Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

OBJECTIVE: To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. METHODS: This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. RESULTS: In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36-3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95-4.85); P = 0.068). CONCLUSION: When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to investigate the association between the trigonometric properties of episiotomy in operative vaginal delivery (OVD) and obstetric anal sphincter injuries (OASIS). METHODS: The study included 72 primiparous women who had an OVD and episiotomy. Cases (n = 36) had sustained OASIS at birth, while controls (n = 36) had not. The groups were matched for instrumental delivery. The episiotomy scar was identified and its trigonometric characteristics were measured at 8-12 weeks postpartum. Data were analysed using conditional logistic analysis. RESULTS: The angle of episiotomy behaves as a factor associated with anal sphincter injury, so women with a mediolateral episiotomy and an angle greater than 20° have an 87% less risk of having an OASIS (odds ratio 0.13, 95% confidence interval 0.03-0.58). The study showed that scarred episiotomies at 8-12 weeks after OVD with an angle ≤ 20°, depth and distance between the episiotomy and anus ≤ 15 mm, total upper triangle perimeter ≤ 75 mm, para-anal triangle perimeter ≤ 15 mm and areas between scar and midline ≤ 250 mm(2) were significantly associated with higher risk of OASIS. CONCLUSIONS: When a mediolateral episiotomy is performed in OVD the technique has a strong effect on the occurrence of OASIS. Additional research is needed to determine if the optimal technique for mediolateral episiotomies produces less OASIS than deferring the performance of episiotomy.

Indoor radon risk mapping of the Canary Islands using a methodology for volcanic islands combining geological information and terrestrial gamma radiation data.

Within the framework of the recent approval of the National Plan Against Radon by the Council of Ministers of the Spanish Government, one of its five axes focuses on the delimitation of priority action areas. In line with this objective, this paper presents the indoor radon risk maps of the Canary Islands. Due to the volcanic origin of the Canary Islands, there is a great deal of geological heterogeneity in the soils on which buildings settle, making it very difficult to delimit radon-risk areas in the process of creating maps. Following a methodology developed in previous works for a study area formed of a set of representative municipalities, this paper presents radon risk maps of the Canary Islands based on lithostratigraphic information and high-resolution terrestrial gamma radiation maps. The goodness of fit of these maps is verified based on a statistical analysis of indoor radon concentration measurements carried out at representative building enclosures. In order to analyse the level of risk to the population, these maps were combined with built up areas (urban fabric) maps and estimations of the annual effective doses due to radon was obtained by applying a dosimetric model. This methodology improves the capability to delimit indoor radon risk areas, with a greater margin of safety. In this respect, it is estimated that areas classified as low risk have indoor radon concentrations 41 % below the current reference level of 300 Bq/m3 established by national regulations in compliance with the precepts laid down in the European EURATOM Directive.

Acinetobacter baumannii infections in a tertiary care hospital in Mexico over the past 13 years.

BACKGROUND: Acinetobacter baumannii has evolved from an opportunistic pathogen into a common and persistent nosocomial bacterium capable of causing severe infections during endemic and epidemic periods. METHODS: The study period extended from January 1999 to December 2011 and involved patients hospitalized at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, Jalisco, Mexico. From each patient, a single isolate was obtained, and a total of 3,680 unique isolates were collected. Susceptibility tests were performed according to the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: A. baumannii has disseminated throughout the Hospital Civil de Guadalajara, Fray Antonio Alcalde, since 1999. A. baumannii isolates obtained from patients treated in the adult intensive care unit represent the majority of the isolates that have been collected. In addition, A. baumannii was isolated from the adult neurosurgical ward and the adult internal medicine ward, and these isolates were frequently obtained from secretions. A persistent decrease in the susceptibility of A. baumannii isolates to meropenem (92% in 1999 to 12% in 2011), imipenem and amikacin has been observed. CONCLUSIONS: A. baumannii became an endemic nosocomial pathogen during the study period at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, and has exhibited a persistent decrease in susceptibility to all categories of antimicrobial agents over the past 13 years.

[Classification and characteristics of interval cancers in the Principality of Asturias's Breast Cancer Screening Program]. / Clasificación y características del cáncer de intervalo en el programa de detección precoz de cáncer de mama en el Principado de Asturias.

OBJECTIVE: To review and classify the interval cancers found in the Principality of Asturias's Breast Cancer Screening Program (PDPCM). A secondary objective was to determine the histological characteristics, size, and stage of the interval cancers at the time of diagnosis. MATERIAL AND METHODS: We included the interval cancers in the PDPCM in the period 2003-2007. Interval cancers were classified according to the breast cancer screening program protocol, with double reading without consensus, without blinding, with arbitration. Mammograms were interpreted by 10 radiologists in the PDPCM. RESULTS: A total of 33.7% of the interval cancers could not be classified; of the interval cancers that could be classified, 40.67% were labeled true interval cancers, 31.4% were labeled false negatives on screening, 23.7% had minimal signs, and 4.23% were considered occult. A total of 70% of the interval cancers were diagnosed in the year of the period between screening examinations and 71.7% were diagnosed after subsequent screening. A total of 76.9% were invasive ductal carcinomas, 61.1% were stage II when detected, and 78.7% were larger than 10mm when detected. CONCLUSIONS: The rate of interval cancers and the rate of false negatives in the PDPCM are higher than those recommended in the European guidelines. Interval cancers are diagnosed later than the tumors detected at screening. Studying interval cancers provides significant training for the radiologists in the PDPCM.

Multiparametric analysis for the determination of radon potential areas in buildings on different soils of volcanic origin.

The transposition of the European EURATOM directive into the regulations of the different member states of the European Union involved governments making great efforts to define priority action maps against indoor radon exposure in buildings over a short time period. In Spain, the Technical Building Code established 300 Bq/m3 as a reference level and set up a classification of municipalities in which remediation measures should be adopted for radon exposure in buildings. Oceanic volcanic islands, such as the Canary Islands, present high geological heterogeneity in a small space due to their volcanic origin. This variability poses a challenge to the elaboration of radiological risk maps, which makes it necessary to have a high density of data to collect local variations. This paper presents a methodology to obtain accurate radon risk maps based on geological criteria and terrestrial gamma radiation. The predictive efficiency of these maps is statistically verified using indoor radon concentration data measured in buildings. Other radiological variables, which are commonly used as criteria for radon risk prediction found in the literature, were also applied, such as the geogenic radon potential and the activity concentration of natural radioisotopes in soils. The higher resolution of the maps obtained allows for a more detailed classification of radon risk zones in the study area than the current risk maps published in the Spanish building regulations.

Methodology for determination of radon prone areas combining the definition of a representative building enclosure and measurements of terrestrial gamma radiation.

The recommendations of the European Atomic Energy Community (EURATOM) have recently been incorporated into Spanish regulations in the Basic Document of Health Standards of the Technical Building Code (CTE), section HS6, on protection against radon exposure. This further accentuates the need to delimit radon prone areas as a strategy to address measures which minimise the effects of this gas on the population. In this research, measurements of terrestrial gamma radiation and indoor radon of dwellings have been carried out in the same location to delimit these risk areas. A new methodology has been developed including a definition of a Representative Building Enclosure (RBE) and it is proposed a Building Storey Index (IBS) which allows normalizing measurements of indoor radon activity concentration taken in different levels from the ground to the RBE. The results show the need to consider the type of contact that exists between the building and the ground as a determining factor of radon risk. Terrestrial gamma radiation is used as a proxy for radioisotopic composition of soils to characterise the indoor radon risk at different geological formation.

Clostridioides difficile-associated diarrhea in surgical service patients in Mexico. / Diarrea asociada a Clostridioides difficile en pacientes de servicios quirúrgicos en México.

INTRODUCTION: Clostridioides difficile is the first cause of healthcare-associated diarrhea in developed countries. In recent years the incidence of C. difficile infection (CDI) has increased worldwide. There is not much information on the topic in Mexico, and little is known about the risk factors for the infection in patients that are hospitalized in surgical services. MATERIALS AND METHODS: A case-control study was conducted that compared the epidemiologic findings and risk factors between surgical patients with PCR-confirmed CDI, surgical patients with diarrhea and a negative PCR test, and surgical patients with no diarrhea. The statistical analysis was carried out using the SPSS version 22.0 program. RESULTS: The majority of the surgical patients with CDI belonged to the areas of neurosurgery, cardiac surgery, orthopedics, and general surgery. A total of 53% of the CDI cases were associated with the hypervirulent CD NAP1/027 strain. The presence of mucus in stools (OR: 1.5, P=.001), fever (OR: 1.4, P=.011), leukocytes in stools (OR: 3.2, P<.001), hospitalization within the past 12weeks (OR: 2.0, P<.001), antibiotic use (OR: 1.3, P=.023), and ceftriaxone use (OR: 1.4, P=.01) were independent risk factors for the development of CDI. CONCLUSIONS: C. difficile-induced diarrhea in the surgical services is frequent at the Hospital Civil de Guadalajara "Fray Antonio Alcalde".

Differences in characteristics of mediolateral episiotomy in proffesionals at the same hospital.

OBJECTIVES: The objective of our study was to compare the theoretical concept of the accoucheur in our institution with regard to the characteristics of the mediolateral episiotomy (MLE), with a crowning head and after a delivery. METHODS: We devised two simple pictorial questionnaires (one with a crowning head and the other in rest after a delivery) in order to explore possible differences in clinical practice between the accoucheurs of our institution with respect to the MLE characteristics. RESULTS: With a crowning head, we found more acute angles when the age of accoucheurs was greater than 35 years old and more than 15 years of experience, but no with the perineum at rest. No difference was found between doctors and midwives, nor between males and females. 28.1% of accoucheurs indicated an acuter episiotomy angle with a crowning head. CONCLUSION: This study confirmed that the individual interpretation of MLE differed widely among professionals at the same hospital. These differences which have been shown could predispose women to a greater risk of anal sphincter injuries. For this reason, there is a need to standardize this practice, to make the technique more homogeneous, particularly in the context of future research into the risks and benefits of episiotomy with respect to major perineal trauma.

[Prospective study with auditory evoked potentials of the brain stem in children at risk]. / Estudio prospectivo con potenciales evocados auditivos de tronco cerebral en niños de riesgo.

OBJECTIVE: The aim of this study was to evaluate methods of hypoacusis screening. PATIENTS AND METHODS: The early detection of audition problems is vital for quick rehabilitation. For this reason, resting on the criteria of the Comisión Española para la Detección Precoz de la Hipoacusia (Spanish Commission for the Early Detection of Hypoacusis), we have carried out a prospective study, from January to May 1998, evaluating patients at risk of suffering from hypoacusis. The study included 151 patients with ages between birth and 14 years. Medical records and brainstem auditory evoked responses (BAER) were carried out. RESULTS: The most common reason for requesting a consultation for the 151 patients included in our study was the suspicion of hypoacusis. Seventy-one (47%) presented pathological BAER, 37 of them were bilateral. In most cases the loss of audition was of cochlear origin, with 11 patients having a serious deafness, 4 with bilateral affection (3 suspicious of hypoacusis and 1 of hyperbilirubinemia) and 7 unilateral deafness. CONCLUSIONS: BAER is a good screening method for children at risk. It is an innocuous, objective and specific test that does not require the patient's collaboration. The level of positives is high (47%).