Serological follow up of positive SARS-CoV-2 cases.

OBJECTIVE: To describe the humoral response in a cohort with mild and asymptomatic SARS-CoV-2 infection previ-ously identified in a community-based serological survey. MATERIALS AND METHODS: This study was an observational follow up of 193 subjects previously identified with positive anti-SARS-CoV-2 antibodies invited for a second test 112 days after the first sampling. All completed a standardized electronic questionnaire. IgM/IgG antibodies were determined using a qualitative IgM/IgG chemiluminescent immunoassay. RESULTS: Among the 193 eligible subjects, a total of 174 (90%) attended the follow-up visit, and their serum samples were tested. Of the samples, 171 (98.3%) were still positive, and 3 (1.7%) were negative. Also, the cut-off index (COI) value of the immunoassay significantly increased from the first to the second test (P <0.001). CONCLUSIONS: Our findings support a sustained humoral response in individuals with mild and asymptomatic SARS-CoV-2 infection up to 112 days after a positive serologic baseline test, accompanied by increasing antibody titers.

Serological follow up of positive SARS-CoV-2 cases / Seguimiento serológico de casos positivos a SARS-CoV-2

Abstract: Objective: To describe the humoral response in a cohort with mild and asymptomatic SARS-CoV-2 infection previously identified in a community-based serological survey. Materials and methods: This study was an observational follow up of 193 subjects previously identified with positive anti-SARS-CoV-2 antibodies invited for a second test 112 days after the first sampling. All completed a standardized electronic questionnaire. IgM/IgG antibodies were determined using a qualitative IgM/IgG chemiluminescent immunoassay. Results: Among the 193 eligible subjects, a total of 174 (90%) attended the follow-up visit, and their serum samples were tested. Of the samples, 171 (98.3%) were still positive, and 3 (1.7%) were negative. Also, the cut-off index (COI) value of the immunoassay significantly increased from the first to the second test (P <0.001). Conclusions: Our findings support a sustained humoral response in individuals with mild and asymptomatic SARS-CoV-2 infection up to 112 days after a positive serologic baseline test, accompanied by increasing antibody titers.

Resumen: Objetivo: Describir la respuesta humoral en una cohorte con una infección leve o asintomática por SARS-CoV-2, previamente identificada en una encuesta serológica comunitaria. Material y métodos: Se realizó un seguimiento observacional de 193 individuos previamente identificados con anticuerpos IgM/IgG anti-SARS-CoV-2 invitados 112 días después de una determinación serológica inicial. Todos los participantes completaron un cuestionario electrónico estandarizado. Se determinaron los anticuerpos IgM/IgG mediante un inmunoensayo quimioluminiscente cualitativo. Resultados: De entre los 193 sujetos elegibles, 174 (90%) acudieron al seguimiento. De las muestras, 171 (98.3%) eran positivas y 3 (1.7%) negativas. Además, el valor de COI del inmunoenasayo se incrementó al comparar la primera y segunda determinación (P <0.001). Conclusiones: Los presentes resultados apoyan una respuesta humoral sostenida en individuos con infección por SARS-CoV-2 con síntomas leves o asintomática hasta 112 días después de una prueba serológica positiva, acompañada de incremento en los títulos de anticuerpos.

Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus.

Objective: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder where the disease activity itself and the medications used for its treatment, may have adverse effects on ovarian function. This study aimed to assess the ovarian reserve (OR) in SLE patients. Materials and methods: The anti-müllerian hormone (AMH) and the antral follicle count (AFC), two markers to evaluate the OR was assessed in 64 SLE patients and compared to normal individuals. Additionally, we assessed whether the disease per se or the pharmacological treatments affect the OR. Results: Patients with SLE displayed alterations in the OR regardless of the presence of alterations of the menstrual cycle. The AFC and AMH were significantly lower in SLE patients with and without menstrual alterations when compared to control individuals (p<0.0001). However, the AFC and AMH levels were significantly correlated (p=0.006) in the SLE patients with menstrual alterations. Except for hydroxychloroquine that was statistically higher in SLE patients with menstrual alterations (p=0.04), the cumulative dose for cyclophosphamide, corticosteroid, and methotrexate was similar in SLE patients regardless of the occurrence of menstrual alterations. Conclusion: The monitoring of AMH and AFC in SLE patients should be used to detect the rapid and irreversible decline of the OR to provide a possibility of pregnancy to the SLE patients.

Prevalence and associated characteristics of anti-SARS-CoV-2 antibodies in Mexico 5 months after pandemic arrival.

BACKGROUND: Seroprevalence of anti-SARS-CoV-2 antibodies is now available in several world regions to better estimate transmission dynamics. However, to date, there is no epidemiological data regarding anti-SARS-CoV-2 prevalence in Mexico. Therefore, we aimed to determine the prevalence of anti-SARS-CoV-2 antibodies and define the clinical and demographic characteristics associated with seroprevalence. METHODS: We conducted a cross-sectional serological survey in Ciudad Guadalupe, NL, Mexico. City government employees voluntarily participated during July 2020. Demographic and clinical characteristics were collected at the time of blood sampling to analyze the associated characteristics. IgM/IgG antibodies were determined using a qualitative chemiluminescent immunoassay. Descriptive statistics were used for categorical and continuous variables. Statistical significance was tested using the Chi-squared test, Student's t-test and the Mann-Whitney. Logistic regression models and the odds ratios (adjusted and unadjusted) were used to estimate the association of demographic and clinical characteristics. RESULTS: Of the 3,268 participants included, 193 (5.9%, 95% CI 5.1-6.8) tested positive for IgM/IgG against SARS-CoV-2. Sex, city of residence, and comorbidities did not show any association with having IgM/IgG antibodies. A total of 114 out of 193 (59.1%) subjects with a positive test were asymptomatic, and the odds of being positive were higher in those who reported symptoms of COVID-19 in the previous four weeks to the survey (OR 4.1, 95% CI 2.9-5.5). CONCLUSIONS: There is a low rate of SARS-CoV-2 infection among government employees that have continuously been working during the pandemic. Six in ten infections were asymptomatic, and seroprevalence is low and still far from herd immunity. Epidemiological surveillance and preventive measures should be mandatory.

Maternal Folic Acid Intake and Methylation Status of Genes Associated with Ventricular Septal Defects in Children: Case-Control Study.

BACKGROUND: DNA methylation is the best epigenetic mechanism for explaining the interactions between nutrients and genes involved in intrauterine growth and development programming. A possible contributor of methylation abnormalities to congenital heart disease is the folate methylation regulatory pathway; however, the mechanisms and methylation patterns of VSD-associated genes are not fully understood. OBJECTIVE: To determine if maternal dietary intake of folic acid (FA) is related to the methylation status (MS) of VSD-associated genes (AXIN1, MTHFR, TBX1, and TBX20). METHODS: Prospective case-control study; 48 mothers and their children were evaluated. The mothers' dietary variables were collected through a food frequency questionnaire focusing on FA and the consumption of supplements with FA. The MS of promoters of genes was determined in the children. RESULTS: The intake of FA supplements was significantly higher in the control mothers. In terms of maternal folic acid consumption, significant differences were found in the first trimester of pregnancy. Significant differences were observed in the MS of MTHFR and AXIN1 genes in VSD and control children. A correlation between maternal FA supplementation and MS of AXIN1 and TBX20 genes was found in control and VSD children, respectively. CONCLUSIONS: A lower MS of AXIN1 genes and a higher MS of TBX20 genes is associated with FA maternal supplementation.

Early triglyceride and glucose index as a risk marker for gestational diabetes mellitus.

OBJECTIVE: To assess the risk of gestational diabetes mellitus (GDM) according to the triglyceride and glucose (TyG) index values during the first trimester of pregnancy in Latin American women. METHODS: Pregnant women were enrolled at their first prenatal visit at the Obstetric Division in the University Hospital "Dr. José E. González". Triglycerides and fasting plasma glucose (FPG) were collected to determine the TyG index. GDM diagnosis was performed by a single-step 2-hour 75-g oral glucose tolerance test. Generalized linear models were used to determine risk ratios; pregnancy outcomes at delivery were collected from the hospital medical records. RESULTS: A total of 164 pregnant women were included. GDM was present in 29 (17.7%) women. No significant differences in age, first-trimester body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), family history of diabetes, and TyG index were observed between GDM cases and the reference group without GDM. The adjusted analysis showed no association between TyG and GDM (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.57-1.88]). Higher TyG index values between women with and without a diagnosis of GDM in the second trimester were observed. No significant differences were identified in pregnancy outcomes, although a trend was observed for hyperbilirubinemia in women with first-trimester TyG index values greater than 8.7. CONCLUSIONS: Our findings do not support the use of the TyG index for GDM prediction in Latin American women.

Diagnostic accuracy of the triglyceride-glucose index for gestational diabetes screening: a practical approach.

The oral glucose tolerance test (OGTT) remains as the gold standard to diagnose gestational diabetes mellitus (GDM); however, this test may be inconvenient and costly. Hence, other easy to perform and accurate diagnostic alternatives would be valuable for maternal care. The objective of the study was to assess the diagnostic performance of the TyG index to screen for GDM at 24-28 of pregnancy. A total of 140 pregnant women who received the one-step 2 h 75 g OGTT were included. Overall GDM prevalence was 27.1% according to IADSPG criteria. The mean TyG index value in the GDM group was significantly higher than the TyG index for the no GDM group (4.88 ± 0.70 versus 4.68 ± 0.19, p<.001). A sensitivity of 89% [95% CI 0.75-0.97] and a specificity of 50% [95% CI 0.39-0.60)], accompanied by a high negative predictive value of 93% was observed. No differences were found in maternal and neonatal outcomes irrespective of the TyG cutoff value for GDM. According to our results, the TyG index may be a highly sensitive and easy to perform screening test for GDM.

The elimination of apoptotic sperm in IVF procedures and its effect on pregnancy rate.

OBJECTIVE: To identify the effect of apoptotic sperm elimination with MACS in patients that require IVF. METHODS: An experimental, cross-sectional, descriptive, prospective and non-blinded study of diagnostic tests performed in patients who required IVF and ICSI from July 2011 to July 2012. Ninety-two couples participated according to the treatment administered to the semen sample; in the control group: the samples were subjected only to density gradients before ICSI, in the study group: the same procedure was performed plus the addition of the MACS technique. Comparing the groups, we assessed the fertilization, division, viable embryos and clinical pregnancy rates in all cases. RESULTS: We found significant differences when using MACS technique in sperm parameters. We found no differences between the total samples of the control and study groups. When separating the own and donated eggs in each group, we found an improvement in the fertilization rates (p<0.001) of the own eggs. In both groups, the handling of donated eggs lead to a significant improvement in the immunological pregnancy test (IPT) and fetal heart rate (FHR) results. Only in the donated eggs group, where MACS was applied, could we see that all cases with positive IPT had a fetal heart rate, which shows a significant difference (p<0.002) when compared with the control group, where the percentage decreased abruptly. CONCLUSIONS: This study demonstrates the effectiveness of the use of annexins (MACS) in eliminating apoptotic sperm, and when the obtained sperm is applied to good-quality eggs.

Tratamiento y desenlace obstétrico de una paciente con artrogriposis múltiple congénita / Clinical treatment and outcome of a patient with arthrogryposis multiplex congenita

Resumen ANTECEDENTES: La artrogriposis múltiple congénita es una alteración excepcional, caracterizada por contracturas musculares en diversas partes del cuerpo. Las pacientes embarazadas con esta enfermedad tienen mayor riesgo de complicaciones obstétricas. CASO CLÍNICO: Paciente de 19 años, con artrogriposis múltiple congénita, de ocho semanas de embarazo, quien acudió al servició médico para iniciar el control prenatal. Recibió asesoría de los riesgos cardiovasculares y del sistema respiratorio, secundarios a la enfermedad de base, que pudieran exacerbarse por el embarazo. El ultrasonido efectuado en la semana 22 del embarazo no reportó alteraciones estructurales. La paciente continuó en control prenatal, sin dificultad respiratoria ni alteraciones cardiovasculares. No recibió anticoagulantes profilácticos, ni manifestó signos de trombosis durante el embarazo. Se decidió la interrupción del embarazo por cesárea, debido a la limitación del movimiento de la cadera. Se programó para cirugía en la semana 38.3 del embarazo, con valoración del servicio de Cardiología, quienes reportaron fracción de eyección del ventrículo izquierdo adecuada y sin evidencia de miocardiopatía. Se aplicó anestesia por vía epidural sin complicaciones. El examen físico del neonato no mostró alteraciones. Actualmente, la madre y su hijo permanecen con buen estado de salud. CONCLUSIONES: Las pacientes embarazadas con artrogriposis múltiple congénita deben recibir asesoría de los riesgos inherentes y posibles complicaciones de la enfermedad. Es importante la intervención de un equipo multidisciplinario, para evaluar la función cardiovascular y respiratoria, además de efectuar revisiones seriadas para asegurar el bienestar materno-fetal.

Abstract BACKGROUND: Arthrogryposis multiplex congenita is a rare entity characterized by the appearance of multiple muscle contractures in various parts of the body. Pregnant patients with this condition have a higher risk of complications in obstetric management. CLINICAL CASE: A 19-year-old patient, with arthrogryposis multiplex congenita, eight weeks pregnant, attended in medical service to start prenatal care. Received advice on the cardiovascular and respiratory system risks, secondary to the underlying disease, that could be exacerbated by pregnancy. The ultrasound during the 22nd week of pregnancy did not report any structural alterations. The patient continued in prenatal control, without respiratory difficulty or cardiovascular alterations. Did not receive prophylactic anticoagulants, neither showed signs of thrombosis. We decide finished the pregnancy by caesarean section, due to the limited movement of the hip. Surgery was scheduled at week 38.3 of pregnancy, with assessment by the Cardiology service, who reported adequate left ventricular ejection fraction and no evidence of cardiomyopathy. Epidural anesthesia was applied without complications. The physical examination of the newborn showed no alterations. Currently, the mother and her son remain in good health. CONCLUSIONS: In pregnant patients with arthrogryposis multiplex congenita its important to explain the inherent risks of their condition and their possible complications. Multidisciplinary management should be performed with cardiovascular, respiratory, and serial reviews to ensure the welfare of the maternal-fetal binomial.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital

Abstract In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus.The median age of patients was 25.3 years (range 13-49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital.

In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus. The median age of patients was 25.3 years (range 13-49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Prevalencia de displasia cervical en embarazadas en el Hospital Universitario de Monterrey: Nuevo León, México / Prevalence of cervical dysplasia in pregnant women at the Hospital Universitario de Monterrey

Objetivo. Determinar la prevalencia de displasia cervical en mujeres embarazadas. Método. Estudio observacional, longitudinal, prospectivo, en el cual se analizaron los resultados de 250 pacientes embarazadas que acudieron a control prenatal en el Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo León, México, en el período enero 2007 a julio de 2008. Resultados. Se analizaron 36 citologías anormales (14,4 por ciento), las cuales reportaron ASCUS 3,2 por ciento (n=8), LIEBG 8 por ciento (n=20), LIEAG 2,4 por ciento (n=6) y CaCu 0,8 por ciento (n=2). La prevalencia de displasia cervical confirmada por biopsia fue 5,6 por ciento (n=14). Conclusiones. Se recomienda realizar la citología cervical a toda paciente embarazada, para la detección y tratamiento oportuno de las displasias cervicales.

Objective. To evaluate the prevalence of cervical dysplasia among pregnant women. Method. We conducted an observational, longitudinal, prospective study, that analyzed the results of 250 cervical smears of preg-nant patients that attended the Obstetrics consult of the University Hospital in Monterrey, Mexico, between January 2007 and July 2008. Results: 36 abnormal smears were analyzed (14.4 percent). Showing ASCUS in 3.2 percent (n=8), LSIL in 8 percent (n=20), HSIL in 2.4 percent (n=6) and AIS in 0.8 percent (n=2). The prevalence of cervical dys-plasia confirmed by biopsy was 5.6 percent (n=14). Conclusions: We recommend performing cervical smears to all pregnant women for detection and appropriate treatment of cervical dysplasia.

Siglo y medio de persistencia / A century and a half of persistence

Este texto contiene una serie de reflexiones del director de la Facultad de Medicina de la Universidad Autónoma de Nuevo León y del Hospital Universitario, en el 150 aniversario de su fundación, sobre sus inicios y evolución, fortalezas actuales y proyecciones futuras. (AU)

[Clinical experience of combined oral contraceptives of low doses in Mexico]. / Experiencia clínica de los anticonceptivos orales combinados (AOC) de baja dosis en México.

BACKGROUND: The combined oral contraceptives are one of the most prescribed medicines. Across the years they have given to more than 60 million women of the whole world a suitable method for the highly reliable and effective natal control. The oral contraceptives are different from other medicines; principally they are not in use for controlling any disease and have the potential of giving advantages. OBJECTIVES: To evaluate the control of the cycle, tolerability and acceptance of an oral contraceptive of ultralow dose with gestodene (60 microg) and ethinylestradiol (15 microg) in a population of healthy women from 18 to 35 years. PARTICIPANTS AND METHODS: The study included adult healthy women, all the users signed assent of informed before being included to the study and of the beginning of any procedure in agreement with the declarations of Helsinki and its amendments. Descriptive statistics was used for the demographic information and the comparison between the initial and final visits of the variables of efficiency. There was used the test (Proof) of ranges of Wilcoxon's sign for related samples. RESULTS: There were included 113 women. The average of age was 26.08 years (SD = 4.43), weight of 62.02 kg (SD = 11.13) and height of 159.20 cm (SD = 6.06). The distribution in four centers was: 32 in the University Hospital (Monterrey), 21 in the Country 2000 (Guadalajara), 30 in in the Medical Center La Mora (Aguascalientes) and 30 in Perinatology National Institute (Mexico City). CONCLUSIONS: The contraceptive efficiency of the combination of 15 microg of ethinylestradiol and 60 microg of gestodene has been demonstrated in previous studies. This study ratifies the international results of efficiency and tolerability.

[Acrosomic reaction of human spermatozoid demonstrated with clorotetracycline]. / Respuesta acrosomal de espermatozoides humanos demostrada con clorotetraciclina.

BACKGROUND: Sperm preparation and acrosomic reaction have been largely studied to explain the physiology of sperm as reproductive cell. OBJECTIVE: To identify the morphological changes on in vitro prepared human sperm cells and in spontaneous and ionophore A23187 induced acrosome reaction of infertile males, through the application of the chlortetracycline test. DESIGN: Experimental prospective study. MATERIALS AND METHODS: Sperm samples of 17 subfertile males were processed as routine for a sperm analysis, we carried out sperm preparation and induction of the acrosomic reaction by means of calcium ions A23187. The prepared sperm with direct swim-up was assessed at one hour and at four hours. Direct aliquots were taken and processed for the test with CTC, we considered as positive result obtaining more than 15% increase in the induced AR versus spontaneous. RESULTS: The whole population was classified as asthenozoospermic. Eight training morphological patterns were identified and we found four types of responses for the induced AR: Type I had an increase at one and at four hours incubation (47%); type II had an increase only after 1 hour incubation (23.5%); type III had an increase only at 4 hours incubation (17.7%), and type IV did not have increase (11.8%). CONCLUSION: These results suggest that in astenozoospermic patients the training process has variations during the incubation time, demonstrated by the response at A23187. These findings could let us to select better spermatozoa in this group of males at the moment when capacitance is actually attained, thus being able to carry out more effective techniques in assisted reproduction.

[In vivo effect of endometria's and human cervix's secretions on the spermatozoid]. / Efecto in vivo de las secreciones del endometrio y del cuello uterino humano en el espermatozoide.

OBJECTIVE: To demonstrate the capacitance stages acquired by the spermatozoa after the in vivo contact with the endometrium and the human cervical canal. STUDY TYPE: Experimental, prospective, and longitudinal. MATERIALS AND METHODS: Spermatozoa obtained from the cervix and endometrium, plus post-capacitated semen in a 1 and 4 hours process, from couples that have proved fertility, were processed to evaluate motility, morphology, vitality and identification of morphological patterns with chlortetracycline and then inducted to acrosomal reaction with ionophore A23187. RESULTS: A safe, fast and harmless technique to obtain endometrial secretions is described. The spermatozoa capacitated in vitro and in vivo developed specific capacitance stages, applying Perry's patterns with the CTC test. Spermatozoa capacitated in vitro and then recovered in the cervix responded favorably to the induction of the acrosomal reaction with calcium ionophore A23187, differing from the obtained with endometrium wash. CONCLUSIONS: The spermatozoa recovered from the endometrium presented a more advanced capacitance stage than that obtained from the cervix, this is demonstrated with the induction of the acrosomal reaction and the CTC test. These findings suggest that endometrial and cervical tissues promote capacitance, different in each one of them and progressive in their biological route.

Niveles de ácido fólico, homocisteína y polimorfismo de la enzima metilentetrahidrofolatorreductasa (MTHFR) en pacientes con preeclampsia severa y eclampsia / Folic acid levels, homocysteine and metilentetrahidrofolatorreductase polimorfism in severe preeclampsia and eclampsia

Objetivo. La preeclampsia y eclampsia, son la principal causa de mortalidad materna. En el estado de Nuevo León de 1990 a 1998, estas patologías representaron 44.1 por ciento. La presencia de sustancias con actividad trombogénica en la sangre materna (homocisteína, proteína C y anticuerpos anticardiolipina) han sido relacionadas. El polimorfismo C677T de la enzima metilentetrahidrofolatorreductasa (MTHFR) favorece la elevación de la homocisteína, la suplementación con ácido fólico (AF) disminuye sus niveles. Se pretende establecer el papel que el AF tiene en la fisiopatología de la preeclampsia en nuestro medio. Tipo de estudio. Longitudinal, prospectivo y comparativo. Materiales y métodos. Casos: mujeres con preeclampsia severa y/o eclampsia (n=13). Controles: mujeres con embarazo normoevolutivo en el tercer trimestre (n=15). Se tomaron 20 mL de sangre en las primeras 24 horas del puerperio midiendo AF, homocisteína y polimorfismo de la MTHFR. Para comparaciones entre ambos grupos se utilizó la preba de t de Student y exacta de Fisher. Resultados. Los valores de homocisteína fueron (xñDE): Casos 9.85 micromol/L ñ 2.88 y controles 7.61 micromol/L ñ 1.32 (p<0.04). La frecuencia ( por ciento) del polimorfismo genético de la MTHFR fue: homocigotas positivas (T/T): 38.46 vs 20, heterocigotas (C/T): 38.46 vs 26.6, homocigotas negativas (C/C): 23 vs 53, para casos y controles respectivamente. Conclusiones. En nuestro estudio el estado homocigoto (T/T) de la MTHFR y los valores elevados de homocisteína en sangre son más frecuentes en mujeres con preeclampsia.

Resolución del trazado sinusoide: presentación de dos casos / Resolution of the sinusoidal trace: report of 2 cases

El patrón sinusoide de la frecuenciaa cardiaca fetal ha sido asociada a una condición fetal deficiente, generalmente debido a una anemia fetal severa o bien por acidosis e hipoxia profundas. Su presencia en un registro de la frecuencia cardiaca fetal generalmene se relaciona con un alto índice de mortalidad perinatal. En este trabajo se informan dos casos de pacientes embarazadas con trazo sinusoide, que presentan resolución ulterior, obteniendo recién nacido que sobreviveron. El primer caso está relacionado a un embarazo complicado con isoinmunización al factor Rh, que desarrolla un sinusoide que desparece posterior a una transfusión intrauterina. El segundo caso es una paciente con embarazo de treienta y tres semanas, politraumatizada por colisión. Al practicar registro de la frecuencia cardiaca fetal, se detecta tazo sinusoide que desaparece dos horas después con medidas de sostén en la madre. Se discute la fisiopatología del sinusoide y su relación con los dos casos anotados Los dos casos presentados en este trabajo nos sugieren que un trazo sinusoide no representa necesariamente un estado pre mortem del feto y que es posible hacerlo desaparecer cuando se emplean medidas terapéuticas adecuadas

Utilidad del diagnóstico de placenta grado III por ecografía en el manejo del embarazo prolongado / Usefulness of diagnosis of placenta stage III by echography in the management of prolonged pregnancy

Con el propósito de determinar la importancia de encontrar una placenta grado III por ecografía en embarazos prolongados se revisaron los resultados obtenidos en 75 pacientes con embarazos de 41 semanas, o más, por amenorrea, en los que se practicó eecografía con sistema de ultrasonido de tiempo real, lineal de 3.5 MHz en la Unidad de Perinatología del Hospital Universitario Dr. José E. González, U.A.N.L., del 27 de octubre de 1986 al 17 de febrero de 1987. Se formaron tres grupos según los grados I, II y III de imagen placentaria y se compararon los seguientes parámetros: Apgar, peso, Ballard y presencia de meconio en líquido amniótico. Los resultados obtenidos en nuestro grupo no mostraron diferencias estadísticamente significativas entre las pacientes con placenta grado III y las pacientes con placenta grados I y II respecto a Apgar, peso, Baillard y presencia de meconio; no por lo que consideramos que el diagnosticar una placenta grado III en pacientes con embarazo prolongado no constituye por sí sola una indicación para interrumpir éste. La incidencia de placenta grado III en nuestro grupo (27.3%) fue significativamente mayor que la reportada en la literatura (15%) para embarazos de término. En el grupo de placentas grado III no se presentó ningún producto pretérmino mientras que hubo cuatro prematuros en el resto de los casos; lo que concuerda con la literatura en lo que se especifica que una vez que la totalidad de la imagen placentaria es grado III se debe considerar al producto maduro

Aspecto del líquido amniótico como índice de madurez fetal / amniotic fluid aspects in index of fetal maturity

En este estudio se correlaciona el aspecto del líquido amniótico con el perfil de fosfolípidos, tratando de establecer si existe la posibilidad de determinar el grado de madurez fetal con la simple visualización del líquido amniótico se estudiaron 268 muestras de líquido amniótico obtenidos por amniocentesis para diagnóstico de madurez fetal; se establecieron tres aspectos de líquido amniótico, tomando en cuenta su transparencia, turbidez, presencia y cantidad de grupos y aspecto lechoso, y se establecieron los siguientes aspectos: Tipo I: líquido claro sin grumos, líquido con escasos grumos. Tipo II: líquido claro con abundantes grumos, líquido turbio. Tipo III: líquido lechoso. Se efectuó una correlación de estos tres aspectos con el perfil de fosfolípidos y se determinó relación L/E, lecitina precipitable, y fosfatidilglecerol, además de la prueba de Clements. El estudio estadístico correspondió a un índice de correlación de Pearsson y el establecimiento de su significancia por el valor de p. El índice de correlación resultó altamente significativo para todas las determinaciones de fosfolípidos, siendo los más altos para la prueba de Clements y para el PG. Se apreció que en los líquidos de aspecto II y III se relacionan con una alta incidencia de madurez fetal, sin encontrar una diferencia significativa entre ambos, siendo esto observado en todos los parámetros determinados en el perfil de fosfolípidos; se encontró un índice de predicción de madurez fetal de 97.2% para el aspecto Tipo II y de 98.4 para el aspecto Tipo III