Efficacy of nitroglycerine infusion versus sublingual nifedipine in severe pre-eclampsia: a randomized, triple-blind, controlled trial.

1. Information regarding the use of continuous i.v. administration of nitroglycerine as an antihypertensive agent in the management of pre-eclampsia is scarce. In the present study, i.v. nitroglycerine or sublingual nifedipine were administered to 32 women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO(4) loading and maintenance doses. Maternal blood pressure and heart rate responses, fetal heart rate responses and perinatal fetal-maternal adverse effects were evaluated using classical parametric and non-parametric data analysis and data modelling by mixed models. 2. An important hypotensive response was observed in both groups, although this reponse was greater, faster and exhibited less variability (more precision) in the nitroglycerine-treated group. Heart rate also increased in both the nitroglycerine- and nifedipine-treated groups (4.6 +/- 4.4 vs 8.6 +/- 5.3 b.p.m., respectively), although the increase in the nifedipine-treated group was almost twofold that in the nitroglycerine-treated group. There were no significant changes in fetal heart rate in response to vasodilator therapy. The frequency of perinatal fetal-maternal adverse effects was similar in both groups at 40% and the adverse effects observed included flushing, headache, palpitations and nausea. 3. In conclusion, i.v. infusion of nitroglycerine is an effective, safe and alternative therapy for severe pre-eclampsia.

Efficacy of human recombinant DNase in pediatric patients with cystic fibrosis.

BACKGROUND: Most respiratory complications in cystic fibrosis (CF) arise from abnormally viscid mucus, and rhDNase has shown to be effective in enhancing mucous clearance. We explored the responses to rhDNase in a Mexican population of CF patients. METHODS: Patients with CF received aerosolized rhDNase (2.5 mg daily) during 3 months, followed by daily aerosolized placebo during 3 months. RESULTS: A total of 21 CF patients entered the study (11.1 +/- 0.5 years of age, mean +/- SEM, 10 girls): 15 patients (71%) had basal forced vital capacity (FVC) higher than the 70% predicted value, and the remainder of the patients had an FVC of between 30 and 70%. As a group, rhDNase progressively increased the forced expiratory flow at 1 sec (FEV1) as well as the FVC, reaching statistical significance (p <0.005) at the end of the third month of treatment. Sputum production and difficulty to expectorate or to breathe also improved during the rhDNase treatment period (p <0.05 to p <0.001). All these changes progressively decreased to basal values after 3 months with aerosolized placebo. Adverse reactions were almost null, with a sole patient reporting dysphonia. CONCLUSIONS: Aerosolized rhDNase was effective in progressively improving respiratory function and symptoms in most CF patients.

Fetal amniotic adhesions. Their topographic concordance with regionally clustered malformations.

BACKGROUND: The amniotic band disruption complex (ABDC) has been segregated recently into various phenotypes. In view of the pathogenic mechanisms that have been proposed, this study was designed to assess if it is one variable process or is composed of several distinct complexes. METHODS: The 48 cases of fetuses with bands or placenta attached to fetal parts cited in this paper included nine new cases and 39 from the literature. They were organized first according to the embryonal topography of the malformations, then according to the position of the adhesions, and finally by the assessment of distances between the cases and between the malformations using the squared Euclidean distances for binary variables and cluster analysis. RESULTS: In all three analyses, three groups were identified: 1) fetuses with cephalo-thoracic anomalies; 2) fetuses with caudal anomalies, and 3) fetuses with mixed anomalies. Nonetheless, overlap among the three groups was apparent. Thus, while fetuses with amniotic bands form three clusters, it appears that these are part of a spectrum and should be considered as variable manifestations of a single entity resulting from a single pathogenetic mechanism. An association was established between the localization of the adhesions and the malformations in various axes. Abdominoschisis, however, was not particularly related to adhesions at one or the other end of the fetus; a short umbilical cord was an almost universal finding. Single umbilical artery (SUA) was especially related to caudal adhesions and malformations (p = 0.004 and 0.001), as well as abdominoschisis (p = 0.002) and agenesis of the abdominal organs (p = 0.008). CONCLUSIONS: The association between amniotic adhesions to the fetus and multiple malformations occurring predominantly in the same area suggest that the former are the cause of the latter. The association of abdominoschisis, as well as a short umbilical cord, with malformations and adhesions in all areas, suggests that these are secondary phenomena to generalized embryonal and fetal tension. SUA, however, with a specifically regional association, is more likely to be due to disruption from exposure in cases with abdominoschisis, often accompanying the loss of abdominal organs.

[Fluorosis in primary dentition in a region with endemic water fluoride]. / Fluorosis en dentición temporal en un área con hidrofluorosis endémica.

OBJECTIVE: The aim of the present study was to estimate the prevalence of dental fluorosis in primary dentition of a San Luis Potosi children population, and its association to fluoride concentration in drinking water and urine. An additional objective was, to develop, validate, and test a specific index for dental fluorosis in primary dentition. MATERIAL AND METHODS: From May 1997, to January 1999, we conducted a cross-sectional study to assess the prevalence of dental fluorosis in primary dentition. Study subjects were 100 children aged 3-6 years, selected at random from three kindergartens in three risk areas of San Luis Potosi. The specific index of dental fluorosis for primary dentition (Dental Fluorosis for Primary Dentition Index--DFPDI) was validated by estimating fluoride concentrations in enamel of teeth with and without dental fluorosis. The Kruskal-Wallis test was used to assess the association between fluoride concentrations in drinking water and urine, with dental fluorosis; the association between risk area and dental fluorosis was assessed with the Mantel-Haenszel chi 2 test. RESULTS: The prevalence of dental fluorosis in primary dentition was 78%; primary molars were most affected in both maxillae and the predominant color was a non-glossy white appearance. We found a strong direct correlation (r = 0.93) between fluoride concentrations in primary teeth and the DFPDI. Associations were found between fluoride concentrations of drinking water and urine, with dental fluorosis (Kruskal-Wallis p = 0.00001), and between risk area and dental fluorosis (Mantel-Haenszel chi 2 p = 0.00001). CONCLUSIONS: DFPDI allowed adequate identification and grading of dental fluorosis in primary dentition. It is important to detect the initial toxic effects of fluoride exposure to predict dental fluorosis in permanent dentition and skeletal fluorosis.

[Consistency and validity of the evaluation of the clinical chart]. / Consistencia y validez en la evaluación del expediente clínico.

OBJECTIVE: Assess the degree of external consistency and validity of the EXP CLIN instrument has for measuring the quality information contained in medical charts. MATERIAL AND METHODS: In a transverse comparative study, two hundred and twelve clinical charts were randomly selected belonging to patients seen at a pediatric hospital. The charts were assessed using the EXP-CLIN for phases: 1) internal assessment: by hospital personnel of the pediatric hospital, and, II) external assessment: by personnel from other hospitals. The results were analyzed using the concordance method. RESULTS: The concordance percentages were found to be 76% for medical charts and medical notes related with the process of diagnosis-treatment, as well as the general characteristics of the clinical chart. The concordance percentages average was 88%, supporting the idea that when the EXP-CLIN instrument is applied twice to the same chart, good concordance is obtained between the two measures. CONCLUSIONS: Given that the application of the instrument documented a good level of external consistency, its use is justified for assessing the quality of the information contained in the charts of the patients seen at our unit.

[Classification by levels of clinico-epidemiological research designs]. / Clasificación en niveles de los diseños de investigación clínico-epidemiológicos.

The objective was to identify the characteristics of epidemiologic designs enabling their classification. A critical review of the literature in the clinical epidemiologic area was done to establish the main differences between designs. A meeting with experts to discuss this controversial topic and obtain criteria by consensus was organized. We propose an integral classification based on levels with two fundamental shafts: intervention and explanatory reasoning.