Intraoperative Findings Associated to Inpatient Mortality From Patients With Gastroschisis in Western Mexico.

BACKGROUND: Intraoperative findings during gastroschisis surgery are the main predictor associated with increased mortality. The aim of our study was to determine the type of surgical findings associated with inpatient mortality in a cohort of patients with gastroschisis from a university hospital in Western Mexico. MATERIALS AND METHODS: Infants with surgically repaired gastroschisis during the period 2011-2017 at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, Mexico) were studied. Data regarding demographics, perinatal history, and intraoperative findings were collected and compared according to whether they were nonsurvivors (cases) or survivors (controls) at hospital discharge. Data were analyzed using logistic regression, determining its adjusted odds ratio (aOR) and its respective 95% confidence intervals (95% CIs). The proper adjustment of the model was verified using the Hosmer and Lemeshow test. RESULTS: Ninety-four patients with gastroschisis were studied, of which 13 were nonsurvivors (13.8%), and 81 (86.2%) were survivors at hospital discharge. In the group of survivors, primary surgical closure was performed more frequently (P = 0.018), whereas staged reduction with a silo predominated in the group of nonsurvivors (P = 0.018), and an increased frequency of complex gastroschisis (0.0001). After logistic regression analysis, intraoperative findings associated with nonsurvival were severe bowel matting (aOR: 7.3; 95% CI: 1.2-44), and prolapse of the small intestine and large intestine, plus any other organ (aOR: 15.9; 95% CI: 1.1-219.6). CONCLUSIONS: Mortality in our cohort was high (13.8%) and was significantly associated with severe bowel matting, and the prolapse of the small and large intestines, plus any other organ.

Asthma prevalence, but not allergic rhinitis nor atopic dermatitis, is associated to exposure to dogs in adolescents.

BACKGROUND: Exposure to pets can be a predisposing factor in the development of certain diseases, including allergic diseases. OBJECTIVE: We analyzed the role that exposure to indoor dogs and cats plays in the prevalence of allergic diseases. METHODS: We examined the cross-sectional data of 1056 women and 936 men aged 15 to 18 years; these individuals were selected through stratified and cluster random sampling. We asked all participants about their exposure to indoor dogs and cats during the year that preceded our study. The prevalence of allergic diseases was determined through core questions taken from The International Study of Asthma and Allergies in Childhood questionnaire. RESULTS: The prevalence was 12.7% (95% CI: 11.3%-14.2%) for asthma, 9.0% (95% CI: 7.8%-10.4%) for allergic rhinitis, and 5.2% (95% CI: 4.3%-6.2%) for atopic dermatitis. The multivariate analyses showed that exposure to indoor dogs, but not indoor cats, was associated with asthma prevalence (aOR 1.37; 95% CI: 1.03-1.83), as was male sex (aOR=1.42; 95% CI: 1.08-1.86), a personal history of allergic rhinitis (aOR=3.24; 95% CI: 2.25-4.66), and a maternal history of asthma (aOR=3.06; 95% CI: 1.89-4.98). The population attributable risk for exposure to indoor dogs was 18%. Notably, neither allergic rhinitis nor atopic dermatitis was found to be associated with dog or cat exposure (p> 0.05). CONCLUSION: Exposure to dogs in late adolescence is a factor associated with asthma, although its contribution to the development of asthma should be investigated in new studies.

Enfermedad periodontal como factor de riesgo adicional asociado con nacimiento pretérmino en México: un estudio de casos y controles.

INTRODUCTION: Substances related to microorganisms involved in periodontal disease can reach the maternal-fetal interface via the hematogenous route and stimulate uterine contractility. OBJECTIVE: To determine the association between periodontal disease and preterm birth. METHOD: Case-control study in 343 preterm and 686 full-term pregnant women. Gestational age was calculated based on the date of the last menstrual period and confirmed with Capurro and Ballard methods. Periodontal disease was diagnosed according to the depth of the space between the tooth root and the gum. The association was measured with logistic regression. RESULTS: Maternal age of the cases was 23.8 ± 6.7 years, and 23.2 ± 6.7 in the controls. Periodontal disease was present in 66.8% of cases and 40.5% of controls. The factors associated with preterm birth were periodontal disease (Odds ratio [OR] = 2.26), history of preterm birth (OR = 4.96), unplanned pregnancy (OR = 2.15) poor prenatal control (OR = 2.53), urinary tract infection (OR = 2.22), preeclampsia (OR = 4.49), premature rupture of membranes (OR = 2.59) and caesarean section delivery (OR = 9.15). CONCLUSION: Periodontal disease in pregnancy was an independent risk factor for preterm birth.

INTRODUCCIÓN: Las sustancias relacionadas con los microorganismos involucrados en la enfermedad periodontal puedan llegar a la interfaz materno-fetal por vía hematógena y estimular la contractilidad uterina. OBJETIVO: Determinar la asociación entre enfermedad periodontal con nacimiento pretérmino. MÉTODO: Estudio de casos y controles de 343 embarazadas pretérmino y 686 de término. Se calculó la edad gestacional por fecha de último periodo menstrual y se confirmó con los métodos de Capurro y Ballard. La enfermedad periodontal se diagnosticó por la profundidad del espacio entre la raíz dental y la encía. La asociación fue medida con regresión logística. RESULTADOS: La edad de las madres en los casos fue de 23.8 ± 6.7 años y en los controles de 23.2 ± 6.7 años. La enfermedad periodontal estuvo presente en 66.8 % de los casos y 40.5 % de los controles. Los factores asociados con nacimiento pretérmino fueron enfermedad periodontal (RM = 2.26), antecedente de nacimiento pretérmino (RM = 4.96), embarazo no planeado (RM = 2.15), control prenatal deficiente (RM = 2.53), infección de vías urinarias (RM = 2.22), preeclampsia (RM = 4.49), ruptura prematura de membranas amnióticas (RM = 2.59) y nacer por cesárea (RM = 9.15). CONCLUSIÓN: La enfermedad periodontal en el embarazo constituyó un factor de riesgo independiente para nacimiento pretérmino.

[Adolescent pregnancy and its maternal and perinatal implications]. / Embarazo en adolescentes y sus repercusiones materno perinatales.

BACKGROUND: Teenage pregnancy alters family dynamics because it is usually an unplanned pregnancy that significantly affects both the personal life of the teenager and in his social environment. It has been associated with increased risk and poor maternal and perinatal outcomes. OBJECTIVE: This study was planned in order to determine which are perinatal and maternal complications of pregnancy in adolescents. METHODS: Case-Control study in the Civil Hospital of Guadalajara Dr. Juan I. Menchaca, from July 1, 2010 to December 31, 2011. The case group was formed with 550 postpartum adolescents < or = 18 years who had had a pregnancy > 27 weeks, forming a control group of 550 postpartum women 20 to 30 years, and data were obtained by direct survey and analyzed with Chi2 statistical test and odds ratio. RESULTS: There were fewer married adolescents, lack of support from their partners, less use of contraception, most addictions, increased frequency of premature rupture of membranes, threats of preterm delivery and respiratory distress syndrome of the newborn. There was no difference in the number of prenatal visits, type of birth, type of amniotic fluid and discomfort common in pregnancy. CONCLUSIONS: The teen pregnancy as well as maternal perinatal repercussions is a sociocultural and economic problem because they are students, dependent on their parents, without support from your partner and not using contraception, so new pregnancies continue to increase its complications.

Prevalence of open neural tube defects and risk factors related to isolated anencephaly and spina bifida in live births from the "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara (Jalisco, Mexico).

We determine the prevalence and trends of open neural tube defects (ONTDs) during 1991 to 2019 at the "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara (Mexico). Also, details of potential risks were obtained in 662 newborns, including those 143 patients with anencephaly and open spina bifida (OSB) classified as isolated (cases) and 519 controls. Data were analyzed using multivariable logistic regression. Among 267 201 live births during the study period, 336 were born with ONTDs, yielding an overall prevalence of 12.6 per 10 000. After folic acid (FA)-related programs began in Mexico (2003-2019), only OSB showed a decline of 20.6%. For anencephaly, associated risks included relatives with neural tube defects (NTDs) (adjusted odds ratio [aOR]: 67.9, 95% confidence interval [95% CI]: 11.3-409.8), pre-pregnancy body mass index (BMI) ≥25 kg/m2 (aOR: 2.6, 95% CI: 1.1-6.0), insufficient gestational weight gain (aOR: 3.0, 95% CI: 1.3-7.1), parity ≥4 (aOR: 3.2, 95% CI: 1.3-7.7), and exposure to analgesic/antipyretic drugs (aOR: 9.0; 95% CI: 2.5-33.0). For OSB, associated risks included consanguinity (aOR: 14.0, 95% CI: 3.5-55.9), relatives with NTDs (aOR: 22.4, 95% CI: 4.5-112.9), BMI ≥25 kg/m2 (aOR: 2.5, 95% CI: 1.6-4.2), insufficient gestational weight gain (aOR: 1.9, 95% CI: 1.1-3.1), and exposures to hyperthermia (aOR: 2.3, 95% CI: 1.2-4.3), common cold (aOR: 6.8, 95% CI: 3.6-12.7), and analgesic/antipyretic drugs (aOR: 3.6, 95% CI: 1.3-10.0). Our high rate probably results from exposures to preventable risks, most related to FA, indicating a need for strengthening existing FA-related programs in Mexico.

Proteinuria selectivity and prednisone response in children with nephrotic syndrome. / Selectividad de proteinuria y respuesta a prednisona en niños con síndrome nefrótico.

BACKGROUND: The proteinuria selectivity index (PSI) can predict the response to prednisone in the primary nephrotic syndrome (PNS). OBJECTIVE: To determine the association of prednisone response with the PSI in patients with PNS. MATERIAL AND METHODS: With analytical cross-sectional design, pediatric patients with PNS were studied with at least six months of prior follow-up, at the Nuevo Hospital Civil de Guadalajara from 2014 to 2015. They were divided into poor response to prednisone (frequent relapses or resistance) and good response (habitual relapses). PSI was calculated with serum and urinary measurement of IgG and transferrin. Chi square and OR were used, with 95% CI. RESULTS: 67 patients with relapsing PNS were studied. The response to prednisone had been good in 33 (49.3%) and poor in 34 (50.7%). The PSI was ≤ 0.10 mg/mg in 23/67 (34.3%); 0.11-0.19 mg/mg in 15/67 (22.4%); and ≥ 0.20 mg/mg 29/67 (43.3%). 3/34 patients (8.8%) presented ≤ 0.1 mg/mg with poor response to prednisone and 20/33 presented good response (60.6%) (p < 0.001; OR: 0.6; 95% CI, 0.010-20). PSI between 0.11-0-19 mg/mg occurred in 8/34 patients (23%) with poor response to prednisone and in 7/33 with good response (21%). PSI ≥ 0.20 mg/mg resulted in 23/34 patients (67.6%) with poor response to the steroid and in 6/33 with good response (18.2%) (p < 0.001; OR: 9.4; 95% CI, 3.01-29.42). CONCLUSIONS: In children with PNS, a PSI ≥ 0.20 mg/mg was associated with a poor response to prednisone treatment and a PSI ≤ 0.10 mg/mg with a satisfactory response.

INTRODUCCIÓN: El índice de selectividad de proteinuria (ISP) puede predecir la respuesta a prednisona en el síndrome nefrótico primario (SNP). OBJETIVO: Determinar la asociación de la respuesta a prednisona con el ISP en pacientes con SNP. MATERIAL Y MÉTODOS: Con diseño transversal analítico, se estudiaron pacientes pediátricos con SNP en recaída con al menos 6 meses de seguimiento previo, en el Nuevo Hospital Civil de Guadalajara, de 2014 a 2015. Se dividieron en mala respuesta a prednisona (recaídas frecuentes o resistencia) y buena respuesta (recaídas habituales). El ISP se calculó con medición sérica y urinaria de IgG y transferrina. Se utilizaron la prueba de chi cuadrada y razones de momios (RM) con sus intervalos de confianza del 95% (IC 95%). RESULTADOS: Se estudiaron 67 pacientes con SNP en recaída. La respuesta a prednisona había sido buena en 33 (49.3%) y mala en 34 (50.7%). De los 67 pacientes, el ISP fue ≤ 0.10 mg/mg en 23 (34.3%), 0.11-0.19 mg/mg en 15 (22.4%) y ≥ 0.20 mg/mg en 29 (43.3%). De los 34 con mala respuesta, el ISP fue ≤ 0.1 mg/mg en 3 (8.8%); de los 33 con buena respuesta, el ISP fue ≤ 0.1 mg/mg en 20 (60.6%) (p < 0.001; RM: 0.6; IC 95%: 0.010-20). El ISP fue 0.110-19 mg/mg en 8 (23%) de los 34 pacientes con mala respuesta a prednisona y en 7 (21%) de los 33 con buena respuesta. El ISP fue ≥ 0.20 mg/mg en 23 (67.6%) de los 34 pacientes con mala respuesta al esteroide y en 6 (18.2%) de los 33 con buena respuesta (p < 0.001; RM: 9.4; IC 95%: 3.01-29.42). CONCLUSIONES: En los niños con SNP, un ISP ≥ 0.20 mg/mg se asoció con mala respuesta a prednisona y un ISP ≤ 0.10 mg/mg se asoció con respuesta satisfactoria.

Umbilical cord disruption sequence caused by long cord in two unrelated infants with amyoplasia.

Encirclement of a fetal body part by the umbilical cord with or without vascular obstruction in either the umbilical cord or the encircled fetal part is considered an umbilical cord loop (UCL). Significant disruption of the encircled fetal parts is recognized as the umbilical cord disruption sequence (UCDS). UCL around fetal parts is an occasional anomaly in infants with amyoplasia. We report on 2 patients with amyoplasia and damage to the fetal limbs caused by UCDS and a long umbilical cord. Patient 1 showed two deep constrictions on the left lower limb caused by UCL with an intact skin and a mild mark of constriction on the left wrist. The umbilical cord in patient 2 produced 5 entanglements around the left thigh which resulted in a deep groove extending down to the femur and also showed an exposed fracture and gangrene of the entire lower limb with an unusual congenital paraumbilical "stoma" that corresponded to the afferent loops of a jejunal atresia. The UCDS in infants with amyoplasia has been associated with short umbilical cords, whereas in patients without congenital contractures, the UCDS or UCL has been related to long umbilical cords. Our observations of UCDS in patients with amyoplasia but with long umbilical cords suggest the influence of both pathogenic factors or the existence of additional mechanisms. Evidence in patient 2 may support a vascular pathogenesis.

[Risk factors associated to neonatal cross-infection]. / Factores de riesgo asociados a sepsis neonatal nosocomial.

BACKGROUND: Late-onset sepsis (occurring after 3 days of age) either cross-infection (CI) or perinatal is the first cause of morbidity and mortality in neonatal intensive care units (NICU) around the world. Our objective was to determine the current incidence of CI risk factors in neonates admitted to the NICU of the Hospital Civil de Guadalajara during a 9-month period. METHODS: A case-control study with 114 newborns; 38 with CI and 76 controls. Odds ratio with 95 % confidence interval were calculated. RESULTS: Associated risk factors were total parenteral nutrition (OR = 16.54, CI = 6.30-43.39, p < 0.001); weight < 1000 g (OR = 7.33, CI = 2.15-25.01, p < 0.001); intravascular catheter (OR = 6.79, CI = 2.68-17.00, p < 0.001); gestational age < 30 weeks (OR = 4.54, CI = 1.61-12.81, p < 0.003); intratracheal intubation and mechanical ventilation with (OR = 6.98, CI = 2.94-16.5, p < 0.001). CONCLUSIONS: Total parenteral nutrition and weight < 1000 g showed the greatest association with cross-infection; in this study, male gender was not a risk factor.

The impact of body mass index on blood pressure measured with mercury sphygmomanometer in children and adolescents with type 1 diabetes mellitus.

Background: Patients with type 1 diabetes mellitus (T1DM) and overweight have more risk to develop changes in blood pressure that increase cardiovascular morbidity and mortality. In this study, the relationship between blood pressure (BP) with the body mass index (BMI) and the average of the last three measurements of glycated hemoglobin (HbA1c) in patients with T1DM was determined. Methods: A cross-sectional analytical study was conducted in children and adolescents with T1DM with over a year since diagnosis. The dependent variables were systolic and diastolic BP, measured with a mercury sphygmomanometer. The independent variables were BMI and average of the last three measurements of HbA1. A linear regression with a 95% confidence interval was used. Results: Seventy-five patients with T1DM were studied. The median of disease duration was 3.5 years (min 1-max 14.8 years), BMI 19.5 ± 3.1 kg/cm2 and HbA1c 8.3 ± 2.4%. Sixty-six patients showed BP < percentile 90 and 9 BP ≥ percentile 90 (12%). Two models of linear regression were constructed, with systolic and diastolic BP as dependent variables. The possible predictor variables were suggested by theoretical context and statistical analysis. The predictive variable of high BP was zBMI (body mass index expressed in z-score) for systolic and diastolic BP. Also, the models suggested that for an increase of one unit of zBMI, corresponded a rise of 5.1 and 3.6 mmHg in systolic and diastolic BP, respectively. Conclusions: A positive correlation between systolic and diastolic BP with zBMI was observed.

Introducción: Los pacientes con diabetes mellitus tipo 1 (DM1) y sobrepeso tienen más riesgo de desarrollar cambios en la presión arterial (PA), y esto incrementa su morbilidad y mortalidad cardiovascular. En este estudio se determinó la relación entre la PA y el índice de masa corporal (IMC) y el promedio de las tres últimas mediciones de hemoglobina glucosilada (HbA1c) de pacientes con DM1. Métodos: Estudio transversal analítico en niños y adolescentes con DM1 con más de un año de evolución. Las variables dependientes fueron la PA sistólica y diastólica medidas con esfigmomanómetro y las variables independientes, IMC y promedio de las últimas tres mediciones de la HbA1c. Se utilizó regresión lineal múltiple con intervalo de confianza del 95%. Resultados: Se estudiaron 75 pacientes con DM1. La mediana del tiempo de evolución de la DM1 fue de 3.5 años (mínimo 1 año-máximo 14.8 años), el IMC 19.5 ± 3.1 kg/cm2 y la HbA1c 8.3 ± 2.4%. De los 75 pacientes, 66 presentaron PA < percentil 90 y 9 PA ≥ percentil 90 (12%). Se construyeron dos modelos de regresión lineal múltiple, con PA sistólica y diastólica como variables dependientes. Las posibles variables predictoras fueron sugeridas por el contexto teórico y el análisis estadístico. El IMC expresado en puntuación zeta (zIMC) fue predictor para PA sistólica/diastólica. Los modelos sugirieron que a cada incremento de unidad del zIMC corresponde un aumento de 5.1 y 3.6 mmHg de PA sistólica y diastólica, respectivamente. Conclusiones: Se observó una correlación positiva de la PA sistólica y la diastólica con el zIMC.

[Procalcitonin a marker in the diagnostic of the newborn with systemic infection]. / Procalcitonina como marcador en el diagnóstico de sepsis neonatal.

BACKGROUND: Laboratory test used in the diagnosis of neonatal sepsis have a low specificity. Recently, procalcitonin has been proposed as a marker to identify the presence of systemic infections. The objective of the study was to evaluate the sensibility and specificity of procalcitonin as a marker of systemic infection in newborn with a suspicion of neonatal sepsis using a blood culture as a gold standard. METHODS: 21 newborn with a suspicion of neonatal sepsis were included in the study, postnatal age 8.3 +/- 5.2 days in a period from October 2003 to a January 2004. Procalcitonin, were measured at the moment of clinical diagnosis and after 24 and 48 hours and twice blood culture were done. RESULTS: Seven blood cultures were positive at the moment of diagnosis as well as 21 determinations of procalcitonin, sensibility 85.7%, specificity 21.7%; (OR = 1.63, 95% CI = 0.14-19.4); determinations after 24 hours showed procalcitonin sensibility and specificity of 85.7% and 28.5% (OR = 2.4, 95% CI = 0.22-26.6) and after 48 hours 100% of sensibility and 42.8% of specificity (OR = 1.75, 95% CI = 1.11-2.75]). CONCLUSIONS: Positive procalcitonin has a good sensibility and moderate specificity 48 hours after clinical diagnosis of neonatal sepsis.

Prevalence of orofacial clefts and risks for nonsyndromic cleft lip with or without cleft palate in newborns at a university hospital from West Mexico.

We determined the overall prevalence of typical orofacial clefts and the potential risks for nonsyndromic cleft lip with or without cleft palate in a university hospital from West México. For the prevalence, 227 liveborn infants with typical orofacial clefts were included from a total of 81,193 births occurred during the period 2009-2016 at the "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara (Guadalajara, Jalisco, Mexico). To evaluate potential risks, a case-control study was conducted among 420 newborns, including only those 105 patients with nonsyndromic cleft lip with or without cleft palate (cases), and 315 infants without birth defects (controls). Data were analyzed using multivariable logistic regression analysis expressed as adjusted odds ratio with 95% confidence intervals . The overall prevalence for typical orofacial clefts was 28 per 10,000 (95% confidence interval: 24.3-31.6), or 1 per 358 live births. The mean values for the prepregnancy weight, antepartum weight, and pre-pregnancy body mass index were statistically higher among the mothers of cases. Infants with nonsyndromic cleft lip with or without cleft palate had a significantly higher risk for previous history of any type of congenital anomaly (adjusted odds ratio: 2.7; 95% confidence interval: 1.4-5.1), history of a relative with cleft lip with or without cleft palate (adjusted odds ratio: 19.6; 95% confidence interval: 8.2-47.1), and first-trimester exposures to progestogens (adjusted odds ratio: 6.8; 95% CI 1.8-25.3), hyperthermia (adjusted odds ratio: 3.4; 95% confidence interval: 1.1-10.6), and common cold (adjusted odds ratio: 3.6; 95% confidence interval: 1.1-11.9). These risks could have contributed to explain the high prevalence of orofacial clefts in our region of Mexico, emphasizing that except for history of relatives with cleft lip with or without cleft palate, most are susceptible of modification.

[Preauricular tags: prevalence, clinical characteristics and maternal risk factors]. / Apéndice preauricular: prevalencia, caracteristicas clínicas y factores de riesgo materno.

OBJECTIVE: To determine prevalence and maternal risk factors associated with preauricular tags. MATERIAL AND METHOD: A case-control study of 254 newborns with isolated preauricular tags not considered part of a syndrome and their controls, and who were delivered at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca between 1990 and 2003. The maternal risk factors were demonstrated by means of a direct interview with the mother. RESULTS: The prevalence of the isolated preauricular tags was 1.96 per 1,000 newborns alive, in a 1.2 men for each woman. The history of another affected relative was strongly associated with preauricular tags (OR 19.28; 95% CI: 4.44-117.60). Infants with preauricular tags frequently showed parents consanguinity (OR 3.04; 95% CI: 0.28-76.26), maternal age > or =35 years (OR 1.14; 95% CI: 0.53-2.48), exposure to some disease (OR: 1.23, 95% CI: 0.72-2.12), and drugs use in the first trimester of pregnancy (OR: 1.11; 95% CI: 0.65-1.92). No associations were found for the frequency of abortion, exposure to organic solvents and maternal occupation. CONCLUSIONS: The prevalence of isolated preauricular tags in this population was similar to that reported in other regions of Latin America, but lower to the prevalences in Sweden and Israel. This malformation has an important hereditary component; however, it is probably that some teratogenic factors, such as diabetes mellitus, can increase its frequency.

[Hyaline membrane disease: mortality and maternal and neonatal risk factors]. / Enfermedad de membrana hialina: mortalidad y factores de riesgo maternos y neonatales.

OBJECTIVE: To identify maternal and neonatal risk factors associated with hyaline membrane disease and its mortality. PATIENTS AND METHOD: A case-control study with 41 newborns with hyaline membrane disease and 123 controls was made between September 2001 and February 2002 in the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. The diagnosis of hyaline membrane disease was done with clinical and radiographic data. Maternal risk factors were obtained by direct interview with the mother; the newborn data were obtained of the clinical files. The association was measured with the odds ratios (OR) and the confidence interval of 95%. RESULTS: The frequency of hyaline membrane disease was of 6.8 per 1,000 live births. Mortality rate was of 2.8 per 1,000 live births. There were 17 deaths (41%). The risk factors associated with hyaline membrane were: illness during the first and second trimester of pregnancy, (OR: 3.28 [1.16-9.31]; OR: 8.88 [3.56-22.50], respectively), Apgar score lower than seven at the first minute (OR: 18.57 [4.50-88.67]), and masculine gender (OR: 2.58 [1.15-5.83]). CONCLUSIONS: Frequency and mortality were similar to the reported by other studies made in population samples. The exposure to illnesses during pregnancy and the low Apgar score were associated with the increased frequency of hyaline membrane disease.

[Prenatal risk factors in late fetal death]. / Factores de riesgo prenatal en la muerte fetal tardía.

OBJECTIVE: To identify the sociodemographics, obstetrical and perinatology factors of risk most frequently associated to fetal death in greater pregnancies of 27 weeks. PATIENTS AND METHODS: From January 2001 to May 2005, in the Hospital Civil de Guadalajara Dr Juan I. Menchaca, we carried out a study of cases and controls with 450 cases of fetal death of more than 27 weeks of gestation and 450 newborn alive whose birth happened immediately later. We compared the frequency of different maternal and fetal variables that in previous forms was associated with fetal death, by means of Chi squared test and exact test of Fisher, the association among these variables and fetal death with the reason of momios was considered. In all the cases the chosen interval of confidence was of 95%. RESULTS: The risk factors associated with fetal death were: maternal age over 35 years, low schooling, multiparity, antecedent of abortion and fetal death, deficient prenatal care, complications in the pregnancy, abnormal amniotic fluid, double circular of umbilical cord to neck of the product and great congenital malformations of newborn. It was not associated with fetal death, the single marital status, primigesta, smoking, male sex of the fetus, simple circulate of umbilical cord to the neck and fetal macrosomia. CONCLUSIONS: Of the risk factors associated with fetal death, the main one is a deficient prenatal care, that of being improved, might diminish the association of some other variables that were associated with fetal death.

[Transient tachypnea of the newborn, obstetric and neonatal risk factors]. / Taquipnea transitoria del recién nacido, factores de riesgo obstétricos y neonatales.

OBJECTIVE: To identify the obstetrics and neonatal risk factors associated with transient tachypnea of the newborn. PATIENTS AND METHODS: Case-control study of 110 neonates with transient tachypnea and 110 newborns controls, between May and October 2000, in the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. The diagnosis of transient tachypnea was done by clinical and radiology data and exclusion of the other causes of respiratory distress. The exposure was documented by a direct interview to the mother and clinical information of the clinical expedient. The association was measured with the odds ratios and confidence interval of 95%. RESULTS: The frequency of transient tachypnea was of 2 percent newborn alive. The risk factors that were associated with transient tachypnea was: low Apgar score at minute (OR: 33.74, CI 95%: 4.73-681.52), premature rupture of amniotic membranes (OR: 3.65, CI 95%: 1.53-8.90), cesarean section (OR: 2.01, CI 95%: 1.14-3.57) and masculine gender (OR: 2.02, CI 95%: 1.14-3.60). It was more frequent in the cases the antecedent of diabetes mellitus and bronchial asthma. CONCLUSIONS: The results suggest that it's necessary to improve the obstetrics surveillance to diminish the frequency of low Apgar score and risk factors associated with transient tachypnea of the newborn.

[Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western México]. / Bacteriemia relacionada con catéter venoso central: incidencia y factores de riesgo en un hospital del occidente de México.

BACKGROUND: Central venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection. METHODS: A prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis. RESULTS: Two hundred four patients with CVC were studied. The average age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06 - 1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76-0.92). CONCLUSIONS: In addition to strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and promotion of antimicrobial resistance should be considered.

[Dermatoglyphics differences among children with nephrotic syndrome according to steroid response]. / Diferencias en los dermatoglifos de niños con síndrome nefrótico de acuerdo a su respuesta a esteroides.

BACKGROUND: Although the association between the type of idiopathic nephrotic syndrome (INS) and a peculiar pattern of fingerprints digital would suggest the presence of genetic factors related to both, this has not been previously studied. This study aimed to evaluate if there are fingerprints patterns differences between children with steroid-resistant INS (SRNS) and those with steroid-sensitive INS (SSNS). METHODS: The frequencies distribution of arches, ulnar loops, radial loops, and whorls was studied in 60 children with SRNS, and 60 children with SSNS. Bivariate analysis to detect the relationship between each fingerprint pattern with the study groups was performed by chi-square test and to evaluate its possible association, the odds ratios (OR) were calculated with 95% confidence's intervals (95%CI). RESULTS: The patients with SRNS had a higher frequency of digital whorls compared with that of patients with SSNS (46.7% vs. 30.7%, p = 0.005). Additional comparisons using a "whorls excesses" definition obtained from normative data in our population (≥ 7 whorls in females or ≥ 8 in males) were associated with increased odds for SRNS (OR 2.96, 95% CI 1.15-7.61). CONCLUSIONS: Our findings indicate that there are differences between children with SRNS and SSNS at the level of digital dermatoglyphics, but further studies are needed to confirm this association and its possible implications.

Introducción: aunque la asociación entre el tipo de síndrome nefrótico idiopático (SNI) y algún patrón peculiar de huellas digitales sugeriría la presencia de factores genéticos relacionados a ambos, esto no ha sido previamente estudiado. Este estudio pretende evaluar si existen diferencias entre los patrones digitales de niños con SNI resistente a esteroides (SNRE) y aquellos con el SNI sensible a esteroides (SNSE). Métodos: se estudiaron las frecuencias de arcos, asas cubitales, asas radiales y rizos en 60 niños con SNRE y 60 niños con SNSE. Se realizó análisis bivariado para detectar la relación entre cada figura digital y los grupos de estudio mediante la prueba de Chi cuadrada y para evaluar su posible asociación se calcularon los odds ratio (OR) con sus intervalos de confianza del 95 %. Resultados: los pacientes con SNRE tuvieron una mayor frecuencia de rizos en comparación con pacientes con SNSE (46.7 % frente a 30.7 %, p = 0.005). Comparaciones adicionales utilizando una definición de «excesos de rizos¼ obtenida datos normativos previos de nuestra población (≥ 7 rizos en mujeres o ≥ 8 en varones), también se asoció a la presencia de SNRE (OR: 2.96, IC95 %: 1.15-7.61). Conclusiones: estos hallazgos indican que existen diferencias entre los niños con SNRE y SNSE a nivel de los dermatoglifos digitales, aunque son necesarios estudios adicionales para confirmar la presente asociación y sus posibles implicaciones.

[Associated factors to abnormal glucosylated hemoglobin in the postpartum period]. / Factores relacionados con la hemoglobina glucosilada anormal en el puerperio inmediato.

OBJECTIVE: To demonstrate the association between risk factors and abnormal glucosylated hemoglobin detected in women during the postpartum period. PATIENTS AND METHODS: A case and control study was carried out at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca during six months. Glucosylated hemoglobin and glucose concentration from 160 fasting women with a pregnancy > or =28 weeks was obtained during the postpartum period. With an odds ratio and confidence interval (95%) the epidemiological meaning of risk factors was identified. RESULTS: The abnormal glucosylated hemoglobin was significantly associated to: single, separated and divorced women (p < 0.05); major frequency of previous caesarean (OR: 2.78, IC 95%:1.25-6.22), p = 0.006, and higher proportion of children with congenital malformations (OR: 12, IC 95%: 1.38-104), p = 0.01. In the group cases 48% of caesareans was associated to probable gestational diabetes: moderate preeclampsia, eclampsia, fetal macrosomy, and preterm deliveries. CONCLUSION: It is necessary to make an early detection of risk factors associated to abnormal glucosylated hemoglobin and to prevent adverse effects as congenital malformations and clinical complications that increase the incidence of caesarean.

THE ASSOCIATION BETWEEN PRE-PREGNANCY OBESITY AND WEIGHT GAIN IN PREGNANCY, WITH GROWTH DEVIATIONS IN NEWBORNS.

INTRODUCTION: obesity in pregnancy has been associated with increased morbidity for the mother and fetus. OBJECTIVE: to quantify the association between obesity in pregnancy with growth deviations of their newborn infants. METHODS: a study of non-matched cases and controls was performed based on the Nuevo Civil Hospital of Guadalajara "Dr. Juan I Menchaca" 2012-2013. The dependent variables were the newborn being either large (LGA) or small for gestational age (SGA), and the independent variable was pre-pregnancy obesity. Gynecoobstetric and socioeconomic data were collected. The association between the dependent and independent variables was assessed with logistic regression. RESULTS: one-hundred and forty-three mother-child dyads were studied with growth deviations of their newborn infants, and 137 mother-child dyads without growth deviations were studied. The age of the patients was 24.7 ± 6.3 vs. 24.0 ± 6.0 years, and the gestational age was 38 ± 1.2 vs. 38 ± 1.5. Factors associated with growth deviations were pre-pregnancy obesity (OR 2.65, 95% CI 1.29- 5.44), elevated weight gain during pregnancy (OR 1.98, 95% CI 1.04-3.76) and disease during pregnancy (OR 2.62, 95% CI 1.05-6.76). A multivariate model with the dependent variable LGA and associated covariates showed that pre-pregnancy obesity and high gestational weight gain were predictors of LGA (OR 2.43, 95% CI 1.10-5.40) and (OR 3.31, 95% CI 1.83-5.96). CONCLUSIONS: in a population of young women with scarce economic resources, pre-pregnancy obesity and high weight gain during pregnancy were predictors of LGA.

Introducción: la obesidad en el embarazo se ha relacionado con mayor morbilidad para la madre y el feto. Objetivo: cuantificar la asociación entre obesidad en el embarazo con desviaciones del crecimiento de sus recién nacidos. Métodos: se realizó un estudio de casos y controles, no pareado, basado en el Nuevo Hospital Civil de Guadalajara "Dr. Juan I Menchaca" de 2012 a 2013. Las variables dependientes fueron recién nacido grande (GEG) y pequeño para edad gestacional (PEG), y la independiente obesidad pre-gestacional. Se recabaron datos socioeconómicos y ginecoobstétricos. La asociación entre las variables dependientes con las independientes, se evaluó con regresión logística. Resultados: se estudiaron 143 díadas madre-hijo con desviaciones en el crecimiento de sus RN, y 137 díadas madre-hijo sin desviaciones. La edad de las embarazadas fue 24.7 ± 6.3 vs 24.0 ± 6.0 años, y la edad gestacional 38±1.2 vs 38±1.5. Los factores asociados con desviaciones en el crecimiento fueron: obesidad pre-gestacional (RM 2.65, IC95% 1.29-5.44), ganancia de peso durante el embarazo elevada (RM 1.98, IC95% 1.04-3.76) y enfermedades durante el embarazo (RM 2.62, IC95% 1.05-6.76). Un modelo multivariado, con la variable dependiente GEG, y las covariables asociadas, demostró que la obesidad pregestacional y ganancia de peso gestacional elevada fueron predictores de GEG (RM 2.43, IC95% 1.10- 5.40) y (RM 3.31, IC95% 1.83-5.96). Conclusiones: en una población de mujeres jóvenes de escasos recursos económicos, la obesidad pregestacional y la ganancia de peso durante el embarazo alta, fueron predictores de productos GEG.

Prevalence and risk factors for gastroschisis in a public hospital from west México.

Mexico is recognized as a country with a high prevalence of gastroschisis, although the cause of this remains unclear. We define the prevalence and potential risk factors for gastroschisis in a public hospital from west México. A case-control study was conducted among 270 newborns, including 90 patients with nonsyndromic gastroschisis (cases) and 180 infants without birth defects (controls), born all during the period 2009 to 2013 at the Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" (Guadalajara, Mexico), from a total of 51,145 live births. Potential maternal risk factors for gastroschisis were compared using multivariate logistic regression analysis to evaluate the deviance explained by different variables of interest. The overall prevalence of gastroschisis in live births was 17.6 per 10,000 births (95% confidence interval [CI] 14.0-21.2), whereas in offspring of women ≤ 19 years old was 29.9 per 10,000 births (95% CI 21.9-38.0). Mothers ≤ 19 years (adjusted odds ratio [aOR] 2.8: 95% CI 1.5-5.1), anemia during pregnancy (aOR 10.7; 95% CI 2.0-56.9), first-trimester exposure to hormonal contraceptives (aOR 3.7; 95% CI 1.0-13.0), and first-trimester alcohol consumption (aOR 3.4; 95% CI 1.6-7.3), were associated with gastroschisis. Contrarily, adjusted OR for pre-pregnancy body mass index ≥ 25 kg/m(2) has protective odds (aOR 0.2; 95% CI 0.1-0.5). Our results suggest an increased risk for gastroschisis among mothers under the age of 20, with anemia during pregnancy, and those who used hormonal contraceptives or consumed alcohol during early pregnancy, whereas, pre-pregnancy overweight has a protective OR, and they are discussed as clues in its pathogenesis.