Diagnóstico ecográfico y manejo de la infección fetal por parvovirus B19 / Prenatal diagnosis and management of fetal parvovirus B19 infection

Introducción: El parvovirus humano B19 (B19V) es una de las principales causas de anemia fetal que puede ocasionar hidropesía fetal grave, siendo el responsable de un 18-27% de las hidropesías fetales no inmunitarias. La infección por el B19V presenta brotes epidémicos cada 4-6 años, ocasionando un mayor número de casos de anemia fetal en los que es necesario realizar tratamiento. Objetivo: Conocer los resultados de los fetos con infección por B19V, su evolución, manejo y resultados perinatales. Material y métodos: Estudio descriptivo retrospectivo de los casos de infección congénita por B19V, diagnosticados en un periodo de 5 años. Resultados: Se analizaron 14 fetos con infección y afectación por el B19V. Un 71,4% de los fetos tuvieron hidropesía fetal. El hallazgo ecográfico más frecuente fue la cardiomegalia (78,6%). Se realizó transfusión intrauterina a 7 fetos. Fallecieron un 40% de los fetos. De los fetos a los que se les realizó TIU, un 42,85% falleció tras el procedimiento, todos ellos presentaron una pancitopenia grave arregenerativa. Conclusiones: Aunque es una patología de buen pronóstico, los resultados dependen en gran medida del estado hemodinámico del feto, así como el grado de afectación hematológica y los riesgos de las técnicas invasivas. Existen parámetros de anemia fetal como es la presencia de regurgitación de la válvula tricúspide que ayudan a predecir un grado de afectación fetal y, por lo tanto, debería tenerse en cuenta para valorar la realización de técnicas invasivas para estimación directa del grado de anemia fetal

Introduction: The human parvovirus B19 virus (B19V) is one of the most common infectious causes of foetal anaemia, which can lead to severe foetal hydrops. This infection causes 17-27% of non-immune foetal hydrops. Epidemic outbreaks of B19V infection occur at intervals of 4-6 years, increasing the number of cases of foetal anaemia requiring treatment. Objective: To determine the findings in foetuses with B19V infection, the clinical course of these pregnancies, their management and perinatal outcomes. Material and methods: A retrospective study of cases of congenital B19V infection diagnosed over a 5-year period. Results: We found 14 foetuses with B19V infection. Hydrops was present in 71.4% of the cases. The most frequent ultrasound finding was cardiomegaly (78.6%). Exchange transfusion was carried out in 7 foetuses. Overall mortality was 40%. Of the 7 treated foetuses, 42.85% died after the procedure. All of them had severe aregenerative pancytopenia. Conclusion: The results of B19V infections largely depend on the degree of the anaemia, the haemodynamic status of the foetus, and the risk of invasive procedures. Some parameters, such as the presence of tricuspid regurgitation, can be used to diagnose foetal anaemia and could therefore be useful as a tool to evaluate the use of invasive procedures to directly estimate the degree of foetal anaemiA

[Epidemiology and clinical study of Bordetella pertussis in Gran Canaria Island, Spain, in the period 2003-2007]. / Estudio clínico-epidemiológico de la infección por Bordetella pertussis en la isla de Gran Canaria en el período 2003-2007.

OBJECTIVE: To describe the epidemiological and clinical pattern of a Bordetella pertussis infection (whooping cough) among hospitalised infants in a paediatric hospital in Gran Canaria island (Spain). METHODS: A retrospective review of the patient hospital records was performed considering only those with a microbiological diagnosis of pertussis by polymerase chain reaction (PCR) for the period September 2003-September 2007. RESULTS: Forty nine patients were identified, of which 47 were < 6 months of age. The annual incidence of hospitalisation was estimated between 103.9 and 204.5 cases per 100,000 infants < 12 months old. Household members were the potential source of infection in at least 65.3 % of the cases. Clinical data were obtained from 47 patients. Complications occurred in 23.4 % of the patients (11 infants), three of them died (6.4 %). Viral coinfections occurred in 33.3 % of the infants diagnosed with pertussis. CONCLUSIONS: Pertussis presents a high complication rate among infants < 6 months old. Pertussis must be considered in the differential diagnosis of infants < 6 months old who present with severe pneumonia. Immunization strategies in the adult population must be reviewed and updated in order to attain higher protection of the more vulnerable paediatric population.

Estudio clínico-epidemiológico de la infección por Bordetella pertussis en la isla de Gran Canaria en el período 2003-2007 / Epidemiology and clinical study of Bordetella pertussis in Gran Canaria Island, Spain, in the period 2003-2007

Objetivo. El objetivo del estudio fue conocer el patrón clínico-epidemiológico de la tos ferina en niños diagnosticados en un hospital pediátrico de la isla de Gran Canaria. Métodos. Se revisaron retrospectivamente las historias clínicas de los pacientes con diagnóstico de infección por Bordetella pertussis mediante reacción en cadena de la polimerasa (PCR) en el período septiembre 2003-septiembre 2007. Resultados. Se detectaron 49 casos de tos ferina, 47 en menores de 6 meses. La incidencia anual de hospitalización osciló entre 103,9 y 204,5 por cada 100.000 niños menores de 12 meses. En al menos el 65,3 % de los casos, la posible fuente de contagio fue un adulto cercano. Se obtuvieron datos clínicos de 47 pacientes. Once niños (23,4 %) presentaron complicaciones, y tres de ellos fallecieron (6,4 %). El 33,3 % de los niños presentaron coinfección con virus. Conclusiones. La tos ferina presenta una alta tasa de complicaciones en lactantes menores 6 meses y debe considerarse en el diagnóstico diferencial de la neumonía grave del lactante. Deberían revisarse las estrategias de vacunación en la población adulta para conseguir una mayor protección de la población pediátrica más susceptible

Objetive. To describe the epidemiological and clinical pattern of a Bordetella pertussis infection (whooping cough) among hospitalised infants in a paediatric hospital in Gran Canaria island (Spain). Methods. A retrospective review of the patient hospital records was performed considering only those with a microbiological diagnosis of pertussis by polymerase chain reaction (PCR) for the period September 2003-September 2007. Results. Forty nine patients were identified, of which 47 were < 6 months of age. The annual incidence of hospitalisation was estimated between 103.9 and 204.5 cases per 100,000 infants < 12 months old. Household members were the potential source of infection in at least 65.3 % of the cases. Clinical data were obtained from 47 patients. Complications occurred in 23.4 % of the patients (11 infants), three of them died (6.4 %). Viral coinfections occurred in 33.3 % of the infants diagnosed with pertussis. Conclusions. Pertussis presents a high complication rate among infants < 6 months old. Pertussis must be considered in the differential diagnosis of infants < 6 months old who present with severe pneumonia. Immunization strategies in the adult population must be reviewed and updated in order to attain higher protection of the more vulnerable paediatric population

Repercusión del herpes gestationis en los estados materno y fetal / Effect of herpes gestationis on maternal and fetal health

Objetivo: Estudiar la repercusión del herpes gestationis en los estados materno y fetal. Sujetos y métodos: La base de este estudio la constituyen 2 pacientes controladas durante los meses de marzo a octubre de 2003 por el Servicio de Ginecología y Obstetricia del Hospital Universitario Son Dureta de Palma de Mallorca. Ambas fueron fotografiadas en diferentes momentos de su evolución y se les realizaron biopsias de las lesiones que confirmaron el diagnóstico de herpes gestationis. Los controles obstétricos realizados no difieren de los habituales durante una gestación de curso normal. Resultados: La evolución de las pacientes fue favorable tras el uso de corticoterapia. Respecto a las complicaciones fetales descritas, observamos un caso de crecimiento intrauterino retardado y otro de prematuridad. El carácter autoinmune de la enfermedad y su predisposición hereditaria quedan reflejados por el hallazgo de antígenos de histocompatibilidad específicos en una de nuestras pacientes. Conclusiones: El herpes gestationis no es una entidad grave siempre y cuando realicemos un diagnóstico y tratamiento correctos

Objective: To analyze the effect of herpes gestationis on maternal and fetal health. Subjects and methods: Two patients were studied from March to October, 2003 by the Obstetrics and Gynecology Service of Son Dureta University Hospital of Palma, Majorca. Both patients were photographed at various times during the course of the disease. The diagnosis of herpes gestationis was confirmed by biopsy. Their obstetric management did not differ from that in normal pregnancy. Results: Outcome in these patients was favorable after steroid therapy. Regarding fetal complications, low intrauterine growth was observed in one fetus and prematurity in the other. The autoimmune character of the disease and hereditary predisposition were reflected in the finding of specific histocompatibility antigens in one of the two patients. Conclusion: Herpes gestationis is not a serious disease if a correct diagnosis is made and appropriate treatment provided

Supramolecular aggregation of two hydroxycarboxylic acid derivatives.

The crystal structures of 7,7-dicyclobutyl-5-hydroxymethyl-6-oxabicyclo[3.2.1]octane-1-carboxylic acid, C17H26O4, (I), and 1-(hydroxymethyl)-7-oxaspiro[bicyclo[3.2.1]octane-6,1'-cyclopentane]-5-carboxylic acid, C13H20O4, (II), determined at 170 K, show that the conformation of the hydroxymethyl group (anti or gauche) affects the dimensionality (one- or two-dimensional) of the supramolecular structures via O-H...O hydrogen bonds. In (I), the carboxyl and hydroxymethyl groups interact with themselves, forming a one-dimensional step-ladder, while in (II), a two-dimensional structure is made up of carboxylic acid centrosymmetric R(2)2(8) dimers connected by hydroxyl-to-ether contacts.

Hydrogen-bonding patterns of two dihydroxylactone derivatives.

In the hydrogen-bonding networks of 8-hydroxy-5-hydroxymethyl-3,6-dioxatricyclo[6.3.1.0(1.5)]dodecan-2-one and 5,7-bis(hydroxymethyl)-3,6-dioxatricyclo[5.3.1.0(1.5)]undecan-2-one, both C11H16O5, layers and double strands, respectively, lead to the formation of chains connected by hydroxy-to-hydroxy contacts, where the hydroxymethyl group, present in both structures, acts as a donor. The secondary structures differ in the hydrogen bonding of these chains via the second hydroxy group, which is involved in hydroxy-to-carbonyl and hydroxy-to-hydroxy bonds, respectively.

[Intense icterus in the course of EBV infectious mononucleosis]. / Intensa ictericia en el curso de una mononucleosis infecciosa por EBV.

Infectious mononucleosis induced by the Epstein Barr Virus (EBV) is a benign illness that is frequently accompanied by a slight hepatic disfunction. On occasion it may be accompanied by autoimmune hemolytic anemia of little clinical importance. Nevertheless, this association can cause a serious set of symptoms that can put the patient's life in danger if it is not treated quickly. We present the case of a 21-year-old male with infectious mononucleosis and severe jaundice (total bilirubin 40 mg/dl) due to the combination of diseased liver and secondary autoimmune hemolytic anemia, caused by the EBV infection.

[The fluorimetric determination of dabequin in biological fluids]. / Fluorimetricheskoe opredelenie dabekhina v biologicheskikh zhidkostiakh.

A study of dabequin was performed to define its possible quantification by spectrofluorimetry. By this technique, dabequin was shown to present maximum excitation and emission wave length at 400 and 450 nm, respectively. Drug emission was determined at different concentrations of sulfuric acid and no changes were observed. Two quantification procedures are compared to determine, which one produces better results in quantifying total serum and blood levels in patients. Specificity of a thin-layer chromatography method, as well as the drug stability in 0.05 M sulfuric acid medium are shown.