Corpus callosum-fastigium and tectal lengths in late-onset small fetuses.

OBJECTIVE: To investigate measurements on neurosonography of midbrain morphology, including corpus callosum-fastigium length and tectal length, in late-onset small fetuses subclassified as small-for-gestational-age (SGA) or growth-restricted (FGR). METHODS: This was a case-control study of consecutive singleton pregnancies delivered at term at a single center between January 2019 and July 2021, including those with late-onset smallness (estimated fetal weight (EFW) < 10th centile) and appropriate-for-gestational-age controls matched by age at neurosonography. Small fetuses were further subdivided into SGA (EFW between 3rd and 9th centile and normal fetoplacental Doppler) and FGR (EFW < 3rd centile or EFW < 10th centile with abnormal cerebroplacental ratio and/or uterine artery Doppler). Transvaginal neurosonography was performed at a mean ± SD gestational age of 33 ± 1 weeks in all fetuses to evaluate corpus callosum-fastigium length and tectal length in the midsagittal plane. Intra- and interobserver agreement was evaluated using the intraclass correlation coefficient and Bland-Altman plots. RESULTS: A total of 70 fetuses with late-onset smallness (29 with SGA and 41 with FGR) and 70 controls were included. Compared with controls, small fetuses showed significantly shorter corpus callosum-fastigium length (median (interquartile range), 44.7 (43.3-46.8) mm vs 43.7 (42.4-45.5) mm, P < 0.001) and tectal length (mean ± SD, 10.5 ± 0.9 vs 9.6 ± 1.0 mm, P < 0.001). These changes were more prominent in FGR fetuses, with a linear trend across groups according to severity of smallness. Corpus callosum-fastigium length and tectal length measurements showed excellent intra- and interobserver reliability. CONCLUSIONS: Small fetuses exhibited shorter corpus callosum-fastigium length and tectal length compared with controls, and these differences were more pronounced in fetuses with more severe smallness. These findings illustrate the potential value of midbrain measurements assessed on neurosonography as biomarkers for brain development in a high-risk population. However, further studies correlating these parameters with postnatal functional tests and follow-up are needed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal neurosonography and infant neurobehavior following conception by assisted reproductive technology with fresh or frozen embryo transfer.

OBJECTIVE: We aimed to explore fetal cortical brain development by neurosonography in fetuses conceived by assisted reproductive technology (ART), including frozen and fresh embryo transfer (ET), compared with those conceived spontaneously (SC), and to investigate its association with infant neurobehavior at 12 months of age. METHODS: This was a prospective cohort study of 210 singleton pregnancies, including 70 SC pregnancies, 70 conceived by in-vitro fertilization (IVF) following frozen ET and 70 conceived by IVF after fresh ET. Fetal neurosonography was performed at 32 ± 2 gestational weeks to assess cortical development. Sulci depths were measured offline and normalized by biparietal diameter (BPD). Ages and Stages Questionnaires (ASQ) were completed postnatally, at 12 ± 1 months of corrected age. Neurosonographic findings were adjusted by regression analysis for maternal age, ethnicity, parity, fetal sex and fetal-weight centile and gestational age at scan, and ASQ scores were adjusted for maternal age, ethnicity, parity, educational level and employment status, gestational age at birth, breastfeeding, infant sex and infant age at the ASQ evaluation. RESULTS: Overall, in comparison to the SC fetuses, fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto-occipital sulci depth adjusted for BPD (mean ± SD: fresh ET, 12.5 ± 2.5 vs frozen ET, 13.4 ± 2.6 vs SC, 13.4 ± 2.6, P < 0.001), cingulate sulci depth adjusted for BPD (median (interquartile range (IQR)): fresh ET, 5.8 (4.2-7.4) vs frozen ET, 5.8 (4.1-7.5) vs SC, 6.5 (4.8-7.8), P = 0.001) and calcarine sulci depth adjusted for BPD (median (IQR): fresh ET, 13.5 (10.1-16.1) vs frozen ET, 14.5 (12.1-15.8) vs SC, 16.4 (14.3-17.9), P < 0.001), together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET than in the frozen ET group. ART infants showed lower ASQ scores as compared to SC infants, particularly in the fresh ET group (mean ± SD global ASQ Z-score: fresh ET, -0.3 ± 0.4 vs frozen ET, -0.2 ± 0.4 vs SC, 0 ± 0.4, P < 0.001). CONCLUSIONS: Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in those conceived following fresh ET. These findings support the existence of in-utero brain reorganization associated with ART and warrant follow-up studies to assess its long-term persistence. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Caracterización del acto homicida según los informes de autopsias realizados por el servicio médico legal de Concepción, periodo 2011-2015 / Characterization of the homicidal act according to the autopsy reports released by the Legal Medical Service of Concepción, 2011-2015

Introducción: Más de la tercera parte de los homicidios reportados a nivel mundial tienen lugar en el continente Americano, siendo Chile uno de los países con las tasas más bajas de Latinoamérica. Actualmente, son escasos los estudios que caracterizan el acto homicida en nuestro país. Se caracterizó el acto homicida según las autopsias realizadas por el Servicio Médico Legal (SML) de Concepción, durante el periodo 2011-2015. Materiales y método: Se realizó un estudio transversal de informes de autopsia con causa homicidio durante los años 2011 a 2015, realizadas por el SML de Concepción, utilizándose las variables: género, edad, procedencia, lugar de ocurrencia del homicidio, estado civil, ocupación, patologías asociadas, causa de muerte, tipo de arma utilizada, alcoholemia, examen toxicológico y atención en centro asistencial. El estudio fue aprobado por comité de ética. Resultados: Del total de autopsias en el periodo 2011-2015; 5.92% (241) correspondieron a homicidios, de los cuales un 89.6% fueron víctimas de sexo masculino. Del total de homicidios estudiados la edad promedio fue de 33 años, un 58.3% del total ocurrieron en vía pública y 42.1% fallecieron por trauma torácico complicado. Finalmente del total de homicidios, un 49,2% poseían alcoholemia negativa y 49.2% examen toxicológico negativo. Discusión: En Chile, el homicidio afecta a una pequeña porción de la población, acercándose a las bajas tasas que presentan diversos países de Europa. En su mayoría, los homicidios reportados fueron hombres entre los 18 y 29 años de edad, resultado similar a lo descrito a nivel mundial.

Introduction: More than a third part of the worldwide reported homicides takes place in the whole american continent, and Chile is one the countries with the lowest rates in latin america. Only a few are the studies that characterize the homicidal act in our country. Characterize the homicide act according to the autopsies reports performed by the Legal Medical Service (SML) of Concepción, during the period 2011-2015. Materials and methods: We made a transversal study with the autopsies reports classified as homicide, performed by the SML Concepción, between the years 2011 and 2015 using variables such as: gender, age, place of residence, place of homicidal act, marital state, occupation, comorbidities, death cause, weapon, blood alcohol concentration, toxicological results and medical assistance. An ethic committee approved the study. Results: From the total autopsies between 2011 and 2015; 5.92% (241) were homicides, of which 89.4% were men. The average age of homicides victims was 33 years old, 58.3% occurred on public areas and 42.1% were died because a complicated thoracic traumatism. And finally from the total homicides, 49.2% had none alcohol in blood such as the 49.2% as well had negative toxicological test. Discussion: In Chile, homicide affects a few number of its population, approaching the low rates that some european countries have. The most of the homicides reported were men between 18 to 29 years old, similar results comparing with the worldwide statistics.

[Weight-stature growth in pediatric patients with urinary tract infection with or without vesicoureteral reflux]. / Crecimiento pondoestatural en pacientes pediátricos con infección urinaria asociada o no a reflujo vesicoureteral.

OBJECTIVE: To evaluate the association between urinary tract infection (UTI), vesical-uretero-renal reflux (VUR) and renal parenchyma damage, without chronic renal failure. PATIENTS AND METHODS: Retrospective study of 85 children with UTI consulting at the ambulatory paediatric unit of a private university centre in Chile, with at least 3 anthropometric evaluations: before, during and after the UTI. The group was divided into two subgroups: with and without VUR. A descriptive and inferential analysis was made. Simple regression modelling and likelihood ratio test was done for the anthropometric measures. RESULTS: Thirty nine children had VUR (46%). Both subgroups were similar. There were no difference in the nutritional status between these. Only girls with VUR have a tendency toward lower height. There was significant association between renal damage, VUR and degree of severity of it. There was no difference in the index weight for height among children with renal damage with or without RVU. In this series, other risk factors as less age, recurrent UTI and bilateral VUR with renal damage, were not cause of malnourish and lower height. CONCLUSIONS: UTI with or without VUR, with or without renal damage, excluding chronic renal failure, might not be a cause of bad physical development in children.

Crecimiento pondoestatural en pacientes pediátricos con infección urinaria asociada o no a reflujo vesicoureteral / Nutritional status in pediatric ambulatory patients with urinary tract infection with or without reflux

Objetivo. Evaluar la asociación entre infección urinaria (ITU), reflujo vesicoureteral (RVU) y daño del parénquima renal cintigráfico, con alteraciones del crecimiento pondoestatural, en ausencia de insuficiencia renal. Pacientes y métodos. Estudio retrospectivo de 85 niños con ITU que consultaron a la unidad de pediatría ambulatoria de un centro privado universitario chileno, con al menos 3 evaluaciones antropométricas: antes, durante y después de ITU. Se dividieron en 2 grupos: con y sin RVU. Se realizó análisis estadístico descriptivo e inferencias para las variables; así mismo se llevó cabo regresión simple y test de verosimilitud para las curvas antropométricas. Resultados. Treinta y nueve niños (46 por ciento) tenían RVU. Las características de la población fueron similares en ambos grupos, sin presentar alteraciones significativas en el estado nutricional. Sólo las niñas con RVU mostraron tendencia a una menor talla. La presencia de lesión renal se asoció a RVU y a grados severos de éste. No hubo diferencia significativa en el IPT en niños con lesión renal cintigráfica con y sin RVU. Otros factores de riesgo como menor edad, ITU recurrente y presencia de RVU bilateral con daño del parénquima renal cintigráfico, no constituyeron una causa de desnutrición o talla baja en esta serie. Conclusiones. La ITU asociada o no a RVU, con o sin lesión del parénquima renal, en ausencia de insuficiencia renal crónica, no constituiría causa de deterioro del crecimiento pondoestatural en los niños (AU)

Complicaciones motoras precoces en parkisonianos de novo tratados con L-Dopa más inhibidor periférico de la decarboxilasa / Early motor complications in parkisonians of novo treated with L-Dopa plus descarboxylase inhibitor

En una serie de 27 pacientes con enfermedad de Parkinson esencial de novo, en grado 2,7 de Hoehn y Yahr como promedio, con un rango de 1 a 4, tratados con levodopa más benserazida durante 16 semanas, se observaron efectos motores adversos leves a moderados en 12 casos (44,4 por ciento): 8 pacientes presentaron diskinesias, 7 distonías y un deterioro de final de dosis. La dosis máxima de levodopa ID utilizada fue de 750 mg los que alcanzaron a la tercera semana, previo ascenso paulatino desde 125 mg inicial. Posteriormente, se buscó la mínima dosis efectiva la cual correspondió a una cifra de 475 mg como media con un rango de 250 a 750 mg correspondiente a 49,7 por ciento de reducción, lográndose un efecto antiparkinsoniano similar al obtenido con la dosis máxima. Se discuten los posibles factores que hayan influido en el porcentaje alto de efectos motores adversos encontrados en esta serie

[Obstructive urinary tract diseases and prenatal diagnosis. Timing of surgical correction]. / Uropathies obstructives et diagnostic prénatal. Moment de la correction chirurgicale.

The Authors are reviewing their experience of Obstructive Uropathies diagnosed and treated surgically in neonates, the last 8 years in their Institution. 67 cases were reviewed, in which 37 presented with ureteropelvic junction obstruction (UPJ). 13 with posterior urethral valves, 11 with primary megaureter and 6 with ureterocele. Prenatal ultrasonography allowed the diagnosis to be made in two third of the patients. UPJ is the most common obstructive uropathy observed. Posterior urethral valves the most severe because of high pulmonary and renal (dysplasia) complication rate. Surgery, when indicated, has no more complications to be expected than in general population, if oriented prophylactic measures are taken in the early peri- and postoperative period.

Plasma levels of diphenylhydantoin and the control of adult epileptic seizures: a Chilean experience.

In a prospective study of 117 adult ambulatory patients, 110 of whom were epileptics treated only with oral diphenylhydantoin (DPH), plasma levels of this drug were determined by gas-liquid chromatography. The average follow-up time was 6 months (range, 3 to 13 months); satisfactory control of seizures was obtained with plasma levels in the 10.2 to 25.8 micrograms/ml range, representing 68% of the patients whose seizures had been controlled. The dosage received by this group was from 4.2 to 6 mg/kg, with an average of 5.1. In general, these results agree with those found in European or North American patients, even though some differences or little clarity in the methodology of other trials make comparison difficult. This similarity of results makes one think that genetic or environmental differences do not alter the response to DPH in our patients, but further studies are necessary in that area. This paper can serve as a basis for the extrapolation of data about DPH coming from other latitudes that have been considered supposedly valid for Latin American epileptic patients.