Exposición a ondansetrón en el primer trimestre de gestación y riesgo de malformaciones congénitas: revisión sistemática y metaanálisis / Exposure to ondansetron in the first trimester of pregnancy and risk of congenital malformations: systematic review and meta-analysis

Resumen OBJETIVO: Determinar si la exposición al ondansetrón en el primer trimestre del embarazo se asocia, en general, con mayor riesgo de malformaciones orofaciales, cardiopatías congénitas, defectos del septo interventricular, de labio o paladar hendidos. MÉTODOLOGÍA: Revisión sistemática y metanálisis de estudios aleatorizados, cohortes y casos y controles publicados en las bases de datos de PubMed, EMBASE y LILACS. RESULTADOS: Se incluyeron 15 estudios: 11 de cohorte y 4 de casos y controles, con 245,679 mujeres expuestas al ondansetrón en el primer trimestre del embarazo. No se encontró una asociación estadísticamente significativa con malformaciones congénitas en general (RM 1.1; IC95%: 0.99-1.22; I2: 72%), con cardiopatías congénitas (RM 1.05; IC95%: 0.95-1.19; I2: 78%) y con comunicación interventricular (RM 1.2; IC95%: 0.97-1.45; I2: 85%). Se encontró un pequeño aumento en el riesgo de defectos orofaciales en general (RM 1.17; IC95%: 1.04-1.32; I2:0%), no se encontró un riesgo mayor de defecto de labio (RM 1.01; IC95%: 0.84-1.21; I2%: 0%) ni de paladar hendido (RM 1.16; IC95%: 0.9-1.5; I2: 31%). CONCLUSIÓN: Los resultados muestran que el tratamiento con ondansetrón en el primer trimestre del embarazo no se asocia con un aumento de malformaciones congénitas en general, ni con un incremento de cardiopatías, labio o paladar hendido, pero sí con incremento leve del riesgo de malformaciones orofaciales.

Abstract OBJECTIVE: To determine whether ondansetron exposure in the first trimester is associated with an increased risk of any congenital malformations. As secondary outcomes, determine if it is associated with a higher overall risk of congenital heart disease, interventricular septal defects, orofacial malformations, cleft lip defect (with or without palate) or cleft palate. METHODOLOGY: A systematic review with meta-analysis was carried out. The search was carried out in the following databases: PUBMED, EMBASE and LILACS, randomized studies, cohorts and cases and controls were chosen. RESULTS: 15 studies were included, 11 cohort studies and four case-control studies, with 245,679 women exposed to ondansetron in the first trimester. No statistically significant association was found with overall congenital malformations (OR, 1.1; 95%, CI 0.99-1.22 I2: 72%), nor with congenital heart diseases (OR, 1.05; 95%, CI 0.95-1.19 I2: 78%) not with ventricular septal defects (OR, 1.2 95% CI 0.97 - 1.45 I2: 85%). A small increased risk was found for overall orofacial defects (OR, 1.17 95% CI 1.04 - 1.32 I2:0%), no increased risk was found for lip defect (with or without palate) (OR, 1.01 CI 95% 0.84 -1.21 I2%: 0%) or cleft palate (OR, 1.16 95% CI 0.9 - 1.5 I2: 31%). CONCLUSION: The results show that the use of ondansetron in the first trimester is not associated with an increase in overall congenital malformations, nor with an increase in heart disease, cleft lip and/or palate, but there is a slight increase in the risk of orofacial malformations.

Tratamiento farmacológico en la restricción del crecimiento fetal: revisión de la bibliografía / Pharmacological management for fetal growth restriction: literature review

Resumen OBJETIVO: Explorar las diferentes estrategias de tratamiento farmacológico de la restricción del crecimiento fetal propuestas a lo largo del tiempo. METODOLOGÍA: Revisión cuasi-sistemática de la evidencia científica histórica disponible acerca del tratamiento médico descrito para la atención de mujeres embarazadas con restricción del crecimiento fetal. RESULTADOS: Entre los tratamientos médicos descritos para tratar la restricción del crecimiento fetal, los donadores de óxido nítrico, las estatinas y la aspirina asociada con omega 3, han tenido desenlaces no consistentes en estudios con limitado tamaño de muestra. Por lo que se refiere a los inhibidores de la 5-fosfodiesterasa, el sildenafilo no se ha asociado con un aumento de la velocidad de crecimiento fetal pero sí con alarmas respecto de su seguridad debidas al incremento de los casos de hipertensión pulmonar fetal y mortalidad perinatal. Por su parte, el tadalafilo ha mostrado desenlaces iniciales favorables y se esperan estudios con mayor tamaño de muestra que permitan emitir recomendaciones claras con respecto a su indicación. También se esperan los desenlaces de estudios clínicos en curso, para definir la indicación de la heparina de bajo peso molecular en este escenario en virtud de sus prometedores resultados iniciales. Los procedimientos más invasivos, como la inyección de factor de crecimiento endotelial vascular y la plasmaféresis, permanecen en estudio como propuestas terapéuticas por los resultados de estudios preclínicos y clínicos con pocos pacientes. CONCLUSIÓN: Por ahora, ninguna estrategia farmacológica propuesta ha conseguido generar recomendaciones fuertes para su indicación; sin embargo, se esperan nuevos estudios con alta calidad metodológica que generen evidencia científica lo suficientemente contundente para recomendar su indicación.

Abstract OBJECTIVE: To explore the different pharmacological treatment strategies for fetal growth restriction proposed over time. METHODOLOGY: Quasi-systematic review of the available historical scientific evidence on the medical treatment described for the care of pregnant women with fetal growth restriction. RESULTS: Among the medical treatments described to treat fetal growth restriction, nitric oxide donors, statins, and aspirin associated with omega-3 have had inconsistent outcomes in studies with limited sample size. As for 5-phosphodiesterase inhibitors, sildenafil has not been associated with an increase in fetal growth velocity, but there have been alarms regarding its safety due to the increase in cases of fetal pulmonary hypertension and perinatal mortality. On the other hand, tadalafil has shown favorable initial outcomes and studies with a larger sample size are awaited to issue clear recommendations regarding its indication. The results of ongoing clinical studies are also awaited to define the indication of low molecular weight heparin in this setting, given its promising initial results. More invasive procedures, such as vascular endothelial growth factor injection and plasmapheresis, remain under study as therapeutic proposals due to the results of preclinical and clinical studies with few patients. CONCLUSION: For now, no proposed pharmacological strategy has managed to generate strong recommendations for its indication; however, new studies with high methodological quality are expected to generate scientific evidence strong enough to recommend its indication.

Perceptions about Healthy Eating and Emotional Factors Conditioning Eating Behaviour: A Study Involving Portugal, Brazil and Argentina.

This study analysed the perceptions about healthy eating as well as some emotional factors conditioning eating behaviour in a sample of people from Portugal, Brazil and Argentina. This is a descriptive cross-sectional study involving a non-probabilistic sample of 2501 participant. Data was collected through a questionnaire applied to adult citizens residing in their respective countries. For data analysis chi-square tests were used, and associations were evaluated by Cramer's coefficients. Moreover, a tree classification analysis was conducted for variables related with perceptions about healthy eating and emotional conditioning of eating behaviour. The results revealed that participants' perceptions are generally in agreement with healthy eating. However, significant differences were found between countries (p = 0.018) and by levels of education (p < 0.0005), with a more accurate perception for Portugal and at the university level. The existence of statistically significant associations between all sociodemographic variables considered and the conditioning of eating behaviour by emotional motivations should be noted. Tree classification analysis showed that the most important discriminant sociodemographic variable for perceptions about healthy eating was education, followed by professional area and country, while the most relevant discriminants for emotional conditioning of eating behaviour were country and then living environment and sex. Thus, it is important to consider these variables in initiatives that aim to promote adherence to behaviours that contribute to the health and well-being of the population.

Hábitos de consumo en la sala de espera / Waiting room intake habits

Introducción: el consumo de alimentos en la sala de espera es un hábito que podría estar relacionado con el incremento en la incidencia de obesidad infantil. Objetivo: analizar el consumo de alimentos y su uso como premio en niños que asisten a un consultorio pediátrico explorando y su relación con el estado nutricional. Población, material y método: se realizó un estudio cuantitativo, descriptivo y transversal en 94 niños entre 1 y 15 años, que asisten a un consultorio pediátrico de la Ciudad Autónoma de Buenos Aires (CABA), República Argentina. Se evaluó el tipo de alimentos/bebidas llevado a la sala de espera, su utilización como premio y la intención de compra luego de la consulta. Se valoró el estado nutricional (IMC/Edad) con Anthro Plus, 2009. El análisis estadístico incluyó t de Student y prueba de Wilcoxon. Resultados: el 46,8% de los padres trajo alimentos a la sala de espera. Alfajores/chocolates (n=10), seguidos de galletitas saladas (n=8) y, entre las bebidas, las gaseosas y jugos (n=6) ocuparon el segundo lugar. El 56,4% de los cuidadores tenía pensado comprar algo de comer al salir de la consulta. Se encontró asociación significativa entre los puntajes z de IMC/Edad y quienes trajeron algún alimento a la sala de espera (p:0,02). El 46,8% de los niños presentó sobrepeso u obesidad. Conclusión: una elevada cantidad de padres utilizó el consumo de alimentos en la consulta, la mayoría de tipo chatarra. Este hábito se asoció significativamente con la presencia de sobrepeso y obesidad en los niños afectados por lo que podría indagarse sistemáticamente en la consulta. (AU)

Introduction: food and drink intake and its use as a reward are common habits in medical waiting rooms in the context of an increase in overweight and obesity prevalence worldwide. Objective: to analyze the habit of food intake, its type and use as a reward and the relation with the nutritional status in children who attend a pediatric outpatient clinic. Population and method: descriptive study, in a sample of 94 children ages 1 to 15 who attended a pediatric outpatient clinic in Buenos Aires, Argentina. We assessed the type of food/ beverage taken to the waiting room and the intention of buying one after the visit. The nutritional status was measured (BMI/AGE) using Anthro Plus software, 2009. Student´s t Test and Wilcoxon test were used for statistical analysis. Results: 46,8% of parents had brought something to eat or drink to the waiting room. Sweets were most frequent, followed by salty snacks and among beverages we found soft drinks and commercial juices. 56,4% of caretakers had the intention of buying something to eat or drink as a reward after the visit. There was a significant correlation between z scores of BMI/AGE and food intake in the waiting room (p= 0,02). 46.8% of the sample was either overweight or obese. Conclusion: many parents use food as a reward, mainly junk food. This habit had a significant correlation with overweight and obesity in affected children and could be assessed systematically in pediatric visits. (AU)

Análisis de alimentos de consumo habitual: parámetros relacionados con factores de riesgo de caries y desgaste erosivo / Commonly consumed foods analysis: risk factors relatedto decay and erosive wear parameters

Objetivo: analizar bebidas y alimentos de consumo frecuente para evaluar el pH, grados Brix (ºBx), efecto buffer a pH 5,5 y 7, y concentración de fosfatos, calcio y fluoruros. Materiales y métodos: en este estudio observacional, descriptivo y transversal, se evaluaron 438 alimentos, divididos en 18 grupos. Se analizó pH, capacidad Buffer a pH 5,5 y 7, grados Brix y concentración de fosfatos, de fluoruros y de calcio. Los datos fueron procesados por SPSS Statistics 20 (IBM Corp., Estados Unidos). Resultados: las gaseosas, el jugo en polvo para diluir, las aguas saborizadas y las bebidas isotónicas presntaron menor pH. El rango de sólidos solubles, expresado en grados Brix, fue de 0,05 a 15,9. El mayor valor de efecto buffer correspondió a los jugos: exprimido, en polvo, listo para consumir y para diluir. En este último, se halló mayor cantidad de fosfato. Sólo en las aguas minerales con gas se observaron fluoruros. El alimento de soja líquido natural presentó el mayor contenido de calcio. Concusiójn: las gaseosas, los jugos, las leches fermentadas y las bebidas isotónicas, resultaron ser ácidas, con bajo efecto buffer, alto valor de grados Brix y contener pocos factores protectores.

Aims: to analyze drinks and foods commonly consumedby evaluating pH, degrees Brix, buffer effect at pH 5.5 and 7.0and phosphate, calcium and fluoride concentration.Materials and methods: In this observational, descriptiveand cross-sectional study, 48 foods were evaluated,divided into 18 groups. pH, buffer capacity at 5.5 and 7, degreesBrix and phosphate, fluoride and calcium concentrationwere analyzed. The data were processed by SPSS Statistics 20(IBM Corp., USA).Results: Soda, juice powder to dilute, flavored water andsports drinks had lower pH. The range of soluble solids (degreesBrix) was from 0.05 to 15.9. The greatest value in buffereffect was in juices: squeezed, powdered, ready to consumeand to be diluted. The latter had a higher amount of phosphate.Only sparkling mineral waters showed detectable valuesfor fluorides. The liquid natural soy food had the highestcalcium content.Conclusion: Soft drinks, juices, fermentable milk, isotonicdrinks were found to be acidic, with lower buffer value,high Brix degrees and low in protective factors.

Riesgo de padecer trastornos de la conducta alimentaria en estudiantes de licenciatura en nutrición en cinco universidades de Argentina / Risks of developing eating disorders on undergraduate nutrition students in five universities of Argentina

Objetivos: Esta investigación desarrollada durante los meses de agosto, septiembre y octubre de 2013- tuvo como objetivo identicar el riesgo de padecer trastornos de la conducta alimentaria en estudiantes cursantes de 1º a 5º año de la carrera de Licenciatura en Nutrición en cinco universidades de Argentina. Materiales y métodos: el diseño del estudio es descriptivo y de corte transversal. El instrumento que se utilizó para recolectar los datos es el Test de Actitudes Alimenticias-26. Resultados y conclusiones: la investigación muestra que los estudiantes presentaron un 13,3% de riesgo de padecer trastornos de la conducta alimentaria, encontrándose que, según la universidad a la que asisten, existe mayor o menor riesgo de presentar trastornos de la conducta alimentaria (TCA). En relación al estado nutricional de los alumnos se observó que aquellos que mostraron sobrepeso y obesidad presentaron mayor riesgo de padecer TCA. El estudio reflejó la gran preocupación de los estudiantes en relación con los alimentos que ingieren y la posibilidad de aumentar su peso corporal. Al detectarse que pueden existir casos de alumnos de la Carrera de Nutrición con algún tipo de TCA, se recomiendan medidas preventivas en relación a este tema y al correcto tratamiento y/o derivación en los casos diagnosticados.

Objetives: The purpose of this study is to identify the risk of developing eating disorders in students from 1st to 5th year of the degree in Nutrition from ¬ve universities in Argentina. It was developed during the months of August, September and October 2013. Materials and methods: the study design is descriptive and cross-sectional, and the measure used to collect the data is the Eating Attitudes Test-26 (EAT-26). Results and conclusions: this research shows that students have 13,3% risk of developing eating disorders. It was found that depending on the University attended by students, there is a greater or lesser risk of eating disorders. It was observed that those who are overweight and obese are at increased risk for these diseases regarding nutritional status of students. It is notorious the concern among students about food and weight gain. This shows that there might be cases of Nutrition students with some sort of eating disorders. That is why we recommend taking preventive measures in relation to this issue and the correct treatment or referral in diagnosed cases.

Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. Do their bladder benefit from it?

AIMS: To report our data on initial urological presentation after in utero myelomeningocele (MMC) closure. METHODS: A prospective urological assessment at first presentation was designed for patients that had undergone in utero MMC closure and referred to our urological facility. The protocol consisted of detailed medical history, renal sonography, voiding cystourethrogram, and urodynamic evaluation. RESULTS: In utero MMC closure was performed in 19 patients at gestational age of 25.6 weeks 25-27. Birth occurred at a mean gestational age of 31.8 weeks 26-36. Hyperactive bladder was observed in 89.5% 17/19. Bladder compliance was normal in two cases (10.5%), was markedly reduced in 10 patients (52.6%) and not possible to be determined due to urinary leakage in 7 patients (36.8%). We observed normal bladder capacity in 8 patients (42.1%), reduced in 11 (57.9%), and detrusor-sphincter dyssynergia in 9 patients (47.4%). Underactive bladder was diagnosed in one case. Clean Intermittent Catheterization was initiated by 11 patients (57.9%) mostly in association with anticholinergics 10/11. Vesicoureteral reflux was found in 5 patients (26.3%) and 9 had pyelonephritis at a mean follow-up of 5.4 months 2-17. CONCLUSIONS: Our data suggested that despite in utero MMC surgery, patients are at risk for bladder abnormal function and renal deterioration and should be aggressively treated, not differently from those operated in the post-natal term. This study has the merit of being a prospectively set evaluation performed by one investigator, including the urodynamic study. We acknowledge the need of long-term follow up.

Hábitos de consumo de bebidas e infusiones sin alcohol y su relación en el estado nutricional en los empleados de mostrador de cuatro farmacias de la ciudad autónoma de Buenos Aires / Consumer habits of beverages and herbal infusions without alcohol intake and its relationship to the nutritional status of employees of four pharmacies from the autonomous city of Buenos Aires

The nutrition transition occurred in recent years was accompanied by changes in the pattern of fluid intake worldwide, replacing water for beverages that provide calories. The aim of this study was to characterize the habitual consumption of non-alcoholic drinks and teas in a group of clerks and relate it to the presence of excess weight. A quantitative, descriptive, correlational, cross-sectional study was performed. A 24h recall and a food frequency questionnaire was used. During the month of August 2012 , 72 individuals, of whom 55.6 % were overweight and obese ( Ow/Ob) were interviewed. The average fluid intake was 2,188 ml/day resulting in 18.22 % water, 24.8 % of drinks and tea without sugar and 56.9 % of drinks and sweetened teas. The latter group contributed 13.8 % of Kcal/day/person, exceeding the WHO recommendations. 64% of respondents exceeded that recommendation, highlighting the Ow/Ob group with 85% inadequacy and 19.6 % of total daily Kcal as simple sugars. These data confirm that there is a relationship between sugar consumption and the presence of excess weight.

La transición nutricional ocurrida en estos últimos años se ha acompañado por cambios en el patrón de ingesta de líquidos a nivel mundial, desplazando al agua por bebidas que aportan calorías. El objetivo de este estudio fue caracterizar el consumo habitual de bebidas e infusiones analcohólicas en un grupo de empleados de comercio y relacionar el mismo con la presencia de exceso de peso. Se realizó un estudio un estudio cuantitativo, descriptivo, correlacional y de corte transversal. Se utilizó un recordatorio de 24 horas y un cuestionario de frecuencia de consumo. Durante el mes de Agosto del 2012, se entrevistaron 72 individuos, de los cuales, un 55.6% presentó sobrepeso y obesidad (Sp/Ob). El consumo promedio de líquidos fue de 2188 ml/día, resultando 18.22% de agua, 24.8% de bebidas e infusiones sin azúcar y 56.9% de bebidas e infusiones azucaradas. Este último grupo aportó 13.8% de las Kcal/día/persona, superando las recomendaciones de la OMS. El 64% de los entrevistados superó dicha recomendación, destacándose el grupo Sp/Ob con un 85% de inadecuación y 19.6% del total de Kcal diarias como azúcares simples. Estos datos confirman que existe una relación entre el consumo de azúcares y la presencia de exceso de peso.

[Safety and effectiveness of oral hypoglycemic agents in women with gestational diabetes. Literature review]. / Seguridad y efectividad de los hipoglucemiantes orales en mujeres con diabetes gestacional. Revisión de la bibliografía.

BACKGROUND: The aim of this article is to review the estimates of studies have proposed the use of oral hypoglycemic agents (HGO) for metabolic control in patients with Gestational Diabetes Mellitus (GDM), evaluating outcomes regarding effectiveness and safety: breast, fetal, obstetric and neonatal outcome; comparing these outcomes with insulin therapy and among themselves, in order to contribute to understand the risks and benefits of using HGO in the current management of GDM. MATERIALS AND METHODS: A review was carried out in the literature recorded in four databases: PubMed, Ovid, Cochrane and ProQuest, between December 2007 and December 2012. RESULTS: Clinical trials (n = 7), meta-analysis (n = 2), systematic reviews (n = 2), cohort studies : (n = 3), cost analysis study (n = 1) and ranked 15 items were included. CONCLUSION: HGO provide adequate control of maternal glycemia and perinatal results comparable insulin therapy, and they should be considered as effective and safe option in the treatment of GDM.

[Use of intracranial translucency measurement in first trimester, beyond spina bifida]. / Utilidad de la medición de la traslucencia intracraneal en el primer trimestre, más allá de la espina bífida.

BACKGROUND: The intracranial translucency (IT) is described as echolucid space located in the fetal central nervous system corresponding to the fourth ventricle. Alteration in the first trimester is associated with neural tube defects (NTDs). OBJECTIVE: To describe as part of the ultrasonographic assessment of the first quarter, the technical and the normal values of intracranial translucency, factors that affect its display, variability and reproducibility, diagnostic operational characteristics (sensitivity and specificity) and other utilities in the prenatal diagnosis. METHODS: We conducted an electronic search of the literature registered in: PubMed, Ovid, and ProQuest, between September 2009 and January 2013. RESULTS: It describes technical and normal values, factors affecting measurement, intra and inter-observer variability, regarding the screening and diagnosis of NTDs. CONCLUSION: The IT should be included in the checklist of valuable structures on 11 to 13 6/7 ultrasound; its alteration should be related not just o NTDs but posterior fossa anomalies.

Racionalización del uso de la cesárea en Colombia. Consenso de la Federación Colombiana de Obstetricia y Ginecología (FECOLSOG) y la Federación Colombiana de Perinatología (FECOPEN). Bogotá, 2014 / Consensus for the Rationalization of Cesarean Section Use in Colombia. Federación Colombiana de Obstetricia y Ginecología (FECOLSOG) and Federación Colombiana de Perinatología (FECOPEN). Bogotá, 2014

Objetivos: identificar la tendencia de la tasa de cesárea, la clasificación, los riesgos materno-perinatales, los factores asociados a dicha tasa y proponer estrategias para racionalizar el uso de cesáreas en Colombia.Materiales y métodos: se realizó una revisión de las estadísticas vitales del Departamento Administrativo Nacional de Estadísticas (DANE) de 1998 a 2013 para estimar la tasa de cesárea, y de las bases de datos Medline vía PubMed, The Cochrane Library, Medline, Embase, Lilacs y OVID, con los términos “cesarean section”, “rate”, “maternal mortality”, “neonatal mortality”, “maternal risk”, “perinatal risk”, “trial of labor”, “vaginal birth after cesarean”, “education”, “audit”, “second opinion”, “strategy”, “multiple strategy” y “multifaceted intervention” para identificar revisiones sistemáticas, metaanálisis y estudios clínicos pertinentes publicados en los últimos diez años en inglés o español. Los resultados y las conclusiones fueron discutidos en consenso no formal de expertos realizado el día 9 de mayo de 2014 en Bogotá D.C y socializados en el XIX Congreso Nacional de Obstetricia y Ginecología realizado los días 29 al 31 de mayo de 2014 en Medellín, Colombia.Resultados: la tasa de cesáreas en Colombia pasó de 24,9% en 1998 a 45,7% en 2013. La cesárea incrementa el riesgo de muerte, las complicaciones maternas graves y la morbilidad respiratoria neonatal comparada con el parto vaginal. Factores médicos, socioculturales y económicos incrementan el uso de la cesárea. Las estrategias multifacéticas demuestran mayor efectividad para reducir la tasa de cesárea.Conclusiones: se deben promover estrategias como educación continua, auditoría, mejoramiento de la calidad e involucrar otros actores sociales para generar un cambio cultural y racionalizar el uso de la cesárea en Colombia.

Objectives: Identifying the cesarean section rate, classification, maternal-perinatal risk factors associated with this procedure and to propose strategies to rationalize the use of c-sections in Colombia.Materials and methods: We conducted a review of the vital statistics from the Departamento Administrativo Nacional de Estadísticas (DANE) from 1998 to 2013 to estimate the rate of caesarean section and an electronic database search in Medline via PubMed, The Cochrane Library, Embase, Lilacs, with the terms “cesarean section”, “rate”, “maternal mortality”, “neonatal mortality”, “maternal risk”, “perinatal risk”, “trial of labor”, “vaginal birth after cesarean section”, “education”, “audit”, “second opinion”, “strategy”, “multiple strategy” and “multifaceted intervention” to identify relevant systematic reviews, meta-analysis and clinical studies published in the last ten years in English or Spanish. The search results and conclusions were discussed in a non-formal consensus on May 9, 2014 in Bogotá D.C and socialized in the 29th National Congress of Obstetrics and Ginecology held on May 29th to 31st of 2014 in Medellín, Colombia.Results: The rate of caesarean sections in Colombia step of 24.9% in 1998 to 45.7% in 2013. C-section increases the risk of death, severe maternal complications and neonatal respiratory morbidity compared with vaginal delivery. Medical, social-cultural and economic factors increase the use of cesarean section. Multifaceted strategies have shown the greatest effectiveness in reducing the rate.Conclusions: Strategies such as education, audit, quality improvement and involvement of other stake holders should be promoted to generate a cultural change and rationalize the rate of cesarean section in Colombia.

[Use of intracranial translucency measurement in first trimester, beyond spina bifida]. / Utilidad de la medición de la translucencia intracraneal en el primer trimestre: más allá de la espina bífida.

BACKGROUND: The intracranial translucency (IT) is described as echolucid space located in the fetal central nervous system corresponding to the fourth ventricle. Alteration in the first trimester is associated with neural tube defects (NTDs). OBJECTIVE: Describe the technique and normal values of translucency and everything that makes this resourse a useful option in the detection of defects and abnormalities. METHODS: We conducted an electronic search of the literature registered in: PubMed, Ovid, and ProQuest, between September 2009 and January 2013. RESULTS: It describes technical and normal values, factors affecting measurement, intra and inter-observer variability, regarding the screening and diagnosis of NTDs. CONCLUSION: The IT should be included in the checklist of valuable structures on 11 to 13 ultrasound; its alteration should be related not just o NTDs but posterior fossa anomalies.

Thermoluminescent chip detector for in vivo dosimetry in pelvis and head & neck cancer treatment.

Our aim is to show the TL dosimetry as a confident QA method for radiotherapy treatments. Before in vivo entrance dose measurements using TLD-100 chips, ECLIPSE TPS-simulated treatments for a Rando anthropomorphic phantom, two for pelvis and one head & neck. In Vivo measurements results with (60)Co beam remained within +/-5% limits. Results for 6 and 15 MV are in conclusion. This is a National Cancer Institute/RJ/Brazil study under the 13.111-IAEA Coordinated Research Project.

Conocimiento y uso de Metodos de Planificacion Familiar; estudiantes Facultad de Medicina Upal. Gestion II 2007

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PAI vacunacion en el Centro de Salud Santa Ana, trabajo de metodologia de la investigacion

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