Deregulation of tissue homeostasis in endometria from patients with polycystic ovarian syndrome with and without endometrial hyperplasia.

OBJECTIVE: To study the proteins involved in endometrial homeostasis in PCOS women. METHODS: Protein expression of Ki67, Bcl-2, Bax, Pro-Caspase-3 and Caspase-3 by immunohistochemistry and/or Western blot, and DNA fragmentation using in situ 3'-end labeling of apoptotic cells, was measured in 9 samples of normal endometrium (NE), 12 PCOS endometria without treatment (PCOSE), 7 endometria from PCOS women with endometrial hyperplasia (HPCOSE) and 9 endometria from patients with endometrial hyperplasia (HE). RESULTS: Cell proliferation was higher in epithelium from PCOSE (P<0.05), HPCOSE and HE vs NE. A higher Bcl-2/Bax relative ratio in PCOSE and HPCOSE was observed, in absence of active Caspase-3 and scarce DNA fragmentation in the four groups of endometria studied. CONCLUSION: As the apoptosis was scarce in all of the groups studied, endometrial homeostasis deregulation in PCOS could be a result of increased proliferation. Therefore, the onset of endometrial hyperplasia in PCOS endometrium could be linked to inadequate cell proliferation, and concomitantly to inadequate cell survival.

Infección por virus de inmunodeficiencia humana en la embarazada. Importancia del conocimiento de la infección en el embarazo y factores de riesgo en la transmisión perinatal / Human immunodeficiency virus infection in pregnant women. The importance of recognizing the infection during pregnancy and risk factors for perinatal transmission

BACKGROUND: Using adequate infection control measures, the rate of vertical transmission of human immunodeficiency virus (HIV) during pregnancy, has been reduced to 3 per cent in Chile. AIM: To determine vertical transmission rate and risk factors associated to perinatal infection in pregnant women with known (KI) and unknown HIV infection (UI). PATIENTS AND METHODS: HIV infected pregnant women whose deliveries were attended at the San Borja Arriaran Hospital were included. Antiretroviral therapy (ART) has been used since 1995 (Zidovudine 13 patients, biOtherapy 4 and triple therapy 14 patients). Newborns have received ART since 1995. Premature labor without evident cause, premature rupture of membranes, and rupture of membranes over 4 h before delivery were evaluated. Delivery was by elective cesarean section since 1993. Breast feeding was avoided. Pregnant women with UI (suspected disease after delivery due to child or mother pathology) did not received ART. Delivery and breast feeding were managed with common obstetrical-neonatal criteria. RESULTS: Fifty three HIV infected pregnant women were studied (43 with KI and 10 with UI). Four children (36.4 per cent) from the KI group and seven (63.6 per cent from the UI group became infected. The global rate of vertical transmission among KI group was significantly lower than UI group: 9.5 per cent (4/42) vs 70.0 per cent(7/10) p < 0.001. Using ART, this rate was further reduced to 6.5 per cent (2/31) and with bitherapy or triple therapy to 0 per cent (0/18). Breast feeding, vaginal delivery, premature delivery with no clinical cause, premature rupture of membranes, rupture of membranes longer than 4 h and lack of ART, were significantly more common in the UI group, compared with KI group. CONCLUSIONS: Vertical transmission in pregnant women with KI is significantly lower compared with UI. Risk factors increasing HIV perinatal infection are: breast feeding, lack of ART, vaginal delivery, premature rupture of membranes, rupture of membranes > 4 h and premature labor without a clinical cause.

[Clinical and microbiological study of acute pelvic inflammatory disease]. / Estudio clínico y microbiológico de la enfermedad inflamatoria pélvica aguda.

Upper genital tract infection was investigated in 46 women admitted to hospital with clinic diagnosis of acute pelvic inflammatory disease (PID) and 62 control women accepted to hospital for laparoscopy Fallopian tubes sterilization. Diagnosis was ratified by laparoscopy in mild and moderate salpingitis; culdocentesis and ultrasonography were performed in severe salpingitis and endometrial sample was made in endometritis. Microbiological specimens were taken from the cervix and abdomen. Antecedents and complete clinical studies were obtained. Patients were treated with antibiotic association sodic G penicillin, chloramphenicol and gentamicin. Risk factors to development PID were: single female (p < 0.05), multiple sexual partner (p < 0.01), previous PID (p < 0.05), infertility (p < 0.05), mean year of IUD use in severe salpingitis (p = 0.05) and mean years of age from women with sexually transmitted bacterias (STB) vs endogenous bacterias (EB) (p < 0.05). In the control group no abdomen bacterias were isolated. In patients with PID, C. trachomatis was detected by serology in 28.3%. N. gonorrhoeae was isolated from the cervix in 23.9% and from the abdomen 17.4%. Besides it was isolated from the abdomen: M. hominis 17.3% and E. coli 15.2%. STB were isolated in 54.3% and EB in 47.8% of the patients. Bacterial association was present on the 37%. Cervix isolation of G. vaginalis and Mycoplasma were not correlated with development of PID. Cervix microbiological samples were useful to know abdomen microbic etiology. They coincide with those in the 90.9%. EB were more frequently isolated from severe salpingitis (p = 0.05) and STB from mild and moderate salpingitis (p = 0.05). Antibiotic association cured all the mild and moderate salpingitis with independence of bacterial etiology. Failure occurred in 2 diffuse peritonitis and 13/14 tubo-ovarian abscesses. Surgery used in severe salpingitis and diffuse peritonitis, principally consisted in anexectomy, peritoneal toilet and drainages. No hysterectomies were performed. Colpotomy drainage was used as a laparotomy complement or as unique drainage. Severe complications of surgery occurred in 10.5%. Failure in antibiotic treatment, surgery and complications were present with preference in PID with EB. After PID 26.5% of women had both Fallopian tubes damaged; in 39.7% tube damage was not evaluated and in 34.2% one tube rested in health. Damage did not depend of bacterial etiology. Conclusion on the necessity of adequate prevention of this disease and it should need education related to the roll of STB and standards about the IUD use.

[AIDS and pregnancy. The clinical management of 2 cases of HIV infection]. / SIDA y embarazo. Manejo clínico de dos casos con infección por VIH.

Two clinical cases of HIV-infected pregnant women are presented: One with declared AIDS and the other a symptomless carrier. The clinical management of these cases are described; that is, the resolution of the delivery and the clinical measures implemented during their hospitalization. Both, the potential ways of propagating the infection among the health workers as well as the universal precautions which must be taken in order to avoid the risk of infection are discussed. The perinatal transmission of the HIV virus and the possible risk factors are also studied in this presentation. In the heterosexual relations of the couples infected with HIV are considered important their associated risk factors. It appears that education is the primary factor to prevent the infection in obs-gyn patients, more than obtaining resources to do massive serological tests on them.

[Experience in obstetrics with intracervical pellets of prostaglandin FZ alpha]. / Experiencia en obstetricia con "Balines" intracervicales de Prostaglandina F2 alfa.

PIP: Pellets of prostaglandin F2alpha (PGF2alpha), introduced intracervically, were used to induce delivery in 12 cases of prolonged pregnancy, 13 cases of retained dead fetus, 10 cases of missed abortion, 4 cases of therapeutic abortion, and 1 case of hydatidiform mole. In the 12 cases of prolonged pregnancy there were 4 failures due to obstetrical complications, or a success rate of 66.67%. In the 10 cases of missed abortion there were 5 failures, in the 4 cases of therapeutic abortion there were 2 failures, in the 13 cases of retained dead fetus there were 3 failures and 4 partial successes, and the 1 cases on hydatidiform mole was also only a partial success. The 4 groups had a success rate of 64.3% and a failure rate of 35.7%. Electronic monitoring of fetal conditions is absolutely necessary when using PGs for induction of delivery. The article reviews the literature on the subject.^ieng