Modulation of quorum sensing activity by copper sulfate, potassium dichromate, and cadmium chloride in biosensor strains.

Beyond their biological roles, metals have a strong impact on the environment. It has been reported that metals are also inhibitory of Quorum Sensing (QS) mechanisms, ones of the best characterized signaling systems in bacteria and fungi. We analyzed the effect of CuSO4, CdCl2, and K2Cr2O7, on QS systems sharing or differing in the bacterial host or the QS signal. The results in this study show that CuSO4 can not only be inhibitory, but also stimulatory of QS activity: at 0.2 mM increased six fold the activity in Chromobacterium subtsugae CV026. This behavior is related to the concentration of the metal and the particular QS system: E. coli MT102 (pJBA132) was no affected, but CuSO4 decreased the QS activity of Pseudomonas putida F117 (pKR-C12) to half its control values. K2Cr2O7 increased four and three folds the QS activities of E. coli MT102 (pJBA132) and P. putida F117 (pAS-C8), respectively, but without effect when combined with CuSO4 or CdCl2. CdCl2 only showed a positive effect in CV026 when combined with CuSO4. Results suggest that factors related with the culture conditions impact on the influence of the metals, and reinforce the importance of the environment in the modulation of QS activity.

Anemia Management in the Cancer Patient With CKD and End-Stage Kidney Disease.

Anemia is a common medical problem among patients with cancer and chronic kidney disease (CKD). Although anemia in patients with CKD is often treated with iron and erythropoietin-stimulating agents, there are controversies with regard to the use of erythropoietin-stimulating agents in cancer patients. In this article, we review the treatment of anemia in patients with cancer and CKD, in addition to summarizing the current guidelines in treatment of anemia in these patients.

Plasticity of fruit and oil traits in olive among different environments.

Olive is a long-living perennial species with a wide geographical distribution, showing a large genetic and phenotypic variation in its growing area. There is an urgent need to uncover how olive phenotypic traits and plasticity can change regardless of the genetic background. A two-year study was conducted, based on the analysis of fruit and oil traits of 113 cultivars from five germplasm collections established in Mediterranean Basin countries and Argentina. Fruit and oil traits plasticity, broad-sense heritability and genotype by environment interaction were estimated. From variance and heritability analyses, it was shown that fruit fresh weight was mainly under genetic control, whereas oleic/(palmitic + linoleic) acids ratio was regulated by the environment and genotype by environment interaction had the major effect on oil content. Among the studied cultivars, different level of stability was observed, which allowed ranking the cultivars based on their plasticity for oil traits. High thermal amplitude, the difference of low and high year values of temperature, negatively affected the oil content and the oleic acid percentage. Information derived from this work will help to direct the selection of cultivars with the highest global fitness averaged over the environments rather than the highest fitness in each environment separately.

Síndrome de Rapunzel con doble tricobezoar simultáneo en una adolescente: Reporte de caso / Rapunzel syndrome with double simultaneous trichobezoar in a teenager: Clinical Case Report

Resumen: Introducción: Los tricobezoares son acúmulos intraluminales de cabello ingerido. El síndrome de Rapunzel hace referencia a la presencia de los tricobezoares gástricos que se extienden al intestino delgado, sumados a la tricotilomanía y tricofagia, los cuales ocurren preferentemente en pacientes psiquiátricos en edad pediátrica. Objetivo: Analizar la aparición y manejo de este síndrome, propor cionando de igual manera datos acerca del entorno familiar y psicoemocional para que, por medio del análisis de los mismos, en un futuro se pueda identificar el riesgo en pacientes con circunstancias similares. Caso clínico: Paciente femenina de 14 años con antecedentes de tricotilomanía y tricofagia de dos años de evolución, que consultó por cuadro de dolor epigástrico asociado a sensación de plenitud posprandial, náuseas y pérdida de peso. Al examen destacaban áreas alopécicas en el cuero cabelludo y a la palpación abdominal se identificó un plastrón cuyo contorno parecía corresponder a los límites gástricos. En los estudios de imágenes se encontró una ocupación gástrica por bezoar. Con la laparotomía más gastrostomía se identificaron dos tricobezoares simultáneos en estómago y duodeno, que fueron resueltos quirúrgicamente y la paciente fue manejada con abordaje psicoemocional. Conclusión: El síndrome de Rapunzel, lejos de ser meramente una entidad quirúrgica, requiere un apoyo psicoemocional para prevenir su recurrencia y limitar su severidad.

Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. Objective: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. Case report: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. Conclusion: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.

Olive Cultivation in the Southern Hemisphere: Flowering, Water Requirements and Oil Quality Responses to New Crop Environments.

Olive (Olea europaea L.) is a crop well adapted to the environmental conditions prevailing in the Mediterranean Basin. Nevertheless, the increasing international demand for olive oil and table olives in the last two decades has led to expansion of olive cultivation in some countries of the southern hemisphere, notably in Argentina, Chile, Perú and Australia. While the percentage of world production represented by these countries is still low, many of the new production regions do not have typical Mediterranean climates, and some are located at subtropical latitudes where there is relatively little information about crop function. Thus, the primary objective of this review was to assess recently published scientific literature on olive cultivation in these new crop environments. The review focuses on three main aspects: (a) chilling requirements for flowering, (b) water requirements and irrigation management, and (c) environmental effects on fruit oil concentration and quality. In many arid and semiarid regions of South America, temperatures are high and rainfall is low in the winter and early spring months compared to conditions in much of the Mediterranean Basin. High temperatures have often been found to have detrimental effects on olive flowering in many olive cultivars that have been introduced to South America, and a better understanding of chilling requirements is needed. Lack of rainfall in the winter and spring also has resulted in an urgent need to evaluate water requirements from the flower differentiation period in the winter to early fruit bearing. Additionally, in some olive growing areas of South America and Australia, high early season temperatures affect the timing of phenological events such that the onset of oil synthesis occurs sooner than in the Mediterranean Basin with most oil accumulation taking place in the summer when temperatures are very high. Increasing mean daily temperatures have been demonstrated to decrease fruit oil concentration (%) and negatively affect some aspects of oil quality based on both correlative field studies and manipulative experiments. From a practical standpoint, current findings could be used as approximate tools to determine whether the temperature conditions in a proposed new growing region are appropriate for achieving sustainable oil productivity and quality.

Colorectal Cancer Survival Disparities among Puerto Rican Hispanics: A Comparison to Racial/Ethnic Groups in the United States.

PURPOSE: Ethnic/racial disparities in colorectal cancer (CRC) survival have been well documented. However, there is limited information regarding CRC survival among Hispanic subgroups. This study reports the 5-year relative survival of Puerto Rican Hispanic (PRH) CRC patients and the relative risk of death compared to other racial/ethnic groups in the US. METHODS: CRC incidence data from subjects ≥50 years was obtained from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology and End Results (SEER) database from January 1, 2001 to December 31, 2003. Relative survival rates were calculated using the life tables from the population of PR and SEER. A Poisson regression model was used to assess relative risk of death by stage, sex, and age. RESULTS: A total of 76,444 subjects with incident CRC were analyzed (non-Hispanic White (NHW) n=59,686; non-Hispanic black (NHB) n=7,700; US Hispanics (USH) n=5,699; PRH n=3,359). Overall and stage-specific five-year survival rates differed by race/ethnicity. When comparing PRH to the other racial/ethnic groups, PRH had the lowest survival rates in regional cancers and were the only racial/ethnic group where a marked 5-year survival advantage was observed among females (66.0%) compared to males (60.3%). A comparable and significantly higher relative risk of death of CRC was observed for PRH and NHB compared to NHW. CONCLUSIONS: Our findings establish baseline CRC survival data for PRH living in Puerto Rico. The gender and racial/ethnic disparities observed in PRH compared to US mainland racial/ethnic groups warrant further investigation of the risk factors affecting this Hispanic subgroup.

Variability in almond oil chemical traits from traditional cultivars and native genetic resources from Argentina.

Almond (Prunus dulcis (Miller) D.A. Webb) genetic resources (Marcona, Guara, Non Pareil, IXL, AI, Martinelli C, Emilito INTA, Cáceres Clara Chica, Javier INTA) were studied during two consecutive crop years in order to evaluate variations in kernel oil yield and composition, and oil oxidative parameters. Total oil, oleic acid, α-tocopherol and squalene contents were found to range between 48.0% and 57.5%, 65% and 77.5%, 370 and 675 µg/g oil, and 37.9 and 114.2 µg/g oil, respectively. The genotype was the main variability source for all these chemical traits. The α-tocopherol content seems to be the most important contributor to both the radical scavenging capacity and the oxidative stability of almond oils analysed. Results obtained from the local genotypes namely Martinelli C, Emilito INTA and Javier INTA may be of interest for almond breeding focused to improve kernel oil yield and composition.

Investigación de vectores y reservorios en brote de Chagas agudo por posible transmisión oral en Aguachica, Cesar, Colombia / Investigation of vectors and reservoirs in an acute Chagas outbreak due to possible oral transmission in Aguachica, Cesar, Colombia / Investigação dos vetores e reservatórios ao surto da doença de Chagas agudo por possível transmissão oral em Aguachica, Cesar, Colômbia

Colombia tiene un registro de 11 casos de Chagas agudo y 80 casos por contaminación oral con Trypanosoma cruzi. Este trabajo analiza los hallazgos entomológicos y parasitológicos del brote de Aguachica, Cesar, en 2010. Un grupo interdisciplinario de profesionales de la salud y de universidades regionales realizó las pruebas de laboratorio a los pacientes y el estudio del foco de transmisión. Se detectaron 11 casos agudos de enfermedad de Chagas en una sola familia con vivienda sin triatominos domiciliados y, Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus y dos Didelphis marsupialis infectados con T. cruzi en palmas de Attalea butyracea y Elaeis oleifera del área urbana de Aguachica. Se analiza la participación del R. pallescens y el rol de las palmas en el ciclo silvestre de T. cruzi y para la transmisión oral de la enfermedad de Chagas. Incursiones esporádicas de R. pallescens, P. geniculatus y E. cuspidatus silvestres desde palmas cercanas al domicilio humano pueden provocar brotes cada vez más frecuentes de Chagas oral.

Colombia recorded 11 cases of acute Chagas disease and 80 cases of oral contamination with Trypanosoma cruzi. The current study analyzes the entomological and parasitological characteristics of the outbreak in Aguachica, Cesar Department, in 2010. An interdisciplinary group of health professionals and regional university personnel conducted the laboratory tests in the patients and the investigation of the transmission focus. Eleven cases of acute Chagas diseases were detected in a single family in a dwelling with domiciliated triatomines and Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus, and two Didelphis marsupialis opossums infected with T. cruzi in Attalea butyracea and Elaeis oleifera palm trees in the urban area of Aguachica. The study analyzes the role of R. pallescens and palm trees in the wild cycle of T. cruzi and in oral transmission of Chagas disease. Sporadic incursions by wild R. pallescens, P. geniculatus, and E. cuspidatus from the nearby palm trees into human dwellings may cause increasingly frequent outbreaks of oral Chagas disease.

A Colômbia tem registro de 11 surtos da doença de Chagas e 80 casos agudos por contaminação oral com Trypanosoma cruzi. Esta pesquisa analisa os achados entomológicos e parasitológicos do surto de Aguachica, Cesar, em 2010. Um grupo interdisciplinar de profissionais da saúde e de universidades regionais efetuou os testes laboratoriais nos pacientes e o estudo de foco de transmissão. Encontraram 11 casos agudos da doença de Chagas em uma única família com domicilio sem triatomíneos e Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus e dois Didelphis marsupialis infectados com T. cruzi em palmeiras de Attalea butyracea e Elaeis oleifera da área urbana de Aguachica. Analisa-se a participação de R. pallescens e a função das palmeiras em o ciclo silvestre de T. cruzi e para a transmissão oral da doença de Chagas. Incursões esporádicas de R. pallescens, P. geniculatus e E. cuspidatus silvestres das palmeiras próximas ao domicilio humano podem provocar surtos cada vez mais frequentes de Chagas oral.

Infestación por triatominos en comunidades indígenas de Valledupar, Colombia / Infestation by triatomine bugs in indigenous communities of Valledupar, Colombia / Infestação por barbeiros em comunidades indígenas de Valledupar, Colômbia

OBJETIVO: Calcular los índices infestación por triatominos en comunidades indígenas en Colombia. MÉTODOS: Se realizó estudio descriptivo en 19 comunidades indígenas del municipio de Valledupar Departamento de Cesar, Colombia. Durante junio a diciembre de 2007 se recolectaron triatominos por búsqueda activa en las viviendas de los indígenas. Los insectos luego fueron identificados por las claves de Lent & Wygodzinsky. Se desarrolló estudio del proceso infectivo en modelo animal y análisis enzimático de cepas de Trypanosoma cruzi, detectadas en heces de triatominos. RESULTADOS: Rhodnius prolixus presentó índice de densidad en las viviendas de 154,7 por ciento, Triatoma dimidiata de 102,45 por ciento, Triatoma maculata de 109,25 por ciento y Panstrogylus geniculatus de 0,3 por ciento. El índice promedio de infestación de las cuatro especies fue de 40,54 por ciento y, el de infección con T. cruzi de 9,4 por ciento. De cinco hemocultivos positivos para T. cruzi, tres se caracterizaron por isoenzimas, clasificándose en T. cruzi grupo I. El estudio de las biopsias reveló pocas características patológicas durante el proceso de infección con las cepas de T. cruzi aisladas de triatominos domiciliados. CONCLUSIÓN: Los altos índices de infestación por triatominos en las viviendas y el índice de infección por T. cruzi, evidencian la transmisión activa de la enfermedad de Chagas, situación que amerita la aplicación de medidas de control vectorial y el estudio seroepidemilógico de la población en riesgo. La identificación de las cepas de T. cruzi como grupo I concuerda con otros estudios realizados en esta región colombiana.

OBJECTIVE: To calculate triatomine infestation indices in indigenous communities in Colombia. METHODS: A descriptive study was carried out in 19 communities in Valledupar Municipality, Cesar Department, Colombia. During June to December, 2007, triatromine bugs were collected from their resting places in households. Taxonomic identification was made according to the keys by Lent & Wygodzinsky. An infection process in animal model and isozyme analysis of triatomine feces were performed. RESULTS: Rhodnius prolixus showed a density index of 154.7 percent, for Triatoma dimidiata was 102.45 percent, T. maculata 109.25 percent and Panstrogylus geniculatus 0.3 percent. The mean infestation index was 40.54 percent, and mean Trypanosoma infection index was 9.4 percent. Of five hemocultures positive for T. cruzi, three were enzimatically identified as T. cruzi group I. Biopsies revealed few pathologic characteristics of infective process with these strains isolated from domiciliary triatomine bugs. CONCLUSIONS: The high triatomine infestation indices in households and the T. cruzi infection index are evidence of active transmission of Chagas disease. The situation merits a vector control program and serological survey of the population at risk. The genetic characterization of T. cruzi strains as group I agrees with other findings on strains in this region of Colombia.

OBJETIVO: Calcular índices de infestação por barbeiros em comunidades indígenas da Colômbia. MÉTODOS: Estudo descritivo em 19 comunidades do município de Valledupar, departamento de Cesar, Colômbia. A coleta de barbeiros foi realizada por busca ativa nas casas dos indígenas de junho e dezembro de 2007. A identificação taxonômica foi feita conforme Lent & Wygodzinsky. A determinação da infecção foi realizada por processo de infecção em modelo animal e análise enzimática em fezes de barbeiros. RESULTADOS: Rhodnius prolixus apresentou nas casas das comunidades um índice de densidade 154,7 por cento, Triatoma dimidiata de 102,45 por cento e T. maculata de 109,25 por cento e Panstrogylus geniculatus de 0,3 por cento, cujo índice de infestação foi de 40,54 por cento, e índice de infecção com T. cruzi de 9,4 por cento. De cinco hemocultivos positivos para T. cruzi, três caracterizam-se como T. cruzi grupo I. O estudo das biópsias revelou poucas características patológicas da identificação do processo de infecção das cepas isoladas a partir de barbeiros domiciliados. CONCLUSÕES: os altos índices de infestação por barbeiros nas casas e o índice de infecção por T. cruzi evidenciam a transmissão ativa da doença de Chagas, situação que merece a aplicação de medidas de controle vetorial e um estudo seroepidemiológico da população sob risco. A caracterização genética das cepas de T. cruzi como grupo I concorda com outros achados para cepas dessa região da Colômbia.

Infestation by triatomine bugs in indigenous communities of Valledupar, Colombia.

OBJECTIVE: To calculate triatomine infestation indices in indigenous communities in Colombia. METHODS: A descriptive study was carried out in 19 communities in Valledupar Municipality, Cesar Department, Colombia. During June to December, 2007, triatromine bugs were collected from their resting places in households. Taxonomic identification was made according to the keys by Lent & Wygodzinsky. An infection process in animal model and isozyme analysis of triatomine feces were performed. RESULTS: Rhodnius prolixus showed a density index of 154.7%, for Triatoma dimidiata was 102.45%, T. maculata 109.25% and Panstrogylus geniculatus 0.3%. The mean infestation index was 40.54%, and mean Trypanosoma infection index was 9.4%. Of five hemocultures positive for T. cruzi, three were enzimatically identified as T. cruzi group I. Biopsies revealed few pathologic characteristics of infective process with these strains isolated from domiciliary triatomine bugs. CONCLUSIONS: The high triatomine infestation indices in households and the T. cruzi infection index are evidence of active transmission of Chagas disease. The situation merits a vector control program and serological survey of the population at risk. The genetic characterization of T. cruzi strains as group I agrees with other findings on strains in this region of Colombia.

Endometrial cancer in Puerto Rico: incidence, mortality and survival (1992-2003).

BACKGROUND: Endometrial cancer is the most common gynecologic malignancy in Puerto Rico and the United States (US). METHODS: We compare the age-specific and age-adjusted incidence and mortality rates and the survival of endometrial cancer in Puerto Rico with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB) and Hispanics in the US. Data from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1992-2003. RESULTS: Age-standardized incidence rates of endometrial cancer increased significantly (p < 0.05) in Puerto Rico (APC = 2.8%) and among NHB (APC = 1.9%) and remained constant (p > 0.05) for NHW (APC = -0.1%) and Hispanics in the US (APC = 0.4%). Mortality trends remained constant in all racial/ethnic groups (p > 0.05). For 1999-2003, women in Puerto Rico had similar incidence of endometrial cancer as Hispanics (Standardized rate ratio [SRR] = 0.94, 95% CI = 0.87-1.01), although their risk was lower than that of NHW (SRR = 0.56, 95% CI = 0.53-0.59) and NHB (SRR = 0.91, 95% CI = 0.84-0.98). Meanwhile, women in Puerto Rico had 15% higher risk of death than Hispanic women (SRR = 1.15, 95% CI = 1.03-1.30) similar risk than NHW (SRR = 0.93, 95% CI = 0.83-1.03), and lower risk than NHB (SRR = 0.51, 95% CI = 0.46-0.57). Puerto Rico (63.1%) and NHB (56.8%) had a lower 5-year survival than NHW (78.4%) and Hispanics (79.5%). An age-adjusted Cox proportional hazards model showed that compared with women in Puerto Rico, Hispanic women in the United States had 37% lower mortality risk (HR = 0.63, 95% CI = 0.56-0.71) and NHW had 53% lower mortality risk (HR = 0.47, 95% CI = 0.43-0.52) after 5 years of diagnosis; NHB women had 22% higher mortality risk than women in Puerto Rico (HR = 1.22, 95% CI = 1.09-1.36). CONCLUSIONS: The lower burden of endometrial cancer in Puerto Rico suggests the presence of protective factors or lower exposure to risk factors in this population, although increases in incidence suggest changes in the occurrence of lifestyles and environmental risk factors. Meanwhile, the lower five-year survival from endometrial cancer among Puerto Ricans suggests a health disparity for this group in areas such as quality of care and/or differences in terms of stage at diagnosis and associated comorbidities. Assessment of disease risk factors and characteristics, and access and response to treatment is required to further understand these results.

Life cycle and reproductive parameters of Clerada apicicornis signoret (Hemiptera: Lygaeidae) under laboratory conditions

The life cycle of Clerada apicicornis was determined under laboratory conditions. Mean development times in days were: egg 27.2, nymph I 12.5, nymph II 12, nymph III 13.4, nymph IV 16.4, nymph V 26. The life expectancy of adults ranged from 117 to 317 days (mean 196 days). Based on a cohort of 29 females of C. apicicornis, a horizontal life table was constructed. The following predictive parameters were obtained: net rate of reproduction (Ro = 48.31), intrinsic rate of population increase (r m = 0.153), generation time (Tc = 28.20 weeks), and finite rate of population increment (lambda = 1.16). The reproductive value (Vx) for each age class of the cohort females was calculated. The following observed parameters were calculated after mortality in each stage: net rate of reproduction (R'o=13.4), intrinsic rate of population increase (r c' =0.09 ), and finite rate of population increment (lambda' =1.1). The generation time (Tc' =27.4) was estimated using the methods of Laughlin and Bengstron. A vertical life table was elaborated and mortality was described for one generation of the cohort

Haematophagy and cleptohaematophagy of Clerada apicicornis (Hemiptera: Lygaeidae), a potential biological control agent of Rhodnius prolixus (Hemiptera: Reduviidae)

Because of its ability to prey on Triatominae in rural houses, Clerada apicicornis has been suggested as a potential biological control agent of Rhodnius prolixus. It has also been suggested as a potential vector of mammalian trypanosomes such as Trypanosoma cruzi, because of its ability to take blood directly from mammals. To help resolve these conflicting ideas, we assessed the haematophagic behaviour of C. apicicornis by carrying out feeding trials on laboratory animals. Cleptohaematophagic behaviour was also assessed by allowing C. apicicornis to feed on R. prolixus previously engorged with avian blood. The low proportion of blood meals taken directly from laboratory animals indicates a facultative haematophagy in this species, whereas a greater proportion of nymphs and adults were able to obtain vertebrate blood by predation on engorged R. prolixus. The results suggest that C. apicicornis is unlikely to be effective as a biological control agent, but is also unlikely to have a significant role in the transmission of vertebrate pathogens.

Disfunción eréctil enfermedad de peyronie: a propósito de un caso / Erectile disfunction peyronie illness: report of a case

En el presente trabajo se presenta un caso de enfermedad de peyronie, en un paciente de 46 años de edad diabetico conocido desde hace 6 años, quien acude por presentar dolor y deformidad del pene durante la erección. Su problema sexual ha generado un conflicto de pareja. La enfermedad de peyronis aparece en el 1 por ciento de los hombres principalmente en la mitad de la vida. La causa no es bien conocida pero se considera que existe una inflamación entre la albugínea y el tejido eréctil, la cual restringe la elasticidad de la cara peneana. Suele estar asociada a disfunción erectil que se agrava por que la distorsión y el dolor pueden provocar un profundo efecto psicológico. Nuestra labor como médicos de familia es la orientación de las parejas con el fin de prevenir la crisis familiares que se suscitan debido a esta patología.

Frecuencia, aspectos epidemiológicos y patología gestacional en el embarazo / Frecuency, epidemiological aspects and gestacional pathology in multiple pregnancy

La frecuencia de embarazo múltiple, diferentes aspectos epidemiológicos, duración de la gestación, tipo de placentación y patología gestacional asociada son analizados en 206 pacientes (202 gemelares y 4 triples) as istidos en la Emergencia Gineco-Obstétrica del Hospital Universitario "Antonio María Pineda" de Barquisimeto desde el 1 de marzo de 1990 al 28 de febrero de 1991; en ese período se atendieron un total de 18.093 partos, siendo la frecuencia de embarazos-partos múltiples de 1.14 por ciento (1,12 por ciento para el gemelar y 0,02 por ciento para el triple). La mayor frecuencia de estos se presentó en las edades de 20 a 29 años con un 50,97 por ciento , así como en las nulípara y las multíparas (con 4 partos o más) con un 53,88 por ciento . Los antecedentes de gemelaridad y la contracepción previa a la gestación no influyeron sobre la frecuencia y no hubo casos con antecedentes de infertilidad. Las 3 patologias gastacionales más frecuentes fueron: la amenaza de parto prematuro, hipertensión inducida por el embarazo y rotura prematura de membrana. La placentación monocorial representó el 58,2 por ciento de todos los casos