Factores de riesgo prenatales en la muerte fetal tardía, Hospital Civil de Guadalajara, México / Prenatal risk factors in the late fetal death, Hospital Civil de Guadalajara, Mexico

Objetivo: Identificar los factores de riesgo sociodemográficos, obstétricos y perinatales que con más frecuencia se asocian a muerte fetal en embarazos mayores de 27 semanas. Método: De enero de 2004 a junio de 2009 en el Hospital Civil de Guadalajara, se realizó un estudio de casos y controles con 528 casos de muerte fetal de más de 27 semanas de gestación y 528 neonatos vivos cuyo nacimiento ocurrió inmediatamente después. Se comparó la frecuencia de diferentes variables maternas y fetales que en forma previa se han reportado asociadas a muerte fetal, por medio de Chi2 y prueba exacta de Fisher; se estimó la fuerza de asociación entre estas variables y muerte fetal con la razón de momios, con un intervalo de confianza del 95 por ciento. Resultados: De los factores de riesgo estudiados se asociaron con muerte fetal: edad materna mayor de 35 años, escolaridad baja, multiparidad, antecedente de aborto y de muerte fetal, atención prenatal deficiente, complicaciones en el embarazo, líquido amniótico anormal, doble circular de cordón umbilical al cuello del producto y malformaciones congénitas mayores del recién nacido. No se asoció con muerte fetal, el estado civil soltero, ser primigesta, tabaquismo, sexo masculino del feto, circular simple al cuello y macrosomía fetal. Conclusiones: De los factores de riesgo asociados con muerte fetal, resalta la atención prenatal deficiente que de ser mejorada, podría disminuir la fuerza de asociación de algunas de las otras variables que se asociaron a muerte fetal.

Objective: To identify sociodemographic, obstetric and perinatal factors most frequently associated with fetal death in pregnancies over 27 weeks. Methods: From January 2004 to June 2009 at the Civil Hospital of Guadalajara, we performed a case-control study of 528 stillbirths over 27 weeks gestation and 528 living infants whose birth occurred immediately afterwards. We compared the frequency of maternal and fetal variables that previously have been reported associated with fetal death by means of Chi2 and Fisher exact test, we estimated the strength of association between these variables and fetal death with odds ratios with a confidence level of 95 percent. Results: The studied risk factors associated with fetal death was: maternal age older than 35 years, low schooling, multiparity, history of abortion and stillbirth, poor prenatal care, pregnancy complications, abnormal amniotic fluid, circular double umbilical cord around the neck of product and major congenital malformations of the newborn. Single marital status, primiparity, smoking, male fetus, simple circular neck and fetal macrosomia, was not associated with fetal death. Conclusions: Risk factors associated with fetal death, like poor prenatal care emphasizes that, if improved, could decrease the strength of association of some of the other variables associated with fetal death.

[Leigh syndrome caused by the mitochondrial DNA G14459A mutation in a Mexican family]. / Síndrome de Leigh causado por la mutación G14459A del ADN mitocondrial en una familia mexicana.

INTRODUCTION: Leigh syndrome is a neurodegenerative and progressive disease that appears usually in childhood due to defects in nuclear or mitochondrial genome. The mutation G14459A in mitochondrial DNA has been associated previously to Leber hereditary optic neuropathy and recently to Leigh syndrome. CASE REPORT: A 10 months-old Mexican girl diagnosed of Leigh syndrome. Molecular-genetic studies detected the mutation G14459A in a percentage close to homoplasmy and in low heteroplasmy in her mother. The rest of the maternally related family members analyzed were negative. CONCLUSION: The G14459A mutation, although not very frequently associated to Leigh syndrome, should be analyzed in patients that do not present the most common point mutations.

Fyn kinase is involved in oligodendroglial cell differentiation induced by apotransferrin.

Mechanisms that regulate oligodendroglial cell (OLGc) differentiation are the focus of intensive research in the field of cellular and molecular neurobiology. We have previously shown that the addition of apotransferrin (aTf) to primary OLGc cultures accelerates their differentiation and induces an increase in the expression of different components of the myelin cytoskeleton (CSK) such as actin, tubulin, and some of the microtubule-associated proteins, particularly the stable tubulin only peptide (STOP). Fyn protein-tyrosine kinase (Fyn kinase), a member of the Src family, participates in signalling pathways that regulate OLGs/myelin cytoskeletal reorganization. It is essential for myelin development in the central nervous system (CNS), and its absence results in hypomyelination. In the present study, we used both primary cell and N19 cell line cultures to investigate further the mechanisms of action involved in the accelerated differentiation of OLGcs induced by aTf. In particular, we were interested in studying the participation of Fyn kinase in the different pathways involved in the reorganization of the OLGc/myelin cytoskeleton. In agreement with results already published, we found that in OLGcs, Fyn kinase is associated with Tau and tubulin. Using a dominant-negative of Tau in which the Fyn-Tau-microtubules (MTs) interaction is blocked, we found that aTf was unable to induce OLGc morphological differentiation. It was also observed that aTf decreases the activated RhoA content in coincidence with a redistribution of actin immunoreactivity. These results give support to our hypothesis that Fyn kinase plays a key role in the differentiation process of OLGcs promoted by aTf.

Molecular bases of the excretion of fetal bile acids and pigments through the fetal liver-placenta-maternal liver pathway.

Since the excretion of potentially toxic cholephilic organic anions (COAs) produced by the fetus, such as bile acids and biliary pigments, cannot be performed by the fetal liver alone, the placenta and the maternal liver must play a key role collaborating in this function. COAs are transported across the plasma membranes of fetal and maternal hepatocytes and trophoblastic cells via similar carrier proteins. OATPs (organic anion-transporting polypeptides), mainly OATP1B1 and OATP1B3 are involved in COA uptake across the basal membrane of adult hepatocytes and trophoblastic cells. Certain OATPs may also play a role in COA efflux from fetal hepatocytes toward the fetal blood and from the trophoblast to the maternal blood. Either unmodified or biotransformed during their transit across the placenta, COAs are transferred to the maternal blood by MRPs (multidrug resistance-associated proteins), such as MRP1, MRP2 and MRP3. BCRP (breast cancer resistance protein) may also be involved in this step. Under physiological circumstances, fetal COAs are taken up by the maternal liver, which eliminates them across the canalicular membrane via MRP2 and BSEP (bile salt export pump). However, when normal biliary excretion is not possible, the accumulation of COAs, in particular in the fetal liver, placenta and maternal liver trio, induces oxidative stress and apoptosis, which has noxious repercussions on normal fetal development and even challenges pregnancy outcome. Treatment of pregnant rats with ursodeoxycholic acid, even though maternal hypercholanemia is not corrected, prevents oxidative damage and the subsequent deleterious effects on the placenta and fetal liver.

[Brainstem lesions: clinicoradiological electrophysiological correlation when chronic]. / Lesiones del tronco cerebral en estadio crónico: correlación clínica, radiológica y electrofisiológica.

INTRODUCTION: The brainstem is a vital structure. Imaging and electrophysiological studies are important aids to clinical diagnosis. OBJECTIVE: To define the clinical, imaging and electrophysiological correlation in 28 patients with chronic brainstem lesions. PATIENTS AND METHODS: We analyzed the results of physical examination, imaging studies (CAT and MR) and brainstem auditory evoked potentials (BEAP) in each patient. RESULTS: There was a predominance of males in the group studied. The commonest age groups were between 25 34 and 35 44 years old. Involvement of the cranial nerves was the commonest neurological finding, and the XII cranial nerve was the one most commonly involved. The condition had persisted for 1 to 4 years in 60.8% of the patients. There was a predominance of lesions of the pons in 28.6%. In five patients classical syndromes were seen. The commonest aetiology was ischaemic cerebrovascular disease in 53.6% of the patients. The lesions were detected on MR in 86.6% of the cases and on CAT scans in only 27.3%. The BEAP was abnormal in 75% of the patients. There was close correlation between the clinical topography and results of MR (p<0.05) but little correlation with the CAT scans or PEATC. CONCLUSION: We consider that MR is the investigation of choice in these patients.

[Genetic diseases of the mitochondrial DNA in humans]. / Enfermedades genéticas del ADN mitocondrial humano.

Mitochondrial diseases are a group of disorders produced by defects in the oxidative phosphorylation system (Oxphos system), the final pathway of the mitochondrial energetic metabolism, resulting in a deficiency of the biosynthesis of ATP. Part of the polypeptide subunits involved in the Oxphos system are codified by the mitochondrial DNA. In the last years, mutations in this genetic system have been described and associated to well defined clinical syndromes. The clinical features of these disorders are very heterogeneous affecting, in most cases, to different organs and tissues and their correct diagnosis require precise clinical, morphological, biochemical and genetic data. The peculiar genetic characteristics of the mitochondrial DNA (maternal inheritance, polyplasmia and mitotic segregation) give to these disorders very distinctive properties. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

The prevalence of nervios and associated symptomatology among inhabitants of Mexican rural communities.

The purpose of the present contribution is to describe the prevalence of nervios through self-report, to identify psychological and somatic symptoms associated with nervios, and to report the comorbidity of nervios with mood and anxiety disorders among Mexican rural-origin adults. The data reported here were collected as part of a larger project, whose aims were to determine the prevalence of selected mental health problems, their sociocultural manifestation and interpretation, and the utilization of mental health services among the inhabitants of rural communities in Mexico. A multi-stage, stratified, random sample of two regions in Mexico was obtained. The total number of participants used in the analyses was 942 adults: 441 men and 501 women. We found a prevalence of nervios of 15.5% in the general population. When analyzed by sex, women had a significantly higher prevalence (20.8%) of this condition than men (9.5%). Also, all the somatic and psychological symptoms associated with nervios had a higher prevalence among women than men.

Pathways to mental health services among inhabitants of a Mexican village.

The purpose of this article is to provide a description of the pathways to the utilization of mental health services among rural Mexicans in a village with a long-standing tradition of male labor migration to the United States. The authors developed a model of pathways to mental health service utilization on the basis of ethnographic field notes and in-depth interviews with 21 villagers who were "potential immigrants." The model describes five sequential help-seeking strategies that townspeople with mental health problems commonly follow to relieve the psychological and physical symptoms associated with their condition. The applications of the findings include the design of sensitive programs for the migratory population that not only incorporates but maximizes pre-existing culture-specific individual and community resources.