The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system.

OBJECTIVE: To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS: We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS: In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS: Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.

Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network.

BACKGROUND: The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES: To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS: This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS: In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION: Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System.

BACKGROUND: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Bases para el diseño de una política pública para la educación nutricional en enfermedades cardiometabólicas en el Municipio Maracaibo, Estado Zulia / Bases for the design of a public policy for nutritional education in cardiometabolic diseases in the municipality of Maracaibo, Zulia state

Las enfermedades cardiometabólicas son de alta prevalencia en edades donde existe una mayor productividad. Esta condición representa un problema público que implica su análisis en el ámbito de las políticas públicas localizadas en contextos específicos como el caso del Municipio Maracaibo del Estado Zulia en Venezuela. El estudio propone elaborar el diseño de una política pública relativa a la educación nutricional, mediante la gestión de proyectos estratégicos para prevenir, educar y controlar las referidas enfermedades. El estudio fue desarrollado durante el período 2019-2020. En lo metodológico se fundamentó en el enfoque de marco lógico que permiten cuestionar y analizar la realidad estudiada, a través de la organización de un diseño de investigación estructurado en un nivel prospectivo-estratégico que implica la sistematización del problema público. El resultado plantea un proyecto didáctico de intervención comunitaria orientado a disminuir la prevalencia de enfermedades cardiometabólicas en esta región del país, mediante un programa de educación nutricional para promocionar estilos de vida saludables. Se concluye que la definición de las enfermedades cardiometabólicas como problema estructurado en el ámbito social, es un prerrequisito para el diseño de una política pública, asociado a proyectos de educación nutricional que contribuyan a atenuar esta condición en la población(AU)

Cardiometabolic diseases are highly prevalent at ages where there is greater productivity. This condition represents a public problem that implies its analysis in the field of public policies located in specific contexts, such as the Maracaibo Municipality of the Zulia State - Venezuela. The study proposes to develop the design of a public policy related to nutritional education, through the management of strategic projects to prevent, educate and control the referred diseases. The study was developed during the 2019- 2020 period. Methodologically, it was based on the logical framework approach that allows questioning and analyzing the reality studied, through the organization of a structured research design at one level; prospective - strategic, and implies the systematization of the public problem. The result proposes a didactic community intervention project aimed at reducing the prevalence of cardiometabolic diseases in this region of the country, through a nutritional education program to promote healthy lifestyles. It is concluded that the definition of cardiometabolic diseases as a structured problem in the social sphere is a prerequisite for the design of a public policy, associated with nutritional education projects that contribute to mitigating this condition in the population(AU)

Insights into the development of grapefruit nutraceutical powder by spray drying: physical characterization, chemical composition and 3D intestinal permeability.

BACKGROUND: The development of functional and nutraceutical foods comes from a greater awareness of the relationship between food and health by consumers. In recent years, the idea of purifying and encapsulating bioactive compounds through techniques such as spray drying has been well received by the food industry. The development and characterization of a grapefruit (Citrus paradisi) nutraceutical powder obtained by spray drying is of great interest owing to the different bioactive compounds and the potential health effects. RESULTS: The grapefruit powder was characterized by a low water amount (1.5 g water per 100 g powder) and a high porosity (75%). The color parameters were L* = 80.0 ± 1.8, hab * = 61.7 ± 0.4 and Cab * = 11.4 ± 0.6. The IC50 values determined for the freeze-dried oxalic acid extract (FDOA) and the freeze-dried methanol-water extract (FDMW) were 0.48 and 0.72 mg mL-1 respectively, while the total phenolic content (TPC) ranged between 1274 and 1294 mg gallic acid equivalent (GAE) per 100 g dry basis (d.b.). Regarding total flavonoid content (TFC), FDOA presented the highest amount (6592 mg quercetin equivalent (QE) per 100 g d.b.). For both extracts, the cell viability in Caco-2 and HT29-MTX was above 90% at 100 µg mL-1 . The bioavailability of the bioactive compounds was analyzed through a 3D intestinal model. Delphenidin-3-glucoside and hesperitin-7-O-glucoside presented a permeation higher than 50%, followed by hesperidin which was close to 30%. CONCLUSION: This work allows to establish that the formulation of grapefruit powder has great potential as a nutraceutical food, with spray drying being a good alternative technique in the food industry. © 2019 Society of Chemical Industry.

Retos del sistema general de seguridad social y salud: prospectiva para el desarrollo social en la Costa Atlántico de Colombia / Challenges of the general system of social security and health: Prospective for social development in the Atlantic Coast of Colombia

Introducción: Concepción interdisciplinaria de la gestión del sistema de salud en el contexto latinoamericano, de acuerdo con lo establecido por la Organización Mundial de la Salud/ Organización Panamericana de la Salud. El artículo propone una estrategia prospectiva de desarrollo social en la Costa Atlántica de Colombia, para afianzar el funcionamiento, desde lo preventivo y asistencial, del Sistema General de Seguridad Social y Salud colombiano. Objetivo: Definir, desde una visión prospectiva para el desarrollo social colectivo, los retos del Sistema General de Seguridad Social y Salud colombiano. Método: Estudio exploratorio, fundamentado en el análisis teórico conceptual que permite derivar el sistema de relaciones de las categorías: gerencia del sistema de salud y desarrollo social colectivo. Se aplica la prospectiva estratégica, mediante el componente empírico-analítico, a través del cual se visualizan escenarios futuros que direccionen el desarrollo del sistema de salud a partir de la interacción entre sus actores representativos. Resultados: Se determinaron debilidades relacionadas con la gestión integral del Sistema General de Seguridad Social y Salud colombiano, específicamente en la Costa Atlántica. En esta región del país el escaso uso de técnicas prospectivas debilita la estrategia gerencial y minimiza la posibilidad de asumir retos y prever incertidumbres en uno de los sistemas que, a través de la efectividad de servicios de salud y calidad de vida, supone un indicador de desarrollo social colectivo. Conclusiones: Necesidad de visionar retos y escenarios para modelar la gestión del Sistema General de Seguridad Social y Salud en la Costa Atlántica de Colombia para afianzar la equidad, la inclusión y la calidad de vida e incrementar los estándares de gestión de la salud en colectivos y comunidades vulneradas(AU)

Introduction: There is an interdisciplinary basis conceived for the management of the health system in the Latin American context, in accordance with the provisions of WHO/PAHO and that is linked with related disciplines, such as management and education. This article proposes a prospective strategy of social development in the Atlantic Coast of Colombia to consolidate its functioning from the preventive and welfare perspectives in the Colombian's General System of Social Security and Health (SGSSS, by its acronym in Spanish). Objective: To define the challenges of the SGSSS from a prospective point of view for the collective social development. Method: An exploratory study, based on the conceptual, theoretical analysis to derive the relations´ system of the following categories: management of the health system, and collective social development. Strategic prospective is used by the empirical-analytical component to visualize future scenarios of probable occurrence that address the development of the health system from the interaction between its representative actors. Results: The weaknesses identified were related to the comprehensive management of the Colombian SGSSS, specifically on the Atlantic Coast, where the limited use of prospective techniques weakens the management strategy and minimizes the possibility of assuming challenges and anticipating uncertainties in one of the systems that through the effectiveness of health services and quality of life warrants responding to collective social development. Conclusions: There is a need to view challenges and scenarios for modeling the management of the SGSSS on the Atlantic Coast of Colombia to strengthen the equity, inclusion and quality of life, and to increase the standards of health management in vulnerable groups and communities(AU)

Retos del sistema general de seguridad social y salud: prospectiva para el desarrollo social en la Costa Atlántico de Colombia / Challenges of the general system of social security and health: Prospective for social development in the Atlantic Coast of Colombia

Introducción: Concepción interdisciplinaria de la gestión del sistema de salud en el contexto latinoamericano, de acuerdo con lo establecido por la Organización Mundial de la Salud/ Organización Panamericana de la Salud. El artículo propone una estrategia prospectiva de desarrollo social en la Costa Atlántica de Colombia, para afianzar el funcionamiento, desde lo preventivo y asistencial, del Sistema General de Seguridad Social y Salud colombiano. Objetivo: Definir, desde una visión prospectiva para el desarrollo social colectivo, los retos del Sistema General de Seguridad Social y Salud colombiano. Método: Estudio exploratorio, fundamentado en el análisis teórico conceptual que permite derivar el sistema de relaciones de las categorías: gerencia del sistema de salud y desarrollo social colectivo. Se aplica la prospectiva estratégica, mediante el componente empírico-analítico, a través del cual se visualizan escenarios futuros que direccionen el desarrollo del sistema de salud a partir de la interacción entre sus actores representativos. Resultados: Se determinaron debilidades relacionadas con la gestión integral del Sistema General de Seguridad Social y Salud colombiano, específicamente en la Costa Atlántica. En esta región del país el escaso uso de técnicas prospectivas debilita la estrategia gerencial y minimiza la posibilidad de asumir retos y prever incertidumbres en uno de los sistemas que, a través de la efectividad de servicios de salud y calidad de vida, supone un indicador de desarrollo social colectivo. Conclusiones: Necesidad de visionar retos y escenarios para modelar la gestión del Sistema General de Seguridad Social y Salud en la Costa Atlántica de Colombia para afianzar la equidad, la inclusión y la calidad de vida e incrementar los estándares de gestión de la salud en colectivos y comunidades vulneradas(AU)

Introduction: There is an interdisciplinary basis conceived for the management of the health system in the Latin American context, in accordance with the provisions of WHO/PAHO and that is linked with related disciplines, such as management and education. This article proposes a prospective strategy of social development in the Atlantic Coast of Colombia to consolidate its functioning from the preventive and welfare perspectives in the Colombian's General System of Social Security and Health (SGSSS, by its acronym in Spanish). Objective: To define the challenges of the SGSSS from a prospective point of view for the collective social development. Method: An exploratory study, based on the conceptual, theoretical analysis to derive the relations´ system of the following categories: management of the health system, and collective social development. Strategic prospective is used by the empirical-analytical component to visualize future scenarios of probable occurrence that address the development of the health system from the interaction between its representative actors. Results: The weaknesses identified were related to the comprehensive management of the Colombian SGSSS, specifically on the Atlantic Coast, where the limited use of prospective techniques weakens the management strategy and minimizes the possibility of assuming challenges and anticipating uncertainties in one of the systems that through the effectiveness of health services and quality of life warrants responding to collective social development. Conclusions: There is a need to view challenges and scenarios for modeling the management of the SGSSS on the Atlantic Coast of Colombia to strengthen the equity, inclusion and quality of life, and to increase the standards of health management in vulnerable groups and communities(AU)

Manual Venezolano de Diabetes Gestacional

La diabetes mellitus gestacional (DMG) es uno de los trastornos metabólicos más frecuentes que pueden afectar el embarazo. Su prevalencia aumenta en la misma proporción que la epidemia de obesidad y sobrepeso. Reconocer y tratar cualquier grado de alteración de la glucemia que afecte la gestación conduce a la disminución de complicaciones maternas y fetales, inmediatas y a largo plazo. A pesar de un cúmulo de investigación básica y clínica, aun no existe un enfoque único para diagnosticar y tratar la diabetes durante el embarazo. Lo deseable para nuestro país es buscar la uniformidad de criterios en la pesquisa y el diagnóstico de la DMG, y de esa manera, poder tener nuestra propia casuística. Es por ello que la Sociedad Venezolana de Endocrinología y Metabolismo ha concebido la idea de elaborar este Manual de Diabetes Gestacional, con la colaboración de la Sociedad de Obstetricia y Ginecología de Venezuela, la Sociedad Venezolana de Medicina Interna y Especialistas que integran el equipo multidisciplinario de atención a la embarazada de alto riesgo conformado por endocrinólogos, internistas, obstetras, nutricionistas, deportólogos y/o biólogos del ejercicio y neonatólogos, para que pueda ser utilizado tanto a nivel primario como en áreas de especialización. Este manual se enfocará en la prevención, la pesquisa, el diagnóstico, el tratamiento y seguimiento de la Diabetes Mellitus Gestacional, pudiendo servir de base para la integración del equipo de salud que se constituya para atender a nuestra paciente.

Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders that can affect pregnancy. Its prevalence increases in the same proportion as the epidemic of obesity and overweight. Recognize and treat any degree of impaired glucose affecting pregnancy leads to decreased maternal and fetal, immediate and long-term complications. Despite a wealth of basic and clinical research, there is no single approach to diagnose and treat diabetes during pregnancy. Desirable for our country is to seek uniformity of criteria in the screening and diagnosis of GDM and thus able to have our own casuistry. That is why the Venezuelan Society of Endocrinology and Metabolism has conceived the idea of a Manual of Gestational Diabetes, in collaboration with the Society of Obstetrics and Gynecology of Venezuela, the Venezuelan Society of Internal Medicine and specialists who make up the multidisciplinary care team high-risk pregnant formed with endocrinologists, internists, obstetricians, nutritionists, exercise physiologists and/or biologists exercise and neonatologist so that it can be used both at the primary level and areas of expertise. This manual will focus on prevention, screening, diagnosis, treatment and monitoring of Gestational Diabetes Mellitus and can serve as a basis for integrating health team to serve our patient.

Sugammadex en paciente neonatal / Sugammadex in the neonatal patient

Introducción: La inclusión de drogas que revierten efectivamente el bloqueo de la placa neuromuscular mejora el perfil de uso de los medicamentos que la relajan, y más aún si estos carecen de efectos adversos de importancia clínica y se pueden emplear en neonatos. Objetivos: Este artículo describe el caso de 2 pacientes pediátricos en quienes se aplicó sugammadex para la reversión de la relajación neuromuscular. Metodología: Estudio observacional descriptivo retrospectivo con un diseño de reporte de casos. Resultados: Se describe el uso exitoso de sugammadex para la reversión del bloqueo neuromuscular inducido por rocuronio en 2 pacientes neonatos y la ausencia de eventos adversos. Discusión: La literatura para el uso de sugammadex en pacientes recién nacidos es poca y controvertida, lo cual no apoya su amplia prescripción en neonatología debido a la falta de estudios que aseguren su efectividad y la ausencia de efectos adversos. No existen dosis recomendadas por grupo etario y una lista de efectos adversos esperables que contraindiquen su administración. Aun así, es ideal poder disponer de medicamentos que reviertan la relajación derivada del uso de bloqueadores neuromusculares en cualquier edad, lo cual incluye a los pacientes neonatos. Conclusiones: Tras una dosis de sugammadex se describe la reversión del bloqueo neuromuscular en 2 pacientes neonatos, siendo esta efectiva para la restauración funcional de la placa neuromuscular. Para poder recomendar su amplio uso en recién nacidos es ideal la realización de estudios experimentales controlados.

Introduction: The inclusion of drugs that effectively reverse the neuromuscular junction blockade enhances the profile of drugs used for relaxation of the neuromuscular junction; better yet if these agents are free from any clinically important adverse effects and amenable to use in neonates. Objectives: This article describes a case of two pediatric patients who received Sugammadex to reverse neuromuscular relaxation. Methodology: Retrospective, descriptive, observational study designed as a case report. Results: This is a description of a Sugammadex successful reversal of Rocuronium-induced neuromuscular blockade in two neonates with no adverse events. Discussion: The literature on the use of Sugammadex in newborn patients is scarce and controversial which does not contribute to a broad prescription of the drug in neonatology settings due to the shortage of studies attesting to its effectiveness and absence of adverse effects. There are no recommended doses per age group and a list of expected adverse effects to contraindícate its administration. However, the idea is to have available drugs that reverse the relaxation resulting from the use of neuromuscular blockers at any age, including neonates. Conclusions: Following the administration of a dose of Sugammadex the reversal of neuromuscular blockade in neonate patients is described with effective functional recovery of the neuromuscular junction. Further experimental controlled trials are needed to recommend the use of Sugammadex in newborn babies.

Hallazgos ecográficos en fetos con alteraciones cromosómicas / Ecographic findings in fetus with cromosomal alterations

Describir los hallazgos ecográficos detectados en los fetos y su relación con el cariotipo anormal obtenido en las amniocentesis genéticas realizadas en el segundo trimestre. Se revisaron todos los informes de los estudios ecográficos realizados previamente a la amniocentesis de los fetos que resultaron con cromosomopatías durante el año 2006. Centro Nacional de Genética Humana y Experimental. Universidad Central de Venezuela. Caracas. En 1786 amniocentesis, se obtuvieron 32 fetos (1,79 por ciento) con cromosomopatías, siendo la trisomía 21 la más frecuente (47 por ciento). De todos los casos con alteraciones cromosómicas 15 fetos (46,9 por ciento) tuvieron uno o más marcadores ecográficos. Los hallazgos ecográficos encontrados en el grupo general fueron pliegue nucal engrosado en 40 por ciento, higroma quístico en 19,5 por ciento, ectasia pielocalicial en 12,5 por ciento, e intestino hiperecogénico, ausencia de hueso nasal, foco ecogénico intracardíaco y pie equino varo, cada uno en un 7 por ciento. Un 53 por ciento de los fetos con trisomía 21 presentaron algún tipo de hallazgo ecográfico anormal, así mismo un 67 por ciento de los fetos con trisomía 18 y 100 por ciento de los fetos que tenían monosomía X, trisomía 22 y triploidía. El ultrasonido juega un papel muy importante en el diagnóstico prenatal. El diagnóstico apropiado de las anomalías estructurales y hallazgos menores, incrementa la sospecha de alguna alteración cromosómica y puede sugerir la realización de procedimientos invasivos de diagnóstico prenatal

To describe the abnormalities detected by detailed second trimester ultrasonography among the fetuses with abnormal karyotype after amniocentesis. Ultrasound studies belonging to fetuses with diagnosed chromosomal anomalies in 2006 were reviewed. Centro Nacional de Genética Humana y Experimental. Universidad Central de Venezuela. Caracas. A total of 1,786 patients underwent amniocentesis with a result of 32 (1.79 percent) fetuses detected with an abnormal karyotype, trisomy 21 (47 percent). Out of all cases with chromosomal anormalies 15 fetuses (46.9 percent) had one or more sonographic markers. Ultrasound markers were: increased nucal fold 40 percent , cystic hygroma (19.5 percent) , pyelectasis 12.5 percent, and echogenic bowel, absent nasal bone, echogenic intracardiac foci and club foot (7 percent) each one. A 53 percent of fetuses with trisomy 21 had some adnormal sonographic marker, as well as 67 percent of trisomy 18 and 100 percent of fetuses with X0, trisomy 22 and triploidy. The second trimester ultrasound plays an important role in prenatal diagnosis. The appropriate detection of structural anomalies and sonographic markers increase the diagnosis of aneuploidies and can suggest the necessity to practice an invasive study

Tratamiento actual del ataque cerebrovascular isquémico (ACV) agudo / Current treatment of acute stroke

El tratamiento del ataque cerebrovascular isquémico (ACV) agudo cambió desde la publicación, en 1995, de los resultados del estudio NINDS (National Institute of Neurological Disorders and Stroke Trial) con activador tisular del plasminógeno. En este artículo se hace una revisión de la fisiopatología del ACV isquémico agudo, la generación del edema, la evaluación clínica, las pruebas diagnósticas, los estudios clínicos, y los criterios de inclusión y de exclusión para la trombólisis intravenosa al cabo de tres horas del inicio de los síntomas.

Anatomía del útero y ovarios del capibara (Hydrochoerus hydrochaerys): irrigación arterial / Anatomy of the uterus and ovaries in the capibara (Hydrochoerus hydrochaeris): arterial irrigation

El objetivo de esta investigación fue describir el patrón vascular arterial del útero y los ovarios del Capibara (Hydrochoerus hydrochaeris). Para llevar a cabo este estudio se emplearon las técnicas de disección simple, clarificación de tejidos y microscopia óptica. Se evaluó un total de quince (15) hembras postpúberes de diferentes edades (6 meses a 2 años de edad). Este estudio demostró que la disposición anatómica de los cuernos, cuerpo y cuello del útero presenta características similares a las descritas en algunas especies de animales domósticos como la perra y la gata, y algunos roedores como la rata y el hamster. El tracto reproductivo está irrigado principalmente por la arteria ovárica, uterina y vaginal, las cuales establecen anastomosis ipsilaterales entre ellas y contralaterales entre las arterias uterinas y vaginales. Se evidenció que la arteria uterina representa la principal fuente de sangre arterial del ovario, enviando ramas segmentales hacia el cuerno y el cuerpo uterino, dividiéndose en su terminación en dos ramas que profundizan las paredes de ambas estructuras, anastomosándose con sus congéneres del lado opuesto. Se requiere más investigación en esta área para complementar la descripción de la irrigación arterio-venosa, lo cual permitiría un mejor entendimiento de la Fisiología reproductiva y el comportamiento sexual en esta especie.

Derivaciones arteriovenosas en el pediculo vascular utero-ovárico de la perra (Canis familiaris) / Venoarterial pathways in the uteroovarian pedicle of the bitch (Canis familiaris)

Mediante técnica de disección simple, clarificación de tejidos, maceración tisular y microscop¡a electrónica de barrido, se estudió la vascularización de los genitales internos de la perra (Canis familiaris) en un total de nueve (9) hembras cíclicas. Este estudio demostró que el tracto reproductivo está irrigado principalmente por las arterias ovárica, uterina, vaginal y vestibular, las cuales establecen anastomosis ipsilaterales entre todas ellas y contralaterales entre la uterina, vaginal y vestibular. En el ligamento ancho, la vena uterina forma un circuito de dos ramas que se anastomosan craneal y caudalmente para permitir la conexión venosa entre el ovario y el cuerno ipsilateral. La vena ovárica presenta una válvula bicúspide bien desarrollada aproximadamente a 3 cm. del polo caudal del ovario. En esta área, la arteria ovárica emite varias ramas que establecen una conexi¢n vascular directa entre la arteria y la vena, siendo la primera vez que se reporta una evidencia microfotográfica de anastomosis arteriovenosas en el pedículo vascular interovárico.

Shock anafiláctico inducido por látex simulando reacción a la oxitocina: caso clínico / Latex induced anaphylactic shock simulating an oxytocin reaction: case report

Se reporta el caso de un shock anafiláctico y paro cardiorrespiratorio debido al látex en una paciente primigesta durante una cesárea segmentaria en relación temporal a la administración de oxitócicos. La paciente permanece hospitalizada en la unidad de cuidados intensivos, evolucionando satisfactoriamente. Se realizan posteriormente pruebas de hipersensibilidad, resultando positivas al látex

Sirenomelia asociada a defectos del tubo neural: reporte de un caso clínico y revisión de la literatura / Sirenomelia rarely associated to neural tube: a case clinic report and review literature

Se presenta el caso de una paciente primigesta de 20 años de edad y sin antecedentes pertinentes, controlada por el Servicio de Prenatal de nuestro centro. Es hospitalizada con los diagnósticos de: embarazo de 20 semanas y malformaciones fetales múltiples. Expulsa feto masculino con sirenomelia asociada extrañamente a anencefalia, cráneo-raquisquisis y esbozos auriculares. Se realiza el examen anatomopatológico correspondiente y se verifican otros hallazgos

El embarazo en adolescentes: un problema de alto riesgo obstétrico / Adolescent prenatal: a high obstetric risk

Valorar el control prenatal y los antecedentes preconcepcionales de las adolescentes embarazadas. Estudio retrospectivo, de 127 pacientes adolescentes embarazadas controladas y atentidas en la Maternidad "Concepción Palacios" entre 1987 y 1994. Servicio de Prenatal, Maternidad Concepción Palacios. La incidencia fue 2,71 por ciento, con un promedio de edad de 15,3 años. El control prenatal se inició en promedio a las 24,5 semanas y el número de consultas fue 6,17. En comparación con la población general se observó mayor frecuencia de trabajo de parto prematuro, hipertensión inducida por el embarazo y ruptura prematura de membranas. El embarazo en las adolescentes debe ser considerado como alto riesgo por la alta incidencia de complicaciones obstétricas y morbilidad materno fetal

Quiste del plexo coroideo: reporte de dos casos / Cyst of the choroid plexus: report of a case

El quiste del plexo coroideo es un hallazgo ecográfico y en ocasiones, se asocia a trisomía 18 ó 21. Se presentan dos casos en fetos con cariotipo normal y resolución espontánea. Cuando se observan recomendamos buscar otras alteraciones mediante el ecosonograma de II nivel, y plantear el estudio genético si existen anormalidades asociadas.

Tracoma en Venezuela: nuevos casos / Tracoma in Venezuela: new cases

Se presentan 6 casos de tracoma obtenidos de la consulta de nuestro servicio, producto de una pesquisa realizada a un grupo de la comunidad. Se hacen consideraciones clínicas, epidemiológicas, terapéuticas, anatomopatológicas e históricas del tracoma