[Epidemiology and classification of arachnoid cysts in children]. / Epidemiología y clasificación de los quistes aracnoideos en niños.

The prevalence of arachnoid cysts in children is 1-3%. They are more frequent in boys. They can be located intracranially or in the spine. Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch). Supratentorial are divided into middle cranial fossa, convexity, inter-hemisferic, sellar region, and intraventricular. Infratentorial are classified into supracerebellar, infracerebellar, hemispheric, clivus, and cerebellopontine angle. Finally spinal arachnoid cysts are classified taking into account whether they are extra- or intradural, and nerve root involvement.

Brain stem tumors in children and adolescents: single institutional experience.

PURPOSE: Pediatric brain stem tumors (BsT) are a heterogeneous group of diseases. Our aim was to analyze our experience to find out prognostic factors. METHOD: A retrospective study with BsT patients was performed. Imaging characteristics, extension of surgery, pathology, and adjuvant therapy were analyzed and correlated with overall survival (OS) and progression-free survival (PFS) as outcome measures. RESULT: Since 1980 to 2010, we analyzed 65 BsT patients, 41 of them girls (63%), median age of 8 years (range 13.9 months to 17.6 years). Twenty-two patients (33.8%) had diffuse intrinsic pontine gliomas (DIPG) and 43 (66.2%) presented with focal BsT. Histology was available in 42 patients; the most frequent is low-grade glioma in 24/42 patients (57%). DIPG's histology (obtained usually at necropsy) confirmed five high-grade gliomas. After median follow-up of 49.3 months (0.5-175 months), 20/22 DIPG patients have died (90.9%), while 27/43 with focal tumors were alive (62.8%). Variables related to outcome were histology (better for low-grade glioma (LGG) OS p < 0.001), surgery (better if operated OS p < 0.001), and adjuvant therapy (worse if given, PFS p = 0.001, OS p = 0.024). The outcome for DIPG was dismal, median OS/EFS of 14.2/9.4 months, significantly worse than focal BsT (p = 0.000), while OS/EFS was 122.8/87.2 months for focal intrinsic, 88.2/47.1 months for exophytic, and 124.4/54 months for cervico-medullary tumors: no differences were found among them, except the histology (OS p < 0.001 for low-grade vs high-grade tumors). CONCLUSION: BsT in children comprised two different groups: diffuse (DIPG) and focal gliomas. The DIPGs continue having a dismal prognosis, needing new approaches, while focal tumors including LGG have better prognosis.

A horizon scan exercise for aquatic invasive alien species in Iberian inland waters.

As the number of introduced species keeps increasing unabatedly, identifying and prioritising current and potential Invasive Alien Species (IAS) has become essential to manage them. Horizon Scanning (HS), defined as an exploration of potential threats, is considered a fundamental component of IAS management. By combining scientific knowledge on taxa with expert opinion, we identified the most relevant aquatic IAS in the Iberian Peninsula, i.e., those with the greatest geographic extent (or probability of introduction), severe ecological, economic and human health impacts, greatest difficulty and acceptability of management. We highlighted the 126 most relevant IAS already present in Iberian inland waters (i.e., Concern list) and 89 with a high probability of being introduced in the near future (i.e., Alert list), of which 24 and 10 IAS, respectively, were considered as a management priority after receiving the highest scores in the expert assessment (i.e., top-ranked IAS). In both lists, aquatic IAS belonging to the four thematic groups (plants, freshwater invertebrates, estuarine invertebrates, and vertebrates) were identified as having been introduced through various pathways from different regions of the world and classified according to their main functional feeding groups. Also, the latest update of the list of IAS of Union concern pursuant to Regulation (EU) No 1143/2014 includes only 12 top-ranked IAS identified for the Iberian Peninsula, while the national lists incorporate the vast majority of them. This fact underlines the great importance of taxa prioritisation exercises at biogeographical scales as a step prior to risk analyses and their inclusion in national lists. This HS provides a robust assessment and a cost-effective strategy for decision-makers and stakeholders to prioritise the use of limited resources for IAS prevention and management. Although applied at a transnational level in a European biodiversity hotspot, this approach is designed for potential application at any geographical or administrative scale, including the continental one.

Cuban Contributions to Latin American Clinical Care and Research on Diabetes and Pregnancy.

Cuban participation in and contributions to education, medical care and research on diabetes and pregnancy in Latin America dates back to the 1970s when the Latin American Diabetes Association was founded. The Cuban health system and its professionals recognized early the problems presented by diabetes during pregnancy for the health of an expectant mother and her children and assimilated and disseminated important lessons that became infl uential in the region. These included: importance of adopting a program within primary health care that offers national coverage for diabetic pregnant women, with a special focus on pre-conception monitoring of diabetic women; benefi ts of defi ning a specifi c range for application of a fasting glucose test to identify risk of gestational diabetes through selective screening for the disease; using insulin to treat gestational diabetes; controlling excessive weight at the beginning and during pregnancy; and underscoring the importance of interdisciplinary treatment of diabetes in pregnancy. The goal was to improve care and research in reproductive health for diabetic pregnant women and their children in Cuba. KEYWORDS: Gestational diabetes, pregnancy, Latin America, Cuba.

Immune Response Generated With the Administration of Autologous Dendritic Cells Pulsed With an Allogenic Tumoral Cell-Lines Lysate in Patients With Newly Diagnosed Diffuse Intrinsic Pontine Glioma.

BACKGROUND AND OBJECTIVE: Diffuse intrinsic pontine glioma (DIPG) is a lethal brainstem tumor in children. Dendritic cells (DCs) have T-cell stimulatory capacity and, therefore, potential antitumor activity for disease control. DCs vaccines have been shown to reactivate tumor-specific T cells in both clinical and preclinical settings. We designed a phase Ib immunotherapy (IT) clinical trial with the use of autologous dendritic cells (ADCs) pulsed with an allogeneic tumors cell-lines lysate in patients with newly diagnosed DIPG after irradiation (radiation therapy). METHODS: Nine patients with newly diagnosed DIPG met enrollment criteria. Autologous dendritic cell vaccines (ADCV) were prepared from monocytes obtained by leukapheresis. Five ADCV doses were administered intradermally during induction phase. In the absence of tumor progression, patients received three boosts of tumor lysate every 3 months during the maintenance phase. RESULTS: Vaccine fabrication was feasible in all patients included in the study. Non-specific KLH (9/9 patients) and specific (8/9 patients) antitumor response was identified by immunologic studies in peripheral blood mononuclear cells (PBMC). Immunological responses were also confirmed in the T lymphocytes isolated from the cerebrospinal fluid (CSF) of two patients. Vaccine administration resulted safe in all patients treated with this schema. CONCLUSION: These preliminary results demonstrate that ADCV preparation is feasible, safe, and generate a DIPG-specific immune response detected in PBMC and CSF. This strategy shows a promising backbone for future schemas of combination IT.

Corrigendum: Immune Response Generated With the Administration of Autologous Dendritic Cells Pulsed With an Allogenic Tumoral Cell-Lines Lysate in Patients With Newly Diagnosed Diffuse Intrinsic Pontine Glioma.

[This corrects the article on p. 127 in vol. 8, PMID: 29755954.].

Controversies in Screening and Diagnosis of Gestational Diabetes: Cuba's Position.

Gestational diabetes is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%, and global prevalence ranges from 2% to 18% depending on the criteria applied. Gestational diabetes can lead to adverse gestational outcomes, such as fetal death, preterm delivery, dystocia, perinatal asphyxia and neonatal complications. Prompt, accurate diagnosis allowing early treatment can benefit both mother and child. The disease is asymptomatic, so clinical laboratory testing plays a key role in its screening and diagnosis. Cuba's approach to diabetes screening and diagnosis differs from some international practices. All pregnant women in Cuba are screened with a fasting plasma glucose test and diagnosed using modified WHO criteria. Some international recommendations are to skip the screening step and instead follow the diagnostic criteria of the Hyperglycemia and Adverse Pregnancy Outcomes study. In Cuba, gestational outcomes for women with diabetes (including gestational diabetes) are satisfactory (preeclampsia 5%; preterm delivery 12%; neonatal macrosomia 7.5%; congenital abnormalities 4.3% and perinatal deaths 4.8%). These data do not indicate a need to change established screening and diagnostic criteria. KEYWORDS Gestational diabetes, screening, diagnosis, early detection, early diagnosis, Cuba.

Macrosomia Predictors in Infants Born to Cuban Mothers with Gestational Diabetes.

INTRODUCTION Fetal macrosomia is the most important complication in infants of women with diabetes, whether preconceptional or gestational. Its occurrence is related to certain maternal and fetal conditions and negatively affects maternal and perinatal outcomes. The definitive diagnosis is made at birth if a newborn weighs >4000 g. OBJECTIVE Identify which maternal and fetal conditions could be macrosomia predictors in infants born to Cuban mothers with gestational diabetes. METHODS A case-control study comprising 236 women with gestational diabetes who bore live infants (118 with macrosomia and 118 without) was conducted in the América Arias University Maternity Hospital, Havana, Cuba, during 2002-2012. The dependent variable was macrosomia (birth weight >4000 g). Independent maternal variables included body mass index at pregnancy onset, overweight or obesity at pregnancy onset, gestational age at diabetes diagnosis, pregnancy weight gain, glycemic control, triglycerides and cholesterol. Fetal variables examined included third-semester fetal abdominal circumference, estimated fetal weight at ≥28 weeks (absolute and percentilized by Campbell and Wilkin, and Usher and McLean curves). Chi square was used to compare continuous variables (proportions) and the student t test (X ± SD) for categorical variables, with significance threshold set at p <0.05. ORs and their 95% CIs were calculated. RESULTS Significant differences between cases and controls were found in most variables studied, with the exception of late gestational diabetes diagnosis, total fasting cholesterol and hypercholesterolemia. The highest OR for macrosomia were for maternal hypertriglyceridemia (OR 4.80, CI 2.34-9.84), third-trimester fetal abdominal circumference >75th percentile (OR 7.54, CI 4.04-14.06), and estimated fetal weight >90th percentile by Campbell and Wilkin curves (OR 4.75, CI 1.42-15.84) and by Usher and McLean curves (OR 8.81, CI 4.25-18.26). CONCLUSIONS Most variables assessed were predictors of macrosomia in infants of mothers with gestational diabetes. They should therefore be taken into account for future studies and for patient management. Wide confidence intervals indicate uncertainty about the magnitude of predictive power. KEYWORDS Fetal macrosomia, fetal diseases, gestational diabetes, risk factors, risk prediction, Cuba.

Historia de la diabetes y embarazo en Cuba después de 1959 / History of diabetes and pregnancy in Cuba after 1959

En 1959 surgió en Cuba lo que se conoce hoy como la Actividad de Diabetes y Embarazo. El objetivo de este informe es describir su origen y desarrollo. Esta labor tuvo su inicio en el Hospital General Calixto García, por quien puede considerarse el pionero en este campo, el Dr. Antonio Márquez Guillén. En 1970, se fundó en el Hospital Ramón González Coro la primera sala hospitalaria destinada a atender específicamente a mujeres embarazadas con diabetes. Esta sala ha estado funcionando bajo la égida del Dr. Lemay Valdés Amador. La atención preconcepcional a la mujer con diabetes se estableció en 1992 en el Instituto Nacional de Endocrinología y uno de sus adeptos más genuinos fue el Dr. Jacinto Lang Prieto. A partir del 2001 la actividad de diabetes y embarazo inició un proceso de consolidación, que tuvo como punto de partida la fundación de un programa nacional y terminó con la realización en 2007 del I Consenso Cubano de Diabetes y Embarazo. El proyecto de colaboración con la Fundación Mundial de la Diabetes, iniciado en el 2007, contribuyó a la extensión de esta actividad a todo el país y a evidenciar los logros de Cuba en la atención de embarazadas diabéticas, lo que motivó que la Federación Internacional de Diabetes nombrara Centro de Excelencia en la atención a la mujer embarazada con Diabetes y Embarazo al Servicio de Diabetes y Embarazo del Hospital Ramón González Coro. Recién en 2017, se realizó el II Consenso Cubano de Diabetes y Embarazo, y se continúa trabajando para mantener los logros alcanzados(AU)

In 1959 arose in Cuba what is known today as the Activity of Diabetes and Pregnancy. The objective of this report is to describe its origin and development. This work had its beginning in General Calixto García Hospital by who can be regarded as a pioneer in this field, Dr. Antonio Márquez Guillén. In 1970, it was founded in Ramón González Coro Hospital the first hospital room designed to attend specifically pregnant women with diabetes. This room has been operated under the aegis of Dr. Lemay Valdés Amador. The preconceptional care to women with diabetes was established in 1992 at the National Institute of Endocrinology and one of its most genuine supporters was Dr. Jacinto Lang Prieto. From 2001, the activity of diabetes and pregnancy began a process of consolidation, which took as its starting point the foundation of a national program and ended with the execution in 2007 of the First Cuban Consensus of Diabetes and Pregnancy. The collaborative project with the World Diabetes Foundation initiated in 2007 contributed to the extension of this activity throughout the country and to demonstrate the achievements of Cuba in the care of pregnant women with diabetes, which prompted that the International Diabetes Federation appointed the service of Diabetes and Pregnancy of Ramón González Coro Hospital as a Center of Excellence in the attention to pregnant women with Diabetes and Pregnancy. Recently in 2017, the Second Cuban Consensus of Diabetes and Pregnancy was carried out, and the work to maintain the achievements continues(AU)

Jacinto Lang y la atención preconcepcional a la mujer con diabetes mellitus en Cuba / Jacinto Lang and preconception care for women with diabetes mellitus in Cuba

RESUMEN El doctor Jacinto Lang Prieto fue uno de los pioneros de la atención preconcepcional a la mujer con diabetes en Cuba, la cual inició a principios de la década de los años 90 del siglo pasado en el Centro de Atención al Diabético del Instituto Nacional de Endocrinología. Junto a su tutor, el Dr. Antonio Márquez Guillén, creó en esta institución una consulta con la finalidad de ofrecer este tipo de atención. Gracias a la labor de estos galenos comenzó, en 2007, la expansión de la atención preconcepcional a todo el país y en 2012, esta actividad estaba establecida a nivel nacional. En el presente, la atención preconcepcional forma parte de la atención al riesgo reproductivo de la mujer con diabetes, labor en la que deben desempeñar un papel preponderante los profesionales de la atención primaria de salud. Lograr la mejoría de este aspecto de la actividad nacional de diabetes y embarazo constituye uno de los retos actuales en este campo en Cuba(AU)

ABSTRACT Dr. Jacinto Lang Prieto was one of the pioneers of preconception care for women suffering from diabetes in Cuba, which began in the early 1990s at the Center for Diabetic Care of the National Institute of Endocrinology. Together with his tutor, Dr. Antonio Márquez Guillén, he created a consultation at this institution in order to offer this care. Thanks to the work of these doctors, in 2007, the expansion of preconceptional care throughout the country began and this activity was established nationwide in 2012. At present, preconception care is part of the risk management to the diabetes reproductive women. Primary health care professionals should play a leading role in providing this care. Improving preconceptional care for diabetes women as part of national strategy of is one of the current challenges in this field in Cuba(AU)

La adolescente diabética embarazada / The pregnant diabetic adolescent

INTRODUCCIÓN: El embarazo en la adolescencia ha sido asociado con problemas adversos para la salud. OBJETIVO: Identificar la morbimortalidad materna y perinatal en adolescentes con diabetes. MÉTODOS: Estudiamos retrospectivamente 138 embarazadas adolescentes (< 20 años) con diabetes. De ellas 101 eran diabéticas pregestacionales (B 2, C 64, D 30, F 1, R 3, y F-R 1 de Priscilla White) y 37 diabÚticas gestacionales (A1 24. A2 8 y A3 5 de Freinkel y Metzger). Comparamos los resultados maternos y perinatales con 242 adolescentes no diabéticas y 482 embarazadas no adolescentes y no diabéticas de la misma institución obtenidas al azar. Para el análisis de las variables se utilizó el test X2 de Fisher y Z para las proporciones, con un significado estadístico de p< 0,05. RESULTADOS: El grado de control metabólico fue calificado de "no óptimo" en el 42,0 por ciento de las diabéticas, lo cual pudo haber contribuido a la significativa mayor frecuencia de parto pretérmino, morbimortalidad perinatal y recién nacidos con peso = o > 4 000 g, esto último fue probablemente responsable de la mayor frecuencia de parto por cesárea. La frecuencia de malformaciones congénitas 11 (8,0 por ciento) resultó muy superior a lo reportado en nuestro país para población general e inclusive para gestantes diabéticas en el Servicio Central de Diabetes y Embarazo. CONCLUSIÓN: Los resultados perinatales adversos en las adolescentes diabéticas pudieron estar en relación, según nuestros resultados, con hiperglucemia de difícil control en estas gestantes y a la falta de asistencia a la consulta de control preconcepcional

INTRODUCTION: Pregnancy in adolescence has been associated with adverse health problems. OBJECTIVE: To identify the maternal and perinatal morbidity and mortality in adolescents presenting with diabetes. METHODS: A retrospective study was conducted in 138 adolescent pregnant patients (< 20 years) with diabetes. From them, 101 were pregestional diabetics (B2, C64, D30, F1, R3 and F-R 1 of Priscilla White) and 37 gestational diabetics (A1 24, A2 8 and A3-5 of Freinkel and Metzger). The maternal and perinatal results were compared to that of 242 non-diabetic adolescents and 482 non-adolescents pregnant and non-diabetics from the same institution at random. For variables' analysis the Fisher X2 test was used and Z for the ratios with a statistical significance of p< 0.05. RESULTS: The level of metabolic control was qualified as "non-optimal" in the 42.0 percent of the diabetics which may be contributed to the significant greater frequency of pre-term labor, morbidity and mortality and of newborns weighing = o > 4 000 g, it was probably the responsible of the greater frequency of cesarean section. The frequency of the eleven congenital malformations (8.0 percent was higher than the reported in our country for the general population and even for pregnants and to the non-attendance to pre-conception control consultation. CONCLUSION: The adverse perinatal results in diabetic adolescents could be in relation, according our results, to hyperglycemia of difficult control in these pregnants and to non-attendance to preconception control consultation

Prediabetes y diabetes gestacional / Prediabetes and gestational diabetes

Se debe considerar a la diabetes gestacional (DG) como toda intolerancia a los carbohidratos que aparece o se reconoce durante el embarazo, independientemente del momento de la gestación al diagnóstico del trastorno metabólico, si se administra o no insulina, o si desaparece o no después del parto. Por ello, resulta un grupo heterogéneo de situaciones con diferentes expectativas y pronósticos, en dependencia del momento de su presentación y del grado de afectación metabólica que manifieste...(AU)

Características maternas y perinatales diferenciales en el diagnóstico de la intolerancia a la glucosa en la primera o segunda mitad del embarazo / Maternal characteristics and perinatal differential diagnosis of glucose intolerance in the first or second half of pregnancy

Objetivo: conocer las diferencias maternas y perinatales en gestantes con diagnóstico de Diabetes Gestacional realizado en la primera mitad del embarazo y aquellas en que el diagnóstico se realizó en la segunda mitad. Pacientes y métodos: estudiamos retrospectivamente 963 diabéticas gestacionales en el período 1992-2005. Las pacientes fueron diagnosticadas siguiendo las normas y criterios de la OMS. En 252 el diagnóstico se efectuó con 20 semanas o menos y en las restantes 711 después de las 20 semanas. Los factores de riesgo para intolerancia a la glucosa utilizados fueron los propuestos por Valdés Amador y cols en 1985...

Repercusión materna y perinatal de la glucemia alterada en ayunas / Maternal and perinatal repercussion of impaired fasting glycaemia

Objetivo: reportar la morbi-mortalidad perinatal y materna de este grado de intolerancia a la glucosa detectada durante el embarazo y que conjuntamente con el diagnóstico de Tolerancia a la Glucosa Alterada (TGA), se ha calificado de Prediabetes. Métodos: se estudiaron los resultados maternos y perinatales en 9 pacientes con resultado de la 2da. hora de la PTGo no patológica (menos de 7,8 mmo/L-140 mg/dL), pero que sí reunían criterios de Glucemia alterada en ayunas (GAA) según la OMS (6,1 a 6,9 mmol/L-110 a 125 mg/dL), en más de una ocasión. Resultados: en 4 de las pacientes fue necesario tratamiento con insulina regular humana Novonordisk a dosis que fluctuaron de 0,5 Ud/kg de peso corporal ideal a 1,6 Ud. El 50 por ciento de los RN presentaron exceso de peso corporal neonatal y 1 de ellos resultó superior a los 4 000 g, el cual desarrolló una hipoglucemia sintomática. Se detecta una anomalía congénita (Hidrocefalia), y 2 amenazas de parto pretérmino con necesidad de tratamiento anticálcico. Conclusión: la Glucemia alterada en ayunas (GAA) según nuestros resultados repercute severamente en la morbilidad materna y perinatal.

Objective: to report the perinatal and maternal morbimortality corresponding to this degree of glucose intolerance detected during pregnancy and that together with the diagnosis of Impaired Glucose Tolerance (IGT) has been classified as Prediabetes. Methods: the maternal and perinatal results were studied in 9 patients with non-pathological respond at the second hour of the OGTT ( 7.8 mmol/L-140 mg/dL), but who fulfilled the criteria of impaired fasting glycaemia (IFG) according to the World Health Organization (6.1 to 6.9 mmol/L-110 to 125 mg/dL) more than once. RESULTS: in 4 of the patients it was necessary the treatment with Novonordisk human regular insulin at doses ranging from 0.5 Ud/kg of ideal body weight to 1.6 Ud. 50 percent of the newborn infants presented excess of neonatal body weight. One of them with a weight over 4 000 g developed a symptomatic hypoglycaemia. A congenital anomaly (hydrocepaly) and two menaces of pretem delivery with need of anticalcic treatment were detected. Conclusion: Impaired fasting glycaemia according to our results has a severe impact on maternal and perinatal morbidity.

Macrosomía neonatal en el embarazo complicado con diabetes / Neonatal macrosomy in pregnancy complicated with diabetes

Se realizó una investigación observacional analítica de tipo caso-control con el objetivo de determinar la frecuencia de la macrosomía neonatal, e identificar su relación con el grado de control metabólico, la edad gestacional a la que se diagnóstico la diabetes durante el embarazo, y el índice de masa corporal al inicio de la gestación, así como su repercusión en la morbilidad materna y perinatal en el embarazo complicado con diabetes. Se estudiaron 279 gestantes diabéticas (33 pregestacionales y 256 gestacionales) que fueron todas las que parieron un recién nacido vivo durante el período 2003-2006, cuando fueron atendidas en el Servicio de Diabetes y Embarazo del Hospital Ginecoobstétrico América Arias. La población fue dividida en 2 grandes grupos: las diabéticas que tuvieron un recién nacido macrosómico y las que no (261 y 28 gestantes, respectivamente). Se analizaron las variables siguientes: edad gestacional a la que se diagnosticó la diabetes (solo en las diabéticas gestacionales), índice de masa corporal al inicio del embarazo, grado de control metabólico, presencia de polihidramnios, tipo de parto, y Apgar del recién nacido al minuto y a los 5 min. La frecuencia de la macrosomía neonatal fue de 9,6 por ciento. El 25 por ciento de las gestantes diabéticas con hijos macrosómicos tuvieron un mal control metabólico, el 64,2 por ciento, sobrepeso corporal y el 10,7 polihidramnios, mientras que el 96,4 por ciento parió por cesárea. En el caso específico de las diabéticas gestacionales con hijos macrosómicos, en el 84 por ciento se diagnosticó tardíamente la enfermedad. No se encontró Apgar bajo en el grupo de los neonatos macrosómicos.

An observational analytical case-control study was carried out aimed at determining the frequency of neonatal macrosomy and at identifying its connection with the metabolic control degree, gestational age at which diabetes mellitus was diagnosed, the body mass index at the beginning of gestation, as well as its impact on maternal and perinatal morbidity in pregnancy complicated with diabetes. 279 diabetic pregnants (33 pregestational and 256 gestational) were studied. All of them gave birth a live newborn from 2003 to 2006, when they received attention at the Service of Diabetes and Pregnancy of América Arias Gynecoobstetric Hospital. The population was divided into 2 big groups: the diabetics that had a macrosomic newborn and those who did not (261 and 28 pregnants, respectively). The following variables were analyzed: gestational age at which diabetes melitus was diagnosed (only among the pregnant diabetics), body mass index at the beginning of pregnancy, metabolic control degree, presence of polyhydramnios, type of delivery and Apgar score of the infant on the first minute and on the fifth minute. The frequency of neonatal macrosomy was 9.6 percent. 25 percent of the diabetic expectants with macrosomic offspring had a poor metabolic control, 64.2 percent were overweight, 10.7 percent had polyhidramnios, and 96.4 percent underwent cesarean. In the specific case of the gestational diabetics with macrosomic children, 84 percent were diagnosed late. No low Apgar score was found in the group of macrosomic neonates.

Control preconcepcional de la paciente diabética / Pregestational control of the diabetic patient

Se realizó una amplia revisión de los cuidados que debe recibir una mujer diabética antes de que decida embarazarse. Es necesario lograr un control metabólico adecuado previo a la gestación para evitar la aparición de malformaciones fetales, que pueden presentarse si existe hiperglicemia durante el período de embriogénesis del embarazo. También es importante precisar la existencia de complicaciones crónicas de la diabetes mellitus y su grado, dado que algunas deben ser corregidas antes del embarazo, o en dependencia de la severidad o del tipo, pudieran desaconsejarlo. Se hace imprescindible además, brindar orientación anticonceptiva a estas mujeres mientras esperan el momento más adecuado para enfrentar la gestación. En este trabajo se recogen las experiencias en relación con este tema y las pautas de acción en la consulta de Riesgo Materno Preconcepcional de la Mujer Diabética.

An extensive literature review of the care that should be given to a diabetic woman before pregnancy was made. It is necessary to have an adequate metabolic control prior to gestation in order to avoid fetal malformation that may occur if hyperglycemia is present in the pregnancy embriogenesis term. It is similarly important to determine chronic complications of diatebes mellitus and their level of impact, given that some of these problems must be solved before pregnancy and, according to severity and type of the complication, a woman may even be advised against pregnancy. It is also essential to provide these women with contraceptive guidance while they are waiting for the most suitable time to get pregnant. This paper reflected the experience gained and the actions taken in the Pregestational Maternal Risk of the Diabetic Women medical consultation service.

Hiperlipidemias asociadas al embarazo en diabéticas y no diabéticas / Hyperlipidemas associtive with pregnancy in diabetic and with diabetic women

Se estudiaron los resultados en cuanto a niveles de colesterol HDL-colesterol y triglicéridos en 55 gestantes no diabéticas en el tercer trimestre del embarazo y se realizaron las mismas determinaciones en 63 gestantes con diabetes mellitus, 64 con diabetes mellitus insulinodependientes y 37 con diabetes mellitus no insulinodependientes, en los diferentes trimestres de la gestación. Se detectaron que tanto las diabéticas como las no diabéticas presentaban una fuerte tendencia a la hipertrigliceridemia durante el embarazo, la cual se hizo más frecuente a medida que progresaba la gestación. La única excepción ocurrió en las gestantes que padecían de "nefropatía diabética" en las cuales se comprobó que la dislipidemia más frecuente fue la tipo IIb de Friedrickson. En las dislipidemias detectadas, no se pudo reconocer influencias en relación con la edad, paridad, peso ganado durante la gestación, y sí con el grado de control metabólico durante el embarazo. Se concluyó que el patrón lipídico de la embarazada diabética bajo un estricto control de la enfermedad se comporta como el reportado para el embarazo y no como el de la enfermedad de base, muy probablemente debido al influjo hormonal de la gestación(AU)

The levels of cholesterol, HDL-cholesterol and triglycerides were studied in 55 nondiabetic pregnant women in the third trimester of pregnancy. The same determinations were obtained among 63 pregnant women with diabetes mellitus, 64 insulin-dependent diabetic expectants and 37 non-insulin dependent diabetic expectants in the different trimesters of gestation. It was observed that both, the diabetics and non-diabetics showed a strong trend toward hypertriglyceridemia during pregnancy and that it was more frequent as the time of pregnancy was longer, excepting those expectants who suffered from "diabetic nephropathy", among whom Friedrickson?s type IIb dyslipidaemia was the most frequent. In the detected dyslipidaemias it was not possible to recognize influences in relation to age, parity or weight gained during pregnancy, but it was observed that the degree of metabolic control during pregnancy did influence on dyslipidaemia. It was concluded that the lipidic pattern of the diabetic pregnant women under a strict control of the disease behaved as the one reported for pregnancy and not as that of the base disease, probably due to the hormonal influence of gestation(AU)