Hemoglobina glucosilada en el diagnóstico de diabetes gestacional en mujeres mexicanas durante el tercer trimestre / Glycosylated hemoglobin in the diagnosis of gestational diabetes in Mexican women during the third trimester

Resumen El objetivo del trabajo fue analizar los valores de hemoglobina glucosilada en el tercer trimestre de embarazo como predictores alternativos de la diabetes gestacional en pacientes del Noreste de México. Se trata de un estudio retrospectivo de casos y controles a partir de 121 expedientes de pacientes embarazadas, divididos en dos grupos, pacientes con diabetes gestacional (casos) y gestantes con valores glucémicos normales (controles). Se analizaron los factores de riesgo asociados a la diabetes gestacional y se obtuvo un punto de corte para la hemoglobina glucosilada. Se encontró que la obesidad materna, la edad y el antecedente del padecimiento fueron asociados significativamente con la diabetes gestacional. Valores de hemoglobina glucosilada ≥5% incrementaron el riesgo de padecer diabetes mellitus gestacional 4 veces y, aunado a un factor de riesgo, la probabilidad se incrementó 7 veces. Se concluye que los valores de hemoglobina glucosilada en el tercer trimestre de embarazo podrían emplearse como prueba diagnóstica de la diabetes gestacional en pacientes del Noreste de México. Sin embargo, aunque las diferencias encontradas fueron estadísticamente significativas, los resultados se deben interpretar con cautela y requieren su confirmación con estudios que incluyan una muestra mayor.

Abstract The objective of this study was to analise glycosylated hemoglobin values in the third trimester of pregnancy as an alternative predictor of gestational diabetes in North East Mexican cohort patients. This is a retrospective case-control study based on 121 records of pregnant patients, divided into two groups, patients with gestational diabetes (cases) and pregnant women with normal glycemic values (control). The risk factors associated with gestational diabetes were analised and a cut-off point for glycosylated hemogestaglobin was obtained. It was found that maternal obesity, age and a history of the condition were significantly associated with gestational diabetes. Values of glycosylated hemoglobin ≥5% increased the risk of suffering from gestational diabetes 4 times, and coupled with a risk factor, the risk increased 7 times. It is concluded that glycosylated hemoglobin values in the third trimester of pregnancy could be used as a diagnostic test for gestational diabetes in patients from the North East of Mexico. Although the differences found were statistically significant, our results must be interpreted with caution and require confirmation by studies with a larger sample.

Resumo O objetivo deste estudo foi analisar os valores da hemoglobina glicada no terceiro trimestre de gestação como preditores alternativos do diabetes gestacional em pacientes na região nordeste do México. Trata-se de um estudo retrospectivo de casos e controles utilizando 121 prontuários de gestantes divididas em dois grupos; pacientes com diabetes gestacional (casos) e gestantes com valores de glicemia normais (controles). Foram analisados os fatores de risco associados a diabetes gestacional obtendo-se um ponto de corte para a hemoglobina glicada. Descobriu-se que a obesidade materna, idade e antecedentes da doença foram associados significativamente ao diabetes gestacional. Valores da hemoglobina glicada ≥ 5% aumentaram o risco de padecer diabetes mellitus gestacional 4 vezes, e juntamente a um fator de risco, a probabilidade aumentou 7 vezes. Conclui-se que os valores da hemoglobina glicada no terceiro trimestre de gestação poderiam ser usados como teste diagnóstico do diabetes gestacional em pacientes da região nordeste do México. Embora as diferenças encontradas tenham sido estatisticamente significativas, os resultados devem ser interpretados com cautela e requerem confirmação através de estudos que incluam uma amostra maior.

Punicalin and ellagic acid from pomegranate peel extract facilitate apoptotic behaviour in the Hela cell line.

Polyphenols may be an effective therapy for both the prevention and treatment of cancer. Previous studies have found that these compounds may inactive Hela cells, which may even be converted into a normal cells post-treatment. The present study extracted phenolic compounds from pomegranate peel, with the polyphenols then purified using different solvents and identified by means of high-performance liquid chromatography-tandem mass spectrometry (HPLC/MS). Once the phenolic compounds had been purified, we evaluated their cytotoxic effects on both the Hela and NIH-3T3 cell lines, on which an apoptosis assay was also carried out. Additionally, apoptosis assay was carried out on Hela and NIH-3T3. Lastly, the proteome profile was analysed via two-dimensional gel electrophoresis (2-DE) and liquid chromatography-tandem mass spectrometry (LC/MS/MS). We isolated and then purified punicalagin and ellagic acid (EA) from pomegranate peel, with both compounds likely to have a cytotoxic effect on Hela and NIH-3T3. However, this effect depends on both concentration and exposure time. Results obtained using a Cayman commercial assay kit suggests that punicalin and EA regulate the apoptosis on the Hela and NIH-3T3 cell lines. Finally, we observed that polyphenols compounds regulate the expression of proteins related to apoptosis. In conclusion, punicalin and EA have a cytotoxic effect on Hela and, furthermore, reactive the apoptotic pathway in this cell.

Morbilidad y mortalidad asociadas con protocolos de transfusión masiva en hemorragia obstétrica severa / Morbidity and mortality associated with mass transfusion protocols in severe obstetric hemorrhage

Resumen OBJETIVO: Determinar la morbilidad y mortalidad debidas a la aplicación de protocolos de transfusión masiva en pacientes con hemorragia obstétrica atendidas en cuidados intensivos. MATERIALES Y MÉTODOS: Estudio de una cohorte retrospectiva de pacientes con hemorragia obstétrica severa atendidas en la unidad de cuidados intensivos obstétricos del Hospital Materno Infantil del Instituto de Seguridad Social del Estado de México y Municipios, entre septiembre de 2014 y mayo de 2019. Se compararon tres protocolos de transfusión masiva en los que se aplicaron los derivados de la sangre en relación con la proporción de concentrado eritrocitario, de plaquetas y plasma con las siguientes proporciones: 2:1:1, 1:1:1 y liberal. Para analizar la posible asociación de las complicaciones con la elección de los diferentes protocolos de transfusión masiva, se utilizó un análisis mediante prueba ANOVA y χ2 en el programa SPSS versión 21; se consideró significativo el valor de p < 0.05. RESULTADOS: Se analizaron 75 pacientes con edad promedio de 32.8 años; 63 eran multigestas. La causa principal de la hemorragia obstétrica fue la atonía uterina. 51 de 75 de los protocolos de transfusión masiva fueron liberales, 11 de ellos con una relación 2:1:1 y 4 de 51 de 1:1:1. Las complicaciones fueron: síndrome de insuficiencia respiratoria aguda, lesión renal aguda, lesión renal aguda originada por la transfusión, infecciones y reintervención quirúrgica. Se encontró asociación positiva con: los días de estancia en cuidados intensivos (p = 0.031), reintervención quirúrgica (p = 0.006) y síndrome de insuficiencia respiratoria aguda (p = 0.044) y los protocolos de transfusión masiva liberal respecto de los protocolos con relación 1:1:1. Solo una paciente falleció y ello se asoció con el protocolo de transfusión masiva liberal. CONCLUSIONES: La aplicación de protocolos de transfusión masiva 1:1:1 y 2:1:1 en pacientes con hemorragia obstétrica severa disminuye el riesgo de complicaciones. La mortalidad materna debido a la aplicación del protocolo de transfusión masiva liberal fue de solo un caso en 51 pacientes.

Abstract OBJECTIVE: To determine the morbidity and mortality due to the application of massive transfusion protocols in patients with obstetric hemorrhage treated in intensive care. MATERIALS AND METHODS: study of a retrospective cohort of patients with severe obstetric hemorrhage treated in the obstetric intensive care unit of the maternal and child hospital of the social Security Institute of the State of Mexico and municipalities, between september 2014 and may 2019. three massive transfusion protocols were compared in which blood derivatives were applied in relation to the ratio of erythrocyte concentrate, platelets and plasma with the following ratios: 2:1:1, 1:1:1 and liberal. to analyze the possible association of complications with the choice of the different mass transfusion protocols, an anova and χ2 test was used in the spss version 21 program; the value of p < 0.05 was considered significant. RESULTS: Seventy-five patients with a mean age of 32.8 years were analyzed; 63 were multigrafted. The main cause of obstetric bleeding was uterine atony. 51 of 75 of the mass transfusion protocols were liberal, 11 of them with a 2:1:1 ratio and 4 of 51 of 1:1:1. The complications were: acute respiratory failure syndrome, acute renal injury, acute renal injury originated by transfusion, infections and surgical reintervention. Positive association was found with: days of stay in intensive care (p = 0.031), surgical reintervention (p = 0.006) and acute respiratory failure syndrome (p = 0.044) and liberal mass transfusion protocols with respect to 1:1:1 ratio protocols. Only one patient died and this was associated with the liberal mass transfusion protocols. CONCLUSIONS: The application of 1:1:1 and 2:1:1 mass transfusion protocols in patients with severe obstetric hemorrhage decreases the risk of complications. Maternal mortality due to the application of liberal mass transfusion protocols was only one case in 51 patients.

Association of the Vascular Endothelial Growth Factor Gene Polymorphism +936 C/T with Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Peripheral neuropathy is one of the most common late complications of diabetes. Vascular endothelial growth factor (VEGF) gene polymorphisms have been associated with the development of peripheral neuropathy in different populations of patients with type 2 diabetes mellitus (DM2). OBJECTIVE: To analyze the prevalence of the +936 C/T VEGF gene polymorphism among patients with DM2 with and without peripheral neuropathy. STUDY DESIGN AND METHODOLOGY: 218 unrelated DM2 patients, 90 with and 128 without peripheral neuropathy were genotyped for the +936 C/T VEGF gene polymorphism using PCR amplification followed by restriction length polymorphism analysis. RESULTS: The CC homozygous VEGF+936 C/T (rs3025039) was the predominant genotype in DM2 patients with peripheral neuropathy, whereas the predominant genotype in patients without neuropathy was the heterozygous C/T. No statistical association was found between genotype distribution and the presence of neuropathy (p = 0.063). The distribution of the genotypes according to the dominant (CC vs. CT + TT) and recessive (TT vs. CT + CC) models showed that the homozygous CC and TT genotypes, respectively, are not risk factors for neuropathy. The CT genotype conferred a protective effect as seen in the over-dominant model (CT vs. CC + TT) (OR = 0.52; 95% CI = 0.300-0.90; p = 0.019). CONCLUSION: We conclude that the VEGF+936 C/T (rs3025039) gene polymorphisms are related to peripheral neuropathy in Mexican DM2 patients, with the heterozygous genotype potentially conferring a protective effect.

Evaluación del control de infecciones poscesárea mediante la implementación de un programa preventivo / Evaluation of post-cesarean infection control through the implementation of a preventive program

Resumen OBJETIVO: Estimar la incidencia de infecciones en pacientes que finalizaron el embarazo por cesárea e identificar los factores de riesgo asociados antes y después de la implementación de un programa preventivo. MATERIALES Y MÉTODOS: Estudio cuantitativo, no experimental, de cohorte prospectiva. Se seleccionaron mujeres que finalizaron el embrazo por cesárea en el Hospital Universitario de Saltillo, entre octubre de 2015 a octubre de 2016. Se practicaron tres medidas preventivas para disminuir el riesgo de infecciones poscesárea: administración profiláctica de antibiótico, lavado vaginal preoperatorio con yodopovidona y retiro del catéter urinario al término de la cirugía. Al séptimo día del alta hospitalaria se citó a las pacientes para evaluar la posibilidad de infección de la herida quirúrgica, endometritis o sepsis. Para el análisis estadístico se utilizó el programa SPSS versión 21. Se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se registraron 103 pacientes. La incidencia de infección de la herida quirúrgica, fue de 1.9% y de dehiscencia 1%; no se registraron casos de endometritis. Al comparar la incidencia de infecciones poscesárea, previo al protocolo (año 2015) y posterior a la implementación de las medidas preventivas, se demostró la disminución de infección de la herida quirúrgica (2.4 a 1.9%) y de endometritis (1.9 a 0%). CONCLUSIÓN: La implementación del programa preventivo de infecciones poscesárea, basado en la administración profiláctica de antibiótico, lavado vaginal con yodopovidona y retiro de la sonda urinaria temprana, disminuye el índice de infecciones puerperales poscesárea.

Abstract OBJECTIVE: An estimates the incidence and risk factors associated with infections in caesarean sections before and after the implementation of the preventive program. MATERIALS AND METHODS: Non-experimental quantitative study of a prospective cohort type. The study population were women they finished the pregnancy by caesarean section during the period of october 2015 to october 2016. Three preventive measures were performed to reduce the risk of postoperative infections: prophylactic antibiotic, preoperative vaginal lavage with iodopovidone and urinary catheter removal at the end of the surgery a follow-up was performed at 7 days identifying patients with infected wound, endometritis and sepsis. The results will be analyzed using the SSPS software versión 21. RESULTS: A total of 103 women were incorporated into the protocol. The incidence of postoperative infections was 1.9% for wound infections, 1.0% dehiscence and 0% endometritis. A comparative analysis was performed of incidences of surgical site infection, endometritis, sepsis and surgical wound dehiscence, prior to the preventive protocol (year 2015) and after the implementation of preventive measures, and we observed a reduction of endometritis from 1.9% to 0% and of the surgical wound infection from 2.4% to 1.9%. CONCLUSION: The preventive program integrated by the use of prophylactic antibiotic, preoperative vaginal lavage with iodopovidone and urinary catheter removal at the end of surgery, reduced the rate of post-cesarean puerperal infections.

Spermatic Cord Leiomyosarcoma Rare Case.

Case description of a male patient of 64 years who presents a left groin-scrotum painless tumor, growing, from several months of evolution. Physical examination demonstrated the existence of a mass effect of the left distal spermatic cord, and was later confirmed by ultrasound and CT. Laboratory parameters were normal. The performed surgery consisted in a radical orchiectomy with high ligation of the left cord. In conclusion, preoperative diagnosis of spermatic cord leiomyosarcoma is difficult we need the combination of present illness, physical examination, exams and the gold standard histopathological and immunohistochemical studies allowed a definitive diagnosis.

Assessment of biochemical parameters and characterization of TNFα -308G/A and PTPN22 +1858C/T gene polymorphisms in the risk of obesity in adolescents.

Obesity is currently considered an inflammatory condition associated with autoimmune diseases, suggesting a common origin. Among other factors, candidate genes may explain the development of this disease. Polymorphisms in the tumor necrosis factor α (TNFα) and lymphoid protein tyrosine phosphatase (PTPN22) genes lead to an increased risk to development of immune and inflammatory diseases. The aim of the present study was to analyze the biochemical parameters and the effect of the TNFα -308G/A and PTPN22 +1858C/T polymorphisms in the susceptibility of adolescents to obesity. A group of 253 adolescent subjects were recruited and classified as obese, overweight or normal weight according to their nutritional status. Anthropometric measurements, clinical and biochemical data were analyzed. DNA was extracted from peripheral blood samples by the phenol-chloroform method, and TNFα -308G/A and PTPN22 1858C/T polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism assays. Clinical, genetic and biochemical parameters were analyzed to determine the existence of a possible association with the development of obesity. Statistically significant differences in body mass index, insulin, triglyceride levels and homeostatic model assessment for insulin resistance (HOMA-IR) index were observed among the three groups analyzed (P≤0.05). The studied polymorphisms did not confer a risk for developing obesity in the analyzed population (P>0.05); however, significantly low levels of insulin and decreased rates of HOMA-IR were observed in the 1858 CT genotype carriers of the PTPN22 gene. In conclusion, no association between the TNFα -308G/A and PTPN22 +1858C/T polymorphisms and the risk to development of obesity in the adolescent population analyzed was observed. However, the 1858 CT genotype of the PTPN22 gene was associated with variations of certain biochemical parameters analyzed.