Complicaciones perinatales asociadas con la ganancia excesiva de peso durante el embarazo / Perinatal outcomes associated to overweight gain during pregnancy in women at a regional hospital in northwest of Mexico

Resumen OBJETIVO: evaluar la asociación entre la ganancia de peso durante el embarazo y las complicaciones perinatales: enfermedad hipertensiva del embarazo, diabetes gestacional, cesárea de urgencia y macrosomía fetal. MATERIALES Y MÉTODOS: estudio de casos y controles anidados en una cohorte de pacientes que recibieron control prenatal y atención del parto en el Hospital General Regional del Instituto Mexicano del Seguro Social de Ciudad Obregón, Sonora. Los momios se calcularon según las complicaciones perinatales, el índice de masa corporal pregestacional y la ganancia total de peso durante todo el embarazo. RESULTADOS: se seleccionó una cohorte de seguimiento de 714 pacientes de las que solo se estudió a 426 que, a su vez, se dividieron en dos grupos de 213 cada uno: de casos y controles. En el grupo de casos la frecuencia de obesidad fue de 17.6% (n = 55) y 40.3% (n=126) de sobrepeso. En el grupo control 6.7% (n=21) de obesidad y 50.8% (n=159) en los controles. En comparación con las pacientes con peso pregestacional normal, no se observó riesgo significativo de complicaciones perinatales en las pacientes con sobrepeso previo a la gestación (RM=0.79, IC 95%: 0.57-1.11, p=0.189). En las pacientes con obesidad pregestacional se observó un riesgo significativo (RM=2.63, IC 95%: 1.51- 4.60, p=.001). CONCLUSIONES: la ganancia de peso a lo largo del embarazo, superior a la recomendada, es un factor riesgo significativo de complicaciones perinatales, independiente del peso previo a la gestación.

Abstract OBJECTIVE: To evaluate the association between weight gain during pregnancy and perinatal complications: hypertensive pregnancy disease, gestational diabetes, emergency cesarean section and fetal macrosomia. MATERIALS AND METHODS: Nested case-control study in a cohort of patients who received prenatal care and delivery care at the Regional General Hospital of the Mexican Social Security Institute of Ciudad Obregon, Sonora. The odds were calculated according to perinatal complications, pregestational body mass index and total weight gain throughout pregnancy. RESULTS: A follow-up cohort of 714 patients was selected, of whom only 426 were studied, which in turn were divided into two groups of 213 each: cases and controls. In the group of cases the frequency of obesity was 17.6% (n=55) and 40.3% (n=126) of overweight. In the control group 6.7% (n=21) of obesity and 50.8% (n=159) in controls. Compared with patients with normal pregestational weight, no significant risk of perinatal complications was observed in pre-gestational overweight (OR=0.79, CI 95%: 0.57-1.11, p=0.189). A significant risk was observed in patients with pregestational obesity (OR=2.63, CI 95%: 1.51- 4.60, p=.001). CONCLUSIONS: Weight gain during pregnancy, higher than recommended, is a significant risk factor for perinatal complications, independent of pre-gestational weight.

Tungiasis / Tungiasis

We present a ten years' old patient immune competent, with multiple lesions of tungiasis in both feet, that consult when she returned of her vacations in Paraguay. We make a brief description of the topic.

Se presenta una paciente de 10 años de edad inmunocompetente con lesiones múltiples de tungiasis en ambos pies, que consulta al regreso de sus vacaciones en Paraguay. Se efectúa una breve revisión del tema.

Alemtuzumab induction in kidney transplantation: clinical results and impact on T-regulatory cells.

Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4+CD25+FoxP3+ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P < .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.

Conversion from a calcineurin inhibitor-based immunosuppressive regimen to everolimus in renal transplant recipients: effect on renal function and proteinuria.

New immunosuppressive agents are being actively researched to avoid complications of chronic allograft nephropathy (CAN), calcineurin inhibitor (CNI) nephrotoxicity, and posttransplantation cancer. The family of mTOR inhibitors offers a unique immunosuppressive opportunity to avoid CNI toxicity and reduce the incidence of malignancy. Nevertheless, increasing data have demonstrated that sirolimus (SRL), the first mTOR introduced in the treatment of solid organ transplant recipients, induces proteinuria, an adverse event that could produce deterioration of long-term renal function. In this short-term study of patients followed for 1 to 16 months, we examined changes in renal function and proteinuria among renal transplant recipients converted from a CNI-based regimen to an everolimus (EVL)-based one, a recently introduced mTOR inhibitor. Our data showed that renal function can be optimized after conversion to EVL by up to 42% in recipients showing CAN grade 1 or 2, or CNI nephrotoxicity. Importantly, patients who improved their creatinine clearance did not show increased proteinuria measured in a voided specimen as the ratio of urinary protein and creatinine concentration (P/C). These results, if confirmed with long-term follow-up and a larger number of patients, would allow us to consider EVL as a promising agent for maintenance immunosuppressive regimens in kidney transplantation.

[Angioplasty in acute myocardial infarction. Early and late results]. / Angioplastia en infarto agudo de miocardio. Resultado inicial y seguimiento alejado.

BACKGROUND: The usefulness of angioplasty in the first hours of an acute myocardial infarction is widely demonstrated. However, its long term effects are less well known. AIM: To report the effects of coronary angioplasty on early and late outcome of patients with acute myocardial infarction. PATIENTS AND METHODS: A non-randomized, consecutive and retrospective analysis of the hospital and late outcome of 70 patients, aged 35 to 85 years, subjected to coronary angioplasty during an acute myocardial infarction. Patients were followed during 12 to 60 months. RESULTS: Angioplasty was performed 5.3 +/- 5 hours after the initial symptoms. Anterior descendent artery was occluded in 63% of patients with a 99.5% luminal occlusion and TIMI 0-1 anterograde flow. An angiographic success was achieved in 83% of procedures with a residual stenosis of 32.3%. Recurrent ischemia was observed in 6% of patients, that were treated with a new revascularization procedure. Thirteen percent of patients died, all due to cardiogenic shock. Severe ventricular failure and failure of revascularization influenced mortality. During the first year of follow up there was a 3.3% mortality and 3.3% of patients required a new revascularization procedure. Eighty percent of patients were asymptomatic and event-free. CONCLUSION: Angioplasty was a useful therapeutic procedure in this group of patients.