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1.
Ginecol. obstet. Méx ; Ginecol. obstet. Méx;92(5): 199-214, ene. 2024. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1574921

RESUMO

Resumen OBJETIVO: Establecer los valores de referencia del índice de pulsatilidad con Doppler pulsado en la valoración materna y fetal de los embarazos en seguimiento entre las 18 y 39 semanas de gestación. MATERIALES Y MÉTODOS: Estudio descriptivo y transversal, efectuado en pacientes con embarazo único, entre las 18 a 40 semanas, que acudieron al Departamento de Medicina Materno Fetal del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, entre los meses de septiembre de 2017 a mayo de 2018. La evaluación Doppler se practicó con medición del índice de pulsatilidad de las arterias uterinas, umbilical, cerebral media y conducto venoso en cada semana del embarazo. Se crearon tablas de referencia para cada semana de la gestación y se establecieron los percentiles 3, 5, 10, 90 y 95. RESULTADOS: Se registraron 862 pacientes. Los valores del índice de pulsatilidad de la arteria umbilical reportaron 17% en semanas tempranas de la gestación y 21% en edades gestacionales mayores. Los valores de la arteria umbilical fueron 3% menores en edades gestacionales tempranas y 10% menores al término del embarazo; 20% para la arteria umbilical, 15% para el conducto venoso y 10% para la arteria cerebral media. Los valores del índice de pulsatilidad medio de las arterias uterinas fueron mayores un 3% en edades gestacionales tempranas y 28% menores al término del embarazo. CONCLUSIONES: Los hallazgos de este estudio sugieren diferencias significativas con las poblaciones de Europa y Norteamérica; incluso difieren de los valores de referencia utilizados en la actualidad en la población mexicana, lo que supone una subestimación de las condiciones fetales o maternas al hacer las evaluaciones de la unidad fetoplacentaria.


Abstract OBJECTIVE: Establish the reference values for the pulsatility index using pulsed Doppler in the maternal and fetal assessment of pregnancies followed at 18 and 39 weeks of gestation. MATERIALS AND METHODS: Descriptive and cross-sectional study, carried out in patients with a singleton pregnancy, between 18 and 40 weeks, who attended the Department of Maternal Fetal Medicine of the National Institute of Perinatology, from September 2017 to May 2018. The Doppler evaluation was performed, with measurement of the pulsatility index of the uterine, umbilical, middle cerebral arteries, and venous duct in each week of pregnancy. Reference tables were created for each gestational age, establishing percentiles 3, 5, 10, 90 and 95. RESULTS: A total of 862 patients were registered. The umbilical artery pulsatility index values were reported to be 17% at early gestational ages and 21% at older gestational ages; Umbilical artery values were 3% lower at early gestational ages and 10% lower at term of pregnancy; 20% for the umbilical artery, 15% for the ductus venosus and 10% for the middle cerebral artery. The values of the mean pulsatility index of the uterine arteries were 3% higher at early gestational ages and 28% lower at the end of pregnancy. CONCLUSIONS: The findings of this study suggest significant differences with the populations of Europe and North America; They even differ from the reference values currently used in the Mexican population, which represents an underestimation of fetal and/or maternal conditions when carrying out evaluations of the feto-placental unit.

2.
J Matern Fetal Neonatal Med ; 36(2): 2286433, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38010351

RESUMO

Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode.Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios.Results: Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively (p < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], p = 0.001; aOR 4.85 [95% CI 1.85, 12.66], p = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] p = 0.002; aOR 5.29 [95% CI 2.01, 13.87], p = 0.001) had higher odds of adverse neonatal outcomes.Conclusion: In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.


Assuntos
Retardo do Crescimento Fetal , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Estudos Retrospectivos , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/etiologia , Cesárea/efeitos adversos , Trabalho de Parto Induzido/efeitos adversos , Idade Gestacional
3.
Int J Mol Sci ; 24(17)2023 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-37685913

RESUMO

Listeria monocytogenes is an important pathogen that has been implicated in foodborne illness. The aim of the present study was to investigate the diversity of virulence factors associated with the mechanisms of pathogenicity, persistence, and formation of biofilm L. monocytogenes by tandem analysis of whole-genome sequencing. The lineages that presented L. monocytogenes (LmAV-2, LmAV-3, and LmAV-6) from Hass avocados were lineages I and II. Listeria pathogenicity island 1 (LIPI-1) and LIPI-2 were found in the isolates, while LIPI-3 and Listeria genomic island (LGI-2) only was in IIb. Stress survival island (SSI-1) was identified in lineage I and II. In the in silico analysis, resistance genes belonging to several groups of antibiotics were detected, but the bcrABC and transposon Tn6188 related to resistance to quaternary ammonium salts (QACs) were not detected in L. monocytogenes. Subsequently, the anti-L. monocytogenes planktonic cell effect showed for QACs (MIC = 6.25 ppm/MBC = 100 ppm), lactic acid (MBC = 1 mg/mL), citric acid (MBC = 0.5 mg/mL) and gallic acid (MBC = 2 mg/mL). The anti-biofilm effect with organic acids (22 °C) caused a reduction of 4-5 log10 cfu/cm2 after 10 min against control biofilm L. monocytogenes formed on PP than SS. This study is an important contribution to understanding the genomic diversity and epidemiology of L. monocytogenes to establish a control measure to reduce the impact on the environment and the consumer.


Assuntos
Listeria monocytogenes , Listeria , Listeria monocytogenes/genética , Genômica , Ácido Láctico , Antibacterianos/farmacologia , Compostos Orgânicos
4.
Gene ; 851: 146966, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36265748

RESUMO

Salmonella enterica serotype Oranienburg is a multi-host, ubiquitous, and prevalent Non-typhoidal Salmonella (NTS) in subtropical rivers, particularly in sediments; little studied so far possible the adaptation and establishment of this microorganism based on its genetic content. This study was focused on the first five genomes of S. Oranienburg in sediments through whole-genome sequencing (WGS) and 61 river water genomes isolated in previous studies. Results showed an open pangenome with 5,594 gene clusters (GCs), and the division of their categories showed; 3,303 core genes, 741 persistent genes, 1,282 accessory genes, and 268 unique genes. Additionally, it showed three main subclades within the same serotype and showed a conserved genetic content, suggesting the display of different adaptation strategies to its establishment. Nine genes for antimicrobial resistance were detected: aac (6') - Iy, H-NS, golS, marA, mdsABC, mdtK, and sdiA, and a mutation in the parC gene p. T57S generating a resistance. In addition, virulence genes and pathogenicity islands (SPI's) were analyzed, finding 92 genes and an identity above 80 % in the SPI's 1 to 5, and the centisomes 54 and 63. The environmental strains of S. Oranienburg do not represent a concern as multidrug resistance (MDR) bacterium; however, virulence genes remain a potential health risk. This study contributes to understanding its adaptation to aquatic environments in Mexico.


Assuntos
Salmonella enterica , Sorogrupo , Virulência/genética , Salmonella enterica/genética , Salmonella , Antibacterianos
5.
Ginecol. obstet. Méx ; Ginecol. obstet. Méx;91(2): 140-146, ene. 2023. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1448325

RESUMO

Resumen ANTECEDENTES: La exposición prenatal al misoprostol puede asociarse con un espectro de defectos congénitos que varían desde anomalías del sistema nervioso central, secuencia de Moebius, defectos en la pared abdominal, defectos transversales en las extremidades hasta alteraciones fetales. Esos defectos se observan más comúnmente con esquemas de solo misoprostol para inducción del aborto. Por esos antecedentes es importante que la historia clínica de toda paciente obstétrica sea exhaustiva para permitir identificar el antecedente de la exposición prenatal luego de un aborto fallido. CASO CLINICO: Paciente de 21 años, con 32 semanas de embarazo, con diagnóstico de feto con ventriculomegalia. En la evaluación ecográfica destacó la ventriculomegalia triventricular severa, simétrica y la angulación de ambas extremidades inferiores en varo. La resonancia magnética reportó: ventriculomegalia no comunicante severa, bilateral, simétrica, por probable estenosis del acueducto de Silvio. Cariotipo 46,XY y perfil TORCH negativo. El embarazo finalizó mediante cesárea, por indicación fetal a las 35 semanas. La evaluación al nacimiento reportó: parálisis facial bilateral, macrocefalia y pie equino varo bilateral. Al volver a interrogar a la paciente refirió haber sido tratada con misoprostol en el primer trimestre del embarazo, con fines abortivos. Al descartar las alteraciones cromosómicas e infecciosas se estableció el diagnóstico de secuencia Moebius. CONCLUSIONES: La exposición prenatal al misoprostol está relacionada con la aparición de defectos vasculares en algunos fetos expuestos. Aún no se ha determinado el espectro preciso ni la estimación potencial de teratogenicidad. La historia clínica es el pilar para la asociación en estos casos.


Abstract BACKGROUND: Prenatal misoprostol exposure can be associated with a spectrum of birth defects, ranging from central nervous system abnormalities, Moebius sequence, abdominal wall defects, as well as transverse limb defects, fetal abnormalities are more commonly seen with the use of the misoprostol-only regimen for induction of abortion, such that a thorough medical history is essential to detect a history of prenatal exposure after a failed abortion. CLINICAL CASE: A 21-year-old patient, with a 32-week pregnancy, who attended the institute with a diagnosis of a fetus with ventriculomegaly, the ultrasound evaluation highlighted severe symmetric triventricular ventriculomegaly and angulation of both lower extremities in varus, magnetic resonance imaging reported severe non-communicating ventriculomegaly Symmetric bilateral, due to probable stenosis of the aqueduct of Silvio, the karyotype reported 46, XY, as well as a negative TORCH profile, however, a cesarean section was performed for fetal indication at 35 weeks, the evaluation at birth showed bilateral facial paralysis, macrocephaly and foot Bilateral equinus varus, upon re-examination the patient referred the use of misoprostol in the first trimester of pregnancy for abortive purposes, so as there were no chromosomal or infectious alterations, a Moebius sequence was suggested. CONCLUSIONS : Prenatal exposure to misoprostol is related to the appearance of vascular disruption defects in some exposed fetuses, the precise spectrum and potential estimation of teratogenicity have not yet been determined, the clinical history is the mainstay for the association in these cases.

6.
Front Microbiol ; 13: 1001700, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36532477

RESUMO

Introduction: Staphylococcus aureus is an important pathogen that can form biofilms on food contact surfaces (FCS) in the dairy industry, posing a serious food safety, and quality concern. Biofilm is a complex system, influenced by nutritional-related factors that regulate the synthesis of the components of the biofilm matrix. This study determines the prevalence of biofilm-associated genes and evaluates the development under different growth conditions and compositions of biofilms produced by S. aureus. Methods: Biofilms were developed in TSB, TSBG, TSBNaCl, and TSBGNaCl on stainless-steel (SS), with enumeration at 24 and 192 h visualized by epifluorescence and scanning electron microscopy (SEM). The composition of biofilms was determined using enzymatic and chemical treatments and confocal laser scanning microscopy (CLSM). Results and discussion: A total of 84 S. aureus (SA1-SA84) strains were collected from 293 dairy industry FCS (FCS-stainless steel [n = 183] and FCS-polypropylene [n = 110]) for this study. The isolates harbored the genes sigB (66%), sar (53%), agrD (52%), clfB/clfA (38%), fnbA/fnbB (20%), and bap (9.5%). 99. In particular, the biofilm formed by bap-positive S. aureus onto SS showed a high cell density in all culture media at 192 h in comparison with the biofilms formed at 24 h (p < 0.05). Epifluorescence microscopy and SEM revealed the metabolically active cells and the different stages of biofilm formation. CLSM analysis detected extracellular polymeric of S. aureus biofilms on SS, such as eDNA, proteins, and polysaccharides. Finally, the level of detachment on being treated with DNase I (44.7%) and NaIO 4(42.4%) was greater in the biofilms developed in TSB compared to culture medium supplemented with NaCl at 24 h; however, there was no significant difference when the culture medium was supplemented with glucose. In addition, after treatment with proteinase K, there was a lower level of biomass detachment (17.7%) of the biofilm developed in TSBNaCl (p < 0.05 at 24 h) compared to that in TSB, TSBG, and TSBGNaCl (33.6, 36.9, and 37.8%, respectively). These results represent a deep insight into the composition of S. aureus biofilms present in the dairy industry, which promotes the development of more efficient composition-specific disinfection strategies.

7.
PLoS One ; 17(12): e0277892, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454778

RESUMO

OBJECTIVE: To relate preevacuation platelet count and leukogram findings, especially neutrophil/lymphocyte ratios (NLR) and platelet/lymphocyte ratios with the occurrence of gestational trophoblastic neoplasia (GTN) after complete hydatidiform mole (CHM) among Brazilian women. METHODS: Retrospective cohort study of patients with CHM followed at Rio de Janeiro Federal University, from January/2015-December/2020. Before molar evacuation, all patients underwent a medical evaluation, complete blood count and hCG measurement, in addition to other routine preoperative tests. The primary outcome was the occurrence of postmolar GTN. RESULTS: From 827 cases of CHM treated initially at the Reference Center, 696 (84.15%) had spontaneous remission and 131 (15.85%) developed postmolar GTN. Using optimal cut-offs from receiver operating characteristic curves and multivariable logistic regression adjusted for the possible confounding variables of age and preevacuation hCG level (already known to be associated with the development of GTN) we found that ≥2 medical complications at presentation (aOR: 1.96, CI 95%: 1.29-2.98, p<0.001) and preevacuation hCG ≥100,000 IU/L (aOR: 2.16, CI 95%: 1.32-3.52, p<0.001) were significantly associated with postmolar GTN after CHM. However, no blood count profile findings were able to predict progression from CHM to GTN. CONCLUSION: Although blood count is a widely available test, being a low-cost test and mandatory before molar evacuation, and prognostic for outcome in other neoplasms, its findings were not able to predict the occurrence of GTN after CHM. In contrast, the occurrence of medical complications at presentation and higher preevacuation hCG levels were significantly associated with postmolar GTN and may be useful to guide individualized clinical decisions in post-molar follow-up and treatment of these patients.


Assuntos
Doença Trofoblástica Gestacional , Neutrófilos , Gravidez , Humanos , Feminino , Estudos Retrospectivos , Brasil , Linfócitos , Contagem de Células Sanguíneas , Estruturas Celulares
8.
Parasitol Int ; 86: 102473, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34600157

RESUMO

Despite the large number of species described to date for the onchoprotepcephalid genus Acanthobothrium (207), only 16 named species have a genetic sequence. With this background, specimens of adult cestodes of the stingray Hypanus longus were collected off San Blas, Nayarit, and onchoproteocephalid larvae in the carangid fish Trachinotus rhodopus from Puerto Ángel, Oaxaca, both located on the Pacific coast of Mexico. The objective of this work is to investigate the phylogenetic position of these adults and larvae using nuclear ribosomal markers (18S rDNA and 28S rDNA). Morphologically, adult specimens were identified as Acanthobothrium cleofanus; larvae were identified only to family level. The phylogenetic position of both taxa was investigated based on the information of two nuclear molecular markers analyzed under Parsimony (PA) and Bayesian Inference (BI) methods. The newly generated sequences of A. cleofanus from Nayarit are identical to the sequences of several samples of Acanthobothrium sp. collected in the Mexican Pacific, which sequence are available in GenBank; DNA sequences obtained from onchoproteocephalid larva clearly place this taxon within Acanthobothrium but representing an independent lineage. In the resulting phylogenetic trees, Uncibilocularis okei was found nested within Acanthobothrium with an unstable position depending on the optimality criteria, indicating the need for more molecular analyzes with a greater number of species of both genera prior to define its phylogenetic relationships.


Assuntos
Cestoides/classificação , Infecções por Cestoides/veterinária , Doenças dos Peixes/parasitologia , Rajidae , Animais , Cestoides/genética , Cestoides/crescimento & desenvolvimento , Infecções por Cestoides/parasitologia , Marcadores Genéticos , Larva/classificação , Larva/crescimento & desenvolvimento , México , Filogenia , RNA Ribossômico 18S/análise , RNA Ribossômico 28S/análise
9.
Polymers (Basel) ; 13(19)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34641171

RESUMO

The aim of this work was to use glycerol (Gly) and sorbitol (Sor) as plasticizers with oxidized starch potato (OS) to produce biodegradable and environmentally friendly films, and to demonstrate the resulting physicochemical and functional viability without subtracting the organoleptic characteristics of the food. Analyses by water vapor permeability (WVP), attenuated total reflection Fourier transform infrared spectra (ATR-FTIR), scanning electron microscopy (SEM), tensile strength (TS), and transparency (UV) showed that the best film result was with 1.5 g of Gly and 2.0 g of Sor, conferred shine, elasticity 19.42 ± 6.20%, and mechanical support. The starch oxidized to 2.5%, contributing a greater transparency of 0.33 ± 0.12 and solubility of 78.90 ± 0.94%, as well as less permeability to water vapor 6.22 ± 0.38 gmm-2 d-1 kPa-1. The films obtained provide an alternative for use in food due to their organic compounds, excellent visual presentation, and barrier characteristics that maintain their integrity and, therefore, their functionality.

10.
Antibiotics (Basel) ; 10(10)2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34680731

RESUMO

Biofilm formation by E. coli is a serious threat to meat processing plants. Chemical disinfectants often fail to eliminate biofilms; thus, bacteriophages are a promising alternative to solve this problem, since they are widely distributed, environmentally friendly, and nontoxic to humans. In this study, the biofilm formation of 10 E. coli strains isolated from the meat industry and E. coli ATCC BAA-1430 and ATCC 11303 were evaluated. Three strains, isolated from the meat contact surfaces, showed adhesion ability and produced extracellular polymeric substances. Biofilms of these three strains were developed onto stainless steel (SS) surfaces and enumerated at 2, 12, 24, 48, and 120 h, and were visualized by scanning electron microscopy. Subsequently, three bacteriophages showing podovirus morphology were isolated from ground beef and poultry liver samples, which showed lytic activity against the abovementioned biofilm-forming strains. SS surfaces with biofilms of 2, 14, and 48 h maturity were treated with mixed and individual bacteriophages at 8 and 9 log10 PFU/mL for 1 h. The results showed reductions greater than 6 log10 CFU/cm2 as a result of exposing SS surfaces with biofilms of 24 h maturity to 9 log10 PFU/mL of bacteriophages; however, the E. coli and bacteriophage strains, phage concentration, and biofilm development stage had significant effects on biofilm reduction (p < 0.05). In conclusion, the isolated bacteriophages showed effectiveness at reducing biofilms of isolated E. coli; however, it is necessary to increase the libraries of phages with lytic activity against the strains isolated from production environments.

11.
Lupus Sci Med ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34158288

RESUMO

OBJECTIVE: To conduct a diagnostic assessment of pregnant women using a screening questionnaire for SLE. MATERIALS AND METHODS: This was an analytical cross-sectional study carried out at the National Institute of Perinatology between 1 November 2019 and 28 February 2020, using a screening questionnaire for SLE. Antinuclear antibody and anti-double stranded DNA antibody tests and a clinical assessment by a rheumatologist were conducted for participants who obtained ≥4 positive responses on the questionnaire. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the screening questionnaire for SLE were calculated. RESULTS: The questionnaire survey was conducted with 540 pregnant patients, 22 of whom (4.1%) had ≥4 positive responses. An antinuclear antibody test was conducted in all aforementioned 22 patients; 17 (77.3%) showed titres of ≥1:80. Of the 22 patients, 19 (86.4%) underwent clinical assessment by a rheumatologist. The patients were classified according to the SLE classification criteria: 7/19 (36.9%) met the revised 1997 American College Rheumatology (ACR) criteria, 8/19 (42.1%) met the Systemic Lupus International Collaborating Clinics criteria and 7/19 (36.9%) met the 2019 ACR/EULAR criteria (sensitivity=0.86, specificity=0.97, PPV=0.77 and NPV=1 for antinuclear antibody titre of ≥1:80; sensitivity=0.88, specificity=0.98, PPV=0.37 and NPV=1 for SLE according to the 2019 ACR/EULAR criteria). CONCLUSIONS: The questionnaire showed high sensitivity and specificity in the diagnosis of SLE. Given its usability and cost:benefit ratio, this strategy should be used for all patients coming in for their first visit to determine who requires antinuclear antibody testing and who needs to be referred to a rheumatologist.


Assuntos
Lúpus Eritematoso Sistêmico , Gestantes , Adulto , Anticorpos Antinucleares , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Gravidez , Complicações na Gravidez , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
12.
An Acad Bras Cienc ; 93(3): e20200924, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34076183

RESUMO

The objectives of this research were to study (1) the dispersion of MWCNTs in an aqueous system by three commercial admixtures (CAds) for concrete, and (2) the effect of CAds and MWCNTs on indirect tensile strength and electrical conductivity of MWCNTs-high early strength (HE) cement-mortar composites. To achieve the objectives, we dispersed MWCNTs in an aqueous system with (1) hydroxylated polymers-based water reducing plasticizer (HPs), a nonionic compound, (2) Naphthalene based superplasticizer (SNF), an anionic compound, and (3) calcium chloride-based accelerating agent (CC) a neutral amphoteric salt. We prepared a total of 242 samples grouped in three sets: (1) Plain mortar [PM] (water + HE cement + Sand), (2) [PM+CAd], and (3) [PM+CAd+MWCNTs]. The three CAds dispersed MWCNTs in an aqueous solution. The CC and HPs admixtures have a two-time bigger dispersing power than the SNF. They demand half of SNF's ultrasound energy for optimal dispersion. Although the SNF (anionic) based superplasticizer resulted incompatible with the HE cement, it improved the indirect tensile strength of [PM+SNF+MWCNTs] composite. In contrast, the CC (amphoteric) based accelerating agent was compatible with the HE cement; the CC adsorption on the MWCNTs surface favors an improvement in the electrical conductivity of [PM+CAd+MWCNTs] composite.


Assuntos
Materiais de Construção , Cimentos de Ionômeros de Vidro , Condutividade Elétrica , Resistência à Tração
13.
Int J Gynaecol Obstet ; 153(1): 95-99, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33040369

RESUMO

OBJECTIVE: To describe the learning curve for amniocentesis among Maternal-Fetal Medicine (MFM) fellows using a low-cost simulation model in Mexico. METHODS: Fourteen first- and second-year MFM fellows with no previous experience in amniocentesis participated in this single-center prospective study from March to June of 2019. The study was approved by the Institutional Review Board at the Instituto Nacional de Perinatologia and written informed consent was obtained from all participants. After an introductory course based on a standardized technique for amniocentesis, each fellow performed this procedure using a low-cost simulation model; experienced operators supervised the procedures. Learning curves were then created using cumulative sum analysis. Thresholds for acceptable and unacceptable failure rates were defined as 10% and 25%, respectively. RESULTS: Experienced MFM specialists evaluated 3675 procedures. On average, MFM fellows performed 263 ± 53 procedures. The mean number to achieve competence was 255 ± 53. The overall failure rate among the trainees was 16%. CONCLUSION: We describe individual learning curves for amniocentesis among MFM fellows using a low-cost simulation model. This approach allows direct assessment of proficiency in amniocentesis before clinical practice.


Assuntos
Amniocentese/métodos , Curva de Aprendizado , Perinatologia/educação , Competência Clínica , Simulação por Computador , Educação de Pós-Graduação em Medicina , Feminino , Humanos , México , Gravidez , Estudos Prospectivos
15.
Gynecol Oncol ; 143(3): 558-564, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27640962

RESUMO

OBJECTIVE: To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6months after uterine evacuation. METHODS: Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. RESULTS: At 6months from uterine evacuation, 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8months; p=0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6months; p<0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p=0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p=0.60). None of the women relapsed, and no deaths occurred in either group. CONCLUSION: In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gonadotropina Coriônica/sangue , Mola Hidatiforme/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Curetagem a Vácuo , Conduta Expectante , Adolescente , Adulto , Brasil , Estudos de Casos e Controles , Quimioterapia Adjuvante , Estudos de Coortes , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Doença Trofoblástica Gestacional , Humanos , Mola Hidatiforme/sangue , Mola Hidatiforme/patologia , Leucovorina/administração & dosagem , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/sangue , Neoplasias Uterinas/patologia , Vincristina/administração & dosagem , Adulto Jovem
16.
Rev Invest Clin ; 65(4): 300-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24304730

RESUMO

OBJECTIVE: The aim of this study is to describe the phenotype of fetuses affected by amniotic band sequence (ABS) that were diagnosed at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes and to propose a new classification based on morphologic findings. MATERIAL AND METHODS: Cases with a final diagnosis of amniotic band sequence, diagnosed between January 1993 and July 2010 in the Department of Maternal Fetal Medicine, were reviewed. Demographic, clinical, and periconceptional data were collected, and the defects were described and classified. The association frequencies of the defects were also determined. RESULTS: We included 50 cases with prenatal diagnosis of amniotic band sequence. The mean maternal age was 25.7 ± 6.9 years. Of these patients, 54% (27/50) were primiparous compared to 22% (11/50) who had three or more previous pregnancies. Craniofacial defects were seen in 78% (39/50) of the cases, followed by defects of the extremities 70% (35/50), abdominal wall, spine, and/or thorax 52% (26/50). The most frequent defects were the following: a) Encephalocele and facial clefts in the craniofacial group. b) Shortening at any level in the limb defects group, and c) Alterations of the spinal column curvature in the group of "other" defects. CONCLUSIONS: The amniotic band sequence shows a tendency to affect women who are in their earlier years of reproduction. We observed an inverse relationship between the number of pregnancies and the frequency of presentation of this pathology. The majority of affected fetuses showed a phenotype that fit into one of many groups. Therefore, we propose classifying the amniotic band sequence phenotypes into the following groups: I. Craniofacial defect + limb defect. II. Craniofacial defect + limb defect + abdominal wall, spinal column, and/or thoracic defects. III. Limb defect + abdominal wall, spinal column, and/or thoracic defects; and IV. Isolated defect (craniofacial, limb, or thoraco-abdominal wall). This classification system will be helpful in diagnosing amniotic band sequence. Based on future research studies, we hope that we can use this classification system as a prognosis fetal factor to establish a more accurate fetal prognosis and recurrence probability. Finally, we created a flowchart describing all of the steps that were followed by our Department from the moment an amniotic band was found by ultrasound until the definitive diagnosis was made and the follow up according to the fetal findings.


Assuntos
Síndrome de Bandas Amnióticas/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Síndrome de Bandas Amnióticas/classificação , Síndrome de Bandas Amnióticas/genética , Síndrome de Bandas Amnióticas/patologia , Árvores de Decisões , Feminino , Humanos , Gravidez
17.
Rev. peru. med. exp. salud publica ; 30(4): 575-582, oct.-dic. 2013. graf, tab
Artigo em Espanhol | LILACS, LIPECS | ID: lil-698115

RESUMO

Objetivos. Determinar el patrón de susceptibilidad antibiótica de cepas de Streptococcus pneumoniae aisladas de portadores nasofaríngeos sanos menores de 2 años de siete regiones del Perú. Materiales y métodos. Entre el 2007 y 2009 se tomaron muestras de hisopado nasofaríngeo a 2123 niños sanos entre 2 y 24 meses de edad en los consultorios de crecimiento y desarrollo (CRED) y vacunación de hospitales y centros de salud de Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, e Iquitos. Se determinó la resistencia a diez antibióticos mediante la prueba de disco-difusión de las cepas de neumococo aisladas. Resultados. Se aislaron 572 cepas. Se encontró altas tasas de resistencia a cotrimoxazol (58%); penicilina (52,2% no-sensibles); tetraciclina (29,1%); azitromicina (28,9%), y eritromicina (26,3%). La resistencia a cloranfenicol fue baja (8,8%). Se encontró 29,5% de multirresistencia. La resistencia a la azitromicina y a la penicilina fue diferente en las siete regiones (p<0,05), hallándose el mayor porcentaje de cepas no-sensibles a penicilina en Arequipa (63,6%), mientras que el menor fue en Cusco (23,4%). Conclusiones. Los elevados niveles de resistencia encontrados para penicilina, cotrimoxazol y macrólidos en cepas de neumococo aisladas de portadores sanos en todas las regiones estudiadas, y su asociación con uso previo de antibióticos, representan un importante problema de salud pública en nuestro país. Esto resalta la necesidad de implementar, a nivel nacional, estrategias para disminuir el uso irracional de antibióticos, sobre todo en la población pediátrica. Es necesario complementar los datos de resistencia a penicilina con la determinación de la concentración mínima inhibitoria para hacer las recomendaciones terapéuticas respectivas.


Objectives. To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. Materials and methods. Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. Results. 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa (63,6%), whereas the lowest percentage was found in Cusco (23.4%). Conclusions. High levels of resistance found to penicillin, co-trimoxasole and macrolides in isolated pneumococcus strains of healthy carriers in all studied regions, and their association to a previous use of antibiotics, represent a significant public health problem in our country. This emphasizes the need to implement nationwide strategies to reduce the irrational use of antibiotics, especially among children. It is necessary to complement data of resistance to penicillin with the determination of minimal inhibitory concentration to make proper therapeutic recommendations.


Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resistência Microbiana a Medicamentos , Nasofaringe/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Portador Sadio , Estudos Transversais , Testes de Sensibilidade Microbiana , Peru
18.
Rev Invest Clin ; 65(3): 248-54, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23877812

RESUMO

OBJECTIVE: To determine the association between some major structural abnormalities detected prenatally by ultrasound and chromosomal abnormalities. MATERIAL AND METHODS: The present study was a retrolective, transversal study. We analyzed case records of patients during the fetal follow-up at the Department of Maternal Fetal Medicine from January 1994 to May 2010 to identify fetal patients with a diagnosis of holoprosencephaly, diaphragmatic hernia, omphalocele, cystic hygroma, hydrops and cardiac defects. We analyzed patients who had a prenatal invasive diagnosis procedure to obtain the odds ratio (OR) for some major isolated anomalies and their different combinations with respect to chromosomal abnormalities. RESULTS: We examined 280 patients with ultrasonographic markers for chromosomal alteration, 197 met inclusion criteria, from which 88 had chromosomal abnormalities. The most frequent diagnosis was trisomy 18 (31.8%), which was followed by trisomy 21 (21.6%), trisomy 13 (21.6%), Turner syndrome (monosomy X) (14.8%) and other chromosomal abnormalities (10.2%). Among the fetuses with nonisolated holoprosencephaly, we obtained an OR of 4.9 95% CI (0.99-24.2) for aneuploidy. Associated omphalocele had an OR of 7.63 95% CI (2.07-46.75), p < 0.01. Interestingly, 62% of aneuploidy cases had associated cardiac defects [OR = 7.7 95% CI (1.4-41.7)]. In addition, associated cystic hygroma had an OR of 2.5 95% CI (0.59-10.91). Heart defects were the most common defects in fetuses with trisomy 18 (57.1%), when they were associated with facial cleft, we had an OR of 11.08 95% CI (2.99-41.11), p < 0.0001. Statistical potency was calculated for each analyzed defect and it was over 80% for all of them but diaphragmatic hernia. CONCLUSIONS: The association of 2 or more structural defects increased the probability of a fetus to be a carrier of a chromosomal disorder; however this was not statistically significative except for associated omphalocele. Heart defects showed the greatest association with all chromosomal abnormalities. The most important association was among heart defect, facial cleft and trisomy 13.


Assuntos
Aberrações Cromossômicas , Transtornos Cromossômicos , Anormalidades Congênitas/genética , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/embriologia , Anormalidades Múltiplas/genética , Adolescente , Adulto , Aneuploidia , Transtornos Cromossômicos/diagnóstico por imagem , Transtornos Cromossômicos/embriologia , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/embriologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Idade Materna , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Adulto Jovem
19.
Rev Peru Med Exp Salud Publica ; 30(4): 575-82, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-24448932

RESUMO

OBJECTIVES: To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. MATERIALS AND METHODS: Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. RESULTS: 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa (63,6%), whereas the lowest percentage was found in Cusco (23.4%). CONCLUSIONS: High levels of resistance found to penicillin, co-trimoxasole and macrolides in isolated pneumococcus strains of healthy carriers in all studied regions, and their association to a previous use of antibiotics, represent a significant public health problem in our country. This emphasizes the need to implement nationwide strategies to reduce the irrational use of antibiotics, especially among children. It is necessary to complement data of resistance to penicillin with the determination of minimal inhibitory concentration to make proper therapeutic recommendations.


Assuntos
Resistência Microbiana a Medicamentos , Nasofaringe/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Portador Sadio , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Peru
20.
Rev Peru Med Exp Salud Publica ; 29(1): 53-60, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22510907

RESUMO

OBJECTIVES: To determine the carriage rate and serotype distribution of Streptococcus pneumoniae in the nasopharynx of healthy children younger than 2 years prior to the universal use of the pneumococcal conjugate vaccines in Peru. MATERIALS AND METHODS: Between 2007 and 2009 we collected nasopharyngeal swab samples from 2,123 healthy children aged 2 to 24 months in the vaccination and healthy children consultation offices of pediatric hospitals and health centers in 7 cities in Peru: on the coast (Lima, Piura), highlands (Cusco, Abancay, Arequipa and Huancayo) and amazon basin (Iquitos). The pneumococcal strains were isolated and identified at the central laboratory of the project in Lima, and serotyped by Quellung reaction in the pneumococcal reference laboratory at the Center for Diseases Control and Prevention (CDC). RESULTS: We found 27% (573/2123) of pneumococcal nasopharyngeal healthy carrier children. Among the 526 analyzed strains, we found 42 serotypes; the most common were: 19F (18.1%), 6B (14.3%); 23F (8.9%) and 14 (6.5%). CONCLUSIONS: The distribution of vaccine serotypes in the analyzed strains was of 50% for the serotypes present in the seven-valent vaccine, 50.2% for the serotypes present in the ten-valent vaccine and 57.2% for those present in the thirteen-valent vaccine.


Assuntos
Vacinas Pneumocócicas , Streptococcus pneumoniae/classificação , Portador Sadio , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Peru , Sorotipagem
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