Infantile/Capillary Hemangioma of the Uterine Corpus: A Rare Cause of Abnormal Genital Bleeding.

BACKGROUND: Infantile hemangiomas are vascular anomalies. However, they rarely cause genital bleeding. Here, we present the case of a young female with an endocavitary hemangioma who presented with abnormal uterine bleeding (AUB). CASE: The patient was an 8-year-old female with genital bleeding. Transabdominal pelvic ultrasound showed a 20-mm highly vascularized focal intrauterine endocavitary lesion. Vascular computerized tomography excluded vascular anomalies. Magnetic resonance imaging suggested a hemangioma. Minimally invasive open surgery was performed to remove the lesion. Subsequent pathology analyses confirmed an infantile/capillary hemangioma. CONCLUSIONS: Infantile hemangiomas are vascular anomalies that should be considered potential causes of AUB in early puberty. The study of these cases should include pelvic ultrasound and vascular magnetic resonance imaging. Experienced surgeons can successfully accomplish fertility-sparing surgical procedures. SUMMARY: We describe an unusual case of peripubertal AUB caused by an endocavitary capillary hemangioma. Management included fertility-sparing surgery and the complete resolution of symptoms.

El ocaso de los libros de texto como fuente de información entre los estudiantes de medicina / The decline of textbooks as a source of information among Medicine students

Introducción: El proceso de enseñanza de la medicina ha cambiado a través de la historia en la medida que sus estudiantes cambian. Los profesores de medicina se adaptan con dificultades a los nuevos estudiantes y muchas veces no son capaces de reconocer los nuevos intereses de sus propios alumnos. En este contexto resulta importante analizar qué métodos de estudio utilizan los actuales alumnos durante los siete años de la carrera de Medicina. Métodos: Estudio basado en metodología mixta: cualitativa (grupales focales)y cuantitativa (encuestas) aplicadas a alumnos de quinto, sexto o séptimo año de la carrera, médicos recién egresados y docentes activos de la Escuela de Medicina de la Pontificia Universidad Católica. Resultados: Los resultados de nuestro estudio muestran que los métodos de estudio que más utilizan los estudiantes de medicina son: apuntes de clases (1-5 años) y los manuales (internado). Los encuestados creen que los manuales son muy importantes, que facilitan el aprendizaje, que deben estar actualizados y que de preferencia deben estar disponibles en formato digital. Los docentes usaron como método preferente de estudio, durante la carrera de medicina, los libros de texto. Conclusión: Los estudiantes de medicina han cambiado, y así han evolucionado sus técnicas de estudio/ aprendizaje. Es indispensable que los métodos docentes se adapten a estas nuevas características; por lo que es indispensable ayudar a los profesores a modernizar sus técnicas docentes adaptándolas a las necesidades de los alumnos.(AU)

Introduction: The process of teaching medicine has changed throughout history as its students change. The medical professors adapt with difficulties to the new students and many times they are not able to recognize the new interests of its own students. In this context, it is important to analyze what methods of study the current students use during the seven years of the medical career. Methods: This study was based on a mixed methodology: qualitative (focus groups) and quantitative (surveys) applied to students in the fifth, sixth or seventh year of the medical studies, recently graduated doctors and active teachers of the Pontificia Universidad Católica de Chile. Results: The results of our study show that the study methods most used by medical students are: class notes (1-5 years) and handbooks (internship). Respondents believe that handbooks are very important, that they facilitate learning, that they should be up to date and that they should preferably be available in digital format. The teachers used as a preferred method of study, during the medical career, textbooks. Conclusion: Medical students have changed, and so have their study / learning techniques evolved. It is essential that teaching methods adapt to these new characteristics; thus, it is essential to help teachers to modernize their teaching techniques by adapting them to the needs of students.(AU)

La prevalencia actual de infección genital por Chlamydia trachomatis en adolescentes y mujeres jóvenes chilenas asintomáticas justifica la vigilancia periódica / The current prevalence of Chlamydia trachomatis infection among teenagers and young asymptomatic Chilean women justifies the periodic surveillance

Introduction: Chlamydia trachomatis infection constitutes the most common sexual transmitted disease (STD) among young women. International studies demonstrate that prevalence changes over time and also according to places. Aims: To estimate the prevalence of this infection among asymptomatic Chilean women (15 to 24 years old) and correlating with risk factor occurrence. Methods: Transversal cohort study to identify C. trachomatis infection through a diagnostic kit designed to detect and amplify cryptic plasmid DNA by quantitative PCR from endocervical sample. Results: 181 women were screened during the period of study. The overall prevalence estimate was 5.5% and founding significant estimate variations (0% to 14.6%) between recruiting centers. There was difference in number of sexual partners (4.1 vs 2.5; p<0.05) between positive and negative women. No difference was observed in age of first coitus, STD history, the use of barrier method or socioeconomic level. However, the probability of being carrier increases as greater is the number of sexual partners, especially when the use of barrier method is low. The latest is not related to the socioeconomic level. Conclusions: One of 12 to 18 women at this age range will have asymptomatic infection. The current prevalence and its variability substantiates the C. trachomatis screening and periodic surveillance.

Introducción: La infección por Chlamydia trachomatis constituye la infección de transmisión sexual (ITS) más común en población femenina joven. Estudios internacionales demuestran que su prevalencia cambia con el tiempo y en diferentes lugares. Objetivos: Estimar la prevalencia de esta infección en mujeres jóvenes chilenas (15 a 24 años), asintomáticas, y correlacionarla con factores de riesgo. Métodos: Estudio de corte transversal para detección de C. trachomatis mediante kit diagnóstico basado en amplificación de ADN plasmidial críptico y uso de RPC cuantitativa en secreción endocervical. Resultados: En el período de estudio fueron tamizadas 181 mujeres. La prevalencia global fue 5,5%, observándose variaciones significativas (0% hasta 14,6%) entre centros. Hubo diferencia en el número de parejas (4,1 vs 2,5; p = 0,04) entre infectadas o no. No hubo diferencia en edad de inicio de actividad sexual, historia de ITS, uso de preservativo o nivel socio-económico. Sin embargo, el riesgo de infección asintomática aumenta a mayor número de parejas sexuales y cuando el uso de método de barrera es infrecuente durante el coito, independiente del nivel socio-económico. Conclusiones: Una de cada 12 a 18 mujeres a esta edad presenta infección asintomática de C. trachomatis. La prevalencia actual y su variabilidad justifican el tamizaje y la vigilancia periódica de C. trachomatis.

[The current prevalence of Chlamydia trachomatis infection among teenagers and young asymptomatic Chilean women justifies the periodic surveillance]. / La prevalencia actual de infección genital por Chlamydia trachomatis en adolescentes y mujeres jóvenes chilenas asintomáticas justifica la vigilancia periódica.

INTRODUCTION: Chlamydia trachomatis infection constitutes the most common sexual transmitted disease (STD) among young women. International studies demonstrate that prevalence changes over time and also according to places. AIMS: To estimate the prevalence of this infection among asymptomatic Chilean women (15 to 24 years old) and correlating with risk factor occurrence. METHODS: Transversal cohort study to identify C. trachomatis infection through a diagnostic kit designed to detect and amplify cryptic plasmid DNA by quantitative PCR from endocervical sample. RESULTS: 181 women were screened during the period of study. The overall prevalence estimate was 5.5% and founding significant estimate variations (0% to 14.6%) between recruiting centers. There was difference in number of sexual partners (4.1 vs 2.5; p<0.05) between positive and negative women. No difference was observed in age of first coitus, STD history, the use of barrier method or socioeconomic level. However, the probability of being carrier increases as greater is the number of sexual partners, especially when the use of barrier method is low. The latest is not related to the socioeconomic level. CONCLUSIONS: One of 12 to 18 women at this age range will have asymptomatic infection. The current prevalence and its variability substantiates the C. trachomatis screening and periodic surveillance.

Tumor de células de la granulosa asociado a hiperandrogenismo femenino rápidamente progresivo / Granulosa cell tumour associated with rapidly progressive female hyperandrogenism

Reportamos el caso de una mujer de 21 años con hiperandrogenismo rápidamente progresivo de origen tumoral ovárico. La biopsia informó tumor de células de la granulosa y la resección fue curativa. Se analizan los posibles mecanismos por los que un tumor de origen en células de la granulosa pueda sintetizar andrógenos.

We report a 21 year old woman with rapidly progressive hyperandrogenism of ovaric tumoral origin. The biopsy of the tumor reported a granulosa cell tumor and the surgery was curative. We analyze the possible mechanisms implied in the androgen production in the granulosa cells of the tumor.

[Combined influence of preconception body mass index and gestational weight gain on fetal growth]. / Influencia combinada del índice de masa corporal pregestacional y de la ganancia de peso en el embarazo sobre el crecimiento fetal.

BACKGROUND: The Chilean Ministry of Health has been using standards for nutritional evaluation and weight gain recommendations during pregnancy in the last 25 years. In the meantime new standards have been developed. AIM: To study the combined influence of preconception maternal nutritional status and gestational weight gain, using new standards to classify those parameters, on perinatal outcomes. MATERIAL AND METHODS: A cohort of 11,465 healthy pregnant women was prospectively followed until term. Their pre-gestational nutritional status was classified using the body mass index cut-offs in use in the United States (USA). Their gestational weight gain was classified using categories proposed in a Danish study. Perinatal outcomes included were risky birth weight, i.e. < 3000 g and ≥ 4000 g, and cesarean delivery. Relative risks for those perinatal outcomes were calculated for all combined categories of pre-gestational nutritional status and gestational weight gain. RESULTS: Relative risks of almost all gestational weight gain results were statistically significant for women having a normal pre-gestational nutritional status meanwhile all of them were not significant for underweight women. Overweight and obese women had similar relative risks values as normal women. However, many of them were not significant, especially in obese women. CONCLUSIONS: There is an independent and combined influence of preconception nutritional status and gestational weight gain on perinatal outcomes, when using standards to classify those parameters developed in the USA and Denmark, respectively.

[Streptococcus agalactiae increase in resistance to erythromycin and clindamycin in vaginal-anal colonization in third quarter of pregnancy in one decade of universal screening]. / Aumento de resistencia de Streptococcus agalactiae vaginal-anal en el tercer trimestre de gestación a eritromicina y clindamicina al cabo de una década de tamizaje universal.

INTRODUCTION: Streptococcus agalactiae (GBS) is the main causative agent of early perinatal sepsis. The acquisition of prevention policies has led to frequent use of intrapartum antibiotics. Surveillance of antimicrobial resistance is indispensable for defining drugs of choice and alternatives for such prophylaxis. OBJECTIVES: To determine the evolution of antimicrobial resistance of GBS from maternal colonization to drugs used in the prevention of neonatal sepsis, between 2002 and 2008. METHODS: We studied 100 GBS positive vaginal and anal samples from pregnant women. Disc diffussion susceptibility method was performed for penicillin, ampicillin, cefazolin, erythromycin and clindamycin according to the Clinical and Laboratory Standards Institute (CLSI). RESULTS: We analyzed the susceptibility of 99 strains. Seventeen were resistant to erythromycin (17.1%) and 13 were resistant to clindamycin (13.1%). Thirteen of the 17 strains resistant to erythromycin had the MLS phenotype (resistance to erythromycin and clindamycin) and 4 had the M phenotype (resistance to erythromycin only). Within the MLS phenotype, resistance was constitutive in 9 strains, and induced in 4 strains (positive D test). Compared with 2002 there was a significant increase in resistance to clindamycin (from 3.27% to 13.1% p < 0.002) and erythromycin (1.09% to 17% p < 0.001). 100% GSB remained sensitive to penicillin and ampicillin. CONCLUSIONS: GBS remains highly susceptible to drugs of choice for prevention of perinatal sepsis. There is a significant increase in antimicrobial resistance to clindamycin and erythromycin. Therefore, it is necessary to request susceptibility testing in GBS from third trimester of pregnancy screening in patients allergic to penicillin.

Influencia combinada del índice de masa corporal pregestacional y de la ganancia de peso en el embarazo sobre el crecimiento fetal / Combined influence of preconception body mass index and gestational weight gain on fetal growth

Background: The Chilean Ministry of Health has been using standards for nutritional evaluation and weight gain recommendations during pregnancy in the last 25 years. In the meantime new standards have been developed. Aim: To study the combined infl uence of preconception maternal nutritional status and gestational weight gain, using new standards to classify those parameters, on perinatal outcomes. Material and Meihods: A cohort of 11,465 healthy pregnant women was prospectively followed until term. Their pre-gestational nutritional status was classified using the body mass Índex cut-offs in use in the United States (USA). Their gestational weight gain was classified using categories proposed in a Danish study. Perinatal outcomes included were risky birth weight, i.e. < 3000 g and ≥ 4000 g, and cesarean delivery. Relative risks for those perinatal outcomes were calculated for all combined categories of pre-gestational nutritional status and gestational weight gain. Results: Relative risks of almost all gestational weight gain results were statistically significant for women having a normal pre-gestational nutritional status meanwhile all of them were not significant for underweight women. Overweight and obese women had similar relative risks valúes as normal women. However, many of them were not significant, especially in obese women. Conclusions: There is an independent and combined infl uence of preconception nutritional status and gestational weight gain on perinatal outcomes, when using standards to classify those parameters developed in the USA and Denmark, respectively.

Estimation of individual neonatal survival using birthweight and gestational age: a way to improve neonatal care.

The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.