Glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes according to the type of basal insulin.

OBJECTIVE: To examine the potential role of the type of basal insulin on glycemic control and maternal and foetal outcomes in pregnant women with type 1 diabetes (T1DM). STUDY DESIGN: Retrospective cohort study of pregnancies attended at 18 Spanish tertiary hospitals. INCLUSION CRITERIA: T1DM, singleton pregnancies, delivery between 2002-2010, and use of the same basal and prandial insulin from before pregnancy until delivery. RESULTS: A total of 1534 pregnancies were included. The basal insulin most commonly used was Neutral Protamine Hagedorn (NPH) (51.7%), followed by glargine (23.2%) and continuous subcutaneous insulin infusion (CSII) (21.1%). CSII users had longer diabetes duration. Multiple logistic regression analysis showed that CSII was independently associated with lower doses of insulin, higher glycated haemoglobin (HbA1c) in all trimesters, and higher rates of miscarriage, preterm birth and neonatal hypoglycemia. Glargine was related to a higher risk of preterm birth and a small-for-gestational age infant (SGA). The odds ratios (OR) of the associations between insulin type and clinical outcomes (from 0.642 to 4.894) have a relevant magnitude. CONCLUSIONS: In this observational study of pregnant women with T1DM, the type of basal insulin was independently associated with metabolic variables and foetal outcomes.

First trimester serum angiogenic/anti-angiogenic status in twin pregnancies: relationship with assisted reproduction technology.

BACKGROUND: The risk of pre-eclampsia (PE) increases in twin pregnancies, especially when assisted reproduction technologies (ART) are used. The aim of this study was to assess angiogenic/anti-angiogenic factors in maternal serum in the first trimester of twin pregnancies and establish if the mode of conception influences angiogenic status. METHODS: This prospective study enrolled women with twin (n = 61) and singleton (n = 50) pregnancies. Dichorionic twin pregnancies were divided into two groups according to their mode of conception. Singleton pregnancies were used as the control group. Soluble fms-like tyrosine kinase (sFlt-1), free placental growth factor (PlGF) and soluble endoglin (sEng) concentrations were measured in the first trimester maternal serum. RESULTS: In the first trimester, women with twin pregnancies had higher serum concentrations of the anti-angiogenic factor sFlt-1 than that with singleton pregnancies (3924 ± 250 versus 2426 ± 162 pg/ml, respectively; P < 0.001). Maternal serum PlGF concentrations were lower in singleton pregnancies than those in twin pregnancies (37 ± 3.7 versus 59 ± 5.6, respectively; P < 0.001). Serum concentrations of sFlt-1 were higher in twin pregnancies conceived by ART than those in spontaneous twin pregnancies (4313 ± 389 versus 3522 ± 300 pg/ml, respectively; P < 0.05). No differences between groups were observed for sEng. CONCLUSIONS: In the first trimester, twin pregnancies conceived using ART showed a heightened anti-angiogenic status that could explain the increased risk of PE in these cases.

Phylogenetic analysis in a recent controlled outbreak of Crimean-Congo haemorrhagic fever in the south of Iran, December 2008.

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus is transmitted to humans through the bite of Ixodid ticks or contact with blood or tissues of CCHF patients or infected livestock. In December 2008, a re-emerging outbreak of CCHF occurred in the southern part of Iran. Five people were hospitalised with sudden fever and haemorrhaging, and CCHF was confirmed by RT-PCR and serological assays. One of the cases had a fulminant course and died. Livestock was identified as the source of infection; all animals in the incriminated herd were serologically analysed and more than half of them were positive for CCHFV. We demonstrated that two routes of transmission played a role in this outbreak: contact with tissue and blood of infected livestock, and nosocomial transmission. Phylogenetic analyses helped to identify the origin of this transmission. This outbreak should be considered as a warning for the national CCHF surveillance system to avoid further outbreaks through robust prevention and control programmes.

The epidemiology of tick-borne relapsing fever in Iran during 1997-2006.

BACKGROUND: Tick-borne relapsing fever is an acute febrile and endemic disease in Iran. For many reasons, the incidence of disease is on decrease, however tick-borne relapsing fever is still a health issue in the rural areas for travelers. This study was carried out during 1997-2006 to investigate the tick-borne relapsing fever in Iran. METHODS: Based on a cross-sectional, retrospective and descriptive study in all the provinces, the residents in the endemic areas who were febrile and suspicious to tick-borne relapsing fever were enrolled in the study. Tick-borne relapsing fever is a notifiable disease in Iran and the national communicable disease surveillance data were used through questionnaires. The infectivity of Ornithodoros species to Borrelia also was studied in two highly endemic areas including Hamadan and Qazvin provinces. RESULTS: During 1997-2006, a total of 1415 cases have been reported from the entire country. The highest prevalence was observed in year 2002 with the incidence rate of 0.41/100,000 population. Ardabil province is the first ranked infected area (625 out of 1415), followed by Hamadan, Zanjan, Kurdestan and Qazvin provinces sequentially. The disease is recorded during the whole year but its peak occurs during summer and autumn. There have been 87.6% of the cases recorded from June to November. Forty five percent of the infected cases were male and one third of the patients were under 5 years of age. Fifty four percent of the patients comprise the children under 10 years. Ninety two percent of the cases were living in rural areas where their dwellings were close to animal shelters. They were involved mainly with farming and animal husbandry activities. All the febrile patients with confirmed spirochetes in their blood samples were treated according to a national guideline for tick-borne relapsing fever treatment. Only 7% of the patients were hospitalized and 0.8% of them exhibited the Jarisch-Herxheimer reaction. The study of infectivity of Ornithodoros species to Borrelia revealed that Ornithodoros tholozani was infected with Borrelia persica and Ornithodoros erraticus with Borrelia microti. CONCLUSION: Travelers to the rural areas with high prevalence of the disease should be made aware of the risk of tick-borne relapsing fever and use of appropriate control measures. Communicable disease surveillance including tick-borne relapsing fever should be pursued as well.

Surveillance and laboratory detection system of Crimean-Congo haemorrhagic fever in Iran.

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus (CCHFV) is transmitted to humans through the bite of Ixodid ticks or by contact with blood or tissues of infected livestock. In addition to zoonotic transmission, CCHFV can be spread from person to person and is one of the rare haemorrhagic fever viruses able to cause nosocomial outbreaks in hospitals. Crimean-Congo haemorrhagic fever is a public health problem in many regions of the world such as Eastern Europe, Asia, the Middle East and Africa. In addition to clinical symptoms, the diagnosis of CCHF is based on the use of serological tests for the detection of immunoglobulin M and immunoglobulin G antibodies and on the use of molecular tools such as RT-PCR. From 1970 to 1978, serological and epidemiological studies were performed in humans and in livestock of Iran. After two decades and observations of CCHF in some provinces of Iran, a CCHF surveillance and detection system was established in 1999, leading to a dramatically decreased mortality rate from 20% (year 2000) to 2% (year 2007).

Síndrome de Goldenhar. Manifestaciones intraútero y tras nacimiento / Goldenhar syndrome. Intrauterine and postnatal features

El síndrome de Goldenhar fue descrito por primera vez en 1952 por Maurice Goldenhar como la asociación entre diferentes anomalías de la región facial, frecuentemente oculares y auriculares. Debido a la complejidad de sus manifestaciones, es conocido como displasia óculo-aurículo-vertebral (AU)

Goldenhar syndrome was first described in 1952 by Maurice Goldenhar as the association of various facial anomalies. The most frequent anomalies are ocular and auricular. Due to the complexity of its manifestations, this syndrome is also known as oculo-auriculo-vertebral dysplasia (AU)

Enfermedad tuberculosa durante el embarazo / Tuberculous disease during pregnancy

La tuberculosis durante el embarazo es una enfermedad de buena evolución con tratamiento, pero que producirá una morbimortalidad materna elevada si no se trata adecuadamente. Presentamos 3 casos de pacientes que en los últimos 2 años fueron diagnosticadas de tuberculosis durante su gestación y han recibido seguimiento en la consulta de Alto Riesgo Obstétrico (ARO) de nuestro hospital

Tuberculosis in pregnant woman has a excelent evolution with adecuate drugs. However, morbility and mortality during pregnancy is very important when patient does not take medication. We report three cases of pregnant women with tuberculosis wich occurred in our hospital

Colitis ulcerosa asociada a la infección por citomegalovirus durante la gestación / Ulcerative colitis associated with cytomegalovirus infection during pregnancy

La colitis ulcerosa es una enfermedad intestinal que cursa con brotes intermitentes. En la actualidad la exacerbación de la enfermedad se ha asociado con la sobreinfección por citomegalovirus, que empeora el cuadro. Presentamos un caso de una paciente con colitis ulcerosa que durante la gestación desarrolla un brote grave que llega a producir un megacolon tóxico. Posteriormente se comprueba que durante este brote tuvo una sobreinfección por citomegalovirus, produciéndose la transmisión maternofetal del virus, por lo que el feto presenta lesiones características de esta infección

Ulcerative colitis is an inflammatory bowel disease characterized by intermittent flares of disease activity. Exacerbations have been associated with cytomegalovirus superinfection. We report the case of a pregnant woman who experienced a severe flare, producing toxic megacolon. Cytomegalovirus infection during this flare was subsequently confirmed. Maternofetal transmission of the virus occurred and the fetus showed the lesions characteristic of this infection

Adenomiosis quística uterina / Cystic uterine adnomyosis

La adenomiosis es una entidad caracterizada por invasión de tipo benigno del endometrio en el miometrio, junto con hipertrofia reactiva de las fibras musculares alrededor de la invasión. El tejido endometrial ectópico es del tipo basal, y produce dolor y, con menos frecuencia, sangrado genital. La adenomiosis quística uterina presenta lesiones quísticas bien circunscritas, que afectan al miometrio y pueden presentar diferentes estadios hemorrágicos. Presentamos un caso de adenomiosis quística tratada con miomectomía (AU)