Consensus for the treatment of upper urinary tract infections during pregnancy / Consenso para el tratamiento de la infección de vías urinarias altas durante la gestación

Objectives: To generate evidence-based recommendations through formal consensus regarding the treatment of upper urinary tract infections during gestation. Materials and methods: Experts in microbiology, public health, internal medicine, infectious diseases, obstetrics, maternal fetal medicine and obstetric and gynecological infections participated in the consensus development group. The group also included professionals with training in clinical epidemiology, systematic data search, and representatives from the Health Secretariat and the Bogota Obstetrics and Gynecology Association. The participants disclosed their conflicts of interest. Starting with a clinical question, outcomes were graded and a systematic search was conducted in the Medline via PubMed, Embase, Lilacs, and Bireme databases. The search was expanded to include institutional repositories and antimicrobial resistance surveillance systems, with no language or date restrictions. The search was updated on October 1, 2022. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to assess the quality of the evidence and determine the strength of the recommendations. Finally, the RAND/UCLA (Research and Development/University of California Los Angeles) methodology was applied for the formal consensus. This document was reviewed by academic peers before publication. Results: The following are the consensus recommendations. Recommendation 1. The initial management of pregnant women with upper urinary tract infections (UTIs) should be approached in a hospital setting. Recommendation 2. The use of second generation cephalosporins is the suggested first option for empirical antimicrobial management in pregnant women with upper UTI in order to improve the rates of clinical and microbiological cure. Recommendation 3. Because of the risk-benefit balance, the use of aminoglycosides is suggested as a second option for empirical antimicrobial treatment in pregnant women presenting with upper UTIs in the second and third trimester. Recommendation 4. The use of third-generation cephalosporins is suggested as the third option for empirical antimicrobial treatment in pregnant women with upper UTIs given that the risk of inducing microbial resistance is high with this group of antibiotics. Recommendation 5. The use of carbapenems is suggested as a first option in pregnant women with upper UTIs and a history of infections caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 6. The use of aminoglycosides or fourth-generation cephalosporins is suggested as a second option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third-generation cephalosporins, taking risk-benefit into account. Recommendation 7. The use of piperacillin/tazobactam is suggested as a third option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third or fourthgeneration cephalosporins. Recommendation 8. Getting a urine culture is recommended in pregnant women with upper UTIs before initiating empirical antimicrobial treatment. Recommendation 9. In pregnant women with upper UTIs, it is suggested to modify therapy in accordance with the results of the sensitivity test when the culture report shows resistance to the antimicrobial agent initiated empirically. Recommendation 10. In pregnant women hospitalized due to upper UTIs, it is suggested to switch to oral antimicrobial therapy after at least 48 hours of modulation of the systemic inflammatory response and the clinical signs of infection, and when tolerance to oral intake is adequate. Recommendation 11. In pregnant women with upper UTIs with no complications secondary to the primary infection, it is recommended to administer antibiotic therapy for a period of 7 to 10 days. Conclusions: It is expected that with this Colombian upper UTI consensus variability in clinical practice will be reduced. It is recommended that groups doing research in maternal fetal medicine assess the implementation and effectiveness of these recommendations.

Objetivos: generar recomendaciones informadas en la evidencia, a través de un consenso formal, orientadas al tratamiento de la infección de vías urinarias altas durante la gestación. Materiales y métodos: en el grupo desarrollador participaron expertos temáticos en microbiología, salud pública, medicina interna, infectología, obstetricia, medicina materno-fetal e infectología ginecobstétrica. También hicieron parte profesionales con entrenamiento en epidemiología clínica, búsqueda sistemática de la información, representantes de la Secretaría de Salud y la Asociación Bogotana de Obstetricia y Ginecología. Los participantes presentaron sus conflictos de interés. A partir de una pregunta clínica se realizó la graduación de los desenlaces y una búsqueda sistemática que abarcó las bases de datos Medline vía PubMed, Embase, Lilacs, Bireme. La pesquisa se amplió a repositorios institucionales y reportes de vigilancia de resistencia antimicrobiana, sin restricción de idioma o fecha, la búsqueda se actualizó el 1 de octubre de 2022. Se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para valorar la calidad de la evidencia y establecer la fuerza de las recomendaciones.Finalmente, se utilizó la metodología RAND/ UCLA (Research and Development/University of California Los Angeles) para el consenso formal. Este documento fue revisado por pares académicos previo a su publicación. Resultados: el consenso formuló las siguientes recomendaciones. Recomendación 1. Se sugiere que el manejo inicial de la gestante con infección de vías urinarias (IVU) altas se realice de forma intrahospitalaria. Recomendación 2. Como primera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de segunda generación con el fin de mejorar la tasa de cura clínica y microbiológica. Recomendación 3. Como segunda opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas en el segundo y tercer trimestre se realice con aminoglucósidos dado su balance riesgo-beneficio. Recomendación 4. Como tercera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de tercera generación, debido a que el riesgo de inducción de resistencia microbiana es alto con este grupo de antibióticos. Recomendación 5. Como primera opción, en mujeres gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de carbapenémicos. Recomendación 6. Como segunda opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera generación se sugiere el uso de aminoglucósidos o cefalosporinas de cuarta generación teniendo en cuenta el riesgo-beneficio. Recomendación 7. Como tercera opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de piperacilina/tazobactam. Recomendación 8. En gestantes con IVU altas se recomienda realizar urocultivo previo al inicio de tratamiento antimicrobiano empírico. Recomendación 9. En gestantes con IVU altas, cuando el urocultivo reporte resistencia al antimicrobiano iniciado de forma empírica, se sugiere modificar la terapia guiada por los resultados del antibiograma. Recomendación 10. En la gestante hospitalizada por IVU altas se sugiere realizar el cambio de terapia antimicrobiana a vía oral cuando la paciente tenga, al menos, 48 horas de modulación de respuesta inflamatoria sistémica y de los signos clínicos de infección, así como adecuada tolerancia a vía oral. Recomendación 11. En gestantes con IVU altas, sin complicaciones secundarias a la infección primaria, se recomienda que la terapia antibiótica se administre de 7 a 10 días. Conclusiones: se espera que este consenso colombiano de IVU altas reduzca la variabilidad en la práctica clínica. Se recomienda a los grupos de investigación en medicina materno fetal e infectología evaluar la implementación y efectividad de las recomendaciones emitidas.

A longitudinal study of free leptin index in pre-eclamptic pregnancies.

The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the aim of our study was to investigate the FLI in mild pre-eclamptic pregnancies in a nested case-control study within a prospective observational study. Circulating levels of leptin and sOB-R levels rise significantly during pregnancy in healthy (p < 0.05) (n = 46) and pre-eclamptic pregnancies (p < 0.05) (n = 20). Serum levels of leptin were significantly higher in pre-eclamptic compared to healthy pregnancies at second and third trimesters of pregnancy (p < 0.05). Additionally, serum levels of sOB-R were significantly lower in pre-eclamptic pregnancies during the second and third trimesters of pregnancy compared to healthy pregnancies (p < 0.05). Moreover, we found that FLI did not vary significantly during pregnancy in healthy women (p > 0.05), while it increases in pre-eclamptic pregnancies (p < 0.05). Indeed, FLI was significantly higher at second and third trimesters of pregnancy in pre-eclamptic compared to healthy pregnancies (p < 0.05). In addition, FLI was significantly higher in the luteal phase compared with the follicular phase of the menstrual cycle in eumenorrheic women (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed the ability of leptin (AUC = 0.72) and FLI (AUC = 0.67) as a reliable predictor for mild pre-eclampsia during the second trimester of pregnancy. In conclusion, our findings show that FLI were significantly increased in mild pre-eclamptic pregnancies and allowed us to hypothesize that this rise might alter leptin bioavailability and bioactivity which might lead to the sympathetic hyperactivity and the hypertensive disorders during pregnancy.

Consenso para el tratamiento de la infección de vías urinarias altas durante la gestación / Consensus for the treatment of upper urinary tract infections during pregnancy

Objetivos: Generar recomendaciones informadas en la evidencia, a través de un consenso formal, orientadas al tratamiento de la infección de vías urinarias altas durante la gestación. Materiales y métodos: En el grupo desarrollador participaron expertos temáticos en microbiología, salud pública, medicina interna, infectología, obstetricia, medicina materno-fetal e infectología ginecobstétrica. También hicieron parte profesionales con entrenamiento en epidemiología clínica, búsqueda sistemática de la información, representantes de la Secretaría de Salud y la Asociación Bogotana de Obstetricia y Ginecología. Los participantes presentaron sus conflictos de interés. A partir de una pregunta clínica se realizó la graduación de los desenlaces y una búsqueda sistemática que abarcó las bases de datos Medline vía PubMed, Embase, Lilacs, Bireme. La pesquisa se amplió a repositorios institucionales y reportes de vigilancia de resistencia antimicrobiana, sin restricción de idioma o fecha, la búsqueda se actualizó el 1 de octubre de 2022. Se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para valorar la calidad de la evidencia y establecer la fuerza de las recomendaciones. Finalmente, se utilizó la metodología RAND/ UCLA (Research and Development/University of California Los Angeles) para el consenso formal. Este documento fue revisado por pares académicos previo a su publicación. Resultados: El consenso formuló las siguientes recomendaciones. Recomendación 1. Se sugiere que el manejo inicial de la gestante con infección de vías urinarias (IVU) altas se realice de forma intrahospitalaria. Recomendación 2. Como primera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de segunda generación con el fin de mejorar la tasa de cura clínica y microbiológica. Recomendación 3. Como segunda opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas en el segundo y tercer trimestre se realice con aminoglucósidos dado su balance riesgo-beneficio. Recomendación 4. Como tercera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de tercera generación, debido a que el riesgo de inducción de resistencia microbiana es alto con este grupo de antibióticos. Recomendación 5. Como primera opción, en mujeres gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de carbapenémicos. Recomendación 6. Como segunda opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera generación se sugiere el uso de aminoglucósidos o cefalosporinas de cuarta generación teniendo en cuenta el riesgo-beneficio. Recomendación 7. Como tercera opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de piperacilina/tazobactam. Recomendación 8. En gestantes con IVU altas se recomienda realizar urocultivo previo al inicio de tratamiento antimicrobiano empírico. Recomendación 9. En gestantes con IVU altas, cuando el urocultivo reporte resistencia al antimicrobiano iniciado de forma empírica, se sugiere modificar la terapia guiada por los resultados del antibiograma. Recomendación 10. En la gestante hospitalizada por IVU altas se sugiere realizar el cambio de terapia antimicrobiana a vía oral cuando la paciente tenga, al menos, 48 horas de modulación de respuesta inflamatoria sistémica y de los signos clínicos de infección, así como adecuada tolerancia a vía oral. Recomendación 11. En gestantes con IVU altas, sin complicaciones secundarias a la infección primaria, se recomienda que la terapia antibiótica se administre de 7 a 10 días. Conclusiones: se espera que este consenso colombiano de IVU altas reduzca la variabilidad en la práctica clínica. Se recomienda a los grupos de investigación en medicina materno fetal e infectología evaluar la implementación y efectividad de las recomendaciones emitidas.

Objectives: To generate evidence-based recommendations through formal consensus regarding the treatment of upper urinary tract infections during gestation. Materials and methods: Experts in microbiology, public health, internal medicine, infectious diseases, obstetrics, maternal fetal medicine and obstetric and gynecological infections participated in the consensus development group. The group also included professionals with training in clinical epidemiology, systematic data search, and representatives from the Health Secretariat and the Bogota Obstetrics and Gynecology Association. The participants disclosed their conf licts of interest. Starting with a clinical question, outcomes were graded and a systematic search was conducted in the Medline via PubMed, Embase, Lilacs, and Bireme databases. The search was expanded to include institutional repositories and antimicrobial resistance surveillance systems, with no language or date restrictions. The search was updated on October 1, 2022. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to assess the quality of the evidence and determine the strength of the recommendations. Finally, the RAND/UCLA (Research and Development/University of California Los Angeles) methodology was applied for the formal consensus. This document was reviewed by academic peers before publication. Results: The following are the consensus recommendations. Recommendation 1. The initial management of pregnant women with upper urinary tract infections (UTIs) should be approached in a hospital setting. Recommendation 2. The use of second generation cephalosporins is the suggested first option for empirical antimicrobial management in pregnant women with upper UTI in order to improve the rates of clinical and microbiological cure. Recommendation 3. Because of the risk-benefit balance, the use of aminoglycosides is suggested as a second option for empirical antimicrobial treatment in pregnant women presenting with upper UTIs in the second and third trimester. Recommendation 4. The use of third-generation cephalosporins is suggested as the third option for empirical antimicrobial treatment in pregnant women with upper UTIs given that the risk of inducing microbial resistance is high with this group of antibiotics. Recommendation 5. The use of carbapenems is suggested as a first option in pregnant women with upper UTIs and a history of infections caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 6. The use of aminoglycosides or fourth-generation cephalosporins is suggested as a second option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third-generation cephalosporins, taking risk-benefit into account. Recommendation 7. The use of piperacillin/tazobactam is suggested as a third option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 8. Getting a urine culture is recommended in pregnant women with upper UTIs before initiating empirical antimicrobial treatment. Recommendation 9. In pregnant women with upper UTIs, it is suggested to modify therapy in accordance with the results of the sensitivity test when the culture report shows resistance to the antimicrobial agent initiated empirically. Recommendation 10. In pregnant women hospitalized due to upper UTIs, it is suggested to switch to oral antimicrobial therapy after at least 48 hours of modulation of the systemic inflammatory response and the clinical signs of infection, and when tolerance to oral intake is adequate. Recommendation 11. In pregnant women with upper UTIs with no complications secondary to the primary infection, it is recommended to administer antibiotic therapy for a period of 7 to 10 days. Conclusions: It is expected that with this Colombian upper UTI consensus variability in clinical practice will be reduced. It is recommended that groups doing research in maternal fetal medicine assess the implementation and effectiveness of these recommendations.

Study of the Ghrelin/LEAP-2 Ratio in Humans and Rats during Different Phases of Pregnancy.

The Liver-Expressed Antimicrobial Peptide 2 (LEAP-2) has emerged as an endogenous GHS-R antagonist and blunts the orexigenic action of ghrelin. This study aimed to determine the Ghrelin/LEAP-2 ratio in humans and rats during pregnancy. In humans, we conducted a nested case-control study within an observational prospective cohort. Healthy and mild preeclamptic pregnant women were studied at each trimester of gestation and three months postpartum. In addition, a group of non-pregnant women was studied into the follicular and luteal phases of the menstrual cycle. Furthermore, Ghrelin/LEAP-2 ratio was investigated in non-pregnant rats and at different periods of rat pregnancy. Human and rat serum ghrelin and LEAP-2 levels were determined using the commercially available ELISA kits. The Ghrelin/LEAP-2 ratio peak around the second trimester of gestation in healthy pregnant women (p < 0.05). Additionally, there were no statistically significant differences in Ghrelin/LEAP-2 ratio between healthy and preeclamptic pregnant women at each trimester of gestation (p > 0.05). The Ghrelin/LEAP-2 ratio in pregnant rat reached the peak around mid-gestation with a similar pattern to the human pregnancy. LEAP-2 was visualized by immunohistochemistry in human term placenta and rat placentas on days 12, 16 and 21 of pregnancy. In conclusion, this study provides the first evidence of a Ghrelin/LEAP-2 ratio peak around the half-way point of pregnancy onwards during human and rat pregnancy, and it might be associated with increased rates of weight gain during pregnancy. Thus, this study suggests that LEAP-2 and Ghrelin/LEAP-2 ratio might play an important role in maternal physiology adaptation of weight gain during pregnancy.

Maternal Fibroblast Growth Factor 21 Levels Decrease during Early Pregnancy in Normotensive Pregnant Women but Are Higher in Preeclamptic Women-A Longitudinal Study.

(1) Background: Fibroblast growth factor 21 (FGF-21) is an endocrine factor involved in glucose and lipid metabolism that exerts pleiotropic effects. The aim of this study was to investigate the serum FGF-21 profile in healthy and mild preeclamptic pregnant women at each trimester of pregnancy; (2) Methods: Serum FGF-21 levels were determined by ELISA in a nested case-control study within a longitudinal cohort study that included healthy (n = 54) and mild preeclamptic (n = 20) pregnant women, women at three months after delivery (n = 20) and eumenorrheic women during the menstrual cycle (n = 20); (3) Results: FGF-21 levels were significantly lower in the mid-luteal phase compared to the early follicular phase of the menstrual cycle in eumenorrheic women (p < 0.01). Maternal levels of FGF-21 were significantly lower in the first and second trimesters and peaked during the third trimester in healthy pregnant women (p < 0.01). Serum levels of FGF-21 in healthy pregnant were significantly lower in the first and second trimester of pregnancy compared with the follicular phase of the menstrual cycle and postpartum (p < 0.01). Serum FGF-21 levels were significantly higher in preeclamptic compared to healthy pregnant women during pregnancy (p < 0.01); (4) Conclusions: These results suggest that a peak of FGF-21 towards the end of pregnancy in healthy pregnancy and higher levels in preeclamptic women might play a critical role that contributes to protecting against the negatives effects of high concentrations of non-esterified fatty acids (NEFA) and hypertensive disorder. Furthermore, FGF-21 might play an important role in reproductive function in healthy eumenorrheic women during the menstrual cycle.

Successful laparoscopic approach to intraperitoneal bladder injury caused during gynecologic surgery. a case report

ABSTRACT Introduction: Urinary tract injuries are common in the context of pelvic surgery; however, there is little information in the medical literature on the management of these injuries using a laparoscopic approach. The following is the clinical case of a patient with intraperitoneal bladder injury secondary to gynecological pelvic surgery that was successfully treated using a laparoscopic approach. Moreover, a management algorithm is proposed based on the scientific data available. Case report. A 39-year-old female patient was admitted to the hospital with generalized abdominal pain and anuria three days after undergoing a left laparoscopic salpingectomy and resection of a migrated intrauterine device. Laboratory tests showed microhematuria, serum creatinine of 4.35mg/dL, and urea nitrogen of 35.2mg/dL. Computed tomography cystography showed a solution of continuity on the left posterolateral intraperitoneal bladder. The patient underwent successful laparoscopic treatment for the bladder injury, and two weeks later, retrograde cystography confirmed its adequate resolution. Conclusions. Based on the benefits of the laparoscopic approach and after extrapolating the outcomes of the laparoscopic management of bladder trauma, it can be concluded that the laparoscopic approach to surgical injuries of the bladder is a feasible therapeutic option.

RESUMEN Introducción. Las lesiones del tracto urinario son frecuentes en el contexto de la cirugía pélvica; sin embargo, existe poca información sobre su manejo por vía laparoscópica. Se presenta el caso de una paciente con una lesión vesical intraperitoneal secundaria a cirugía pélvica ginecológica, quien recibió manejo por abordaje laparoscópico, y se propone un algoritmo de tratamiento. Presentación del caso. Mujer de 39 años quién, luego de tres días de practicársele una salpingectomía izquierda y una resección del dispositivo intrauterino migrado mediante abordaje laparoscópico, consultó al servicio de urgencias por dolor abdominal generalizado y oligoanuria. Los exámenes de laboratorio evidenciaron microhematuria, creatinina sérica de 4.35mg/dl y nitrógeno ureico de 35,2mg/dl. En cistografía por tomografía computarizada (cisto-TC) se observó una solución de continuidad de la pared vesical posterolateral izquierda intraperitoneal. A la paciente se le trató la lesión vesical de forma exitosa por vía laparoscópica, y dos semanas después, también mediante cistografía retrógrada se confirmó una adecuada resolución de la misma. Conclusión. Dados los resultados satisfactorios del manejo laparoscópico en la paciente y los beneficios de esta técnica, se puede concluir que el abordaje laparoscópico de las lesiones quirúrgicas de la vejiga es una opción terapéutica factible.

Diagnostic Accuracy of Rapid Point-of-Care Tests for Detecting Active Syphilis: A Systematic Review and Meta-Analysis.

BACKGROUND: Syphilis represents an important cause of morbidity and mortality. Point-of-care (POC) test offers the advantages of diagnosing the condition and the possibility of starting treatment immediately. METHODS: MEDLINE, Embase, CENTRAL, LILACS, World Health Organization International Clinical Trials Registry Platform, Web of Science, OpenGrey, and DARE were searched without language restrictions from inception to September 30, 2020. Diagnostic test accuracy studies that enrolled men and nonpregnant women of reproductive age under field conditions were analyzed. Only studies wherein all the patients had undergone a rapid POC test and those that included the reference standard (treponemal plus nontreponemal test) were eligible for inclusion. Studies were independently assessed for inclusion, data extraction, and bias risk. The data from these studies were extracted for meta-analyses. The quality of the evidence was assessed using the GRADE approach. Registration Prospero CRD42018107532. RESULTS: Nine studies with 9666 participants were included. Nine POC brands were assessed. Sensitivities of the tests ranged from 0.67 to 1.00 and specificities from 0.93 to 1.00. The mean sensitivity and specificity of all the included studies was 0.86 (95% confidence interval, 0.79-0.91) and 0.98 (95% confidence interval, 0.96-0.99), respectively. CONCLUSIONS: Based on the results of this systematic review, the POC test for syphilis showed good sensitivity and excellent specificity.

Pelvic abscess mistaken for malignant ovarian tumor in a postmenopausal woman. case report

ABSTRACT Introduction: Tubo-ovarian abscesses are rare in postmenopausal women. They have been associated with benign gynecological conditions such as endometriosis, uterine polyp or leiomyoma, and malignant diseases such as endometrial adenocarcinoma, epithelial and non-epithelial malignant ovarian tumors, squamous cell carcinoma of the cervix, and adenocarcinoma of the colon. Their presentation represents a diagnostic and therapeutic challenge for clinicians. Case report: A 72-year-old female patient was admitted with a 3-day history of abdominal pain and distension, fever, irritative urinary symptoms and urinary retention. Lab tests on admission showed elevated white blood cells and neutrophils count, and CA-1 25 at 222 U/mL. Ultrasound and magnetic resonance imaging revealed a solid retrouterine cystic mass of 15 cm. Suspecting tumor versus tubo-ovarian abscess, a tomography-directed biopsy was performed, finding foul-smelling purulent material. An exploratory laparotomy was performed with intraoperative findings of solid-cystic retrouterine pelvic mass with purulent content, adhesions, and inflammatory involvement of the uterine tubes. Pathology reported ovarian fibroma and tubo-ovarian abscess. The patient evolved satisfactorily in the postoperative period and in the subsequent follow-up appointments. Conclusions: The reported case illustrates how a possibility of ovarian cancer with peritoneal carcinomatosis can actually be a benign condition (tubo-ovarian abscess) that responds well to medical-surgical treatment. Diagnostic imaging and tumor markers are helpful in differentiating a malignant ovarian disease from a benign process.

RESUMEN Introducción. Los abscesos tubo-ováricos son poco frecuentes en la posmenopausia y se asocian con patologías ginecológicas benignas como endometriosis, pólipo endometrial o leiomioma uterino, y con patologías malignas como adenocarcinoma de endometrio, tumores malignos epiteliales y no epiteliales de ovario, carcinoma escamocelular de cérvix y adenocarcinoma de colon. Su presentación representa un reto diagnóstico y terapéutico para el médico. Presentación del caso. Paciente femenina de 72 años, quien consultó por cuadro clínico de tres días de evolución consistente en dolor y distensión abdominal asociados a fiebre y síntomas urinarios irritativos y retención urinaria. Los exámenes de ingreso mostraron leucocitosis con neutrofilia y CA-125 en 222 U/mL El ultrasonido y la resonancia magnética evidenciaron una masa retrouterina solido-quística de 15 cm. Ante sospecha de tumor versus absceso tubo-ovárico, se realizó biopsia dirigida por tomografía mediante la cual se encontró material purulento fétido. Se practicó laparotomía que confirmó masa pélvica retrouterina sólido-quística con contenido purulento, adherencias y compromiso inflamatorio de las trompas uterinas. El resultado de patología informó fibroma ovárico y absceso tubo-ovárico. La paciente evolucionó de satisfactoriamente en el posoperatorio y en los controles posteriores. Conclusiones. El caso reportado ilustra cómo, en ocasiones, un posible diagnóstico de car-cinomatosis por cáncer de ovario puede ser realmente una patología benigna (absceso tubo-ovárico) que responde bien a un tratamiento médico-quirúrgico. Las imágenes diagnósticas y los marcadores tumorales son de gran ayuda para diferenciar una patología ovárica maligna de un proceso benigno.

Exercise-induced changes in miRNA expression in coronary artery disease.

OBJECTIVES: Micro ribonucleic acids (miRNAs) are small non-coding RNA molecules that control gene expression by translational inhibition. Exercise has been shown to affect several miRNAs' expression in healthy subjects, but this has not yet been studied in patients with coronary artery disease (CAD). Since exercise training confers beneficial long-term effects and may also trigger acute coronary events, it is of utmost interest to be able to identify those who are risk for untoward effects. Therefore, we set out to assess miRNA expression in response to maximal ergospirometry in patients with CAD. METHODS: Total RNA was extracted from blood drawn immediately before and 5 min after maximal cycle-ergospirometry (10 male and 10 female CAD patients). A qRT-PCR was performed for 187 target miRNAs associated with endothelial function/dysfunction, cardiovascular disease, myocardial infarction, and sudden cardiac death. RESULTS: In response to a maximal ergospirometry, 33 miRNAs significantly changed their expression levels. Of these miRNAs 16 were significantly differently expressed between gender. Using multi-variance analysis, nine miRNAs (let-7e-5p; miR-1; miR-19b-1-5p; miR-103a-3p; miR-148b-3p; miR-181b-5p; miR-188-5p; miR-423-5p; miR-874-3p) showed significantly different responses to maximal ergospirometry between genders. CONCLUSIONS: We report for the first time that in patients with CAD, miRNA expression is amenable to maximal ergospirometry and that the extent of changes differs between genders. Affected by exercise and gender were miRNAs that are associated, among others, with pathways for glucose metabolism, oxidative stress, and angiogenesis. Future studies should assess whether disease-specific miRNA expression in response to maximal exercise might serve as a marker for patient outcome.

Maternal Serum Angiopoietin-Like 3 Levels in Healthy and Mild Preeclamptic Pregnant Women.

Objective: Angiopoietin-like protein 3(ANGPTL3) is an important regulator of lipoprotein metabolism in the fed state by inhibiting the enzyme lipoprotein lipase in oxidative tissues. However, the possible role of ANGPTL3 throughout gestation and its relationship with hormonal and biochemical variables are still unknown. The aim of this study was to determinate serum ANGPTL3 level in healthy non-pregnant women, during healthy and preeclamptic pregnancy and postpartum. Methods: Serum ANGPTL3 was analyzed by enzyme-linked immunosorbent assay (ELISA), in a prospective cohort of healthy pregnant women (n = 52) and women with mild preeclampsia (n = 21), and women at three months postpartum (n = 20) and healthy non-pregnant women (n = 20). The results obtained were correlated with biochemical, hormonal and anthropometric variables and insulin resistance indices. Results: Levels of ANGPTL3 were not different between the follicular and the luteal phases of the cycle in healthy non-pregnant women. There was a significant reduction in serum ANGPTL3 levels from the first to the third trimester in healthy pregnant women compared with healthy non-pregnant and postpartum women (p <0.01). ANGPTL3 levels do not differ significantly during the three trimesters of pregnancy neither in healthy women nor in preeclamptic women. The serum levels of ANGPTL3 in women who developed preeclampsia are not statistically different from those observed in healthy pregnant women in each trimester of pregnancy. A significant lineal positive correlation was observed between serum ANGPTL3 levels and triglyceride (P =0.0186, r =0.52), very low-density lipoprotein cholesterol (P =0.0224, r =0.50), and total cholesterol levels (P =0.0220, r =0.50) in healthy non-pregnant women (P 0.05). Besides, there were no significant correlations between serum ANGPTL3 and body mass index (BMI), high-density lipoprotein cholesterol, glucose, insulin, leptin, or HOMA-IR (P >0.05). Conclusions: We describe for the first time the profile of ANGPTL3 throughout pregnancy and postpartum as well as and discussed about explore their potential contribution interactions with lipoprotein metabolism throughout pregnancy and postpartum. Thus, low levels of ANGPTL3 during pregnancy might favor lipid uptake in oxidative tissues as the main maternal energy source, while may helping to preserve glucose for use by the fetus and placenta.

Prevalence of high-risk human papilloma virus infection and abnormal cytology of the anal transformation zone in women with cervical dysplasia. Bogotá, Colombia, 2017-2019 / Prevalencia de infección por virus del papiloma humano de alto riesgo y citología anormal en la zona de transformación anal en mujeres con displasia cervical. bogotá, colombia, 2017-2019

RESUMEN Objetivo: Establecer la prevalencia de infección anal por virus de papiloma humano de alto riesgo (VPH- AR) y citología anal anormal en mujeres con displasia cervical confirmada. Materiales y métodos: Estudio de corte transversal que incluyó pacientes entre 30 y 65 años con diagnóstico nuevo de displasia cervical por histopatología, en dos unidades de colposcopia y patología del tracto genital inferior (una de carácter público y otra privada) entre diciembre de 2017 y abril de 2019. Se excluyeron mujeres con infección por virus de inmunodeficiencia humana (VIH), inmuno compromiso (uso de esteroides, trasplante, quimioterapia), en embarazo o con malformaciones anorrectales. Muestreo consecutivo. Se evaluaron variables sociodemográficas, tipo de relaciones sexuales, el grado de displasia cervical, resultado positivo de prueba de reacción en cadena de la polimerasa para VPH de alto riesgo en canal anal y tipo de VPH-AR identificado (16-18 u otro). Se utilizó estadística descriptiva. Resultados: De 188 candidatas a ingresar se incluyeron 100 pacientes en el análisis, se encontró unaprevalencia de 32 % de infección por VPH de alto riesgo y de 2,8 % de citología anal anormal (ASCUS) en el canal anal. El 68,8 % de las infecciones por VPH-AR en el canal anal correspondió a genotipos de VPH-AR diferentes a 16 o 18. Conclusiones: La prevalencia de infección anal por VPH-AR en mujeres con displasia cervical fue del 32 %. Es importante determinar la utilidad del tamizaje del compromiso de la mucosa anal por virus VPH de alto riesgo de cáncer en mujeres con displasia cervical. Se requieren estudios sobre el pronóstico de la infección anal por VPH-AR en las mujeres con displasia cervical.

ABSTRACT Objective: To determine the prevalence of anal infection caused by high risk human papilloma virus (HR-HPV) and of abnormal anal cytology in women with confirmed cervical dysplasia. Materials and methods: Cross sectional study that included patients between 30 and 65 years of age with a new diagnosis of cervical dysplasia by histopathology attended in two lower genital tract colposcopy and pathology units (one public and one private institution), conducted between December 2017 and April 2019. Women with human immunodeficiency virus (HIV) infection, immune compromise (use of steroids, transplant, chemo therapy), pregnancy or anorectal malformations were excluded. Consecutive sampling. Socio demographic variables, intercourse type, degree of cervical dysplasia, positive results of HR HPV Polymerase Chain Reaction test in anal canal and HR - HPV type indentified (16-18 or others) were evaluated. Descriptive statistics were used. Results: Of 188 candidates, 100 were included in the analysis. A 32 % prevalence of high-risk HPV infection and a 2.8 % prevalence of abnormal cytology in the anal canal (ASCUS) were found. Of the HR-HPV infections in the anal canal, 68.8 % corresponded to HR-HPV genotypes different from 16 or 18. Conclusions: Prevalence of HR HPV infection in women with lower genital tract dysplasia was 32%. It is important to determine the usefulness of screening for anal mucosa compromise by HPV virus associated with a high risk of cancer in women with cervical dysplasia. Studies are needed on the prognosis of anal HR-HPV infection in women with cervical dysplasia.

Acute Effects of Winter Sports and Indoor Cycling on Arterial Stiffness.

Sedentary lifestyle predisposes to endothelial dysfunction, increased arterial stiffness and cardiovascular diseases, all of which can be positively modified by regular physical exercise training. A decrease in physical activity during winter months coincides with higher rates of cardiovascular events. In order to identify winter sports suitable to overcome this seasonal exercise deficit and thus contribute to cardiovascular health, it was the aim of this study to compare immediate effects of cross-country skiing (XCS) and alpine skiing (AS) on arterial stiffness as an alternative to indoor cycling (IC). After baseline assessment, eighteen healthy subjects performed one session of XCS, AS, and IC in randomized order. Pulse wave analysis was conducted (Mobil-o-Graph®) before and 10-min after exercise. Parameters of arterial stiffness and wave reflection were reduced after XCS and IC, but not after AS: central systolic blood pressure (IC: -8.0 ± 5.4 mmHg; p < 0.001), amplitude of the backward pressure wave (IC: -1.4 ± 2.7 mmHg; p < 0.05), reflection coefficient (XCS: -6.0 ± 7.8%; IC: -5.7 ± 8.1%; both p < 0.1), and pulse wave velocity (IC by -0.19 ± 0.27 m/s; p < 0.01). Higher exercise intensities correlated with greater reductions of arterial stiffness (all p < 0.05). Single sessions of XCS, IC but not AS led to comparable improvement in arterial stiffness, which was even more pronounced during higher exercise intensities. With regard to arterial stiffness, IC and XCS emerge as more effective to counteract the winter exercise deficit and thus the deleterious cardiovascular effects of a sedentary lifestyle.

Sífilis congénita resultado de una Neurosífilis materna no diagnosticada. Reporte de caso / Congenital syphilis due to undiagnosed maternal neurosyphilis: case report

Resumen En el mundo, se ha evidenciado un aumento de los casos de sífilis, de sífilis gestacional y de sífilis congénita. Se presenta el caso de un recién nacido con sífilis congénita, hijo de una madre con sífilis latente de duración indeterminada (VDRL 1:4 diluciones) diagnosticada y tratada a la semana 12 de gestación, VIH negativa, con compañero seronegativo para sífilis; a pesar del tratamiento con tres dosis de 2'400 000 U de penicilina benzatínica, no modificó los títulos del VDRL ni en el control de la semana 25 de gestación, ni en el momento del parto. En el posparto, la madre fue diagnosticada con neurosífilis y recibió tratamiento con penicilina cristalina durante 14 días. El recién nacido fue diagnosticado con sífilis congénita por presentar VDRL 1:4 diluciones, aumento de aminotransferasas, hematuria y proteinuria, recibiendo tratamiento con penicilina cristalina durante 10 días. La paciente evolucionó favorablemente y el control a los 6 meses fue normal. Deben fomentarse medidas útiles en la prevención de la sífilis gestacional: métodos de barrera, conocimiento de la enfermedad y asistencia a control prenatal. Es fundamental identificar y tratar a las gestantes con sífilis mediante tamizaje serológico para prevenir la sífilis congénita; el seguimiento serológico debe ser estricto para verificar la eficacia del tratamiento e investigar las gestantes que no modifican los títulos después del tratamiento. MÉD.UIS.2020;33(1):73-80.

Abstract In the world, there has been an increase in cases of syphilis, gestational syphilis and congenital syphilis. It's presented the case of a newborn with congenital syphilis, son of a mother with latent syphilis of indeterminate duration (VDRL 1: 4 dilutions) diagnosed and treated at week 12 of gestation, HIV negative, with seronegative partner for syphilis; despite treatment with three doses of 2'400 000 U of benzathine penicillin, the VDRL titres remained unaltered on both the control of the 25th week of gestation and at the time of delivery. The mother, in the postpartum period, was diagnosed with neurosyphilis and was treated with crystalline penicillin for 14 days. The newborn was diagnosed with congenital syphilis by presenting 1:4 VDRL dilutions, increased aminotransferases, hematuria and proteinuria; he was treated with crystalline penicillin for 10 days. Useful measures should be promoted in the prevention of gestational syphilis such as barrier methods, knowledge of the disease and assistance to prenatal control. It is mandatory to identify and treat pregnant women with syphilis by serological screening for the disease in order to prevent congenital syphilis. Serological follow-up should be strict to verify the effectiveness of the treatment and to investigate pregnant women who do not modify the titres after treatment. MÉD.UIS.2020;33(1):73-80.

Prevalence of high-risk human papilloma virus infection and abnormal cytology of the anal transformation zone in women with cervical dysplasia. Bogotá, Colombia, 2017-2019.

OBJECTIVE: To determine the prevalence of anal infection caused by high risk human papilloma virus (HR-HPV) and of abnormal anal cytology in women with confirmed cervical dysplasia. METHODS: Cross sectional study that included patients between 30 and 65 years of age with a new diagnosis of cervical dysplasia by histopathology attended in two lower genital tract colposcopy and pathology units (one public and one private institution), conducted between December 2017 and April 2019. Women with human immunodeficiency virus (HIV) infection, immune compromise (use of steroids, transplant, chemo therapy), pregnancy or anorectal malformations were excluded. Consecutive sampling. Socio demographic variables, intercourse type, degree of cervical dysplasia, positive results of HR HPV Polymerase Chain Reaction test in anal canal and HR - HPV type indentified (16-18 or others) were evaluated. Descriptive statistics were used. RESULTS: Of 188 candidates, 100 were included in the analysis. A 32 % prevalence of high-risk HPV infection and a 2.8 % prevalence of abnormal cytology in the anal canal (ASCUS) were found. Of the HR-HPV infections in the anal canal, 68.8 % corresponded to HR-HPV genotypes different from 16 or 18. CONCLUSIONS: Prevalence of HR HPV infection in women with lower genital tract dysplasia was 32%. It is important to determine the usefulness of screening for anal mucosa compromise by HPV virus associated with a high risk of cancer in women with cervical dysplasia. Studies are needed on the prognosis of anal HR-HPV infection in women with cervical dysplasia.

TITULO: PREVALENCIA DE INFECCIÓN POR VIRUS DEL PAPILOMA HUMANO DE ALTO RIESGO Y CITOLOGÍA ANORMAL EN LA ZONA DE TRANSFORMACIÓN ANAL EN MUJERES CON DISPLASIA CERVICAL. BOGOTÁ, COLOMBIA, 2017-2019. OBJETIVO: Establecer la prevalencia de infección anal por virus de papiloma humano de alto riesgo (VPH- AR) y citología anal anormal en mujeres con displasia cervical confirmada. METODOS: Estudio de corte transversal que incluyó pacientes entre 30 y 65 años con diagnóstico nuevo de displasia cervical por histopatología, en dos unidades de colposcopia y patología del tracto genital inferior (una de carácter público y otra privada) entre diciembre de 2017 y abril de 2019. Se excluyeron mujeres con infección por virus de inmunodeficiencia humana (VIH), inmuno compromiso (uso de esteroides, trasplante, quimioterapia), en embarazo o con malformaciones anorrectales. Muestreo consecutivo. Se evaluaron variables sociodemográficas, tipo de relaciones sexuales, el grado de displasia cervical, resultado positivo de prueba de reacción en cadena de la polimerasa para VPH de alto riesgo en canal anal y tipo de VPH-AR identificado (16-18 u otro). Se utilizó estadística descriptiva. RESULTADOS: De 188 candidatas a ingresar se incluyeron 100 pacientes en el análisis, se encontró unaprevalencia de 32 % de infección por VPH de alto riesgo y de 2,8 % de citología anal anormal (ASCUS) en el canal anal. El 68,8 % de las infecciones por VPH-AR en el canal anal correspondió a genotipos de VPH-AR diferentes a 16 o 18. CONCLUSIONES: La prevalencia de infección anal por VPH-AR en mujeres con displasia cervical fue del 32 %. Es importante determinar la utilidad del tamizaje del compromiso de la mucosa anal por virus VPH de alto riesgo de cáncer en mujeres con displasia cervical. Se requieren estudios sobre el pronóstico de la infección anal por VPH-AR en las mujeres con displasia cervical.

Exercise responsive micro ribonucleic acids identify patients with coronary artery disease.

AIMS: Exercise is a trigger for acute coronary events especially in the untrained. Identifying subjects at risk remains a challenge. We set out to assess whether a distinct pattern of micro ribonucleic acids (miRNAs) expressed in response to an acute bout of all-out exercise might exist that would allow discrimination between health and disease. METHODS: Twenty healthy subjects and 20 patients with coronary artery disease (CAD) performed an all-out cycle ergometry. Total RNA was extracted from blood drawn before and after exercise. Each blood sample was analysed for 187 target miRNAs by quantitative reverse transcription polymerase chain reaction. RESULTS: At baseline, 18 miRNAs allowed discrimination between healthy subjects and CAD patients. In response to an acute all-out exercise in healthy subjects 51 miRNAs and in CAD patients 60 miRNAs were significantly modulated (all p < 0.05). Using logistic regression analysis, a unique pattern of pre-exercise miR-150-5p, post-exercise miR-101-3p, miR-141-3p and miR-200b-3p together with maximal oxygen uptake and maximal power corrected for bodyweight allowed discrimination between healthy subjects and CAD patients with an accuracy of 92.5%. CONCLUSION: In this most comprehensive analysis of exercise effects on circulating miRNAs to date we demonstrate for the first time that a distinct combination of miRNAs together with variables of exercise capacity allow robust discrimination between healthy subjects and CAD patients. We postulate that miRNAs may eventually serve as biomarkers to identify patients with CAD and possibly even those at risk of exercise-induced cardiac events.

Cervical carcinosarcoma: Case report and review of the literature / Carcinosarcoma del cuello uterino: reporte de caso y revisión de la literatura

ABSTRACT Objective: To report the case of a patient with cervical carcinosarcoma and intra-abdominal bleeding, and to review the available literature on the treatment and prognosis of this condition. Materials and methods: Case report of an 84-year-old patient who presented with an abdominal mass and urinary tract obstruction. During hospital stay, she developed intra-abdominal bleeding with signs of shock, requiring total abdominal hysterectomy with bilateral salpyngo-oophorectomy, hypogastric artery ligation and pelvic packing as interventions to control bleeding. Histology reported a diagnosis of carcinosarcoma of the uterine cervix. The patient evolved adequately and was referred for oncologic management. The search in the literature was conducted in the Medline vía PubMed, SciELO and Ovid databases, using the terms "uterine carcinosarcoma" "treatment" "cancer treatment" "treatment review" and "treatment outcome". The search was limited by language type but not by year of publication. Results: Of the references, 19 met the inclusion and exclusion criteria, and they were predominantly case reports. The clinical stage most frequently reported was FIGO IB in close to 53% of cases, and the most frequent presentation was genital bleeding associated with a pelvic mass. With an average follow-up of 15 months, survival in patients receiving radiotherapy or taken to surgery is 17% and 68%, respectively. Of the patients taken to surgery as primary treatment, 63% remained disease-free during the first two years of follow-up, with a frequency of nearly 100% during the same period when radiotherapy was given after surgery. Conclusions: Cervical carcinosarcoma is an infrequent condition whose most common clinical manifestation is the presence of genital bleeding accompanied by a pelvic mass. Surgery, radiotherapy and chemotherapy are therapeutic options available for the treatment of this entity. However, regardless of the treatment provided, survival prognosis in women with this disease is lower than in women with squamous cell carcinoma or adenocarcinoma. Further studies of high methodological quality are required to assess the safety and effectiveness of the various interventions used as therapeutic approach to this entity.

RESUMEN Objetivo: reportar el caso de una paciente con carcinosarcoma del cuello uterino con sangrado intraabdominal, y revisar la literatura disponible sobre el tratamiento y pronóstico de la entidad. Materiales y métodos: se reporta el caso de una paciente de 84 años, que consultó por masa abdominal y obstrucción del tracto urinario. Durante la estancia hospitalaria presentó sangrado intraabdominal con signos de choque, por lo que fue necesario realizar histerectomía abdominal total con salpingo-oforectomía bilateral, ligadura de hipogástricas y taponamiento de cavidad pélvica como intervenciones para controlar el sangrado. El estudio histológico reportó como diagnóstico carcinosarcoma del cérvix. La paciente evolucionó de forma adecuada y fue remitida para continuar manejo por oncología. Para la búsqueda de la literatura se realizó una pesquisa en las bases de datos Medline vía PubMed, SciELO y Ovid, utilizando los términos "uterinecarcinosarcoma" "treatment "cáncer treatment" "treatmentreview" y "treatmentoutcome". La búsqueda se limitó por tipo de idioma, pero no por año de publicación. Resultados: 19 estudios cumplieron con los criterios de inclusión y de exclusión, estas fueron predominantemente reportes de caso. El estadio clínico reportado con mayor frecuencia fue FIGO IB en cerca del 53 % de los casos, y la presentación más frecuente fue el sangrado genital acompañado de masa pélvica. Con un seguimiento promedio de 15 meses, la sobrevida para este tumor es del 17 % para las pacientes que recibieron radioterapia. El 63 % de las pacientes que recibieron cirugía como tratamiento primario permanecieron libres de enfermedad durante los dos primeros años de seguimiento, con una frecuencia cercana al 100% para este mismo periodo cuando se administró radioterapia posterior a la cirugía. Conclusiones: el carcinosarcoma de cérvix es una entidad poco frecuente, cuya manifestación clínica más común suele ser la presencia de sangrado genital acompañado de masa pélvica. Dentro de las opciones terapéuticas disponibles para tratar esta entidad se encuentran la cirugía, la radio y la quimioterapia. No obstante, independientemente del tratamiento proporcionado, el pronóstico de sobrevida para las mujeres con esta patología es inferior al de las mujeres con carcinomas escamosos o adenocarcinomas. Se requieren estudios de alta calidad metodológica que evalúen la seguridad y la efectividad de las diferentes intervenciones para el abordaje terapéutico de esta entidad.

Triglycerides/Glucose and Triglyceride/High-Density Lipoprotein Cholesterol Indices in Normal and Preeclamptic Pregnancies: A Longitudinal Study.

Metabolic changes have been correlated with adverse pregnancy outcomes. The aim of the present study is to determine the TyG and TG/HDL-c indices in a cohort of healthy pregnant (n = 142), preeclamptic (n = 18), and healthy nonpregnant women (n = 56). Preeclamptic women were selected from the same cohort. Pregnant women were followed during three periods of pregnancy and postpartum. The results showed a significant increase in the values of TyG and TG/HDL-c (p < 0.01) as pregnancy progresses, without significant differences between healthy and preeclamptic women. TyG and TG/HDL-c indices are significantly low in nonpregnant and three months' postpartum women when compared with each gestational period studied. TyG and TG/HDL-c indices are positively correlated with HOMA-IR in the early and middle pregnancy (p < 0.05). Multiple linear regression using the TyG and TG/HDL-c indices as dependent variables showed that TyG index was significantly associated with HOMA-IR, gestational age, HDL-c, TC, LDL, fasting insulin, and mean BP (p < 0.001); meanwhile, TG/HDL-c index was only associated with HOMA-IR (p < 0.0242) and gestational age (p < 0.001). In conclusion, the TyG and TG/HDL-c indices could be useful in monitoring insulin resistance during pregnancy.

Serum 25-hydroxyvitamin D levels throughout pregnancy: a longitudinal study in healthy and preeclamptic pregnant women.

BACKGROUND: Worldwide there is a high prevalence of 25-hydroxyvitamin D (25OHD) deficiency and has been associated with adverse outcomes during pregnancy. OBJECTIVE: This is a nested, case-control study in a longitudinal cohort to compare the serum 25OHD levels and other biomarkers throughout pregnancy in a group of 20 preeclamptic women and 61 healthy pregnant women. An additional group of 29 healthy non-pregnant women were also studied during the two phases of the menstrual cycle. RESULTS: Mean 25OHD levels in non-pregnant women were 31.9 ng/mL and 34.9 ng/mL during follicular and luteal phase, respectively (P < 0.01). Mean serum 25OHD levels in healthy pregnant women were 26.5, 30.1 and 31.9 ng/mL, at first, second and third trimester, respectively (P < 0.001). The first trimester levels of 25OHD were lower than those of healthy non-pregnant women (P < 0.001), showing a significant recovery at third trimester. In the group of healthy pregnant women, the 25OHD levels were 25.7 ng/mL and 27.2 ng/mL at 3 and 6 months postpartum, respectively; both values were lower than those observed in the non-pregnant women (P < 0.001). In preeclamptic women, 25OHD serum levels were similar to those of healthy pregnant women; nevertheless, they remained almost unchanged throughout pregnancy. CONCLUSION: There were no significant differences between healthy and preeclamptic pregnant women in terms of 25OHD levels throughout the pregnancy. Serum 25OHD levels in non-pregnant women were higher during luteal phase compared with follicular phase. The 25OHD levels of non-pregnant women tended to be higher than those of pregnant women.

First Colombian consensus on congenital Chagas and clinical approach for women of child-bearing age diagnosed with Chagas / Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas

Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. To generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: «Chagas disease/congenital¼, «prevention and control¼, «diagnosis¼, «therapeutics¼ and «pregnancy¼. Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-to-face discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas con- génito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos Mes (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizo, clasifico y organizo en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.