Mecánica Tusígena / Cough Mechanics

El control neurológico de la tos o la neurofisiología de la tos, implica una serie de eventos complejos en el sistema nervioso que coordinan y desencadenan este reflejo protector pulmonar. Esta intrincada red de señales nerviosas y coordinación muscular se origina en los receptores de la tos, pasa por el centro de la tos en el bulbo raquídeo y finalmente activa los músculos necesarios para la adecuada eliminación del agente irritante. Este mecanismo involucra, la detección del estímulo por receptores especializados, transducción de señales que viajan a lo largo de fibras nerviosas aferentes hacia el sistema nervioso central, centro integrador a nivel del bulbo raquídeo, en el centro de la tos es donde se procesa las señales de los receptores y se coordina la respuesta. La integración de las señales y la respuesta radica en este centro de la tos y en la corteza cerebral quien regula y modula la tos. El control neuronal cortical de la tos implica la participación consciente y voluntaria de la corteza cerebral en la percepción, regulación y adaptación de la tos. La coordinación muscular requiere que la señal viaje por vías nerviosas eferentes motoras hacia los músculos involucrados, la contracción muscular se integra en una secuencia específica que desencadena las fases de la tos, inspiración máxima, compresión y expulsiva.

The neurological control of cough, or the neurophysiology of cough, involves a series of complex events in the nervous system that coordinate and trigger this lung protective reflex. This intricate network of nerve signals and muscle coordination originates from the cough receptors, passes through the cough center in the medulla oblongata, and finally activates the muscles necessary for proper elimination of the irritant. This mechanism involves the detection of the stimulus by specialized receptors, transduction of signals that travel along afferent nerve fibers towards the central nervous system, integrating center at the level of the medulla oblongata, in the cough center is where the signals are processed. receptors and the response is coordinated. The integration of signals and response resides in this cough center and in the cerebral cortex, which regulates and modulates coughing. Cortical neural control of cough involves the conscious and voluntary participation of the cerebral cortex in the perception, regulation, and adaptation of cough. Muscle coordination requires that the signal travel through efferent motor nerve pathways to the muscles involved; muscle contraction is integrated into a specific sequence that triggers the cough, maximum inspiration, compression, and expulsive phases.

Intraoperative Hypotension Is Not Correlated With Acute Kidney Injury During Spinal Fusion Surgery.

BACKGROUND: Intraoperative hypotension (IOH) has been found to be associated with organ damage, including cardiac injury and acute kidney injury (AKI). However, to our knowledge, this relationship has not been studied in a neurosurgery-specific patient population. In this report, we review our institutional experience to understand the magnitude of association between IOH in spinal fusion operations and incidence of postoperative AKI. METHODS: This retrospective cohort study included 910 patients who underwent posterior spinal fusion procedures performed in the prone position. Intraoperative variables collected and analyzed include minute-by-minute mean arterial pressure (MAP) from an arterial catheter, intermittent blood pressure cuff readings, volume of administered intravenous fluids, urine output, and all relevant vitals and administered medications. The electronic medical record was queried for additional patient data. IOH was defined as MAP <65 mm Hg for greater than 10 minutes. The primary endpoints of the study were presence and staging of AKI ( [Kidney Disease: Improving Global Outcomes] consensus classification), postoperative ileus, and postoperative troponin leak. RESULTS: Using a partial correlation analysis, no association was found between IOH metrics (IOH occurrence, IOH duration >10 minutes, and total IOH time) and any outcome metrics, including AKI, except for vasopressor usage and estimated blood loss. Patient age at surgery was not associated with any outcome variables. The lack of association between IOH and AKI contrasts with existing literature; this could be due to underlying differences in our patient population or could highlight a more complex relationship between IOH and AKI than previously understood. CONCLUSION: Occurrence and duration of IOH were not associated with AKI, postoperative ileus, troponin leak, length of stay, or any other major outcome variables in spinal fusion patients. CLINICAL RELEVANCE: These findings depart from previous literature showing a correlation between IOH and AKI and provide level 3 evidence clinically relevant to spinal surgery. Further research is needed to better understand the exact nature of this relationship.

Application of a TEG-Platelet Mapping Algorithm to Guide Reversal of Antiplatelet Agents in Adults with Mild-to-Moderate Traumatic Brain Injury: An Observational Pilot Study.

BACKGROUND: Traumatic intracranial hemorrhages expand in one third of cases, and antiplatelet medications may exacerbate hematoma expansion. However, the reversal of an antiplatelet effect with platelet transfusion has been associated with harm. We sought to determine whether a thromboelastography platelet mapping (TEG-PM)-guided algorithm could limit platelet transfusion in patients with hemorrhagic traumatic brain injury (TBI) prescribed antiplatelet medications without a resultant clinically significant increase in hemorrhage volume, late hemostatic treatments, or delayed operative intervention. METHODS: A total of 175 consecutive patients with TBI were admitted to our university-affiliated, level I trauma center between March 2016 and December 2019: 54 preintervention patients (control) and 121 patients with TEG-PM (study). After exclusion for anticoagulant administration, availability of neuroimaging and emergent neurosurgery, 62 study patients and 37 control patients remained. Intervention consisted of administration of desmopressin (DDAVP) for nonsurgical patients with significant inhibition at the arachidonic acid or adenosine diphosphate receptor sites. For surgical patients with significant inhibition, dual therapy with DDAVP and platelet transfusion was employed. Study patients were compared with a group of historical controls, which were identified from a prospectively maintained registry and typically treated with empiric platelet transfusion. RESULTS: Median age was 75 years (interquartile range 85-67) and 77 years (interquartile range 81-65) in the TEG-PM and control patient groups, respectively. Admission hemorrhage volumes were similar (10.7 cm3 [20.1] in patients with TEG-PM vs. 14.1 cm3 [19.7] in controls; p = 0.41). There were no significant differences in admission Glasgow Coma Scale, mechanism of trauma, or baseline comorbidities. A total of 57% of controls versus 10% of patients with TEG-PM (p < 0.001) were transfused platelets; 52% of intervention patients and 0% controls were treated with DDAVP. Expansion hemorrhage volumes were not significantly different (14.0 cm3 [20.2] patients with TEG-PM versus 13.6 cm3 [23.7] controls; p = 0.93). There was no significant difference in rates of clinical deterioration, delayed neurosurgical intervention, or late platelet transfusion between groups. CONCLUSIONS: Among patients with hemorrhagic TBI prescribed preinjury antiplatelet therapy, our study suggests that the use of a TEG-PM algorithm may reduce platelet transfusions without a concurrent increase in clinically significant hematoma expansion. Further study is required to prove a causative relationship.

Effectiveness of Oral Antibiotic Therapy in Prevention of Postoperative Wound Infection Requiring Surgical Washout In Spine Surgery.

BACKGROUND: Surgical site infections (SSIs) after spine surgery are a significant cause of morbidity. Surgeons often prescribe oral antibiotics in the postoperative setting for infected-appearing wounds to prevent reoperation for infection; however, the efficacy of this practice has not been well studied. METHODS: Neurosurgical spine patients with clinical concerns for SSI at the University of Pennsylvania were retrospectively studied from 2014 to 2018. Clinical predictors of 90-day reoperation for infection despite antibiotic treatment and variables that influenced antibiotic prescription were analyzed. RESULTS: Three hundred and ninety-two patients were included in the study. Preoperative albumin level, days elapsed to antibiotic prescription from index surgery, preoperative hemoglobin level, surgical location, gender, discharge disposition, and level of wound concern were significant predictors of reoperation for infection on bivariate analysis. Days elapsed to antibiotic prescription, surgical location, and level of wound concern remained significant after multivariable logistic regression. Variables that significantly predicted prescription of an antibiotic include length of stay, cerebrospinal fluid leak, race, and level of wound concern. Length of stay, race, and level of wound concern remained significant after multivariable analysis. CONCLUSIONS: Wound infection remains a challenging problem in spine surgery and it is reasonable to perform early reoperation in patients with high clinical concerns for infection, because bacterial isolates are often resistant to common oral antibiotics. Patients with wounds with low clinical concerns for infection may undergo a trial of oral antibiotics; however, duration of treatment should not be prolonged.

Resecting the dominant lesion: Patient outcomes after surgery and radiosurgery vs stand-alone radiosurgery in the setting of multiple brain metastases.

BACKGROUND: Brain metastases are the most common central nervous system (CNS) tumors, occurring in 300,000 people per year in the US. While there are immediate local benefits to surgical resection for dominant lesions, including reduction of tumor burden and edema, the survival benefits of surgical resection, over radiosurgery, remains unclear. METHODS: The University of Pennsylvania Health System database was retrospectively reviewed for patients presenting with multiple brain metastases from 1/1/16-8/31/18 with one dominant lesion > 2 cm in diameter, who underwent initial treatment with either resection of the dominant lesion or Gamma Knife radiosurgery (GKS). Inclusion criteria were age > 18, > 1 brain metastasis, and presence of a dominant lesion (>2 cm). We analyzed factors associated with mortality. RESULTS: 129 patients were identified (surgery=84, GKS=45). The median number of intracranial metastases was 3 (IQR: 2-5). The median diameter of the largest lesion was 31 mm (IQR: 25-38) in the surgery group vs 21 mm (IQR: 20-24) in the GKS group (p < 0.001). Mortality did not differ between surgery and GKS patients (69.1% vs 77.8%, p = 0.292). In a multivariate survival analysis, there was no difference in mortality between the surgery and GKS cohorts (aHR: 1.35, 95% CI: 0.74-2.45 p = 0.32). Pre-operative KPS (aHR: 0.97, 95% CI: 0.95-0.99, p = 0.004), CNS radiotherapy (aHR: 0.33, 95% CI: 0.19-0.56 p < 0.001), chemotherapy (aHR: 0.27, 95% CI: 0.15-0.47, p < 0.001), and immunotherapy (aHR: 0.41, 95% CI: 0.25-0.68, p = 0.001) were associated with decreased mortality. CONCLUSION: In our institution, patients with multiple brain metastases and one symptomatic dominant lesion demonstrated similar survival after GKS when compared with up-front surgical resection of the dominant lesion.

Neural Crest-Like Stem Cell Transcriptome Analysis Identifies LPAR1 in Melanoma Progression and Therapy Resistance.

Metastatic melanoma is challenging to clinically address. Although standard-of-care targeted therapy has high response rates in patients with BRAF-mutant melanoma, therapy relapse occurs in most cases. Intrinsically resistant melanoma cells drive therapy resistance and display molecular and biologic properties akin to neural crest-like stem cells (NCLSC) including high invasiveness, plasticity, and self-renewal capacity. The shared transcriptional programs and vulnerabilities between NCLSCs and cancer cells remains poorly understood. Here, we identify a developmental LPAR1-axis critical for NCLSC viability and melanoma cell survival. LPAR1 activity increased during progression and following acquisition of therapeutic resistance. Notably, genetic inhibition of LPAR1 potentiated BRAFi ± MEKi efficacy and ablated melanoma migration and invasion. Our data define LPAR1 as a new therapeutic target in melanoma and highlights the promise of dissecting stem cell-like pathways hijacked by tumor cells. SIGNIFICANCE: This study identifies an LPAR1-axis critical for melanoma invasion and intrinsic/acquired therapy resistance.

Tumor-infiltrating mast cells are associated with resistance to anti-PD-1 therapy.

Anti-PD-1 therapy is used as a front-line treatment for many cancers, but mechanistic insight into this therapy resistance is still lacking. Here we generate a humanized (Hu)-mouse melanoma model by injecting fetal liver-derived CD34+ cells and implanting autologous thymus in immune-deficient NOD-scid IL2Rγnull (NSG) mice. Reconstituted Hu-mice are challenged with HLA-matched melanomas and treated with anti-PD-1, which results in restricted tumor growth but not complete regression. Tumor RNA-seq, multiplexed imaging and immunohistology staining show high expression of chemokines, as well as recruitment of FOXP3+ Treg and mast cells, in selective tumor regions. Reduced HLA-class I expression and CD8+/Granz B+ T cells homeostasis are observed in tumor regions where FOXP3+ Treg and mast cells co-localize, with such features associated with resistance to anti-PD-1 treatment. Combining anti-PD-1 with sunitinib or imatinib results in the depletion of mast cells and complete regression of tumors. Our results thus implicate mast cell depletion for improving the efficacy of anti-PD-1 therapy.

Penetrating Spinal Column Injuries (pSI): An Institutional Experience with 100 Consecutive Cases in an Urban Trauma Center.

BACKGROUND: Gunshot wound (GSW) injuries are among the leading causes of penetrating spinal column injury (pSI). Patients with pSI often have concurrent polytrauma that complicates management. METHODS: We retrospectively reviewed charts between January 2012 to June 2018 at an urban Level 1 trauma center and analyzed bracing and surgical indications, antibiotic and magnetic resonance imaging (MRI) use, and patient outcomes. RESULTS: We identified 100 patients with pSI with an average age of 27.2 (range, 15-58) years. Five patients had knife injuries and 95 suffered GSW. Polytrauma occurred in 90% of patients with an average of 3.39 bullets per patient (range, 1-23). Fourteen patients underwent either decompressive surgery (n = 8) or decompression and fusion (n = 6). Thirty-five patients were externally braced. A total of 43% of patients presented as American Spinal Injury Association-A compared with 26% who were intact. Although 14 patients received prophylactic antibiotics for retained bullets or durotomies, only 2 patients had postoperative wound infections and 4 had extraspinal infections from retained bullets. All inpatient mortalities (n = 5) were patients with cervical pSI. Thirteen patients with GSW obtained MRI scans without complications. Among our cohort, only 65 patients had follow-up with a median follow-up period of 1.25 (range, 1-60) months. CONCLUSIONS: Management of pSI in urban trauma centers is complex, as these victims routinely have polytrauma that takes precedence. Indications for surgical intervention are narrow and secondary to surgery for polytrauma. External bracing may be overutilized. The efficacy of prophylactic antibiotics remains unclear. MRI can contribute valuable information but is limited by uncertainty regarding bullet compatibility. Lack of follow-up limits the study of this population.

Hematoma subcapsular hepático roto en el curso de un síndrome de HELLP / Broken hepatic subcapsular hematoma in the course of HELLP syndrome

Se presenta un caso poco frecuente de un hematoma subcapsular hepático roto en el curso de un síndrome de HELLP, en una paciente como complicación de la preeclampsia que resultó en una mortalidad materna. Se realizó, además, una revisión de la literatura(AU)

We report a rare case of a ruptured hepatic subcapsular hematoma in the course of in a patient with HELLP syndrome as a complication of preeclampsia resulting in maternal mortality. A review of the literature was also carried out(AU)

Caracterización de la mortalidad materna en Villa Clara (2001 - 2015) / Characterization of Maternal Mortality in Villa Clara (2001 - 2015)

Introducción: la mortalidad materna es un término estadístico que describe la muerte de una mujer durante o poco después de un embarazo. Objetivo: caracterizar la mortalidad materna en la provincia de Villa Clara (2001 - 2015). Métodos: se presentan los resultados de una serie de quince años de estudio de la mortalidad materna en Villa Clara, Cuba en un estudio observacional, descriptivo, retrospectivo de las muertes maternas ocurridas desde enero del 2001 hasta 2015 en el territorio. Resultados: la distribución de las muertes maternas en la provincia ha sido proporcional. Es destacable que en los años 2004 y 2010 no se hayan registrado. En el resto de los años, el comportamiento osciló entre uno y cinco casos anuales. En el período, el total de muertes maternas en el territorio resultó en 34 en relación con las 788 reportadas en todo el país. Entre las causas de mortalidad materna predominan las relacionadas con eventos hemorrágicos en 9 casos, seguidas de la enfermedad tromboembólica con 5 defunciones y las cardiopatías al igual que el embolismo de líquido amniótico con 4 casos. Se reportan diferentes causas infrecuentes en el periodo de estudio con un caso cada una. Conclusiones: se concluye que en el periodo en estudio se ha mantenido una estabilidad en la incidencia de muertes maternas en el territorio con excepción de dos años donde no se reportaron. Las causas fundamentales coinciden con la hemorragia y la enfermedad tromboembolica seguidas de otras afecciones(AU)

Introduction: Maternal mortality is a statistical term that describes the death of a woman during or shortly after a pregnancy. Objective: Characterize maternal mortality in the province of Villa Clara (2001 - 2015). Methods: The results of a fifteen - year study of maternal mortality in Villa Clara, Cuba, are presented in an observational, descriptive, retrospective study of maternal deaths from January 2001 to 2015. Results: The distribution of maternal deaths in the province has been proportional. It is remarkable that no mortality was registered in 2004 and 2010. In the rest of the years, the behavior oscillated between one and five cases per year. In the period, the total of maternal deaths in the territory resulted in 34 in relation to the 788 reported throughout the country. Among the causes of maternal mortality are those related to hemorrhagic events in 9 cases, followed by thromboembolic disease with 5 deaths and heart disease, as well as amniotic fluid embolism with 4 cases. Different infrequent causes are reported in the study period with one case each. Conclusions: In the period under study, there has been a stability in the incidence of maternal deaths in the territory with the exception of two years when no mortality was registered. The underlying causes coincide with bleeding and thromboembolic disease followed by other conditions(AU)

Dental disease patterns in methamphetamine users: Findings in a large urban sample.

BACKGROUND: The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface. METHODS: Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease. RESULTS: On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance. CONCLUSIONS: MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive. PRACTICAL IMPLICATIONS: The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.

Resultados de la atención a gestantes con preeclampsia grave en villa clara (2009-2010) / Results of expectant women´s care with severe preeclampsy in Villa Clara (2009-2010)

Introducción: la preeclampsia representa un riesgo para la madre y el producto de la concepción. Objetivos: Describir los resultados de la atención a la gestante con preeclampsia grave en Villa Clara durante los años 2009 y 2010. Métodos: estudio descriptivo de corte transversal en 238 gestantes que ingresaron en la sala de Cuidados Especiales Perinatales del Hospital Universitario Ginecoobstétrico “Mariana Grajales” con diagnóstico de preeclampsia grave en el período de enero del 2009 a diciembre del 2010. Resultados: entre los 20 y 35 años, se diagnosticaron con preeclampsia grave 109 mujeres (71,0 %). La media de edad fue de 27,3 años y predominó la nuliparidad (60,51 %). El 47,90 % de las gestantes tuvieron su parto antes de las 37 semanas de embarazo, y el 43,27 % tuvieron recién nacidos con peso inferior a los 2 500 g; de ellos, 15 pesaron menos de 1 000 gramos (6,30 %). Predominó la ausencia de complicaciones maternas y perinatales. Las principales complicaciones maternas resultaron la hipertensión persistente en el puerperio (13,02 %) y el hematoma retroplacentario (9,24 %); entre las complicaciones neonatales, se describen el bajo peso al nacer en el 43,27 %, las hipocalcemias en el 17,64 % y la sepsis en el 8,40 %. En el período de estudio, no se informaron muertes maternas en la provincia. Conclusiones: la atención a la preeclampsia grave resultó en un mínimo de complicaciones maternas y perinatales y fue un factor decisivo para preservar la vida de las madres con este padecimiento.

Introduction: preeclampsia represents a risk for the mother and for the product of the conception. Objectives: To describe the results of the expectant women´s care with severe preeclampsia in Villa Clara during 2009 and 2010 years. Methods: a descriptive study of transversal type was carried out in 238 expectant women admitted at the special perinatal care´s ward of the Gynecological and Obstetric University Hospital “Mariana Grajales”, who were diagnosed with severe preeclampsia between January, 2009 and December, 2010. Results: a number of 109 women (71,0 %), between 20 and 35 years old were diagnosed with severe preeclampsia. The average age was of 27, 3 years and nulliparity predominated (60,51 %). The 47,90 % of expectant women gave birth before the 37 weeks of pregnancy and the 43,27 % had newly born with a weight inferior to 2500 g; 15 of them weight less than 1000 grams (6,30 %).The were no considerable maternal and perinatal complications. The main maternal complications were persistent hypertension during puerperium (13,02 %) and retroplacental hematoma (9,24 %); as well as, main neonatal complications were low birth weight in 43,27 %, hypocalcaemia in 17,64 % and sepsis in 8,40 %. During this period there were not reported maternal deaths in the province. Conclusions: severe preeclampsia care resulted in a minimum of maternal and perinatal complications and it was an important factor for the preservation of mother´s life with this suffering.

Resultados de la atención a pacientes con riesgo de preeclampsia-eclampsia / Outcomes of patient care at risk of preeclampsia-eclampsia

Introducción:en la consulta de Riesgo de preeclampsia-eclampsia se realiza el diagnóstico precoz de formas graves y tempranas de preeclampsia. Objetivos: demostrar los resultados de la atención a gestantes con riesgo de preeclampsia eclampsia. Métodos: estudio descriptivo de corte transversal en el municipio de Santa Clara, provincia Villa Clara, en el año 2010. La muestra se conformó con 181 gestantes a las que se les aplicó una encuesta que incluyen los factores de riesgo, se diseñaron estrategias de seguimiento y diagnóstico precoz de formas graves e incipientes de la preeclampsia. Resultados: las edades extremas resultaron el 58,01 porciento del total, con 105 mujeres a predominio del subgrupo de la avanzada edad materna 69 (38,12 porciento)...

Introduction: early diagnosis of serious and early forms of pre-eclampsia is made in the consultation for pre-eclampsia eclampsia. Objectives: to show the results in the care of pregnant women at pre-eclampsia eclampsia risk. Methods: a cross sectional study in the municipality of Santa Clara, Villa Clara during 2010. The sample consisted of 181 pregnant women to whom they were given a survey including risk factors; strategies were designed for monitoring and early diagnosis of serious and emerging forms of preeclampsia. Results: the extreme ages were 58.01 percent out of the total, 105 women with a predominance of the subgroup of advanced maternal age 69 (38.12 percent)...

Caracterización del riesgo cardiovascular y del síndrome metabólico en gestantes con riesgo de preeclampsia/eclampsia / Characterization of cardiovascular risk and metabolic syndrome in pregnant women at risk of preeclampsia / eclampsia

Entre los factores de riesgo de preeclampsia eclampsia se incluye el riesgo cardiovascular y del síndrome metabólico. Objetivos: identificar factores de riesgo cardiovascular y del síndrome metabólico en una población de gestantes con riesgo de preeclampsia eclampsia. Método: estudio descriptivo de corte transversal en el Municipio de Santa Clara, Villa Clara, en el año 2011. La muestra se conformó con 181 gestantes con al menos dos factores de riesgo...

La histerectomía obstétrica como terapéutica segura en la morbilidad extremadamente grave / Obstetric hysterectomy as a safe therapy in the extremely severe morbidity

Introducción: la histerectomía obstétrica se define como la extirpación del útero después de un evento obstétrico, opción terapéutica vinculada con estados de morbilidad obstétrica extremadamente grave. Objetivo: determinar características obstétricas y generales en una población de pacientes con morbilidad obstétrica extremadamente grave a las cuales se les realizó histerectomía obstétrica. Métodos: estudio descriptivo de corte transversal, realizado desde enero del 2007 a diciembre del 2009, en el Hospital Ginecobstétrico Mariana Grajales de Santa Clara, Villa Clara. Se revisaron los expedientes de 71 pacientes a quienes se hizo histerectomía obstétrica. Se calculó la incidencia y se identificaron las características clínicas y obstétricas, la relación con el tipo de parto y los principales hallazgos anatomopatológicos asociados a la histerectomía obstétrica. Resultados: se realizó una histerectomía obstétrica cada 463 partos. El promedio de edad de las pacientes fue de 33,8 + 6,78 años. El 78,6 por ciento tenía antecedentes de cesárea. Predominó la histerectomía total abdominal en el 63,3 por ciento de la muestra y en 27 pacientes se realizaron ligaduras de las arterias hipogástricas, 38 por ciento. Se requirió el ingreso en la terapia intensiva en un 69 por ciento de las pacientes histerectomizadas. No se reportaron muertes maternas vinculadas con las histerectomías obstétricas en estos tres años en la provincia. Conclusiones: la histerectomía obstétrica es una opción terapéutica asociada a la morbilidad obstétrica extremadamente grave, donde el accionar oportuno, con dominio técnico y cumpliendo las indicaciones pertinentes se convierte en una herramienta que garantiza la vida de muchas pacientes en momentos críticos

Introduction: the obstetric hysterectomy is defined as the removal of uterus after an obstetric event, therapeutic option linked to stages of extremely severe obstetric morbidity. Objective: to determine the obstetric and general features in a group of patients presenting with an extremely severe obstetric morbidity underwent to obstetric hysterectomy. Methods: a cross-sectional and descriptive study was conducted from January, 2007 to December, 2009 in the Mariana Grajales Gynecology and Obstetrics Hospital of Santa Clara, Villa Clara province. The medical records of l71 patients were reviewed who underwent obstetric hysterectomy. Incidence was estimated identifying the clinical and obstetric features, the relation with the type of labor and the main anatomical-pathological findings associated with obstetric hysterectomy. Results: an obstetric hysterectomy was performed by 463 labors. The mean age of patients was of 33.8 ± 6.78 years. The 78.6 percent had a history of cesarean section. There was predominance of abdominal total hysterectomy in the 63.3 percent of the sample and in 27 patients ligatures of hypogastric arteries were performed (38 percent). It was necessary the admission in intensive therapy service of the 69 percent of hysterectomy patients during this past year in the province. Conclusions: the obstetric hysterectomy is a therapeutic option associated with the extremely severe obstetric morbidity, where a timely action, a technical mastery and fulfilling the pertinent indications, it become a tool to guarantee the life of many patients in critical situations

Preeclampsia con signos de agravamiento y su relación con los resultados maternos y perinatales, 2009-2010 / With signs of worsening preeclampsia and its relationship to maternal and perinatal outcomes, 2009-2010

Introducción: la preeclampsia representa un riesgo para la madre y el producto de la concepción. Objetivos: describir los resultados del manejo de la preeclampsia con signos de agravamiento en Villa Clara durante los años 2009 y 2010. Material y método: estudio descriptivo de corte transversal en 238 gestantes que ingresaron en la sala de Cuidados Especiales Perinatales del Hospital Gineco-Obstétrico "Mariana Grajales" con diagnóstico de preeclampsia grave en el período de enero del 2009 a diciembre del 2010. Se utilizaron estadígrafos como el porcentaje, la medida y la desviación estándar...

Predictores de la preeclampsia/eclampsia en un grupo de gestantes de alto riesgo / Pre-eclampsia/eclampsia predictors in high risk pregnants

INTRODUCCIËN: Los trastornos hipertensivos durante el embarazo son muy frecuentes y ocurren en más del 10 por ciento de todas las gestaciones a término. OBJETIVO: Determinar los factores de riesgos en este grupo de pacientes que permitan establecer estrategias de trabajo diferenciadas en pro del bienestar materno fetal. MÉTODOS: Se realizó un estudio descriptivo, de corte transversal, en 30 gestantes con riesgo de preeclampsia/eclampsia que acuden a la consulta municipal de atención al riesgo de preeclampsia/eclampsia en la ciudad de Santa Clara, Villa Clara, en el periodo comprendido entre septiembre de 2009 a enero de 2010. RESULTADOS: La mayoría de las pacientes fueron nulíparas (70 por ciento), con malnutrición por exceso (80 por ciento) y en edades extremas (56,6 por ciento) con predominio de la avanzada edad materna (33,3 por ciento), se encontró un gran porcentaje de gestantes con riesgo de síndrome metabólico. Se proponen estrategias de atención con enfoque de riesgo a estas gestantes en la atención prenatal. CONCLUSIONES: La nuliparidad, las cifras de glicemia elevadas en la captación del embarazo y la malnutrición por exceso fueron algunos de los factores de predicción más frecuentemente encontrados para la preeclampsia/eclampsia en el grupo estudiado.

INTRODUCTION: The hypertensive disorders during pregnancy are very frequent and occur in more then the 10 percent of all term pregnancies. OBJECTIVE: To determine the risk factors in this group of patients to allow establishing differential working strategies for the social maternal wellbeing. METHODS: A cross-sectional and descriptive study was conducted in 30 pregnant women with risk of pre-eclampsia/eclampsia in the Santa Clara city, Villa Clara province from September, 2009 to January, 2010. RESULTS: Most of patients were nulliparous (70 percent), with excessive malnutrition (80 percent) and in extreme ages (56.6 percent) with predominance of maternal old age (33.3 percent), as well as a high percentage of pregnants with metabolic syndrome risk. Authors propose care strategies approaching the risk of these patients during the prenatal care. CONCLUSIONS: Nulliparity, figures of a high level glycemia during the pregnancy screening and the excessive malnutrition were some the more frequent prediction factors for the pre-eclampsia/eclampsia in the study group.

Buenas prácticas clínicas en la atención a las gestantes diabéticas / Good clinical practice in the care of diabetic pregnant women

La repercusión de la diabetes mellitus en los resultados perinatales depende en gran medida del control metabólico alcanzado, para lo cual se han ideado numerosos protocolos de tratamiento, que unidos a las buenas prácticas clínicas logran resultados de calidad en el binomio madre hijo. Objetivo: Caracterizar la influencia de la diabetes sobre los resultados obstétricos y perinatales en el Hospital universitario Gineco-Obstétrico "Mariana Grajales", de Villa Clara en los años 2008-2009.

Algunos factores asociados a la morbilidad obstétrica extremadamente grave / Some features associated with the critically severe obstetric mortality

Se realizó un estudio descriptivo longitudinal y prospectivo en el Hospital Universitario Ginecoobstétrico "Mariana Grajales" de Santa Clara de enero de 2007 a diciembre de 2008, con el objetivo de describir los principales factores relacionados con la morbilidad obstétrica grave. Para la recogida de la información se confeccionó un formulario con las variables de interés a través de la revisión de historias clínicas individuales, de entrevistas a las pacientes y de datos ofrecidos por el departamento de estadísticas del hospital. Se constató que en el periodo del estudio 93 pacientes presentaron morbilidad obstétrica grave. Las principales causas estuvieron relacionadas con la hemorragia con 39,8 % y la preeclampsia 37,6%; la sepsis solo apareció relacionada en un 4,3 %; el parto distócico por cesárea fue un evento obstétrico relacionado directamente con la morbilidad grave y la realización de histerectomías obstétricas. Existe una relación directa entre los resultados maternos y los resultados perinatales en este grupo de pacientes. Se utilizaron los servicios de Terapia intensiva en los casos de extrema gravedad y ocurrieron 4 muertes maternas en estos dos años, se dejaron de vivir un total de 169 años por causas asociadas a la maternidad, y como promedio de años de vida potencialmente perdidos, cada mujer dejó de vivir 42,25 años por dichas causas

A prospective, longitudinal and descriptive study was conducted in "Mariana Grajales" Gynecology-Obstetrics University Hospital from January, 2007 to December, 2008 to describe the major factors related to asevere4 obstetric mortality. For information collection a form was designed including the interesting variables by individual medical records review, by interviews with patients and of data offered by hospital statistic department. We verified that during the study period 93 patients had a severe obstetric mortality. Major causes were related to hemorrhage (39,8 percent) and pre-eclampsia (37,6 percent); sepsis only was related to these causes in the 4,3 percent; dystocia cesarean section labor was a obstetric event related directly to the severe mortality and carrying out of obstetric hysterectomies. There is a direct link among maternal findings and the perinatal ones in this group of patients. Intensive Care Unit services were used in cases critically severe with 4 maternal deaths during these two years with a total of 169 years lost by causes associated with motherhood, and as average of potentially lost life years, each woman lost 42,45 years of life due such causes