Ética en el control perinatal en relación a mortalidad materna en el Perú, 2007 / Ethics in perinatal control in relation to maternal mortality in Peru, 2007

INTRODUCCIÓN: La mayoría de muertes maternas se producen en países en vías de desarrollo; Perú el año 2007 fue el segundo país con la más alta tasa de mortalidad materna en Sudamérica, lo cual podría deberse a un déficit en la cobertura y la calidad de los servicios de salud. OBJETIVO: Evaluar la relación estadística entre el control perinatal y la mortalidad materna por departamentos en el Perú. MATERIAL Y MÉTODO: Estudio ecológico con corte transversal bivariado. Se estudiaron la razón de mortalidad materna y 6 indicadores del control perinatal (primera atención prenatal durante el primer trimestre de gestación, partos institucionales, entre otros) del año 2007 por departamentos en el Perú. La información se obtuvo de fuentes oficiales: Encuesta Nacional Demográfica y de Salud familiar y Ministerio de Salud. Se utilizó el programa Epidat 3.1. Se determinó Odds ratio y chi cuadrado y un nivel de confianza del 95 por ciento. RESULTADOS: Únicamente se encontró asociación estadísticamente significativa (p<0,05) entre mortalidad materna con: primera atención prenatal durante el primer trimestre de gestación, partos institucionales, partos atendidos por personal calificado y atención postnatal. Sólo se pudo calcular el Odds ratio para atención postnatal: probabilidad del 95,45 por ciento de que exista una alta razón de mortalidad materna cuando existe una pobre cobertura de atenciones postnatales. DISCUSIÓN: En el Perú, la poca cobertura de primera atención durante el primer trimestre, partos institucionales, y partos por profesional calificado están asociados a mortalidad materna. Un especial interés debe existir en la prevención de la mortalidad materna mejorando la atención postnatal.

INTRODUCTION: Most maternal deaths occur in developing countries, Peru was the second country with the highest maternal mortality rate in South America in 2007, which could be dueto gaps in coverage and quality of health services. OBJECTIVE: To evaluate the statistical relationship between perinatal care and maternal mortality in the departments of Peru. MATERIALAND METHOD: transversal bivariate ecological study. Maternal mortality ratio at 2007 and its relation to 6 indicators of perinatal care (first prenatal care during the first trimester of pregnancy, institutional births, among others) were studied using departments as analysis unit. The information was obtained from official sources: Encuesta demográfica y de salud familiar 2007 and Ministerio de Salud. Software Epidat 3.1 was used for the analysis. Odds ratio and chi squared were obtained with a confidence level of 95 percent. RESULTS: It was only found statistically significant association (p <0.05) between maternal mortality and first prenatal care during the first trimester of pregnancy, institutional births, births attended by skilled staff and postnatal care. It was only possible to calculate Odds ratio for postnatal care indicator, which showed 95.45 percent of probability of higher maternal mortality rate when there is poor postnatal care coverage. DISCUSSION: In Peru, the low coverage of first prenatal care during the first trimester of pregnancy, institutional births and births attended by qualified personnel are associated to maternal mortality. Postnatal care should be considered with special interest in order to prevent maternal mortality.

Quiste hepático ciliado embrionario multilocular. Aportación de un nuevo caso y revisión de la literatura / A new multilocular ciliated hepatic foregut cyst. Case report and review of the literature

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Effect of pregnancy on the roles of nitric oxide and prostaglandins in 5-hydroxytryptamine-induced contractions in rat isolated thoracic and abdominal aorta.

1. Vascular resistance and sensitivity to circulating pressor and vasoconstrictor substances are blunted during pregnancy. This has been attributed mainly to an increased production of endothelium-derived mediators. The aim of the present study was to determine whether pregnancy changes the relative participation of nitric oxide (NO) and prostaglandins (PG) in the modulation of the contractile response to 5-hydroxytryptamine (5-HT) in two anatomically distint segments of the rat aorta. 2. Full concentration-response curves to 5-HT were obtained in isolated rings from the thoracic and abdominal portion of the aorta from pregnant and non-pregnant rats in the presence and absence of the NO synthase (NOS) inhibitor N(G)-nitro-l-arginine methyl ester (L-NAME; 10 micromol/L) or the PG synthesis inhibitor indomethacin (10 micromol/L). Cyclo-oxygenase (COX)-1, COX-2 and endothelial (e) NOS protein expression were determined in the same tissues by immunoblot. 3. The effects of pregnancy were accentuated in the abdominal compared with the thoracic aorta. In addition, the relative participation of the NO and PG pathways seems to be changed during pregnancy. Although NO seems to be the mediator mainly responsible for the effect of pregnancy in the thoracic aorta, our results suggest a complex interaction between NO and PG in the abdominal aorta. Indomethacin significantly reduced the contractile response of both segments of the aorta, whereas expression of COX-1, COX-2 and eNOS were increased only in the abdominal segment of pregnant animals. 4. These results show that the effect of pregnancy is not homogeneous along the aorta. There seems to be a mutual interaction between PG and NO in the abdominal, but not in the thoracic, aorta from pregnant rats: the role of NO becomes evident in the absence of vasodilatory PG, whereas the participation of the latter increases in the absence of NO working as a compensatory mechanism.

Breast metastasis of primary colon cancer.

Metastatic tumors to the breast from colon adenocarcinoma are very rare. They are usually indicative of disseminated disease, and the prognosis is poor. Generally, radical operation should be avoided unless needed for palliation. This case report described a patient with breast metastasis from colon adenocarcinoma treated by simple mastectomy.

Ketoconazole in bipolar patients with depressive symptoms: a case series and literature review.

BACKGROUND: Data from several studies suggest that medications, such as ketoconazole, which lower cortisol levels, may be effective for major depressive disorder (MDD). As with MDD, the manic, depressive, and mixed phases of bipolar disorder are frequently associated with elevated cortisol levels. The literature on the use of cortisol-lowering strategies in mood disorders is reviewed, and a case series illustrating the use of ketoconazole in bipolar depression is presented. METHODS: For the review, the MEDLINE and PSYCHINFO databases were searched, as were the bibliographies of pertinent articles to find papers on the use of cortisol-lowering agents in patients with mood disorders. In our open-label case series (n = 6), ketoconazole (up to 800 mg/day) as an add-on therapy was given to patients with treatment-resistant or intolerant bipolar I or II disorders with current symptoms of depression. RESULTS: Several case reports and small open studies suggest that cortisol-lowering agents may be useful for patients with depression. Two recent placebo-controlled trials of ketoconazole on patients with MDD report conflicting results. In our case series, all three patients who received a dose of at least 400 mg/day had substantial reductions in depressive symptoms. None had significant increases in mania. However, cortisol levels were not lowered in any of the subjects. CONCLUSIONS: The literature suggests that cortisol-lowering medications may be effective for a subset of depressed patients. Our preliminary findings suggest that ketoconazole may be useful in some patients with bipolar depression. Larger clinical trials are needed to confirm our observations.

Intrachromosomal triplication of distal 7p.

A female infant who died at 2 years of age with growth and psychomotor retardation, wide anterior fontanelle, downward slanting palpebral fissures, large, simple ears, joint dislocation/contractures, recurrent infections, and severe pulmonary hypertension was found to have a de novo 7p+ chromosome. The G banding pattern was suggestive of a triplication of 7p21.3 and 7p22; results of fluorescence in situ hybridisation studies using a chromosome 7 specific library, a subtelomeric 7p repeat (109A6), and yeast artificial chromosome clones 786g1 and 850a1, which are respectively associated with the (CA)n repeat markers D7S517 and D7S513, supported the cytogenetic interpretation and showed that the middle repeat was inverted. The patient's phenotype was consistent with the 7p duplication syndrome, allowing for the effects of the extra burden introduced by the partial tetrasomy. The present rearrangement may have resulted from several meiotic events occurring at the four chromatid stage, namely an unequal crossover or interhomologue translocation with points of exchange at 7p22 and 7p15 followed by the inverted insertion of 7p21.3-->p21.2 at the former breakpoint junction; moreover, a further duplication including D7S517 within the terminal 7p22 band is also required.

A familial syndrome with hypotonia, mental retardation and dysmorphic features resembling Cohen syndrome.

Since its original description (2), many new cases of Cohen syndrome have been reported, most of them showing a quite variable expressivity. Autosomal recessive inheritance is widely accepted (MIM : 216550) (11), however, multiple instances of sporadic cases are observed. From a literature review (52 cases), we could determinate, in order of frequency, the most important clinical traits of the Cohen syndrome. We report here a father and two sons with dysmorphic features resembling Cohen syndrome and transmitting by an autosomal dominant mode.

High recurrence of recombinants in a family with pericentric inversion of chromosome 18.

We report a family in which the father carries a pericentric inversion involving two third of the chromosome 18 (p11.2q22). Of his three children, the proposita and her youngest brother show partial duplication of the short arm and partial deficiency of the long arm; the oldest sister shows the other recombinant (partial duplication of the long arm and partial deficiency of the short arm). In the literature, we found only one family in which both recombinants of a parental pericentric inversion were present in the same offspring and none with three affected and both kinds of recombinants. A review of the reported familial cases reveals that the risk of aneusomy of recombination, at least for chromosome-18 inversion carriers, may be close to 20% and no only 5-10% as previously reported.

Floating-Harbor syndrome. A neuropsychological approach.

We describe a six year old Mexican girl whose clinical picture (short stature with delayed bone age, language difficulties and triangular face with prominent nose) was compatible with the diagnosis of Floating-Harbor Syndrome (FHS). A neuropsychological evaluation disclosed a mild mental retardation, a constructive apraxia, a comprehensive and expressive language impairment. The analysis of the present case and sixteen patients previously described establishes that the FHS is mainly characterized by proportionate short stature with significantly delayed bone age, delayed expressive language and peculiar face.

Generalized osteoporosis in a patient with oculocutaneous hypopigmentation syndrome (OOCHS), without cerebral defects. A new syndrome?

An 8-year-old male patient presented a unique pattern of congenital anomalies. Prominent findings included a combination of severe osteoporosis and congenital oculocutaneous hypopigmentation. The patient may represent a hitherto undescribed syndrome of unknown etiology.

A familial Xp+ chromosome, dup (Xq26.3-->qter).

A maternally transmitted Xp+ chromosome was associated with an abnormal phenotype, including developmental delay and short stature, in two male cousins and their 12 year old aunt. The respective mothers were not mentally impaired but had short stature. The G banding pattern identified the extra chromosome segment as a repeat of Xq26.3-->qter attached to an apparently intact Xp22.3 sub-band, so the Xp+ chromosome may be described as rea(X)(Xqter-->p22.3::Xq26.3-->Xqter). The rearranged chromosome was late replicating in 97 to 100% of the metaphases in the mothers but it was early replicating in 43% of the lymphocytes in the mentally defective female (n = 100 cells/subject). Fluorescence in situ hybridisation using X and Y chromosome paints, as well as cosmids A and 1A1 specific for loci within Xq28, confirmed both the identity of the extra segment and the entirety of the Xp pseudoautosomal region. Therefore, the phenotypic consequences in this family can be related to the Xq26.3-->qter functional disomy allowing for the effects of X inactivation in the female carriers.