentan brevemente algunas reflexiones sobre la enseñanza de la Medicina, el rol del docente y el de los estudiantes; así como varias opiniones sobre las prácticas pedagógicas en las ciencias médicas dentro de un contexto universitario, tomando como punto principal el papel de la educación en la Facultad de Medicina de la Universidad Nacional de Colombia. De esta forma, se abordarán las ideas de algunos expertos en materia educativa.

This paper briefly presents some considerations on the teaching of Medicine as a discipline, the roles of teachers and students, as well as several opinions about pedagogical practices regarding Medical Sciences in a university context by means of focusing on the role of education in the Faculty of Medicine of National University of Colombia. This way, the ideas of some experts on education will be discussed.

Longitudinal analysis of maternal serum Follistatin concentration in normal pregnancy and preeclampsia.

OBJECTIVE: Follistatin (FST) is a regulator of the biological activity of activin A (Act A), binding and blocking it, which could contribute to the modulation of its pro-inflammatory activity during pregnancy. We sought to investigate, in this nested case-control study, FST serum levels during normal pregnancy and correlate it with the FST profile in preeclamptic pregnant women, normal pregnant women followed 3 months postpartum and eumenorrheic nonpregnant women throughout the menstrual cycle. SUBJECTS AND METHODS: Follistatin serum levels determined by ELISA, biochemical and anthropometric variables were measured in normal pregnant (n = 28) and preeclamptic (n = 20) women during three periods of gestation. In addition, FST serum levels were measured in a subset of normal pregnant women (n = 13) followed 3 months postpartum and in eumenorrheic nonpregnant women (n = 20) during the follicular and luteal phases of the menstrual cycle. RESULTS: Follistatin serum levels in the eumenorrheic nonpregnant and postpartum group were significantly lower when compared to levels throughout gestation (P < 0·01). Serum FST levels increased in each period of pregnancy analysed, being significantly higher towards the end of gestation (P < 0·01). FST levels were lower in late pregnancy in preeclamptic women compared to normal pregnant women (P < 0·05). Finally, FST levels were higher in the luteal phase when compared with the follicular phase of the menstrual cycle (P < 0·05). CONCLUSIONS: These analyses would permit the consideration that changes in FST levels during pregnancy contribute to the control of the Act A system.

Costo-efectividad del diagnóstico etiológico de la cervicitis por c. trachomatis basado en pruebas rápidas comparado con el abordaje sindrómico, en mujeres no gestantes con síntomas de infección del tracto genital inferior / Cost-effectiveness of etiologic diagnosis for C. trachomatis infection based on rapid tests versus syndromic approach in non-pregnant women with symptoms of lower genital tract infection

Objetivo: estimar la razón costo-efectividad del diagnóstico etiológico con pruebas rápidas para la cervicitis por C. trachomatis frente al diagnóstico sindrómico, en mujeres no gestantes con síntomas de infección del tracto genital inferior en Colombia. Materiales y métodos: se construyó un árbol de decisión para determinar la razón de costo-efectividad de la aproximación etiológica con las pruebas rápidas Acon®Plate, Acon®Duo y QuickVue® para la detección de C. trachomatis comparada con el diagnóstico sindrómico. La perspectiva fue la del sistema de salud colombiano incluyendo todos los costos médicos directos. El horizonte de tiempo fue de 15 días, ya que la unidad de resultado fue el número de casos correctamente identificados (número de verdaderos positivos y verdaderos negativos). Las características operativas de las pruebas se obtuvieron en un estudio de corte transversal diseñado y conducido para este propósito. Resultados: la alternativa más costosa y más efectiva fue QuickVue® seguida de Acon®Plate y del abordaje sindrómico. Acon®Duo fue una estrategia dominada. La razón de costo-efectividad incremental de QuickVue®, comparada con Acon®Plate, fue de $ 430.671; la de Acon®Plate, comparada con el abordaje sindrómico, fue de $ 79.747. Conclusión: si la disponibilidad a pagar (DAP) por un caso correctamente identificado adicional es mayor que $ 430.671, QuickVue® sería la mejor alternativa en términos de costo-efectividad; de otro lado, si la DAP está entre $ 79.747 y $ 430.671, Acon®Plate sería la alternativa costo-efectiva. Finalmente, si la DAP es menor que $ 79.747, el abordaje sindrómico sería la mejor alternativa en términos de costo-efectividad.

Objective: To estimate the cost-effectiveness of etiological approach with rapid tests for C. trachomatis cervicitis versus syndromic diagnosis, in non-pregnant women with symptoms of lower genital tract infection in Colombia. Materials and methods: A decision tree was developed for determining the cost-effectiveness ratio of the aetiological approach using the Acon®Plate, Acon®Duo and QuickVue® quick tests for the detection of C. trachomatis, compared with the syndromic diagnosis. The perspective was that of the Colombian healthcare system, including medical direct costs. The time period was 15 days, considering that the outcome unit was the number of cases identified correctly (number of true positives and true negatives). The operational characteristics of the tests were derived from a cross-sectional study designed and conducted for that specific purpose. Results: The more costly and effective option was QuickVue®, followed by Acon®Plate and the syndromic approach. Acon®Duo was a dominated strategy. The incremental cost-effectiveness ratio for QuickVue® compared with Acon®Plate was $430.671, and that of Acon®Plate compared with the syndromic approach was $79.747. Conclusion: If the willingness to pay (WTP) for an additional case that is correctly identified is greater than $430.671, QuickVue® would be the best option in cost-effectiveness terms. On the other hand, if the WTP is between $79.747 and $430.671, Acon®Plate would be the cost-effective strategy. Finally, if the WTP is less than $79.747, the syndromic approach would be the best option in cost-effectiveness terms.

Guía de práctica clínica para la detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico / Clinical practice guidelines for early detection of abnormalities during labor, care for normal and dystocic delivery

Objetivo: realizar recomendaciones para detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico. Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta Guía fue adaptada de la “Guía de práctica clínica sobre la atención del parto normal” (País Vasco - 2010) y actualizada por procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN). Esta guía y sus secciones hacen parte de un grupo de 25 GAI basadas en la evidencia que incorporan consideraciones económicas y de implementabilidad en el contexto del Sistema General de Seguridad Social en Salud colombiano, y que se desarrollaron por iniciativa del Ministerio de Salud y Protección Social y el Departamento de Ciencia, Tecnología e Innovación (Colciencias) en temas prioritarios y de alta prevalencia en el país mediante contrato otorgado a la Universidad Nacional de Colombia en el año 2010. Resultados: se presentan las recomendaciones para la asistencia del trabajo de parto y el parto asociadas con mayor probabilidad de obtener un resultado materno fetal exitoso durante la atención del parto. Conclusiones: se espera que las recomendaciones de esta GPC sean utilizadas por los profesionales de la salud de los programas de atención de la gestación con el fin de disminuir la morbilidad y mortalidad atribuibles a complicaciones del trabajo de parto y el parto.

Objective: To make recommendations for early detection of abnormalities during labor, and care of normal and dystocic delivery. Materials and methods: The Guideline Developer Group (GDG) prepared this CPG during 2011-2012 in accordance with the Methodology Guideline for the development of Comprehensive Care Guidelines of the Colombian General System of Social Security, on the basis of the available scientific evidence, and with the active participation of patient groups, scientific societies and stakeholders. In particular, the evidence for this section was adapted from the “Clinical practice guideline for normal delivery care” (País Vasco – 2010) and adapted through systematic procedures for the search and assessment of the evidence as well as for the generation of recommendations. The level of evidence and the power of the recommendations were expressed using the Scottish Intercollegiate Guidelines Network (SIGN) system. Results: We present the recommendations for labor and delivery care associated with the highest probability of a successful outcome for the mother and the baby. Conclusions: It is expected that the recommendations contained in this CPG will be used by practitioners in pregnancy care programs in order to reduce morbidity and mortality attributable to labor and delivery complications.

Prevalencia de Chlamydia Trachomatis detectada por reacción en cadena de la polimerasa en un grupo de mujeres jóvenes sintomáticas y asintomáticas en Bogotá, Colombia / Prevalence of Chlamydia trachomatis detected by polymerase chain reaction in a group of young symptomatic and asymptomatic women in Bogotá, Colombia

Introducción: la Chlamydia trachomatis (CT) es considerada hoy como la causa más frecuente de infeccions de transmisión sexual y enfermedad pélvica inflamatoria. Aproximadamente la mitad de los casos de infección por Chlamydia trachomatis cursan en forma asintomática lo que dificulta su detección clínica temprana y aumenta la probabilidad de secuelas a largo plazo. Objetivo: determinar la prevalencia de infección por C. trachomatis en un grupo de mujeres jóvenes con y sin leucorrea en Bogotá, Colombia. Metodología: estudio de corte transversal en el que se investigó por la técnica de reacción en cadena de la polimerasa de C. trachomatis en 355 muestras de orina obtenidas de mujeres jóvenes con o sin leucorrea. Las muestras fueron recolectadas en dos instituciones de primer nivel de la Secretaría Distrital de Salud y en dos instituciones públicas de educación superior, durante los meses de junio y julio del 2004. Se investigaron variables sociodemográficas de interés y prácticas anticonceptivas. Resultados: se detectaron 19 muestras positivas, de las cuales 5 correspondían a mujeres sin leucorrea y 14 pacientes con leucorrea. La prevalencia de infección fue 5,35 por ciento (IC 95 por ciento 3,25-8.23) en el grupo total, 2,86 por ciento (IC 95 por ciento 0,93-6,54) en las mujeres sin leucorrea y 7,78 por ciento (IC 95 por ciento 4,31-12,70) en las pacientes con leucorrea. Conclusión: la prevalencia encontrada en este estudio indica que la infección por C. trachomatis constituye un problema de interés en salud pública. Aunque la leucorrea puede considerarse como un marcador de infección por Chlamydia, dada la tendencia a mayor frecuencia en este grupo de pacientes, la prevalencia en mujeres asintomáticas fue importante y justifica ofrecer su detección en forma más amplia.

Tamizaje serológico y con PCR para determinar la prevalencia de Chlamydia trachomatis en pacientes con vaginosis y vaginitis inespecífica que asisten a hospitales de la Secretaría de Salud de Bogotá / Serologic and PCR screening to determine the prevalence of Chlamydia trachomatis in patients with vaginitis and inespecific vaginitis in two public hospitals in Bogotá

Chlamydia trachomatis (CT) es uno de los agentes etiológicos más importantes en las infecciones de transmisión sexual. En la mujer CT causa patologías tales como cervicitis, uretritis y enfermedad pélvica inflamatoria, entre otras. Los objetivos de este trabajo fueron determinar la prevalencia de la infección y la concordancia de las pruebas diagnósticas para CT en pacientes sintomáticas de vaginitis o leucorrea inespecífica, que asistieron al hospital Pablo VI de Bosa y al Hospital del Sur de Bogotá, durante los meses de junio y julio de 2004. Se obtuvieron 180 muestras simultáneas de suero y de orina para la determinación de IgG, IgM e IgA anticlamidia y para PCR, respectivamente. La detección de los anticuerpos para CT en suero se realizó mediante el método ELISA (VIRCEL) y la detección del DNA en orina se hizo con la prueba AMPLICOR CT PCR (ROCHE). La prevalencia de la infección fue del 31 porciento (56 casos). La mediana de edad en mujeres con evidencia de infección reciente o activa fue de 23 años; 37 pacientes (66)porciento positivas para algún marcador tenían infección activa. En 24 participantes (42.8)porciento con infección activa, de acuerdo con los resultados serológicos, no se detectó el DNA en orina; en 14 pacientes (25 porciento de las pacientes positivas en las pruebas serológicas) se encontró el PCR positivo en las muestras de orina. Una prevalencia del 31 porciento en mujeres sintomáticas indica que la infección por Chlamydia es un problema para la salud pública. Implantar un programa de tamizaje para la búsqueda activa de casos, así como la búsqueda activa de contactos sexuales, reducirá el peso socioeconómico de la infección. La prueba ideal para diagnóstico tanto de cervicitis como de uretritis en el mismo procedimiento deberá utilizar muestra de orina y de cepillado cervical.

Pasado, presente y futuro de las progestinas / Past, present and future of progestogens

En este artículo se presentan los hitos en la historia del descubrimiento de la progesterona y de la síntesis de las progestinas, así como la asociación entre estos desarrollos y las aplicaciones terapéuticas de los progestágenos en anticoncepción hormonal y terapia de reemplazo hormonal. También se describe la clasificación actual de los progestágenos y las perspectivas de investigación futura.