Electrocardiographic predictors of atrial fibrillation in patients with cryptogenic stroke.

BACKGROUND: Empiric anticoagulation is not routinely indicated in patients with cryptogenic stroke without documentation of atrial fibrillation (AF). Therefore, identification of patients at increased risk of AF from this vulnerable group is vital. OBJECTIVES: To identify electrocardiographic (ECG) predictors of AF in patients with cryptogenic stroke or transient ischemic attack (TIA) undergoing insertion of an implantable cardiac monitor (ICM). METHODS: In this single-center study, 48 patients with cryptogenic stroke or TIA had an ICM implanted for detection of AF between January 2013 and September 2019. Patients with and without AF were compared in terms of p-wave duration and a novel index (MVP score). RESULTS: During a mean follow-up of 16 ± 14 months, AF was detected in seven patients (15%). Diagnosis of AF was made after a mean of 10 ± 14 months, with time to first AF detection ranging between 1 and 40 months. Patients with AF had a longer p-wave duration (136 ± 9 ms vs. 116 ± 10 ms; p = .0001) and a higher MVP score (4.5 ± 1.2 vs. 2.0 ± 0.9, p = .0001) than those without AF. Advanced interatrial block (IAB) was observed in 43% of patients with ICM evidence of AF and 0% of those without AF (p = .002). Age, LA size or LVEF were not predictors of AF. CONCLUSION: An increased p-wave duration, advanced IAB and high MVP score are associated with AF occurrence in patients with cryptogenic stroke. Identifying patients with these markers may be helpful as they may benefit from more exhaustive and prolonged monitoring.

[Clinical usefulness of biomarkers in cardiac failure]. / Utilidad de los biomarcadores en insuficiencia cardiaca en la práctica clínica.

The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.

Virus-Specific T Cells From Cryopreserved Blood During an Emergent Virus Outbreak for a Potential Off-the-Shelf Therapy.

During the first outbreak of an emergent virus, methods need to be developed to rapidly establish suitable therapies for patients with high risk of severe disease caused by the pathogen. Considering the importance of the T-cell response in controlling viral infections, adoptive cell therapy with virus-specific T cells has been used as a safe and effective antiviral prophylaxis and treatment for immunocompromised patients. The main objective of this study was to establish an effective and safe method to cryostore whole blood as starting material and to adapt a T-cell activation and expansion protocol to generate an off-the-shelf antiviral therapeutic option. Additionally, we studied how memory T-cell phenotype, clonality based on T-cell receptor, and antigen specificity could condition characteristics of the final expanded T-cell product. Twenty-nine healthy blood donors were selected from a database of convalescent plasma donors with a confirmed history of SARS-CoV-2 infection. Blood was processed using a fully automated, clinical-grade, and 2-step closed system. Eight cryopreserved bags were advanced to the second phase of the protocol to obtain purified mononucleated cells. We adapted the T-cell activation and expansion protocol, without specialized antigen-presenting cells or presenting molecular structures, in a G-Rex culture system with IL-2, IL-7, and IL-15 cytokine stimulation. The adapted protocol successfully activated and expanded virus-specific T cells to generate a T-cell therapeutic product. We observed no major impact of post-symptom onset time of donation on the initial memory T-cell phenotype or clonotypes resulting in minor differences in the final expanded T-cell product. We showed that antigen competition in the expansion of T-cell clones affected the T-cell clonality based on the T-cell receptor ß repertoire. We demonstrated that good manufacturing practice of blood preprocessing and cryopreserving is a successful procedure to obtain an initial cell source able to activate and expand without a specialized antigen-presenting agent. Our 2-step blood processing allowed recruitment of the cell donors independently of the expansion cell protocol timing, facilitating donor, staff, and facility needs. Moreover, the resulting virus-specific T cells could be also banked for further use, notably maintaining viability and antigen specificity after cryopreservation.

Half-Normal Saline vs Normal Saline for Cavotricuspid Isthmus-Dependent Atrial Flutter Ablation.

Background: Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models compared with normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS vs NS irrigation for typical AFL ablation. Methods: Sixty patients undergoing catheter ablation of typical AFL were randomized 1:1 to NS or HNS irrigation. Endpoints included time to CTI block, acute reconnection, incidence of steam pops, and recurrence of AFL during follow-up. Results: Baseline characteristics were comparable between both arms. The mean age of the patients was 68.5 ± 8.2 years, 20% were female, and 32% had atrial fibrillation before being enrolled. Bidirectional CTI block was obtained in all patients with no difference in time to CTI block between groups (6.4 ± 4.4 minutes vs 7.6 ± 4.5 minutes, respectively; P = 0.15). There was a trend to less acute reconnection in the HNS group compared with NS (13.3% vs 26.6%; P = 0.46). Steam pops occurred in 4 patients using HNS vs none in the NS group, but no major complications were observed. During the follow-up, rate of AFL recurrence was similar between groups (6.7% with HNS vs 10% with NS; P = 0.5). There was no difference in time to recurrence (7.6 ± 6.9 vs 4.9 ± 4.5 months; P = 0.6). Conclusions: In this small pilot randomized controlled trial, there was no significant difference between HNS and NS for CTI ablation; however, HNS may increase the incidence of steam pops.

Contexte: Pour prévenir la récurrence d'un flutter auriculaire (flutter) typique, l'ablation de l'isthme cavotricuspidien exige un bloc de conduction bidirectionnel permanent. Dans des modèles expérimentaux, l'irrigation par cathéter au moyen d'un soluté demi-salin produit des lésions plus larges et plus profondes, comparativement à un soluté physiologique salin. La présente étude a été réalisée dans le but de comparer l'efficacité clinique et l'innocuité de l'irrigation au moyen d'un soluté demi-salin à celles de l'irrigation par un soluté physiologique salin dans les cas d'ablation d'un flutter. Méthodologie: Soixante patients soumis à une ablation d'un flutter typique par cathéter ont été répartis au hasard dans un rapport de 1:1 en deux groupes d'irrigation, soit par soluté demi-salin, soit par soluté physiologique salin. Les critères d'évaluation de l'étude étaient les suivants : temps écoulé jusqu'au bloc de l'isthme cavotricuspidien, reconnexion aiguë, jet de vapeur sonore (steam pop) et récidive de flutter durant le suivi. Résultats: Les caractéristiques initiales étaient comparables dans les deux groupes. Les patients avaient une moyenne d'âge de 68,5 ± 8,2 ans, 20 % étaient des femmes et 32 % présentaient une fibrillation auriculaire avant leur admission à l'étude. Un bloc bidirectionnel dans l'isthme cavotricuspidien a été obtenu chez tous les patients, sans différence entre les groupes en ce qui a trait au temps écoulé jusqu'à l'obtention du bloc isthmique (6,4 ± 4,4 minutes vs 7,6 ± 4,5 minutes, respectivement; p = 0,15). Une tendance vers un nombre plus faible de cas de reconnexion aiguë a été notée dans le groupe d'irrigation par soluté demi-salin, comparativement au soluté physiologique salin (13,3 % vs 26,6 %; p = 0,46). Un jet de vapeur sonore est survenu chez 4 patients recevant un soluté demi-salin contre aucun dans le groupe sous soluté physiologique salin, mais aucune complication importante n'a été relevée. Durant le suivi, le taux de récidive de flutter a été similaire dans les deux groupes (6,7 % sous soluté demi-salin vs 10 % sous soluté physiologique salin; p = 0,5). Aucune différence n'a été notée pour ce qui est du temps écoulé jusqu'à la survenue d'une récidive (7,6 ± 6,9 vs 4,9 ± 4,5 mois; p = 0,6). Conclusions: Dans cette petite étude pilote contrôlée et avec répartition aléatoire, aucune différence significative n'a été observée entre le soluté demi-salin et le soluté physiologique salin pour l'ablation de l'isthme; toutefois, le soluté demi-salin augmenterait la fréquence des cas de jet de vapeur sonore.

[Comparison of isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy]. / Isosorbide y dinoprostona en inducción del trabajo de parto.

BACKGROUND: it has been suggested that nitric oxide generators, such as isosorbide dinitrate, may be an alternative to mimic the effects of signal transduction mechanisms leading to cervical ripening, without affecting uterine contractility. OBJECTIVE: to compare the isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy. MATERIAL AND METHODS: in a randomized controlled blinded clinical trial, we studied 66 patients divided into 2 groups: 33 patients were given 20 mg of isosorbide dinitrate and to the other 33 were administered 0.5 mcg of dinoprostone; in both groups the drugs were administered vaginally each 6 h and at maximum 3 times. It was carried out a cardiotocographic study in order to determine the presence or absence of uterine activity and to exclude disorders of the fetal heart frequency; it was performed a vaginal examination to assess cervical conditions determining the Bishop score at 0, 6 and 12 h. RESULTS: there were no differences between the groups in the determinations of mean arterial pressure, maternal heart frequency, fetal heart frequency and Bishop score registered at 6 y 12 h followed the drugs administration. The time of delivery was 20.7 +/- 1.8 h in the group of women treated with dinoprostone; and 16.3 +/- 1.4 h in women treated with isosorbide dinitrate (p=0.032). The cost was higher in women treated with dinoprostone ($560 vs $12, respectively, p=0.001). There was no difference between the groups related to: frequency of meconium stained liquid (p=1.000), mode of delivery by caesarean section (p=0.918), Apgar score at 1 minute (p=0.764) and 5 minutes (p=0.294) and mother discharged with healthy baby (p=1.000). CONCLUSIONS: the isosorbide dinitrate is associated with lower duration of labor compared with dinoprostone. There was no difference in the maternal-fetal outcome by using whatever drug.

Wide Complex Tachycardia in Patient With Cardiac Device.

Electrocardiographic clues for a differential diagnosis of wide complex tachycardia in a patient with a pacemaker are presented. (Level of Difficulty: Intermediate.).

Reverse Remodeling in Human Heart Failure after Cardiac Resynchronization Therapy Is Associated With Reduced RHO-Kinase Activation.

Background: Reverse remodeling is a clinically relevant endpoint in heart failure with reduced ejection fraction (HFrEF). Rho-kinase (ROCK) signaling cascade activation correlates with cardiac remodeling and left ventricular (LV) systolic dysfunction in HFrEF patients. Cardiac resynchronization therapy (CRT) is effective in HFrEF, especially when there is a left bundle block, as this treatment may stimulate reverse remodeling, thereby improving quality of life and prolonging survival for patients with this severe condition. Here, we evaluate the hypothesis that ROCK activation is reduced after effective CRT in HFrEF. Methods: ROCK activation in circulating leukocytes was evaluated in 28 HFrHF patients, using Western blot (myosin light chain phosphatase subunit 1 phosphorylation, MYPT1p/t), before and three months after initiation of CRT. LV systolic function and remodeling were assessed by echocardiography. Results: Three months after CRT, LV ejection fraction increased an average of 14.5% (p < 0.001) in 13 patients (responders), while no change was observed in 15 patients (non-responders). End-systolic diameter decreased 16% (p < 0.001) in responders, with no change in non-responders. ROCK activation in PBMCs decreased 66% in responders (p < 0.05) but increased 10% in non-responders (NS). LV end-diastolic diameter was also 5.2 mm larger in non-responders vs. responders (p = 0.058). LV ejection fraction, systolic diameter, and ROCK activation levels were similar in both groups at baseline. Conclusion: In HFrEF patients, 3 months of effective CRT induced reverse myocardial remodeling, and ROCK activation was significantly decreased in circulating leukocytes. Thus, decreased ROCK activation in circulating leukocytes may reflect reverse cardiac remodeling in patients with heart failure.

Close-coupled pacing to identify the "functional" substrate of ventricular tachycardia: Long-term outcomes of the paced electrogram feature analysis technique.

BACKGROUND: The conduction delay and block that compose the critical isthmus of macroreentrant ventricular tachycardia (VT) is partly "functional" in that they only occur at faster cycle lengths. Close-coupled pacing stresses the myocardium's conduction capacity and may reveal late potentials (LPs) and fractionation. Interest has emerged in targeting this functional substrate. OBJECTIVE: The purpose of this study was to assess the feasibility and efficacy of a functional substrate VT ablation strategy. METHODS: Patients with scar-related VT undergoing their first ablation were recruited. A closely coupled extrastimulus (ventricular effective refractory period + 30 ms) was delivered at the right ventricular apex while mapping with a high-density catheter. Sites of functional impaired conduction exhibited increased electrogram duration due to LPs/fractionation. The time to last deflection was annotated on an electroanatomic map, readily identifying ablation targets. RESULTS: A total of 40 patients were recruited (34 [85%] ischemic). Median procedure duration was 330 minutes (interquartile range [IQR] 300-369), and ablation time was 49.4 minutes (IQR 33.8-48.3). Median functional substrate area was 41.9 cm2 (IQR 22.1-73.9). It was similarly distributed across bipolar voltage zones. Noninducibility was achieved in 34 of 40 patients (85%). Median follow-up was 711 days (IQR 255.5-972.8), during which 35 of 39 patients (89.7%) did not have VT recurrence, and 3 of 39 (7.5%) died. Antiarrhythmic drugs were continued in 53.8% (21/39). CONCLUSION: Functional substrate ablation resulted in high rates of noninducibility and freedom from VT. Mapping times were increased considerably. Our findings add to the encouraging trend reported by related techniques. Randomized multicenter trials are warranted to assess this next phase of VT ablation.

[Prevalence of maternal sadness and its associated factors]. / Prevalencia de tristeza materna y sus factores asociados.

BACKGROUND: Frequently occur emotional changes during pregnancy and postpartum. These changes can produce feelings of sadness, anxiety, or fear. In most women, these feelings called "maternity blues" or "baby blues" disappear quickly, if they do not disappear or worsen, they are catalogued as postpartum depression. OBJECTIVE: To determine the prevalence of maternity blues and the associated factors. MATERIAL AND METHOD: In a cross-sectional study, women at immediate postpartum were recruited. It was applied face-to face the Edinburgh test for determining maternity blues. Other registered data were: maternal age, education level, parity, death sons, history of depressive episodes, sleeping disorders, and if the pregnancy was planned or unplanned. The statistical analysis included arithmetic mean, percentages, Chi2, Student t test; and logistic regression analysis for determining the associated factors with the maternity blues. An alpha value was set at 0.05. RESULTS: Overall 1,134 women, 21 of them (1.8%) were diagnosed as maternity blues. The significant factors associated with maternity blues were: the history of death sons, p < 0.002; depressive episodes, p < 0.001; and sleeping disorders, p < 0.003. CONCLUSION: The frequency of maternity blues is low in our population. The associated factors with this disease should be identified during antenatal care in order to offer special care to these women, in order to avoid the complications associated with this entity.

Prevalence of HIV antibodies in pregnant women with increased risk for AIDS.

The prevalence of Human immunodeficiency virus (HIV) antibodies in pregnant women varies widely between industrialized and developing countries. There is a lack of information about the status of HIV-infected pregnant women with increased risk for AIDS. Our objective was to determine the prevalence of HIV antibodies in pregnant women with increased risk at the Hospital of Obstetrics and Gynecology of the Mexican Institute of Social Security, Leon, Mexico, from December 18, 2003, through February 28, 2006. In a cross-sectional study, 2,257 pregnant women with at least one risk factor for AIDS were recruited. In these women, a sample of blood to determine HIV antibodies was taken. There were two women with positive HIV antibodies; therefore, the HIV seroprevalence was 0.8 per 1,000. Of the two HIV-positive women, one of them had a history of chronic sexually transmitted diseases; she was married to a man who was working outside of our country for about 10 months, and also he had tattoos. The other HIV-positive woman had a history of chronic sexually transmitted diseases, and her husband had intercourse with different women. The risk factors of use of tattoos, migration to foreign countries, and use of injectable drugs were more frequent among the male partners than in the pregnant women (P < .001). We concluded that in our country as well as in other developing countries, the prevalence of HIV antibodies in pregnant women with risk factors is low but still present. Because a significant number of risk factors for AIDS also were found in their male partners, HIV testing should be performed in all pregnant women as well as in their male partners.

[Acceptance of contraceptives in the postpartum period in unplanned pregnancies]. / Aceptación de anticonceptivos durante el puerperio en embarazos no planeados.

BACKGROUND: In spite the high rate of contraceptives use, the unplanned pregnancies still frequently occur. It is unknown the amount of women with unplanned pregnancies who accept contraceptive methods at immediate postpartum. OBJECTIVE: To determine the frequency of women with unplanned pregnancies who accept contraceptives at immediate postpartum and the associated factors with its acceptance. MATERIAL AND METHOD: In a cross-sectional study, women at immediate postpartum were recruited. They were asked if their pregnancy was planned or unplanned; if at postpartum accepted some contraceptive method and reasons for acceptance or not. The statistical analysis included arithmetic mean, standard error, percentages, chi2, Student t test; and logistic analysis regression for determining the associated factors with the acceptance of contraceptives. An alpha value was set at 0.05. RESULTS: Of 1,024 women 566 (55.3%) had a planned pregnancy and 457 of them (80.7%) accepted contraceptives. The remaining 458 women (44.7%) had an unplanned pregnancy and 402 (87.8%) accepted contraceptives, p = 0.003. The significant factor associated with the acceptance of contraceptives was the multiparity, p = 0.034. CONCLUSION: There is more acceptance of contraception in women with unplanned pregnancy. In these women the multiparity is associated with higher acceptance of contraceptive methods. It is recommended to reinforce the contraceptive counselling in this group of women.

[Progression of gestational hypertension to chronic hypertension]. / Evolución de hipertensión gestacional a hipertensión crónica.

BACKGROUND: The gestational hypertension is the most frequent cause of hypertension during the pregnancy. The gestational hypertension is a provisional diagnosis only during the pregnancy; it is unknown the number of women with gestational hypertension who progress to chronic hypertension. OBJECTIVE: To determine the number of women with gestational hypertension who progress to chronic hypertension. MATERIAL AND METHODS: A cohort prospective study was carried out; we includedl96 patients with the diagnosis of gestational hypertension at the time of the interruption of the pregnancy; after 12 weeks, a follow up appointment was scheduled in order to measure the blood pressure and to determine how many patients progressed to chronic hypertension. The data were analyzed with arithmetic mean, standard error and percentage values. For the comparison of variables, the Chi2 test and a logistic regression analysis were used; an alpha value was set at 0.05. RESULTS: Thirteen patients (6.6%) with diagnosis of gestational hypertension progressed to chronic hypertension. It was found that advanced age (p = 0.007), high body mass index (p = 0.013) and the antecedent of hypertensive disease in a previous pregnancy (p = 0.048) were significantly associated with the progression to chronic hypertension. CONCLUSIONS: The overweight, advanced maternal age and the antecedent of hypertensive disorder in a previous pregnancy are the variables associated with the progression from gestational hypertension to chronic hypertension.

[Predictive value of Doppler fluxometry of umbilical and middle cerebral arteries with the perinatal outcomes in fetus with intrauterine growth restriction]. / Valor predictivo de la flujometría Doppler de las arterias umbilical y cerebral media con los resultados perinatales en fetos con restricción del crecimiento intrauterino.

OBJECTIVE: To determine the predictive value of the Doppler fluxometry of the umbilical artery and middle cerebral artery with the perinatal outcome in fetuses with intrauterine growth restriction. MATERIAL AND METHODS: We carried out a cross-sectional study. There were included 220 pregnant women with diagnosis of intrauterine growth restriction. We carried out in these women Doppler fluxometry of umbilical artery and middle cerebral artery. It was followed the perinatal outcome of the newborns. We used student's t test for comparing the fluxometry indexes; and logistic regression analysis to determine its association with the perinatal outcome. An alpha value was set at 0.05. RESULTS: The fluxometry indexes of the umbilical artery were abnormal in all the cases of intrauterine growth restriction. The fluxometry indexes of the middle cerebral artery were abnormal in a small number of fetuses with perinatal complications. In the logistic regression analysis the fluxometry index of the umbilical artery was significant in order to predict bad perinatal outcome, in the other hand, the middle cerebral artery was not significant. The perinatal complications diagnosed were: distress respiratory syndrome (37.2%) necrotizing enterocolitis (6.2%) and sepsis (6.2%). CONCLUSIONS: The Doppler fluxometry of the umbilical artery have better predictive value than the middle cerebral artery for predicting bad perinatal outcome. We recommend the assessment of umbilical artery as first choice in order to determine the well-being in fetuses with intrauterine growth restriction.

Living close, doing differently: small-scale asynchrony in demography of two species of seabirds.

Studies on spatiotemporal pattern of population abundance predict that close populations should exhibit a high level of synchrony, reflected in a parallel time variation of at least one demographic parameter. We tested this prediction for two threatened species of Procellariiformes sharing similar life history traits: the European Storm Petrel (Hydrobates pelagicus) and the Balearic Shearwater (Puffinus mauretanicus). Within each species, we compared adult survival, proportion of transients (breeders that do not settle), and average productivity at two neighboring colonies. Physical and environmental features (e.g., food availability) of the breeding sites were similar. However, while Balearic Shearwater colonies were free of predators, aerial predators occurred especially in one colony of the European Storm Petrel. Despite this difference, we found similar results for the two species. A high proportion of transient birds was detected in only one colony of each species, ranging between 0.00-0.38 and 0.10-0.63 for the petrels and shearwaters, respectively. This seems to be an emergent feature of spatially structured populations of seabirds, unrelated to colony size or predator pressure, that can have important demographic consequences for local population dynamics and their synchrony. Local survival of resident birds was different at each colony, an unexpected result, especially for predator-free colonies of Balearic Shearwater. Productivity varied between the two colonies of European Storm Petrels, but not between the two colonies of Balearic Shearwaters. We demonstrated that within each species, several demographic parameters were colony specific and sufficiently different to generate short-term asynchronous dynamics. Our findings suggest that, in spatially structured populations, local factors, such as predation or small-scale habitat features, or population factors, such as individual quality or age structure, can generate unexpected asynchrony between neighboring populations.

[Placental histopathological changes in gestational hypertension]. / Alteraciones histopatológicas placentarias en la hipertensión gestacional.

BACKGROUND: Preeclampsia develops after a partial disorder in the process of placental formation, perhaps due to a deficiency of the trophoblast invasion by its spiral arteries and acute aterosis in its miometrial segments. It has not been reported if these changes also appear in placentas of women with gestational hypertension without proteinuria. OBJECTIVE: To describe histopathological changes in the placenta of patients with hypertensive disorders during pregnancy. MATERIAL AND METHODS: Cross-sectional study carried out in 138 patients divided into three groups: 46 with normotensive pregnancy (A group or control), 46 with gestational hypertension (group B), and 46 with preeclampsia (group C). There were registered sociodemographic and clinical variables; and the histopathological study of the placenta was performed. Mean, standard error and percentages were used. We calculated analysis of variance for comparing groups and linear regression for determining correlation between histopathological changes and blood pressure (it was assigned an alpha value of 0.05). RESULTS: There were more histopathological changes in groups of gestational hypertension and preeclampsia compared with controls (p < 0.01). Most frequent changes in all groups were: sincitial hyperplasia and fibrin deposits around the villi. There was correlation between histopathological changes and blood pressure (r= 0.27, p <0.01). CONCLUSION: There are more histopathological changes in placentas of women with hypertensive disease; number of histopathological changes is correlated with the severity of hypertension.

Quiste dentígero en relación con tercer molar inferior retenido / A Dentigerous Cyst Related to Retained Lower Third Molar

Introducción: El quiste dentígero es un quiste odontogénico, casi siempre asociado a la corona de un diente retenido. Sus ubicaciones más frecuentes son la zona de tercer molar inferior y canino superior. Objetivo: Caracterizar la presentación de un quiste dentígero en un paciente adulto. Presentación de caso: Se presentó el caso de una paciente de 27 años de edad que acude a consulta por presentar sensación de opresión, dolor e inflamación en región de tercer molar inferior izquierdo. Al examen oral se observa tejido dentario en correspondencia con molar 38 parcialmente brotado con ligero edema de la mucosa a su alrededor. En radiografía panorámica se observa imagen radiolúcida en relación con cara mesial del 38 con discreto halo radiopaco, redondeada, compatible con un quiste dentígero. Conclusiones: Un diagnóstico a tiempo de estas lesiones constituye la clave para un tratamiento exitoso y menos invasivo, lo cual evitaría complicaciones mayores como la malignización, el crecimiento exagerado que puede ocasionar deformidad facial y la disfunción masticatoria permanente(AU)

Introduction: Dentigerous cyst is an odontogenic cyst, almost always associated with the crown of a retained tooth. Its most frequent locations are the areas of the lower third molar and the upper canine. Objective: To characterize the presentation of a dentigerous cyst in an adult patient. Case presentation: The case is presented of a 27-year-old female patient who came to the clinic with a sensation of pressure, pain and inflammation in the region of the lower left third molar. Oral examination permits to observe some dental tissue corresponding with molar 38 partially erupted with slight edema of the surrounding mucosa. Panoramic radiograph shows a radiolucent image related to the mesial side of 38, with a discrete radiopaque halo, rounded, compatible with a dentigerous cyst. Conclusions: A timely diagnosis of these lesions is the key to a successful and less invasive treatment, which would avoid major complications, such as malignization, the exaggerated growth that can cause facial deformity and permanent masticatory dysfunction(AU)

Mexican women's reasons for accepting or declining HIV antibody testing in pregnancy.

OBJECTIVE: To determine pregnant women's reasons for accepting or declining the HIV test in Leon, Mexico. DESIGN: A cross-sectional study using a face-to-face questionnaire. SETTING: The antenatal clinic at a tertiary-care referral hospital in Leon, Mexico. PARTICIPANTS: 1184 pregnant women. DATA COLLECTION: Reasons for accepting or declining the HIV antibodies test, socio-economic characteristics and risk factors for HIV were recorded. Blood samples were obtained from women who accepted to be tested, and positive serologies to HIV on duplicate enzyme-linked immunosorbent assay testing were confirmed by Western Blot assay. FINDINGS: 1009 (85.2%) women accepted the HIV antibodies test. The main reason for accepting it was that women felt the test could be beneficial to their babies (45.1%). The two main reasons for rejecting the HIV antibodies test were that women felt the test was unnecessary because their husbands did not have sexual intercourse with other women (32.6%), and because they did not have permission from their husbands for accepting the test (23.5%). None of the women tested positive for HIV antibodies (0 per 1009). KEY CONCLUSIONS: The reasons for accepting the HIV test were similar to those reported in developed countries. One important reason for declining the test was that women did not have their husband's permission. IMPLICATIONS FOR PRACTICE: The acceptance rate for HIV testing in pregnant women could be improved by counselling men on the value of their wives being tested in pregnancy.

[Risk factors associated with dystocic delivery]. / Factores de riesgo asociados con el parto distócico.

BACKGROUND: the dystocic delivery is a frequent complication and its perinatal repercussions vary from minor lesions to severe brain damage. It has been reported diverse factors associated with this medical complication. OBJECTIVE: to identify the risk factors with significant association with dystocic delivery. MATERIAL AND METHODS: a case-control study was carried out. There were included 750 patients, divided into 250 women with dystocic deliveries (cases) and 500 women with eutocic deliveries (controls). Demographic and clinical variables were registered. The statistical analysis was performed with percentages, arithmetic media, standard deviation, Student t test, chi2 and logistic regression analysis. An alpha value was set at 0.05. RESULTS: the factors with statistical significance were: advanced age (p < 0.001), major patient's height (p < 0.001), major new born's weight (p = 0.009), lower parity (p < 0.001), and prolonged duration of labor (p = 0.04). Other variables such as number of pregnancies, previous cesarean sections, spontaneous abortions, weight of the patient, weight earned during pregnancy, number of medical appointments during antenatal care, previous dystocic delivery, and premature rupture of the membranes, were not significant. CONCLUSIONS: there are clinical and demographic risk factors associated with dystocic delivery. To identify this risk factors during the antenatal care could diminish the frequency of dystocic deliveries and therefore to avoid the associated maternal-fetal complications.

Psychopathological Symptoms and Psychological Wellbeing in Mexican Undergraduate Students.

College life involves a process of adaptation to changes that have an impact on the psycho-emotional development of students. Successful adaptation to this stage involves the balance between managing personal resources and potential stressors that generate distress. This epidemiological descriptive and transversal study estimates the prevalence of psychopathological symptomatology and psychological well-being among 516 college students, 378 (73.26%) women and 138 (26.74%) men, ages between 17 and 24, from the city of Monterrey in Mexico. It describes the relationship between psychopathological symptomatology and psychological well-being, and explores gender differences. For data collection, two measures were used: The Symptom Checklist Revised and the Scale of Psychological Well-being. Statistical analyses used were t test for independent samples, Pearson's r and regression analysis with the Statistical Package for the Social Sciences (SPSS v21.0). Statistical analyses showed that the prevalence of psychopathological symptoms was 10-13%, being Aggression the highest. The dimension of psychological well-being with the lowest scores was Environmental Mastery. Participants with a higher level of psychological well-being had a lower level of psychopathological symptoms, which shows the importance of early identification and prevention. Gender differences were found on some subscales of the psychopathological symptomatology and of the psychological well-being measures. This study provides a basis for future research and development of resources to promote the psychological well-being and quality of life of university students.

[Maternal and fetal morbidity in obese pregnant women]. / Morbilidad materno-fetal en embarazadas obesas.

OBJECTIVE: To determine the maternal and fetal morbidity in obese pregnant women compared with non-obese pregnant women. PATIENTS AND METHODS: It was carried out a case-control study. There were included 342 patients who had a body mass index previous to the pregnancy of 18.5 to 24.9 (control group) and 342 pregnant women with body mass index > 30 (group of obese women). We registered the mother and newborns' data to evaluate their morbidity. The groups were compared with Student's t test or Mann Whitney's U test for continuous data and chi-square or Fisher exact test for categorical variables. RESULTS: We found more macrosomic newborns in the group of obese women (p = 0.003) and a higher number of caesarean sections (48.8 vs 37.4%, p = 0.003). The maternal morbidity characterized by gestational diabetes was higher in the obese ones (3.5 vs 0.58%, p = 0.015). Other variables as preterm delivery, stillbirths, malformations, admissions to the neonatal intensive care unit, as well as the development of hypertensive disorders of pregnancy were not significant. CONCLUSION: We found higher maternal and fetal morbidity in obese women. Therefore, these patients should be considered as carriers of high-risk pregnancies. This strategy could avoid complications associated to this group of patients.