Oxytocin system polymorphisms rs237887 and rs2740210 variants increase the risk of depression in pregnant women with early abuse.

Prepartum depression is associated with early adversity, pregnancy complications, preterm delivery, postpartum depression, and long-term effects on child neurodevelopment. The oxytocin (OXT) system is affected by early adverse experiences and has been associated with depression. In the current study, we investigated risk factors for prenatal depressive symptoms, mainly the effects of early childhood and adolescence trauma, in combination with the presence of certain variants of polymorphisms of OXT and OXT receptor (OXTR) genes. We hypothesized that early childhood and adolescence trauma has higher negative effects in carriers of genetic variants of the OXT/OXTR system, increasing their risk for depression. Early in pregnancy (8-14 weeks), 141 pregnant women from a Uruguayan population were asked to provide DNA samples and complete questionnaires that assessed their experience of child abuse, depression symptoms, and other variables that included demographic information. Our results showed that 23.5% of pregnant women had depressive symptoms. Several OXT and OXTR genetic variants were associated with higher risk of prepartum depression only in those pregnant women who suffered emotional abuse during infancy or adolescence. Logistic regression (Nagelkerke's R2  = .33) revealed that women who suffered early abuse and were carriers of the variants CC of rs2740210 (OXT) or AA of rs237887 (OXTR) had significantly higher risk of experiencing depressive symptoms. Antecedents of psychiatric disorders also contributed to the risk of depression. We conclude that emotional abuse contributes to the risk of depression in different ways in women carrying different OXT and OXTR genetic variants. Early detection and closer follow-up of women with child abuse and certain OXT genetic variants, among other risk factors, could reduce the long-term impact of prepartum depression.

AEGO: asistente telemático para la enseñanza ginecoobstétrica en la pandemia de COVID-19 / AEGO: telematics assistant for teaching Gynecology and Obstetrics in COVID-19 pandemic

Introducción: La enseñanza de la ginecología y obstetricia abarca teoría y práctica, que tradicionalmente se impartieron presencialmente, situación que ha cambiado en 2020 debido a la pandemia de COVID-19.Material y métodos.Desarrollamos una herramienta docente basada en tecnologías de la información y la comunicación. AEGO es un asistente para la enseñanza de la ginecoobstetricia: clases filmadas durante consultas reales, técnicas semiológicas y sesiones de colposcopia, juego serio de visitas de control de embarazo, incluyendo procedimientos diagnósticos ginecoobstétricos y una encuesta de satisfacción.Resultados.El análisis de la encuesta realizada a 169 estudiantes indica que los temas que suscitaron mayor interés fueron las maniobras semiológicas y la consulta ginecológica. La encuesta evaluó la percepción de los estudiantes sobre la herramienta AEGO, que se evaluó en semiología obstétrica, con un 88% de satisfacción; semiología ginecológica, con un 95%; semiología en general, con un 80%; y manejo del parto, con un 95%. Preguntados sobre la equivalencia entre la enseñanza por AEGO y la enseñanza tradicional del curso a distancia instaurado a raíz de la pandemia, solamente el 7% de los estudiantes juzgó AEGO como insuficiente. En el ejemplo de metrorragias, los estudiantes juzgaron AEGO como equivalente a lo tradicional (47%) o complementario (44%). En cuanto a la prevención del cáncer genitomamario, el 43% consideró AEGO equivalente a la enseñanza 'presencial a distancia por zoom' y el 47% lo definió como complementario.Conclusión.AEGO es una herramienta muy útil para la enseñanza de la ginecología y la obstetricia, y tiene, potencialmente, la capacidad de incrementar los temas que se van a enseñar. (AU)

Introduction: The teaching of gynecology and obstetrics encompasses theory and practice were traditionally taught in presence, a situation that has changed in 2020 due to the COVID-19 pandemic.Material and methods.We developed a teaching tool based on information and communication technologies. AEGO is an assistant for the teaching of gynecoobstetrics: filmed classes during real consultations, semiological techniques and colposcopy sessions, serious set of pregnancy control visits, including gyneco-obstetric diagnostic procedures and a satisfaction survey.Results.The analysis of the survey of 169 students indicates: the topics that aroused the greatest interest were semiological maneuvers and gynecological consultation. The survey evaluated the students' perception of the AEGO tool that was evaluated in obstetric semiology with 88% satisfaction, gynecological semiology with 95%, semiology in general 80% and delivery management 95%. Asked about the equivalence between teaching by AEGO and the traditional teaching of the distance course established as a result of the pandemic, only 7% of students judged AEGO as insufficient. In the example of metrorrhagias, students judged AEGO as equivalent to traditional (47%) or complementary (44%). Regarding the prevention of genito-breast cancer, 43% considered AEGO equivalent to 'face-to-face distance learning by zoom' and 47% defined it as complementary.Conclusion.AEGO is a very useful tool for the teaching of gynecology and obstetrics and potentially has the ability to increase the topics to be taught (AU)

Pathophysiological and molecular considerations of viral and bacterial infections during maternal-fetal and -neonatal interactions of SARS-CoV-2, Zika, and Mycoplasma infectious diseases.

During pregnancy, a series of physiological changes are determined at the molecular, cellular and macroscopic level that make the mother and fetus more susceptible to certain viral and bacterial infections, especially the infections in this and the companion review. Particular situations increase susceptibility to infection in neonates. The enhanced susceptibility to certain infections increases the risk of developing particular diseases that can progress to become morbidly severe. For example, during the current pandemic caused by the SARS-CoV-2 virus, epidemiological studies have established that pregnant women with COVID-19 disease are more likely to be hospitalized. However, the risk for intensive care unit admission and mechanical ventilation is not increased compared with nonpregnant women. Although much remains unknown with this particular infection, the elevated risk of progression during pregnancy towards more severe manifestations of COVID-19 disease is not associated with an increased risk of death. In addition, the epidemiological data available in neonates suggest that their risk of acquiring COVID-19 is low compared with infants (<12 months of age). However, they might be at higher risk for progression to severe COVID-19 disease compared with older children. The data on clinical presentation and disease severity among neonates are limited and based on case reports and small case series. It is well documented the importance of the Zika virus infection as the main cause of several congenital anomalies and birth defects such as microcephaly, and also adverse pregnancy outcomes. Mycoplasma infections also increase adverse pregnancy outcomes. This review will focus on the molecular, pathophysiological and biophysical characteristics of the mother/placental-fetal/neonatal interactions and the possible mechanisms of these pathogens (SARS-CoV-2, ZIKV, and Mycoplasmas) for promoting disease at this level.

Guía de manejo obstétrico y del recién nacido en madre aloinmunizada / Guidelines for the obstetric management of an alloimmune mother and her newborn / Guia de manejo obstétrico e neonatal em mães aloimunizadas

Resumen: La aloinmunización es una respuesta biológica frente a la exposición de antígenos no propios. La gestación, las transfusiones de hemocomponentes, los trasplantes de órganos sólidos y células hematopoyéticas, así como el consumo de drogas intravenosas exponen a las pacientes al desarrollo de aloanticuerpos antieritrocitarios. El hallazgo de los mismos debe cumplir con las instancias diagnósticas para identificar la probabilidad de estar asociados a enfermedad hemolítica feto neonatal (EHFN) y su oportuna derivación a policlínica de alto riesgo obstétrico (ARO) para su correcto seguimiento. Es fundamental que sean los laboratorios de inmunohematología de los servicios de hemoterapia y medicina transfusional los encargados de los estudios diagnósticos de aloinmunización eritrocitaria(1). En este sentido hemos elaborado esta guía con el objetivo de protocolizar de manera multidisciplinaria el manejo de las embarazadas aloinmunizadas y sus recién nacidos.

Abstract: Alloimmunization is the biological response to exposure to non-HLA antigens. Pregnancy, transfusion of blood components, solid organ and hematopoietic cell transplantation, as well as intravenous drug use expose patients to the development of anti-erythrocyte antibodies. When the latter are found, they must match diagnostic criteria to identify the potential association to hemolytic disease of the fetus and newborn (HDFN) and its timely referral to the high-risk obstetric risk polyclinic for due follow-up. It is of the essence for erythrocyte alloimmunization diagnostic tests to be carried out by the immunohematology laboratories of the Hemotherapy and Transfusional Medicine services. To that end, we have prepared these guidelines with the purpose of providing a multidisciplinary protocol for the handling of maternal alloimmunization and alloimmunization of the newborn.

Resumo: A aloimunização é uma resposta biológica à exposição a antígenos não próprios. A gravidez, as transfusões de hemocomponentes, os transplantes de órgãos sólidos e células hematopoiéticas, bem como o uso de drogas intravenosas expõem os pacientes ao desenvolvimento de anticorpos antieritrocitários. O achado destes deve obedecer a critérios diagnósticos para identificar a doença e a probabilidade de estarem associados a doença hemolítica feto neonatal (DHPN) e seu encaminhamento oportuno para uma unidade de alto risco obstétrico para acompanhamento adequado. É fundamental que os laboratórios de imuno-hematologia dos serviços de Hemoterapia e Medicina Transfusional se encarreguem dos estudos diagnósticos da aloimunização eritrocitária. Elaboramos este guia com o objetivo de estabelecer um protocolo multidisciplinar para o manejo de gestantes aloimunizadas e seus recém-nascidos.

Efectos adversos y motivos de retiro de implante subdérmico Jadelle® en usuarias de Policlínica de salud Sexual y Reproductiva del Hospital de Clínicas en período junio 2015- diciembre 2017 / Adverse effects and reasons of remove of subdermico implant Jadelle® in users of Sexual and Reproductive Health Clinics of Hospital de Clinicas in period june 2015-december 2017

INTRODUCCIÓN: La anticoncepción hormonal, a través de implantes subdérmicos, es uno de los métodos anticonceptivos reversibles de larga duración más eficaces en la actualidad que está disponible en nuestro país en forma gratuita en el sistema público. OBJETIVO: Reconocer los efectos adversos y los motivos de retiro del Implante Jadelle® en usuarias del Hospital de Clínicas, así como evaluar la información recibida por las usuarias al momento de la colocación. MATERIAL Y MÉTODOS: Un total de 160 pacientes participaron en el estudio a través de una encuesta previo consentimiento informado. Se utilizó la estadística descriptiva en números absolutos y porcentuales. Resultados: Previo al uso, recibieron información sobre los probables efectos adversos del método el 83% de ellas, y acerca de la efectividad del método el 89 %. En cuanto a efectos adversos los presentaron el 80,6% de las usuarias, siendo la irregularidad de la menstruación la causa más frecuente constituyendo un 61%. CONCLUSIONES: Es alta la frecuencia de pacientes que presentan efectos adversos y que solicitan retiro del implante antes del tiempo a causa de ello, 35% de las usuarias, siendo el principal motivo la irregularidad menstrual en un 43% de los casos. Es recomendable realizar un correcto asesoramiento previo a la colocación e incentivar a las pacientes a concurrir a los controles médicos, luego de la colocación, para brindar asesoramiento y tratamiento si se presentara algún efecto adverso, con el fin de obtener una mejor continuidad de uso del método.

INTRODUCTION: Hormonal contraception, through subdermal implants, is one of the most effective long active reversal contraceptive methods currently available in our country for free in the public system. OBJETIVE: Recognize the adverse effects and the reasons for its withdrawal in users of the Hospital de Clínicas as well as to evaluate the information received by the users at the time of placement. METHODOLOGY: A total of 160 patients participated in the work with prior informed consent through a survey. Descriptive statistics were used in absolute and percentage numbers. They received information on the probable adverse effects of the 83% pre-use method, about the effectiveness of the 89% method. RESULTS: Regarding adverse effects, they were present in 80.6% of the users; the being irregularity of menstruation is the most frequent, constituting 61%. Concluding that the frequency of patients presenting with adverse effects and requesting removal of the implant before the time is high because of it, 35% of the users who requested removal menstrual irregularities were the main reason for 43% of patients. CONCLUSIONS: It is advisable to make a correct advice prior to placement and encourage patients to attend medical controls, after placement, to provide advice and treatment if any adverse effect occurs, in order to give better use in terms of method time.

Desarrollo y ensayo de dos procedimientos para la detección rápida de Streptococcus agalactiae en exudados vaginorrectales / Development and testing of two procedures for the quick detection of Streptococcus agalactiae in rectal-vaginal exudates

Introducción: la infección por Estreptococo grupo B (EGB) puede afectar gravemente a la madre y al feto durante la gestación y al recién nacido luego del parto. Actualmente, eldiagnóstico de colonización durante el embarazo se realiza por métodos microbiológicos a partir de exudados vaginorrectales. Objetivo: desarrollar métodos rápidos y de bajo costo para la detección del antígeno grupo específico de EGB en exudados vaginorrectales.Material y método: se utilizaron dos cepas de EGB, una autóctona (IH23) y la cepa de referencia O90R, que solo expresa el polisacárido específico de grupo. Para cada una se preparó un antisuero policlonal que se utilizó para el desarrollo de un test inmunocromatográfico y uno de aglutinación de látex. Como controles se emplearon cultivos bacterianos, polisacáridos purificados de EGB y muestras vaginorrectales. Resultados: los límites de detección obtenidos para la inmunocromatografía fueron de 210 μg/ml y 50 μg/ml para los polisacáridos purificados de sobrenadante y pared, respectivamente, no lográndose detectar antígenos de EGB en las muestras clínicas analizadas. El límite dedetección del látex fue 65 μg/ml frente al polisacárido purificado de sobrenadante de cultivo de IH23 y 6,5 x 107 UFC/ml de IH23. La sensibilidad y especificidad para el látex fue de 30% y90%, respectivamente. Conclusiones: los métodos desarrollados no alcanzaron el límite de detección requerido parasu aplicación en muestras clínicas. Esto concuerda con lo descripto en la bibliografía para ensayos rápidos basados en reacciones antígeno-anticuerpo y muestra la necesidad deagregar pasos previos de extracción y concentración o mejorar la calidad de los reactivos inmunológicos empleados.

Introduction: group B streptococcal infection (GBS) may seriously affect mother and fetuses during pregnancy, and the newborn after delivery. Today, diagnosis of colonization during pregnancy is done by means of microbiological methods of vaginal and rectal exudates. Objective: to develop fast and low cost methods to detect the GBS specific group antigen in vaginal-rectal exudates. Method: we used two EGB strains, one of the (IH23)autochthonous and the reference strain O90R, that only expresses the group specific polysaccharide. We prepareda polyclonal antiserum for each one of them which was used to conduct an immunochromatographic test and alatex agglutination test. We used bacterial culture, EGB purified polysaccharides and vagina,-rectal samples as control. Results: detection limits obtained for the immunochromatographic test were 210 μg/ml and 50 μg/ml for purifiedpolysaccharides and cell wall, respectively, there being no EGB antigens detected in the clinical samples analyzed. Latex detection limit was 65 μg/ml compared to purified polysaccharides of IH23 culture supernatant and 6,5 x 107 UFC/ml of IH23. Sensitivity and specificity for latex was 30% and 90% respectively.Conclusions: the methods used failed to reach the detection limit required for its application in our clinical samples. This agrees with what is described in bibliography about quick tests based on antigen-antibody reactions and indicated the need to add previous extractionand concentration steps or to improve the quality of the immunologic reagents used.

Introdução: a infecção por Estreptococo grupo B (EGB) pode afetar gravemente a mãe e o feto durante a gravidez e o recém nascido imediatamente depois do parto. Atualmente, o diagnóstico de colonização durante a gestação é feita por métodos microbiológicos empregando exsudados vaginorretais.Objetivo: desenvolver métodos rápidos de baixo custo para a detecção do antígeno grupo específico de EGB emexsudados vaginorretais. Material e método: foram utilizadas duas cepas deEGB, uma autóctone (IH23) e a cepa de referência O90R, que expressa somente o polissacarídeo específico do grupo.Para cada uma foi preparado um antisoro policlonal utilizado para o desenvolvimento de um teste imunocromatográfico e um de aglutinação de látex. Foram empregadoscultivos bacterianos, polissacarídeos purificados de EGB e amostras vaginorretais como controles. Resultados: os limites de detecção obtidos para a imunocromatografia foram de 210 μg/ml e 50 μg/ml para ospolissacarídeos purificados de sobrenadante e parede, respectivamente, no sendo possível detectar antígenos de EGB nas amostras clínicas analisadas. O limite dedetecção do látex foi 65 μg/ml quando comparado com o polissacarídeo purificado de sobrenadante de cultivo deIH23 y 6,5 x 107 UFC/ml de IH23. A sensibilidade e especificidade para o látex foi de 30% y 90%, respectivamente. Conclusões: os métodos desenvolvidos não alcançaramo limite de detecção requerido para sua aplicação em amostras clínicas. Estes resultados são similares aos dadosdescritos na bibliografia para ensaios rápidos baseados em reações antígeno-anticorpo e mostram a necessidade de agregar passos prévios de extração econcentração ou melhorar a qualidade dos reativos imunológicos utilizados.

Uso de simuladores en ginecología y obstetricia. Experiencia en la enseñanza de pregrado / Use of medical simulators in obstetrics and gynaecology. Experience in undergraduate education

Introducción: Los cursos de Ginecología y Obstetricia se dictan en el penúltimo año de la carrera de Doctor en Medicina y representan el primer contacto curricular de los estudiantes con la disciplina. El perfil del egresado del plan de estudios vigente se orienta a la formación de medico generalista, por lo que el egresado debe ser competente en un numero básico de destrezas en el área ginecobstétrica. Objetivos: El objetivo del presente trabajo es introducir el uso de simuladores en la enseñanza del pregrado de ginecología y obstetricia. Metodología: En el transcurso del curso de ginecología del año 2003 los estudiantes fueron divididos en forma aleatorizada en dos grupos, uno de los cuales realizó su entrenamiento con simuladores. Se realizó un seguimiento del aprendizaje por medio de planillas de verificación. Resultados: De los resultados surge que los estudiantes del grupo que realizó su entrenamiento con simuladores tuvieron mas oportunidades de realizar las maniobras sobre todo aquellas que implican mayor dificultad como ser la colocación del especulo y el examen vaginal. Conclusiones: De acuerdo a esto se podría afirmar que la utilización de simuladores constituye una buena herramienta para la adquisición de destrezas en el área gineco obstétrica, y pueden ser una alternativa para la enseñanza a nivel del pregrado (AU)

The courses in gynaecology and obstetrics are given during the seventh year of the medicine career and represent the students’ first contact with the discipline. Most graduates from our medical school eventually become GPs, so they must be trained in a number of basic skills in obstetrics and gynaecology. Aims: To introduce the use of medical simulators in undergraduate courses of obstetrics and gynaecology. Methodology: During the gynaecology course in the 2003 academic year, students were randomly divided into two groups. The experimental group did their training with medical simulators. Their learning was followed up using a checklist for pelvic examination. Results: The results show that the students that did their training with simulators had more opportunities to perform the manoeuvres, especially those involving greater difficulty like vaginal examination and “ speculum” introduction. Conclusions: The use of medical simulators constitutes a good tool for the acquisition of skills in the obgyn area. Simulators provide a useful alternative in undergraduate education (AU)