Zika virus prevention behaviors and knowledge among male partners of pregnant people and lack of condom use as a prevention behavior from the Zika en Embarazadas y Niños (ZEN) prospective cohort study, Colombia.

OBJECTIVE: Zika virus (ZIKV) infection in pregnancy can cause brain and eye abnormalities and neurodevelopmental sequelae. In the absence of medical countermeasures, behavioral interventions were recommended to prevent mosquito bites and sexual transmission of ZIKV. This report uses data from the Zika en Embarazadas y Niños (ZEN) prospective cohort study in Colombia to describe the knowledge, attitudes, and behaviors (KAB) related to ZIKV prevention in male partners compared to those of their pregnant partners at study enrollment during February 2017-2018. RESULTS: Most male partners reported wearing protective clothing such as long pants (97.6%) and long sleeves (72.8%), as well as covering ankles and feet (89.1%) to prevent ZIKV infection. When comparing the preventive behavior of condom use between male and pregnant partners, 26 pairs (10.0%) both responded that they performed the behavior. Overall, 25.1% of male partners and 18.9% of pregnant people reported any condom use during the three months before enrolling in ZEN. When comparing other preventive behaviors between male and pregnant partners, the behavior which was most frequently reported by both partners was wearing long pants (85.4%), and the least frequently reported by both partners was using condoms after finding out about a partner's pregnancy (3.4%).

Topical negative pressure wound therapy to prevent wound complications following caesarean delivery in high-risk obstetric patients: A randomised controlled trial.

BACKGROUND AND AIMS: We investigated whether the use of a prophylactic negative pressure wound therapy (NPWT) system in women undergoing caesarean would decrease wound complications in a high-risk population. MATERIALS AND METHODS: A randomised controlled trial was performed. Women with risk factors for wound complications undergoing caesarean delivery were randomised to a standard dressing or NPWT placed over their caesarean wound. We standardised the closure of the subcutaneous fat and skin layers, both with Vicryl. Patients were followed for wound complications for up to 6 weeks after their caesareans. The incidence of wound complications was the primary outcome. The single-use NPWT system, PICO, was provided by Smith and Nephew for use in this trial. The trial was registered on clinicaltrials.gov, # NCT03082664. RESULTS: We report here on 154 women randomised to either a standard dressing or to the NPWT. Wound complication rates were equivalent between groups, with 19.4 and 19.7% (P = 0.43) of women with follow-up information available experiencing wound complications. CONCLUSION: We found no difference in wound complications in women with risk factors treated with a prophylactic NPWT system or standard wound dressing at the time of caesarean birth.

Zika virus knowledge, attitudes and prevention behaviors among pregnant women in the ZEN cohort study, Colombia, 2017-2018.

BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause severe birth defects in the fetus and is associated with neurodevelopmental abnormalities in childhood. Our objective was to describe ZIKV knowledge and attitudes among pregnant women in Colombia while ZIKV was circulating and whether they predicted the adoption of behaviors to prevent ZIKV mosquito-borne and sexual transmission. METHODS: We used self-reported data from Zika en Embarazadas y Niños (ZEN), a cohort study of women in early pregnancy across three regions of Colombia during 2017-2018. We used Poisson regression to estimate associations between knowledge, attitudes and previous experience with mosquito-borne infection and preventative behaviors. RESULTS: Among 1519 women, knowledge of mosquito-borne transmission was high (1480; 97.8%) and 1275 (85.5%) participants were worried about ZIKV infection during pregnancy. The most common preventive behavior was wearing long pants (1355; 89.4%). Regular mosquito repellent use was uncommon (257; 17.0%). While ZIKV knowledge and attitudes were not associated with the adoption of ZIKV prevention behaviors, previous mosquito-borne infection was associated with increased condom use (prevalence ratio 1.4, 95% CI 1.1 to 1.7). CONCLUSIONS: Participants were well informed about ZIKV transmission and its health consequences. However, whether this knowledge resulted in behavior change is less certain.

Superación pedagógica de los profesores de Histología en la Universidad de Ciencias Médicas de Matanzas / Pedagogical upgrading of the Histology professors in the University of Medical Sciences of Matanzas

La enseñanza de las ciencias básicas en las universidades médicas constituye una prioridad para la formación del profesional de la salud, porque ofrece los fundamentos teóricos que propician la comprensión de la morfofisiología del organismo humano, sus interdependencias y sus relaciones con el medio en que nace, crece, se desarrolla y muere. En tal sentido, se deriva la necesidad de mantener la superación de los docentes para el perfeccionamiento de la dirección del proceso de enseñanza-aprendizaje desde los primeros años de la carrera de medicina y en esta investigación, en particular, en el uso del dibujo de imágenes microscópicas para la enseñanza de estos conocimientos en la disciplina Bases Biológicas de la Medicina. El objetivo del artículo fue caracterizar la superación pedagógica de los profesores de Histología en la Universidad de Ciencias Médicas de Matanzas. Se realizó una revisión bibliográfica de artículos que abordaban esta temática, así como de documentos normativos para la formación de los docentes en esta área pedagógica. Se identificaron tres momentos que caracterizaban la trayectoria de la superación pedagógica de los profesores de las ciencias biomédicas; en particular, el papel del dibujo de imágenes microscópicas como medio de enseñanza en ese proceso. Se consideró que no se dedicaba tiempo en los programas a su desarrollo, por lo que se deriva la necesidad de la superación profesoral y el perfeccionamiento de la didáctica de esta disciplina(AU)

The teaching of basic sciences in medical universities is a priority for the training of health professionals, because it provides the theoretical foundations that promote the understanding of the morphophysiology of the human organism, its interdependencies and its relationship with the environment in which it is born, grows, develops and dies. In this respect, it is necessary to maintain the upgrading of professors in view of improving the guidance of the teaching-learning process from the first academic years of the medical major and, particularly in this research, through the use of drawn microscopic images for the teaching of this knowledge in the discipline Biological Basis of Medicine. The objective of the article was to characterize the pedagogical upgrading of Histology professors at the University of Medical Sciences of Matanzas. A bibliographic review of articles dealing with this topic was carried out, as well as of normative documents for the training of professors in this pedagogical area. Three moments were identified that characterized the pathway of the pedagogical upgrading of biomedical sciences professors, particularly the role of drawn microscopic images as a teaching aid in this process. The programs were not considered to devote any time to its development, thus the need appearing for the upgrading of professors and the improvement of the didactics of this discipline(AU)

Valoración del uso del dibujo de imágenes microscópicas en la enseñanza de las ciencias biomédicas

Introducción: el dominio, por parte de los profesores, del dibujo en el proceso de enseñanza-aprendizaje de Histología, en la disciplina Bases Biológicas de la Medicina, constituye una prioridad, y algunos autores consideran que requiere mayor atención pedagógica, por lo que es necesaria la superación profesoral. Objetivo: valorar el uso del dibujo de imágenes microscópicas en la enseñanza de las ciencias biomédicas. Materiales y métodos: se aplicaron métodos teóricos y empíricos, y se constataron los presupuestos teóricos y metodológicos a través de la triangulación de los datos recogidos. Resultados: hay consenso sobre la importancia del uso del dibujo como medio de enseñanza de los conocimientos de histología en la disciplina Bases Biológicas de la Medicina, y se reafirma que su utilización por parte de los profesores es deficitaria. La utilización del dibujo histológico como medio de enseñanza debe estar más presente en la formación de profesores. Conclusiones: el uso del dibujo de imágenes microscópicas como medio de enseñanza de las ciencias básicas biomédicas, es parte esencial de la formación de los profesores, por lo que debe tener una atención priorizada en el proceso de enseñanza-aprendizaje y la didáctica particular de esta disciplina. Por su importancia para la comprensión de los estudiantes, debe potenciarse su empleo y consolidarse desde lo teórico-metodológico en los documentos normativos y en el trabajo metodológico.

Introduction: mastery, by teachers, of drawing in the teaching-learning process of Histology, in the discipline Biological Bases of Medicine, constitutes a priority, and some authors consider that it requires more pedagogical attention, for which teacher training is necessary. Objective: assess the use of drawing microscopic images in the teaching of biomedical sciences. Materials and methods: theoretical and empirical methods were applied, and theoretical and methodological assumptions were established through the triangulation of the data collected. Results: there is consensus on the importance of the use of drawing as an aid for teaching knowledge of histology in the discipline Biological Bases of Medicine, and it is reaffirmed that its use by professors is deficient. The use of histological drawing as a teaching aid should be more present in teacher training. Conclusions: the use of drawing microscopic images as a teaching aid for basic biomedical sciences is an essential part of teacher training, so it must have priority attention in the teaching-learning process and the particular didactics of this discipline. Due to its importance for the understanding of students, its use should be promoted and consolidated from the theoretical-methodological point of view in the normative documents and in the methodological work.

Severity of illness by pregnancy status among laboratory-confirmed SARS-CoV-2 infections occurring in reproductive-aged women in Colombia.

BACKGROUND: Multiple studies have described increased risk of severe coronavirus disease (COVID-19) among pregnant women compared to nonpregnant women. The risk in middle-income countries where the distributions of age groups and preexisting conditions may differ is less known. OBJECTIVES: To determine whether pregnant women with SARS-CoV-2 infection are at increased risk for severe COVID-19 compared to nonpregnant women in Colombia. METHODS: We analysed national surveillance data from Colombia, of women aged 15-44 years with laboratory-confirmed infection with SARS-CoV-2 by molecular or antigen testing, from 6 March 2020 to 12 December 2020. An enhanced follow-up of pregnant women with COVID-19 was established to monitor pregnancy and birth outcomes. RESULTS: Of 371,363 women aged 15-44 years with laboratory-confirmed SARS-CoV-2 infection, 1.5% (n = 5614) were reported as pregnant; among those, 2610 (46.5%) were considered a complete pregnancy for reporting purposes at the time of analysis. Hospitalisation (23.9%) and death (1.3%) occurred more frequently among pregnant symptomatic women compared to nonpregnant symptomatic women (2.9% and 0.3%, respectively). Compared to nonpregnant symptomatic women, pregnant symptomatic women were at increased risk of hospitalisation (adjusted risk ratio [RR] 2.19, 95% confidence interval [CI] 2.07, 2.32) and death (RR 1.82, 95% CI 1.60, 2.07), after adjusting for age, type of health insurance and presence of certain underlying medical conditions. Among complete pregnancies, 55 (2.1%) were pregnancy losses, 72 (2.8%) resulted in term low birthweight infants and 375 (14.4%) were preterm deliveries. CONCLUSIONS: Although pregnant women were infrequently reported with laboratory-confirmed SARS-CoV-2 infection, pregnant symptomatic women with COVID-19 were at increased risk for hospitalisation and death compared to nonpregnant symptomatic women. Almost all infections we reported on were third-trimester infections; ongoing follow-up is needed to determine pregnancy outcomes among women infected earlier in pregnancy. Healthcare providers should counsel pregnant women about preventive measures to protect from SARS-CoV-2 infection and when to seek care.

Performance of a Maternal Abdominal Surface Electrode System for Fetal Heart Rate and Uterine Contraction Monitoring from 34 to 37 Weeks.

OBJECTIVE: The objective of this study was to compare performance of a maternal surface electrode patch with ultrasound- and tocodynamometer-based monitoring to detect fetal heart rate and uterine contractility in late preterm labors. STUDY DESIGN: Thirty women between 340/7 and 366/7 weeks' gestation were monitored simultaneously with a Doppler/tocodynamometer system and a wireless fetal-maternal abdominal surface electrode system. Fetal and maternal heart rate and uterine contraction data from both systems were compared. Reliability was measured by the success rate and percent agreement. Deming regression and Bland-Altman analysis estimated the concordance between the systems. Uterine contractions were assessed by visual interpretation of monitor tracings. RESULTS: The success rate for the surface electrode system was 89.5% (95% confidence interval [CI], 85.7-93.3), and for ultrasound it was 88.4% (95% CI, 84.9-91.9; p = 0.73), with a percent agreement of 88.1% (95% CI, 84.2-92.8). Results were uninfluenced by the patients' body mass. The mean Deming slope was 1 and the y-intercept was -3.0 beats per minute (bpm). Bland-Altman plots also showed a close relationship between the methods, with limits of agreement less than 10 bpm. The percent agreement for maternal heart rate was 98.2% (95% CI, 97.4-98.8), and for uterine contraction detection it was 89.5% (95% CI, 85.5-93.4). CONCLUSION: Fetal heart rate and uterine contraction monitoring at 340/7 to 366/7 weeks using abdominal surface electrodes was not inferior to Doppler ultrasound/tocodynamometry for fetal-maternal assessment. REGISTRATION: clinicaltrials.gov/February 20, 2017/identifier NCT03057275. KEY POINTS: · Monitoring the preterm fetal heart rate with surface electrodes is feasible.. · Preterm contractions can be monitored with surface electrodes.. · The technique was noninferior to standard external monitors..

Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016-2018.

Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May-November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia's existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.

UV radiation dose in real time with a cryogenic SiPM using Monte Carlo-Geant4 simulation.

At the moment, there is no method that allows the user to calculate the dose of UV radiation during the liquid nitrogen (LN2) sterilization process while complying with quality control regulations. This article describes a simulating method using Geant4 to obtain the dose of UV radiation in real-time with a cryogenic Silicon PhotoMultipliers (SiPM) inside the LN2 container. The results present the zone of minimum UV radiation and the estimation of the radiation dose with a cryogenic SiPM, located in the minimum zone to certify the absence of microorganisms in the LN2.

Diagnóstico diferencial de adenoma folicular y carcinoma papilar de tiroides mediante variables cariométricas. Matanzas 2013-2016 / Differential diagnosis of thyroidal follicular adenoma and papillary carcinoma by means of karyometric variables. Matanzas 2013-2016

RESUMEN Introducción: los carcinomas diferenciados de tiroides se originan en el epitelio folicular. De ellos el carcinoma papilar muestra una mayor incidencia. Una variante del mismo es la folicular, que en ocasiones muestra un patrón arquitectural que imita a un adenoma folicular. Objetivo: contribuir al diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular de tiroides, utilizando variables cariométricas de las células foliculares. Materiales y métodos: se aplicaron técnicas morfométricas a muestras de biopsias de tiroides con carcinoma papilar variante folicular y adenoma folicular, así como a muestras sin patología, en el período comprendido de enero de 2013 a diciembre de 2016, obtenidas en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Las técnicas aplicadas se basaron en las variables cuantitativas: área, perímetro y factor de forma nuclear de las células foliculares. Los resultados se expresaron en porcentajes; la media aritmética como medida de tendencia central; desviación típica, incluyéndose el cálculo de los valores máximo, mínimo y recorrido para cada variable comprendida en el estudio, reflejados en tablas y gráficos realizados a través del software Microsoft Office Excel. Resultados: se obtuvieron valores elevados de área y perímetro nuclear de las células foliculares del carcinoma papilar variante folicular con relación al adenoma folicular, mientras que el factor de forma no arrojó resultados significativos para la diferenciación de dichas enfermedades tiroideas. Conclusiones: la aplicación de técnicas morfométricas a variables cariométricas en el tiroides, para el diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular, ofrece resultados aplicables en estudios histopatológicos (AU).

ABSTRACT Introduction: differentiated thyroid carcinomas are originated in the follicular epithelium. Of them, the papillary carcinoma shows higher incidence. Follicular carcinoma, one of its variants, occasionally shows an architectural pattern imitating a follicular adenoma. Objective: to contribute to the differential diagnosis between the papillary carcinoma, follicular variant, and thyroid follicular adenoma, using karyometric variables of follicular cells. Materials and methods: morphometric techniques were applied to samples of biopsies of thyroids with papillary carcinoma, follicular variant, and follicular adenoma, and also to samples without any pathology, in the period from January 2013 to December 2016, gathered in the University Hospital Comandante Faustino Perez, of Matanzas. The applied techniques were based on quantitative variables: area, perimeter and nuclear form factor. Results were expressed in percentages; the arithmetic median as measure of central tendency; typical deviation, including the calculation of maximal, minimal values and the course for each variable included in the study, were drawn in tables and graphics using Microsoft Office Excel software. Results: highs values of area and nuclear perimeter of the follicular cells of the papillary carcinoma, follicular variant, were obtained, while the shape factor did not show significant results for those thyroidal diseases differentiation. Conclusions: the application of morphometric techniques to karyometric variables in the thyroids, for the differential diagnosis between the papillary carcinoma, follicular variant, in follicular carcinoma, offers results that can be applied in histopathological studies (AU).

Clase metodológica instructiva de la asignatura Sistema Masticatorio, orientada a la relación básico-clínica / Instructive methodological class of the Masticatory System subject, oriented towards the basic-clinical relationship

RESUMEN La preparación del personal docente en las universidades exige un alto nivel científico y de maestría pedagógica. Todo esto requiere un esmerado trabajo metodológico que garantice una planificación organización, regulación y control del proceso docente educativo. Para esto se diseñó una clase metodológica instructiva sobre mucosa oral, de la asignatura Sistema Masticatorio, en la disciplina Histología, con el objetivo de instruir al profesor en la utilización de la vinculación básico-clínica. Se indicó a los profesores cómo relacionar el contenido de la clase con la clínica, desde el punto de vista de las lesiones precancerosas y sus factores de riesgo. Se logró la instrucción de los docentes en la utilización del contenido de las asignaturas y disciplinas de las Ciencias Básicas con la relación básico-clínica, y así se contribuyó a ampliar el espectro científico metodológico de los docentes en la Universidad de Ciencias Médicas de Matanzas (AU).

ABSTRACT Training the teaching staff in the universities demands a high scientific level and pedagogical expertise. All of these requires a careful methodological work guaranteeing the teaching-learning process planning, organization, regulation and control. For that the authors designed an instructive methodological lesson aimed to train the teaching staff in the use of the basic-clinical link during a lesson of the subject Masticatory System about Oral Mucosa, in the subject Histology. They indicate to professors how to relate the lesson content to clinic from the point of view of pre-cancer lesions and its risk factors. Training the teaching staff in the use of subjects and disciplines of the Basic Sciences with the basic-clinical relation, the authors contribute to widening the scientific methodological spectrum of the teaching staff of the Matanzas University of Medical Sciences (AU).

Epidemiology of cytomegalovirus Infection among mothers and infants in Colombia.

We assessed maternal and infant cytomegalovirus (CMV) infection in Colombia. Maternal serum was tested for CMV immunoglobulin G antibodies at a median of 10 (interquartile range: 8-12) weeks gestation (n = 1501). CMV DNA polymerase chain reaction was performed on infant urine to diagnose congenital (≤21 days of life) and postnatal (>21 days) infection. Maternal CMV seroprevalence was 98.1% (95% confidence interval [CI]: 97.5%-98.8%). Congenital CMV prevalence was 8.4 (95% CI: 3.9%-18.3%; 6/711) per 1000 live births. Among 472 infants without confirmed congenital CMV infection subsequently tested at age 6 months, 258 (54.7%, 95% CI: 50.2%-59.1%) had postnatal infection.

Neurodevelopmental findings in children 20-30 months of age with postnatal Zika infection at 1-12 months of age, Colombia, September-November 2017.

BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause infant brain and eye abnormalities and has been associated with adverse neurodevelopmental outcomes in exposed infants. Evidence is limited on ZIKV's effects on children infected postnatally within the first year of life. OBJECTIVE: To determine whether any adverse neurodevelopmental outcomes occurred in early childhood for children infected postnatally with ZIKV during infancy, given the neurotoxicity of ZIKV infection and the rapid brain development that occurs in infancy and early childhood. METHODS: The Colombia Instituto Nacional de Salud (INS) conducted health and developmental screenings between September and November 2017 to evaluate 60 children at ages 20-30 months who had laboratory-confirmed symptomatic postnatal ZIKV infection at ages 1-12 months. We examined the frequency of adverse neurologic, hearing, eye, and developmental outcomes as well as the relationship between age at Zika symptom onset and developmental outcomes. RESULTS: Nine of the 60 (15.0%) children had adverse outcomes on the neurologic, hearing, or eye examination. Six of the 47 (12.8%) children without these adverse findings, and who received a valid developmental screening, had an alert score in the hearing-language domain which signals the need for additional developmental evaluation. CONCLUSION: Neurologic, hearing, eye, and developmental findings suggest reassuring results. Since the full spectrum of neurodevelopmental outcomes in children postnatally infected with ZIKV remains unknown, routine paediatric care is advised to monitor the development of these children to ensure early identification of any adverse neurodevelopmental outcomes.

Cohort profile: congenital Zika virus infection and child neurodevelopmental outcomes in the ZEN cohort study in Colombia.

Zika en Embarazadas y Niños (ZEN) is a prospective cohort study designed to identify risk factors and modifiers for Zika virus (ZIKV) infection in pregnant women, partners, and infants, as well as to assess the risk for adverse maternal, fetal, infant, and childhood outcomes of ZIKV and other congenital infections. ZIKV infection during pregnancy may be associated with longterm sequelae. In the ZEN cohort, 1,519 pregnant women and 287 partners were enrolled from 3 departments within Colombia between February 2017 and January 2018, as well as 1,108 infants born to the pregnant women who were followed to 6 months. The data include baseline questionnaires at enrollment; repeated symptoms and study follow-up questionnaires; the results of lab tests to detect ZIKV and other congenital infections; medical record abstractions; infant physical, eye, and hearing exams; and developmental screening tests. Follow-up of 850 mother-child dyads occurred at 9 months, 12 months, and 18 months with developmental screenings, physical exams, and parent questionnaires. The data will be pooled with those from other prospective cohort studies for an individual participant data meta-analysis of ZIKV infection during pregnancy to characterize pregnancy outcomes and sequelae in children.

Zika Virus Disease and Pregnancy Outcomes in Colombia.

BACKGROUND: In 2015 and 2016, Colombia had a widespread outbreak of Zika virus. Data from two national population-based surveillance systems for symptomatic Zika virus disease (ZVD) and birth defects provided complementary information on the effect of the Zika virus outbreak on pregnancies and infant outcomes. METHODS: We collected national surveillance data regarding cases of pregnant women with ZVD that were reported during the period from June 2015 through July 2016. The presence of Zika virus RNA was identified in a subgroup of these women on real-time reverse-transcriptase-polymerase-chain-reaction (rRT-PCR) assay. Brain or eye defects in infants and fetuses and other adverse pregnancy outcomes were identified among the women who had laboratory-confirmed ZVD and for whom data were available regarding pregnancy outcomes. We compared the nationwide prevalence of brain and eye defects during the outbreak with the prevalence both before and after the outbreak period. RESULTS: Of 18,117 pregnant women with ZVD, the presence of Zika virus was confirmed in 5926 (33%) on rRT-PCR. Of the 5673 pregnancies with laboratory-confirmed ZVD for which outcomes had been reported, 93 infants or fetuses (2%) had brain or eye defects. The incidence of brain or eye defects was higher among pregnancies in which the mother had an onset of ZVD symptoms in the first trimester than in those with an onset during the second or third trimester (3% vs. 1%). A total of 172 of 5673 pregnancies (3%) resulted in pregnancy loss; after the exclusion of pregnancies affected by birth defects, 409 of 5426 (8%) resulted in preterm birth and 333 of 5426 (6%) in low birth weight. The prevalence of brain or eye defects during the outbreak was 13 per 10,000 live births, as compared with a prevalence of 8 per 10,000 live births before the outbreak and 11 per 10,000 live births after the outbreak. CONCLUSIONS: In pregnant women with laboratory-confirmed ZVD, brain or eye defects in infants or fetuses were more common during the Zika virus outbreak than during the periods immediately before and after the outbreak. The frequency of such defects was increased among women with a symptom onset early in pregnancy. (Funded by the Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).

Cell-Free DNA as an Addition to Ultrasound for Screening of a Complete Hydatidiform Mole and Coexisting Normal Fetus Pregnancy: A Case Report.

Background Complete hydatidiform mole and coexisting normal fetus pregnancies (CHMCF) are rare and can be life-threatening to the mother. Definitive diagnosis can be made with chorionic villus sampling or amniocentesis. However invasive procedures carry a risk of bleeding. We present the case of a twin molar pregnancy where a cell-free DNA screening test was utilized to evaluate for CHMCF pregnancy. Case A patient presented at 15-week gestational age with suspected CHMCF pregnancy. Ultrasound revealed a normal-appearing pregnancy abutting a multicystic lesion concerning for a complete mole. Cell-free DNA was obtained and was suggestive of complete paternal uniparental disomy. Pathological evaluation of the products of conception confirmed the diagnosis of CHMCF. Conclusion In atypical cases, cell-free DNA may be useful in evaluation of molar pregnancy.

Farmacopuntura en pacientes con disfunción dolorosa de la articulación temporomandibular / Pharmacopuncture in patients with temporomandibular joint painful dysfunction

Introducción: El síndrome de disfunción temporomandibular constituye un problema de salud importante, que afecta a más de 50 % de la población mundial. Objetivo: Describir la evolución terapéutica de pacientes con afecciones temporomandibulares tratados con farmacopuntura. Métodos: Se realizó un estudio descriptivo de 60 pacientes con síndrome de disfunción temporomandibular en fase aguda, atendidos en el Hospital Clinicoquirúrgico Faustino Pérez de Matanzas, desde enero hasta diciembre de 2018. Se administró una solución compuesta por lidocaína, vitamina B12 y betametasona en puntos acupunturales determinados. Además, se utilizó la escala verbal del dolor. Resultados: Se encontró que el grupo etario de 60 años y más, así como el sexo femenino fueron los más afectados. De los factores asociados a este síndrome predominó el estrés en 100 % de los pacientes; 63,3 % presentaron dolor moderado y 53,3 % se aliviaron totalmente. Conclusiones: La farmacopuntura alivió el dolor asociado al síndrome de disfunción temporomandibular en la mayoría de los afectados, entre las 3 primeras sesiones de tratamiento.

Introduction: The temporomandibular dysfunction syndrome constitutes an important health problem that affects more than 50 % of the world population. Objective: To describe the therapeutic clinical course of patients with temporomandibular affections treated with pharmacopuncture. Methods: A descriptive study of 60 patients with temporomandibular dysfunction syndrome in acute phase was carried out, they were assisted in the Faustino Pérez Clinical Surgical Hospital from Matanzas, from January to December, 2018. A solution composed by lidocaine, B12 vitamin and betamethasone was administered in certain acupunctural points. Also, the pain verbal scale was used. Results: It was found that the 60 years and over age group, as well as the female sex were those most affected. Of the factors associated to this syndrome stress prevailed in 100 % of patients; 63.3 % presented moderate pain and 53.3 % were totally relieved. Conclusions: Pharmacopuncture relieved the pain associated with the temporomandibular dysfunction syndrome in most of those affected, in the first 3 treatment sessions.

Técnica morfométrica en el diagnóstico diferencial de hiperplasia endometrial compleja y adenocarcinoma endometroide. Matanzas; 2014-2015 / Morphometric technique in the differential diagnosis of complex endometrial hyperplasia and endometroid adenocarcinoma. Matanzas; 2014-2015

RESUMEN Introducción: la función del endometrio está regida por el eje hipotálamo hipofisario mediante las hormonas sexuales por lo que es vulnerable a los desórdenes de este sistema los que provocan diferentes trastornos funcionales que se traducen en alteraciones morfológicas. Es fundamental su estudio para el diagnóstico de patologías que son un problema de salud en la población femenina. Objetivo: determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal, en el municipio Matanzas, enero2014 -2015. Material y Métodos: se realizó un estudio observacional descriptivo de corte transversal y se aplicó morfometría a una muestra de 30 biopsias endometriales, con el objetivo de determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal. Resultados: el área total de la glándula fue la variable analizada que mostró mayores valores y reflejó marcadas diferencias entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y el endometrio proliferativo normal, seguida por la altura del epitelio por tanto existen diferencias cuando se estudian variables que tiene en cuenta la morfología glandular. Conclusiones: existen diferencias morfométricas entre la hiperplasia endometrial y el adenocarcioma endometroide cuando se estudian variables que tienen en cuenta la morfología y arquitectura glandular (AU).

SUMMARY Introduction: the endometrium function is ruled by the pituitary- hypothalamus axis by means of sexual hormones; therefore it is vulnerable to the disorders of this system provoking different functional disorders resulting in morphological alterations. It is very important to study them for the sake of the diagnosis of diseases that are a health problem in female population. Objective: to determine the morphometric differences for the differential histopathological diagnosis among the complex endometrial hyperplasia, the endometrioid adenocarcinoma and the normal proliferative endometrium e, in the municipality of Matanzas, in the period January 2014-2015. Methods: a cross-sectional descriptive observational study was carried out applying morphometry to a sample of 30 endometrial biopsies, with the objective of determining the morphometric differences for the differential histopathological diagnosis among the complex endometrial hyperplasia, endometrial adenocarcinoma and normal proliferative endometrium. Results: the gland total area was the used variable showing more values and revealed stark differences among complex endometrial hyperplasia, endometrioid adenocarcinoma and normal proliferative endometrium, followed by the epithelium height; hence there are differences when variables are studied taking into account glandular morphology. Conclusions: there are morphometric differences between endometrial hyperplasia and endometrioid adenocarcinoma when there are studied variables taking into account glandular morphology and architecture (AU).

Zika virus detection in amniotic fluid and Zika-associated birth defects.

BACKGROUND: Zika virus infection during pregnancy can cause serious birth defects, which include brain and eye abnormalities. The clinical importance of detection of Zika virus RNA in amniotic fluid is unknown. OBJECTIVE: The purpose of this study was to describe patterns of Zika virus RNA testing of amniotic fluid relative to other clinical specimens and to examine the association between Zika virus detection in amniotic fluid and Zika-associated birth defects. Our null hypothesis was that Zika virus detection in amniotic fluid was not associated with Zika-associated birth defects. STUDY DESIGN: We conducted a retrospective cohort analysis of women with amniotic fluid specimens submitted to Colombia's National Institute of Health as part of national Zika virus surveillance from January 2016 to January 2017. Specimens (maternal serum, amniotic fluid, cord blood, umbilical cord tissue, and placental tissue) were tested for the presence of Zika virus RNA with the use of a singleplex or multiplex real-time reverse transcriptase-polymerase chain reaction assay. Birth defect information was abstracted from maternal prenatal and infant birth records and reviewed by expert clinicians. Chi-square and Fisher's exact tests were used to compare the frequency of Zika-associated birth defects (defined as brain abnormalities [with or without microcephaly, but excluding neural tube defects and their associated findings] or eye abnormalities) by frequency of detection of Zika virus RNA in amniotic fluid. RESULTS: Our analysis included 128 women with amniotic fluid specimens. Seventy-five women (58%) had prenatally collected amniotic fluid; 42 women (33%) had amniotic fluid collected at delivery, and 11 women (9%) had missing collection dates. Ninety-one women had both amniotic fluid and other clinical specimens submitted for testing, which allowed for comparison across specimen types. Of those 91 women, 68 had evidence of Zika virus infection based on detection of Zika virus RNA in ≥1 specimen. Testing of amniotic fluid that was collected prenatally or at delivery identified 39 of these Zika virus infections (57%; 15 [22%] infections were identified only in amniotic fluid), and 29 infections (43%) were identified in other specimen types and not amniotic fluid. Among women who were included in the analysis, 89 had pregnancy outcome information available, which allowed for the assessment of the presence of Zika-associated birth defects. Zika-associated birth defects were significantly (P<.05) more common among pregnancies with Zika virus RNA detected in amniotic fluid specimens collected prenatally (19/32 specimens; 59%) than for those with no laboratory evidence of Zika virus infection in any specimen (6/23 specimens; 26%), but the proportion was similar in pregnancies with only Zika virus RNA detected in specimens other than amniotic fluid (10/23 specimens; 43%). Although Zika-associated birth defects were more common among women with any Zika virus RNA detected in amniotic fluid specimens (ie, collected prenatally or at delivery; 21/43 specimens; 49%) than those with no laboratory evidence of Zika virus infection (6/23 specimens; 26%), this comparison did not reach statistical significance (P=.07). CONCLUSION: Testing of amniotic fluid provided additional evidence for maternal diagnosis of Zika virus infection. Zika-associated birth defects were more common among women with Zika virus RNA that was detected in prenatal amniotic fluid specimens than women with no laboratory evidence of Zika virus infection, but similar to women with Zika virus RNA detected in other, nonamniotic fluid specimen types.

Zika Virus Disease in Colombia - Preliminary Report.

BACKGROUND: Colombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. METHODS: Using the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of microcephaly for evidence of congenital ZVD. RESULTS: By April 2, 2016, there were 65,726 cases of ZVD reported in Colombia, of which 2485 (4%) were confirmed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay. The overall reported incidence of ZVD among female patients was twice that in male patients. A total of 11,944 pregnant women with ZVD were reported in Colombia, with 1484 (12%) of these cases confirmed on RT-PCR assay. In a subgroup of 1850 pregnant women, more than 90% of women who were reportedly infected during the third trimester had given birth, and no infants with apparent abnormalities, including microcephaly, have been identified. A majority of the women who contracted ZVD in the first or second trimester were still pregnant at the time of this report. Among the cases of microcephaly investigated from January 2016 through April 2016, four patients had laboratory evidence of congenital ZVD; all were born to asymptomatic mothers who were not included in the ZVD surveillance system. CONCLUSIONS: Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing. (Funded by Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).