Obstetric and Perinatal Outcomes after Very Early Preterm Premature Rupture of Membranes (PPROM)-A Retrospective Analysis over the Period 2000-2020.

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study. Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119,888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9; range 17-34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson's coefficient -0.128 (p < 0.05). Conclusions: In the period 2000-2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.

[Massive hookworm infection as a cause of intestinal bleeding and severe anemia]. / Infección masiva por Ancylostoma duodenale como causa de hemorragia intestinal y anemia severa.

Overt gastrointestinal bleeding caused by hookworm infection is rarely reported. We present a 34 year old male with lower gastrointestinal bleeding with evidence of massive hookworm infection on colonoscopy and discuss the need to consider hookworm infection as a possible etiology of gastrointestinal bleed in endemic areas.

Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences.

There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.

Physical Activity in Work and Leisure Time during Pregnancy, and Its Influence on Maternal Health and Perinatal Outcomes.

BACKGROUND: Physical inactivity during pregnancy has been shown to be linked to an increased risk of complications. However, during pregnancy, doubts arise about what type, intensity and frequency of physical activity are most recommended. OBJECTIVE: Our main objective was to know the level of physical activity (PA) and sedentary lifestyle in a representative sample of pregnant women in Málaga, one of the most populated cities in Spain. Also, we aimed to find out the effects of PA on obstetric and perinatal outcomes and on the mental health of pregnant women, differentiated according to PA intensity and domain. METHODS: Five hundred and forty full-term pregnant women who had their obstetric checks in the maternity ward of the Regional University Hospital of Málaga were recruited through consecutive sampling. Participants answered a questionnaire that included the WHO Global Physical Activity Questionnaire (GPAQ), the Edinburgh Depression Scale (EDS), the Generalized Anxiety Disorder Scale (GAD-7) and some other sociodemographic and health-related questions. Subsequently, information about perinatal outcomes was obtained after birth. RESULTS: Only 50.8% of women followed the WHO recommendations on activity. We found a high proportion of obese pregnant women and a direct effect of a sedentary lifestyle on the rate of cesarean sections and vulvovaginal tears in spontaneous births, as well as on the mental health of future mothers. Women's age, the number of children, BMI at the beginning of pregnancy and leisure time physical activity (LTPA) explained anxiety scores, and age, LTPA, BMI at the end of pregnancy and intense work-related physical activity (WTPA) predicted depression scores. CONCLUSIONS: LTPA improves obstetric outcomes, helping to reduce the rate of cesarean sections and vulvovaginal tears, as well as reducing prenatal anxiety and depression.

[Disseminated cutaneous sporotrichosis with joint involvement in a woman with type 2 diabetes]. / Esporotricosis cutánea diseminada con compromiso articular en una mujer con diabetes tipo 2.

Disseminated sporotrichosis is a rare presentation of this mycosis. Although it has been described in immunocompetent individuals, there is often T cell-mediated immune compromise. We report the case of a woman with uncontrolled Type 2 diabetes who developed disseminated cutaneous sporotrichosis. The course of the disease presented several complications including hepatitis secondary to itraconazole and knee arthritis with culture positive for Sporothrix schenckii during treatment with saturated solution of potassium iodide. The case discussion includes aspects of the pathogenesis of disseminated sporotrichosis and management of the infection and its complications.

[Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis]. / Blastomicosis oral, papilomatosis laríngea y tuberculosis esofágica.

Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient's history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable.

Infección masiva por Ancylostoma duodenale como causa de hemorragia intestinal y anemia severa / Massive hookworm infection as a cause of intestinal bleeding and severe anemia

El sangrado gastrointestinal masivo causado por uncinarias es raramente reportado. El caso de un paciente varón de 34 años que se presentó con hemorragia digestiva baja con evidencia de infección masiva por uncinarias en la colonoscopia es reportado en este manuscrito. Además, se discute la necesidad de considerar la infección por uncinarias como una posible etiología del sangrado gastrointestinal en áreas endémicas...

Overt gastrointestinal bleeding caused by hookworm infection is rarely reported. We present a 34 year old male with lower gastrointestinal bleeding with evidence of massive hookworm infection on colonoscopy and discuss the need to consider hookworm infection as a possible etiology of gastrointestinal bleed in endemic areas...

Esporotricosis cutánea diseminada con compromiso articular en una mujer con diabetes tipo 2 / Disseminated cutaneous sporotrichosis with joint involvement in a woman with type 2 diabetes

La esporotricosis diseminada es una presentación infrecuente de esta micosis. Aunque ha sido descrita en sujetos inmunocompetentes, con frecuencia existe compromiso de la inmunidad mediada por células T. Reportamos el caso de una mujer con diabetes tipo 2 no controlada que desarrolló esporotricosis cutánea diseminada. El curso de la enfermedad presentó varias complicaciones que incluyeron hepatitis secundaria a itraconazol y artritis de la rodilla con cultivo positivo para Sporothrix schenckii durante el tratamiento con solución saturada de ioduro de potasio. La discusión del caso incluye aspectos de la patogénesis de la esporotricosis diseminada y el manejo de la infección y sus complicaciones.

Disseminated sporotrichosis is a rare presentation of this mycosis. Although it has been described in immunocompetent individuals, there is often T cell-mediated immune compromise. We report the case of a woman with uncontrolled Type 2 diabetes who developed disseminated cutaneous sporotrichosis. The course of the disease presented several complications including hepatitis secondary to itraconazole and knee arthritis with culture positive for Sporothrix schenckii during treatment with saturated solution of potassium iodide. The case discussion includes aspects of the pathogenesis of disseminated sporotrichosis and management of the infection and its complications.

Blastomicosis oral, papilomatosis laríngea y tuberculosis esofágica / Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis

El compromiso esofágico es una complicación infrecuente de la tuberculosis incluso en países con alta prevalencia de infección. Se presenta el caso de un paciente de 57 años no seropositivo al virus de inmunodeficiencia humana (VIH), con diagnóstico simultáneo de blastomicosis en cavidad oral y papilomatosis laríngea, ambas confirmadas por anatomía patológica. La biopsia de esófago reveló esofagitis granulomatosa con necrosis; la tinción de Ziehl-Neelsen mostró bacilos ácido-alcohol resistente, sugerentes de tuberculosis. El antecedente de tuberculosis pulmonar en dos oportunidades y abandono de tratamiento determinó el inicio de tratamiento antituberculoso de segunda línea a través de un tubo de gastrostomía, más itraconazol vía oral. La evolución fue favorable.

Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient’s history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable.