Multiplex PCR in the empirical antibiotic treatment of patients with SARS-CoV-2 and bacterial respiratory superinfection.

Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic led to overuse of antimicrobials, which increased concerns regarding antimicrobial resistance. Objective: To measure the impact of a multiplex polymerase chain reaction (PCR) pneumonia panel on empirical antibiotic treatment for patients with critical coronavirus disease 2019 (COVID-19) with suspected bacterial respiratory superinfection. Methods: This descriptive, prospective study was undertaken in a 36-bed intensive care unit from June 2020 to July 2021. Patients with severe COVID-19 who were ventilated and under suspicion of bacterial respiratory superinfection were included in the study. The intervention was a semi-quantitative multiplex PCR alongside concurrent standard cultures. When PCR panel results were expected to be obtained within 3 h of sampling, empirical antibiotic treatment was not administered while awaiting the results. Otherwise, empirical treatment was initiated. Patients classified as 'avoided empirical treatment' avoided 48-72 h of empirical antibiotic therapy. For those patients who received empirical treatment, the PCR panel results were used to decide whether treatment should be escalated, de-escalated, maintained or stopped. Positive and negative predictive values, and 'avoided empirical treatment' were calculated. Medical conduct and panel results were analysed for patients who received empirical treatment. Results: Eighty-two patients (71% male, 29% female) were included in this study. The mean age was 57.5 years, and the mean APACHE II score was 16. Ninety PCR panels were performed, and the negative and positive predictive values were 99.9% and 66.7%, respectively. Empirical treatment was avoided in 61% of episodes. Of those patients who were receiving antibiotics when the PCR panel was performed, treatment was de-escalated in 71%, escalated in 14%, stopped in 9% and maintained in 6%. A diagnosis of bacterial respiratory superinfection was ruled out in 19% of cases. Conclusions: PCR panels prevented the initiation of empirical antibiotic treatment in two-thirds of patients, and led to de-escalation in more than two-thirds of those who had started empirical antibiotic treatment. The high negative predictive value of the PCR panel allowed the diagnosis of bacterial respiratory superinfection to be ruled out. This tool represents a significant contribution to diagnostic stewardship in order to avoid the unnecessary use of antibiotics.

Hospital environment hygiene nurse: a key player to reduce healthcare associated infections by multi-resistant organisms.

BACKGROUND: Multi-Resistant Organisms (MRO) healthcare-associated infections (HAI) are closely associated with contamination of surfaces. Outsourced companies are usually in charge of both hospital hygiene and environmental hygiene personnel (EHP) supervision, which can result in bias. METHODS: A quasi-experimental study. The intervention was to add the "Hospital Environment Hygiene Nurse" (HEHN). MRO acquired infection rate and MRO acquired colonized rate were calculated, pre and post intervention. Confounding variables: MRO carriage rate upon admission and hospitalisation days median (HDM) were calculated. RESULTS: Median length of stay: 5 days (p=0.85, interquartile range=6 days). Carriage rate upon admission: 4.3% for pre-intervention vs 5.3% post-intervention, dif. (CI 95%): 1% (-1% to 2.9%) p=0.33. MRO acquired infection rate: 4.3% for pre-intervention vs. 2% post-intervention, Standardized Infection Ratio (SIR) (CI 95%): 0.47 (0.25 to 0.87). MRO acquired colonization rate:10.4% for pre-intervention vs. 7.9% post-intervention, SIR (CI 95%): 0.75 (0.53 to 1.07). CONCLUSIONS: As a reinforcement to standard infection control (IC) measures in place, the incorporation of an exclusive, full-time HEHN was significantly useful to reduce MRO HAI.

Obstrucción de arteria central de la retina: casos clínicos y controversias respecto a su manejo / Central retinal artery occlusion: clinical cases

Se presentan 3 casos clínicos de obstrucción de arteria central de la retina del ojo izquierdo: Una paciente con patología cardiovascular concomitante, sin posibilidad de fibrinolisis selectiva, con antecedentes de amaurosis fugax y secuelas neurológicas por episodios previos de tromboembolismo a territorio superior no detectados, y 2 pacientes que consultaron tardíamente en los cuales no se efectuó ningún tratamiento, sólo búsqueda del origen del cuadro ocular, en forma ambulatoria. Se discute acerca del tratamiento actual de las obstrucciones arteriales retinales agudas y la controversia referente a los ensayos clínicos en curso.

We present three clinical cases about central retinal artery occlusion all in the left eye: A female patient with concomitant cardiovascular disease, without chance selective fibrinolysis, who suffered amaurosis fugax and neurologic consequences from undetectable previous events of thromboembolism upward central nervous system, and two male patients with late consultation which no treatment was applied, only seeking origin of the ocular disease, by n outpatient basis. We discuss about current treatment of acute central retinal artery occlusion and controversy referring to ongoing clinical trials.

Crecimiento, supervivencia y herbivoría de plántulas de Brosimum alicastrum (Moraceae), una especie del sotobosque neotropical

Growth, survival and herbivory of seedlings in Brosimum alicastrum (Moraceae), a species from the Neotropical undergrowth. Growth responses, survival, and herbivory, on seedlings of Brosimum alicastrum were studied in a neotropical Mexican forest. We selected 122 seedlings and divided them into three groups assigned to defoliation treatments: control or 0 (n=21), 50 (n=51) and 90% (n=50). Every 4 months during two years we measured seedling growth (in terms of relative growth rate in biomass, leaf area growth, produced leaves and height growth) and survival. In addition, we evaluated every 12 months pathogen damage and insect herbivory using a 2 mm-2 grid. Separately, we estimated mammal herbivory in 3-month old seedlings that were selected within a plot of 500 m x 10 m (N=1095). Pathogen damage and insect herbivory were evaluated within the same plot in 113 seedlings. We found that 50 % defoliated seedlings showed compensatory responses in all growth parameters. Relative growth rate and height growth also had a compensatory response in seedlings at 90% defoliation. Relative growth rate and leaf area growth gradually decreased with time although height growth seedling showed an opposite pattern. Leaves produced were not affected by time. Estimated seedling survival probability increased with defoliation to a maximum of 97%, decreasing at 24 month to 37%. Mammal herbivory was more frequent and severe than herbivory caused by pathogens and insects. In some cases, mammal herbivory produced total defoliation. Compensatory growth in leaf area growth, produced leaves and height growth seedling suggest a synergic compensatory mechanism expressed in a whole-plant growth biomass (relative growth rate). Compensation and survival results suggest trade-offs at the leaf level, such as leaf area growth and produced leaves versus chemical defenses, respectively. Rev. Biol. Trop. 56 (4): 2055-2067. Epub 2008 December 12.

Se estudiaron las respuestas de crecimiento, supervivencia y los diferentes tipos de herbivoría sobre plántulas de B. alicastrum en una selva neotropical de México. Se seleccionaron 122 plántulas de una población las cuales se asignaron a tres tratamientos de defoliación: control o 0% (n=21), 50% (n=51) y 90% (n=50). Cada 4 meses durante dos años se midió su crecimiento (en términos de la tasa relativa de crecimiento en biomasa, área foliar, hojas producidas y altura) y supervivencia. Además cada 12 meses, mediante el uso de una cuadricula de 2mm-2, se evaluó la herbivoría causada por patógenos e insectos. También dentro de una parcela de 500 m largo x 10 m de ancho se evaluó en 1095 plántulas de 3 meses de edad la herbivoría por mamíferos. En la misma parcela pero en 113 plántulas se estimó la herbivoría por patógenos e insectos. Las plántulas defoliadas al 50% compensaron su crecimiento en todas las estructuras medidas, pero sólo la tasa relativa de crecimiento y altura lo hicieron con la defoliación al 90%. La tasa relativa de crecimiento y el área foliar disminuyeron gradualmente con el tiempo, contrario a la altura con un patrón opuesto. El número de hojas producidas no se afectó por el tiempo. La probabilidad estimada de supervivencia incrementó hasta un 95% con la defoliación y disminuyó hasta un 37% a los 24 meses. La herbivoría por mamíferos fue el más incidente y severo, en algunos casos hasta un 100% de defoliación. En tanto la causada por patógenos e insectos fue secundaria. El crecimiento compensatorio en área foliar, producción de hojas y altura sugieren un mecanismo compensatorio sinérgico expresado a nivel del crecimiento individual de la planta (tasa de crecimiento en biomasa). Al mismo tiempo junto con la supervivencia sugiere un posible compromiso entre las respuestas de crecimiento a nivel de la hoja - área foliar y hojas producidas - versus producción de defensas químicas.

Incidentalomas en patología del tiroides / Frecuency and characteristics of thyroid incidentalomas

Introducción: La realización de la Ultrasonografía de alta resolución ha hecho posible la detección de pequeños nodulos tiroideos asintomáticos. El incidentaloma tiroideo con una frecuencia entre el 1,5 al 10 por ciento, ha originado el dilema de cómo deben ser tratados1,2. Objetivos: Determinar su incidencia, las características clínicas y ultrasonográficas, así como el manejo más apropiado cuando se detectan incidentalmente nodulos tiroideos benignos o malignos igual o menores de 1,0 cm. Material y Método: Se realizó la revisión retrospectiva de las historias clínicas en 817 pacientes tratados por patología tiroidea entre 1984 y 2007. Resultados: La prevalencia del incidentaloma tiroideo fue del 8,44 por ciento. El porcentaje de malignidad fue del 27,54 por ciento. Entre los incidentalomas tiroideos benignos o malignos, no se encontraron diferencias significativas en relación con la edad, número, tamaño, y en las pruebas de función tiroidea, o gammagrafía con Tc99. Las características al ultrasonido de ecoestructura sólida, márgenes irregulares, o presencia de calcificaciones resultaron significativas en la detección de incidentalomas tiroideos malignos (p < 0,05). Conclusiones: No se evidenciaron diferencias significativas en los parámetros clínicos y de laboratorio entre los nodulos tiroideos benignos o malignos menores de 1,0 cm; sin embargo, los hallazgos reportados al ultrasonido pueden servir de base en la elección de la mejor decisión en cuanto a las estrategias a seguir para su óptima conducción.

Background: High-resolution ultrasonography deteets asymptomatic small thyroid nodules. These so called thyroid incidentalomas have created a clinical dilemma about their proper management. Aim: To report the incidence, clinical features and management of thyroid nodules of less than 1 cm diameter, detected incidentally on ultrasound. Material and Methods: Retrospective review of medical records of 817 patients admitted to a surgical ward for the management of a thyroid nodule. The frequency, and characteristics of incidentalomas, defined as nodules of less than 1,5 cm diameter detected incidentally, was studied. Results: Sixty nine patients (8,4 percent) had an incidentaloma. Of these 19 (27 percent) were malignant. There were no significant differences in age, nodule size and number, thyroid function tests, and Tc99 thyroid scans between benign and malignant incidentalomas. On ultrasound examination, a solid echo-structure, irregular margins, and the presence of calcifications were more common in malignant incidentalomas (p < 0,05). Conclusions: In this series, 8 percent of patients had an incidentaloma and the frequency of malignaney among these lesions was 27 percent. Ultrasound examination can be useful to differentiate between benign and malignant nodules.

Endoteliopatía corneal autoinmune como manifestación de uveitis intermedia / Corneal autoimmune endotheliopathy as manifestation of intermediate uveitis in children

Background: Intermediate Uveitis (IU) is an important cause of uveitis in children. It is considered a chronic intraocular inflammation that mainly affects the anterior vitreous and peripheral retina. Pars Planitis is a subtype of IU, consisting of a white opacity that covers the pars plana and ora serrata plus vitreous condensations in the eye. Corneal endothelium disease is a rare clinical finding associated with pars planitis. Objective: Describe the corneal manifestations in IU and its associated treatment between ophthalmology and pediatric rheumatology. Case-report: A 5 years-old boy with autoimmune endotheliopathy and unilateral pars planitis in the right eye. Initially, he was treated topically, but evolved with intraocular complications that required systemic medication. Long-term follow-up was performed, searching for associated systemic diseases, until one of these entities appeared. Conclusion: It is very important to search for inflammation in the anterior vitreous and pars plana in all children with corneal endotheliopathy, considering that an early and integral management of IU could diminish the risk of visual impairment as a complication.

Introducción: La Uveitis Intermedia (UI) es una causa importante de uveitis infantil. Se considera como una inflamación intraocular crónica que afecta principalmente a la retina periférica y vitreo anterior. La Pars Planitis es un subtipo de UI caracterizada por opacidades blanquecinas sobre la pars plana y ora serrata más condensaciones vitreas. La enfermedad del endotelio corneal es un hallazgo clínico infrecuente asociado con la Pars Planitis. Objetivo: Destacar la manifestación corneal de una UI y el tratamiento de la enfermedad entre oftalmólogo y reumatólogo infantil. Caso clínico: Se presenta caso clínico de niño de 5 años de edad con endoteliopatía autoinmune asociada a Pars Planitis unilateral del ojo derecho, que en principio se trató localmente, pero evolucionó con complicaciones intraoculares que requirieron medicación sistémica y se efectuó un seguimiento clínico por varios años buscando enfermedades sistémicas asociadas a UI hasta que ella apareció. Conclusión: Es necesario buscar la presencia de inflamación de pars plana y vitreo en todo niño que se presente con endoteliopatía corneal, considerando que el tratamiento oportuno y manejo integral del paciente con UI puede disminuir el riesgo de pérdida visual asociado a las complicaciones de esta enfermedad.

[Growth, survival and herbivory of seedlings in Brosimum alicastrum (Moraceae), a species from the Neotropical undergrowth]. / Crecimiento, supervivencia y herbivoría de plántulas de Brosimum alicastrum (Moraceae), una especie del sotobosque neotropical.

Growth responses, survival, and herbivory, on seedlings of Brosimum alicastrum were studied in a neotropical Mexican forest. We selected 122 seedlings and divided them into three groups assigned to defoliation treatments: control or 0 (n=21), 50 (n=51) and 90% (n=50). Every 4 months during two years we measured seedling growth (in terms of relative growth rate in biomass, leaf area growth, produced leaves and height growth) and survival. In addition, we evaluated every 12 months pathogen damage and insect herbivory using a 2 mm(-2) grid. Separately, we estimated mammal herbivory in 3-month old seedlings that were selected within a plot of 500 m x 10 m (N=1095). Pathogen damage and insect herbivory were evaluated within the same plot in 113 seedlings. We found that 50% defoliated seedlings showed compensatory responses in all growth parameters. Relative growth rate and height growth also had a compensatory response in seedlings at 90% defoliation. Relative growth rate and leaf area growth gradually decreased with time although height growth seedling showed an opposite pattern. Leaves produced were not affected by time. Estimated seedling survival probability increased with defoliation to a maximum of 97%, decreasing at 24 month to 37%. Mammal herbivory was more frequent and severe than herbivory caused by pathogens and insects. In some cases, mammal herbivory produced total defoliation. Compensatory growth in leaf area growth, produced leaves and height growth seedling suggest a synergic compensatory mechanism expressed in a whole-plant growth biomass (relative growth rate). Compensation and survival results suggest trade-offs at the leaf level, such as leaf area growth and produced leaves versus chemical defenses, respectively.

Resistencia a la terapia antirretroviral en pacientes infectados con el virus VIH-1 en Chile 2002-2005 / Resistance to anti-retroviral therapy in Chilean patients with HIV-1 from 2002 to 2005

Background: Resistance limits the effectiveness of anti-retroviral therapy. In Chile, there is free access to highly active anti-retroviral therapy since 2001, but there is no information about the frequency of mutations associated to drug resistance. Aim: To determine the most common mutations associated to anti-retroviral drug resistance in Chile. Materials and Methods: Retrospective study of 710 genotype analysis coming from 568 patients aged 22 to 70 years (85 percent males) with virological failure. The analysis was performed using a commercially available sequencing kit (Trugene HIV-1 genotypic assay from Bayer S.A). Results: Mean CD4+ cell count and viral load were 154 cells/fil and 228784 RNA copies/ml, respectively. The frequency of resistance to nucleoside RT inhibitors (NRTI), non nucleoside RT inhibitors (NNRTI) and protease inhibitors (PI) was 71 percent, 62 percent and 22 percent, respectively. The most common mutations found were T215Y (46 percent), L10F (44 percent), Ml84V (3896), K103N (35 percent) and M41L (32 percent). Fifty five percent of mutations corresponded to the TAM (thymidine analogue mutations) group. Multiresistance was 47 percent to NNRTI, 7 percent to NRTI, 4 percent to PI and 0.7 percent to all groups. During the four years of the study, there was a significant increase in NNRTI resistance. Conclusions: These data provides important information about the epidemiology of drug resistance mutations and should help to design newHAARTstrategies.

[Resistance to anti-retroviral therapy in Chilean patients with HIV-1 from 2002 to 2005]. / Resistencia a la terapia antirretroviral en pacientes infectados con el virus VIH-1 en Chile 2002-2005.

BACKGROUND: Resistance limits the effectiveness of anti-retroviral therapy. In Chile, there is free access to highly active anti-retroviral therapy since 2001, but there is no information about the frequency of mutations associated to drug resistance. AIM: To determine the most common mutations associated to anti-retroviral drug resistance in Chile. MATERIALS AND METHODS: Retrospective study of 710 genotype analysis coming from 568 patients aged 22 to 70 years (85% males) with virological failure. The analysis was performed using a commercially available sequencing kit (Trugene HIV-1 genotypic assay from Bayer S.A). RESULTS: Mean CD4(+) cell count and viral load were 154 cells/microl and 228784 RNA copies/ml, respectively. The frequency of resistance to nucleoside RT inhibitors (NRTI), non nucleoside RT inhibitors (NNRTI) and protease inhibitors (PI) was 71 %, 62% and 22%, respectively. The most common mutations found were T215Y (46%), L10F (44%), Ml84V (3896), K103N (35%) and M41L (32%). Fifty five percent of mutations corresponded to the TAM (thymidine analogue mutations) group. Multiresistance was 47% to NNRTI, 7% to NRTI, 4% to PI and 0.7% to all groups. During the four years of the study, there was a significant increase in NNRTI resistance. CONCLUSIONS: These data provides important information about the epidemiology of drug resistance mutations and should help to design new HAART strategies.

Effects of chronic hypobaric hypoxia on testis histology and round spermatid oxidative metabolism.

In order to evaluate the effects of the exposition to continuous chronic hypobaric hypoxia (CCHH) and intermittent chronic hypobaric hypoxia (ICHH) on testis histology and on oxidative metabolism of spermatogenic cells (SC), male rats were exposed to a 4600-m simulated altitude (PO2: 89.6 mmHg). After 60 days, ICHH and CCHH groups presented a significant decrease in testicular mass, an increase in interstitial space, a decrease in height of the seminiferous epithelium, depletion of cellular elements, vacuolization in epithelial cells and folding of the basal membrane. Round spermatids from animals exposed to CCHH presented a significant decrease in energy-dependent cell shape changes. Round spermatid mitochondria of CCHH rats seem to be limited in their ability to handle reducing equivalents. These mitochondria also appear to be uncoupled under basal conditions. Round spermatids from CCHH rats evidence large oxygen consumption (QO2) insensitive to inhibition by cyanide, a process that could be partly related to lipoperoxidation. Thus, exposure of male rats to CCHH and ICHH induced evident changes in testicular morphology and loss of spermatogenic cells, in all stages of the spermatogenic cycle. This post-meiotic spermatogenic cell loss in the testis correlated well with metabolic changes in round spermatids that evidenced a strong metabolic stress in these cells.

Diagnóstico y manejo de la pielectasia fetal / Diagnosis and management of fetal pyelectasis

Pielectasia es la dilatación leve de la pelvis renal, con o sin dilatación de los cálices, alteración que pude ser detectada mediante ultrasonografía prenatal. La pielectasia se detecta en 2,9 por ciento de los fetos evaluados (rango: 2-7 por ciento). El criterio más utilizado para el diagnóstico es la medición del diámetro antero-posterior de la pelvis renal mayor a 4 mm antes de las 33 semanas y mayor a 7 mm después de las 33 semanas. Se recomienda clasificar a las pielectasias de acuerdo al grado de dilatación en leve (<10 mm), moderada (entre 11 y 15 mm) y severa (>15 mm). El manejo antenatal es conservador. La evaluación postnatal se basa en confirmar la dilatación, determinar la etiología y descartar obstrucción.

Obstrucción de rama macular de arteria central de la retina / Occlusion of the macular branch of the central retinal artery

We report a 54 years old female on oral anticoagulant treatment with a mitral valve disease, with a history of two transient ischemic attacks and a decreased visual acuity. She was assessed by an ophthalmologist and signs of retinal vascular disease were found. During follow up, the patient experienced an acute unilateral loss of vision in the left eye. Fundoscopy revealed an obstruction of a macular branch of central retinal artery. Aspirin was added to oral anticoagulants and one month later, the patient experienced an upper gastrointestinal bleeding. After four months of follow up, there is no recovery of left eye vision

Maltrato infantil: realidad local / Child abuse: local reality

Introducción: Presentamos evolución histórica del maltrato infantil (MI) y análisis epidemiológico del problema, enfatizando en estudios nacionales que destacan un efecto positivo de las campañas para disminuir el MI físico grave, pero con permanencia de factores de violencia intrafamiliar que perpetúan la agresividad. Propósito: Realizar un estudio sobre Mi desde 3 puntos de vista: 1. Hospitalario, 2. Extrahospitalario y 3. Salud Privada: 1. Experiencia de interconsultas por sospechas de MI referidas a un Servicio de Oftalmología público en 2 años y presentación de 4 casos clínicos. 2. Estudio prospectivo de 78 niños víctimas de MI respecto a Salud Visual. 3. Experiencia personal respecto de 2 pacientes con compromiso ocular de segmento posterior por MI. Conclusión: Destacar el manejo multidiciplinario del MI y el valor del trabajo para acercar y sensibilizar a los oftalmologos frente a un niño sospechoso de MI.

Duplicación congénita de colon en el adulto: informe de un caso / Congénita duplication of colon in the adult: case report

Una malformación congénita que rara vez se puede observar en la edad adulta y que puede acompañarse de anomalías en otros aparatos y sistemas es la duplicación de un segmento del tubo digestivo. En el presente trabajo se reporta el caso de una joven de 19 años atendida en el Hospital Escuela con duplicación incompleta de colon sigmoides y se revisa la literatura...

Short-term bioeffects of an infrared pulsed laser device on burned rat skin monitored by transverse relaxation times (NMR).

BACKGROUND AND OBJECTIVE: The aim of this study was to determine whether the application of an infrared pulsed laser device (IPLD) on the burned skin of rats induced significant changes in the water dynamics of the burned tissues as measured by nuclear magnetic resonance (NMR) at a proton frequency of 90 MHz by using transverse relaxation times (T2, I/T2). STUDY DESIGN/MATERIALS AND METHODS: Seven groups (GI-GVII), each consisting of four albino rats (Sprague-Dawley), of 12-14 weeks of age were used in the experiment. Rats in GI-GVI were anesthetized and burned with a hot tip. GI, GIII, GV were not irradiated. GII, GIV, GVI were irradiated at 0 hours; 0 and 24 hours; and 0, 24, and 48 hours, respectively. Rats in GVII served as controls and were neither burned nor irradiated. Samples from all groups were obtained and monitored by NMR by using transverse relaxation times (T2 and 1/T2). An unpaired Student's t-test and a one-way analysis of variance (ANOVA I) were preformed on the mean values obtained (T2, 1/T2). The statistical design was chosen to give a 95% power of contrast 1-beta (1/T2). The modulated beam of the IPLD used is composed of two superposed waves; a carrier wave (3 MHz), and a drive force wave in the near infrared (904 nm, f = 1014 Hz). A dose of 1.5 x 10(3) J/M2 per session was applied by placing the IPLD directly over the burned tissue by using a top-hat distribution. RESULTS: The results of a t-test on the T2 and 1/T2 values did not show statistically significant differences at 0 and 24 hours between the irradiated groups, the nonirradiated groups, and the nonburned nonirradiated (control) group. Nonetheless, at 48 hours after the burn, we found a statistically significant difference in the 1/T2 values for the irradiated specimens compared with the nonirradiated specimens and the control group. Furthermore, the variance of the 1/T2 values as a function of time showed a tendency to decrease significantly only for the irradiated specimens. CONCLUSION: These findings show possible effects on the water dynamics of burned rat tissue in a short term as a result of the IPLD's application.

[Changes in the weight of women from rural and urban areas in normal pregnancy]. / Modificaciones en el peso de las mujeres del área rural y urbana durante el embarazo de curso normal.

Ethnographic, nutrition and genetic differences are known that determine diverse clinical outcomes all over the world and to enhanced according to geographic location. In the State of Michoacan, Mexico, the 50.7% of the population lives a rural lifestyle and the 20% are women in reproductive age with a birth rate of 37.8 x 1000 inhabitants per year, which is significant to asses weight gain behavior during pregnancy. The objective of this study was to evaluate the Gestational Weight Gain Pattern (GWGP) in the east rural area in the State of Michoacan, and comparing this with women in the urban area of Morelia city. The research was performed during six months, in which 68 women with normal pregnancy were enrolled and controlled throughout their pregnancy in the rural clinics and who received attention for labor and delivery in a hospital. The inclusion criteria was: a first consultation before the 14 weeks of gestation. Pregnancy and delivery attention was granted according with the Mexican Official Norm (Norma Official Mexicana). The results indicated that the pregnancy weight gain assessed every three months and globally were significantly different in both populations in the second and third trimesters except in the first trimester, and it was significantly higher for the urban population, p > .05. The women age at the pregnancy, the school education, the number of prenatal consultations were less in the native women, the parity was significantly higher in the rural area, p > .05. There were no differences in the Body Mass Index (BMI).

[Pattern of wight gain during normal pregnancy]. / El patrón de incremento ponderal durante el embarazo normal.

The maternal weight gain during pregnancy has been established as a common acceptance criterion about 11 Kg., and its evaluation is of interest in Gynecology and Obstetrics; the objective of this study was to evaluate the Gestational Weight Gain Pattern (GWGP) during the normal pregnancy and its association with the maternal height, pregestional weight, Body Mass Index (BMI) schooling, the intergensic interval and the newborn weight. It was found through a longitudinal and prospective study in women of the urban area, under prenatal control in the Instituto Mexicano del Seguro Social (IMSS), in Morelia, Mich. México, that the average overall GWGP was of 9.3 Kg, and a normality band within 6.6 to 12 Kg which is smaller than the established by obstetrics criteria. It was not found a correlation between the GWGP and the newborn weight, now that the 94.3% of them had normal weight. The mother's age, weight, body mass index and schooling didn't show any correlation with the maternal weight gain during the pregnancy. It was shown that the mother's height and parity influence notably the GWGP. It's convenient the adoption during the prenatal control to determine that the GWGP normality is in agreement with the bio-psycho-social characteristics of the Mexican woman.

Vitamin E modifies neither fructosamine nor HbA1c levels in poorly controlled diabetes.

OBJECTIVE: To examine the effects of vitamin E on total serum protein glycation (fructosamine), hemoglobin glycation (HbA1c), and serum levels of glucose, total cholesterol, triglycerides, LDL-C, HDL-C, apolipoprotein A1 and apolipoprotein B. MATERIAL AND METHODS: Sixty poorly controlled diabetic patients were randomly assigned to receive either 1200 mg/day of vitamin E or identical placebo capsules during a two month period following a double blind cross-over design with a four week wash-out period between regimens. RESULTS: Seven patients were excluded from the study because of reasons not related to the medication. In the remaining 53 patients, the levels of serum glucose, fructosamine, HbA1c, total cholesterol, HDL-C, LDL-C, Apo A1 and Apo B did not vary significantly with vitamin E as compared with placebo. CONCLUSIONS: No significant effects of vitamin E on any of the parameters evaluated were observed in poorly controlled diabetic patients.