Etiology and diagnostic approach of recurrent miscarriage at a reference center in Bucaramanga, Colombia.

OBJECTIVE: The purpose of this study was to determine the etiologies of recurrent miscarriage in our hospital and whether its diagnostic approach followed the recommendations of the American Society of Reproductive Medicine (ASRM) guidelines published in 2012 and the National Institute for Health and Care Excellence (NICE) guidelines published in 2011. METHODS: This was a retrospective study. The medical records of 158 patients diagnosed with recurrent miscarriage between 2013 and 2018 at Santander University Hospital were reviewed. The Institutional Review Board of HUS approved the study in May 2020. RESULTS: The most common etiologies identified were protein S deficiency, thrombophilia, and cervical insufficiency, with incidence rates of 25.9%, 10.7%, and 3.8%, respectively. Moreover, the most frequently requested diagnostic tests were for protein S, protein C, and anti-phospholipid IgG. Abnormal results for protein S were obtained in 49% of the patients, whereas lupus anticoagulant was abnormal in 12.8%, and Factor V Leiden gene mutations in 8.5% of the patients. Three substantial deviations from the recommended diagnostic approach for recurrent miscarriage by international guidelines were identified in our population: the lack of request for cytogenetic analysis of pregnancy tissue, request for cytogenetic analysis for the parents in only 0.6% of the study sample, and the request for imaging tests to assess uterine anatomy in only 6.3% of the studied population. Both the ASRM and NICE guidelines were only partially followed with a combined adherence rate of 66.5%. CONCLUSION: The diagnostic approach for recurrent miscarriage poses important clinical challenges when compared to the recommendations of international guidelines. Therefore, the development of a local recurrent miscarriage assessment protocol is proposed in our institution.

A Shift in Pathotype Diversity and Complexity of Phytophthora sojae in Brazil.

Soybean root and stem rot caused by the oomycete Phytophthora sojae is a destructive disease worldwide that can affect plants at any growth stage. The use of resistant cultivars is the most effective method of controlling the disease. Therefore, monitoring changes in the population of P. sojae regarding the dynamics of avirulence genes capable of overcoming resistance genes (Rps) is important to reduce yield losses and to enhance the effectiveness of the Rps genes. Forty isolates of P. sojae sampled from a region of high incidence of soybean root and stem rot in Brazil were characterized using 14 soybean differentials, and 28 pathotypes were identified. Compared with a study conducted a decade ago, there was a major shift in pathotype diversity and complexity toward both higher numbers of different pathotypes and of avirulence genes in a given individual in the current population of P. sojae. Breeding programs aiming at developing soybean cultivars with resistance to root and stem rot should consider the high variability in the population of P. sojae and seek for strategic deployment of genes and germplasm.

Health risks caused by short term exposure to ultrafine particles generated by residential wood combustion: a case study of Temuco, Chile.

Temuco is one of the most highly wood smoke polluted cities in Chile; however, there is scarce evidence of respiratory morbidity due to fine particulate matter. We aimed to estimate the relationship between daily concentration of ultrafine particles (UFP), with an aerodynamic diameter ≤ 0.1 µm, and outpatient visits for respiratory illness at medical care centers of Temuco, Chile, from August the 20th, 2009 to June the 30th, 2011. The Air Pollution Health Effects European Approach (APHEA2) protocol was followed, and a multivariate semi-parametric Poisson regression model was fitted with GAM techniques using R-Project statistical package; controlling for trend, seasonality, and confounders. The daily UFP were measured by a MOUDI NR-110 sampler. We found that results of the statistical analyses show significant associations between UFP and respiratory outpatient visits, with the elderly (population ≥ 65 years), being the group that presented the greatest risk. An interquartile increase of 4.73 µg/m(3) in UFP (lag 5 days) was associated with respiratory outpatient visits with a relative risk (RR) of 1.1458 [95% CI (1.0497-1.2507)] for the elderly. These results show novel findings regarding the relevance of daily UFP concentrations and health risk, especially for susceptible population in a wood smoke polluted city.

Particulate air pollution and health effects for cardiovascular and respiratory causes in Temuco, Chile: a wood-smoke-polluted urban area.

Temuco is one of the most highly wood-smoke-polluted cities in the world. Its population in 2004 was 340,000 inhabitants with 1587 annual deaths, of which 24% were due to cardiovascular and 11% to respiratory causes. For hospital admissions, cardiovascular diseases represented 6% and respiratory diseases 13%. Emergency room visits for acute respiratory infections represented 28%. The objective of the study presented here was to determine the relationship between air pollution from particulate matter less than or equal to 10 microm in aerodynamic diameter (PM10; mostly PM2.5, or particulate matter <2.5 microm in aerodynamic diameter) and health effects measured as the daily number of deaths, hospital admissions, and emergency room visits for cardiovascular, respiratory, and acute respiratory infection (ARI) diseases. The Air Pollution Health Effects European Approach (APHEA2) protocol was followed, and a multivariate Poisson regression model was fitted, controlling for trend, seasonality, and confounders for Temuco during 1998-2006. The results show that PM10 had a significant association with daily mortality and morbidity, with the elderly (population >65 yr of age) being the group that presented the greatest risk. The relative risk for respiratory causes, with an increase of 100 microg/m3 of PM10, was 1.163 with a 95% confidence interval (CI) of 1.057-1.279 for mortality, 1.137 (CI 1.096-1.178) for hospital admissions, and 1.162 for ARI (CI 1.144-1.181). There is evidence in Temuco of positive relationships between ambient particulate levels and mortality, hospital admissions, and ARI for cardiovascular and respiratory diseases. These results are consistent with those of comparable studies in other similar cities where wood smoke is the most important air pollution problem.