[Metabolic syndrome in workers of a second level hospital]. / Síndrome metabólico en trabajadores de un hospital de segundo nivel.

BACKGROUND: People with metabolic syndrome (20-25 % of the world population) are three times more likely to suffer a heart attack or stroke and twice as likely to die from this cause. The objective of this study was to assess the prevalence of metabolic syndrome in workers of a second level hospital. METHODS: This was a cross-sectional study with 160 healthcare workers in Monterrey, México. Sociodemographic, anthropometric and biochemical data were obtained to assess the prevalence of metabolic syndrome. Bivariate and multiple logistic regression analysis were carried out in order to assess the relationship between metabolic syndrome and sociodemographic and occupational variables. RESULTS: The prevalence of metabolic syndrome among workers was 38.1 %. Nurses were more affected with 32.8 %. Overweight and obesity were prevalent in 78 %. In the logistic regression there was a significant association between metabolic syndrome and not having partner (OR 3.98, 95 % CI [1.54-10.25]) and obesity (OR 4.69, 95 % CI [1.73-12.73]). CONCLUSIONS: The prevalence of metabolic syndrome and obesity is alarming. Appropriate and prompt actions must be taken in order to reduce the risk of cardiovascular disease in this population.

Introducción: las personas con el síndrome metabólico (20-25 % de la población mundial) tienen una probabilidad tres veces mayor de sufrir un ataque cardiaco o un accidente cerebrovascular y una dos veces mayor de morir por esta causa. El objetivo es determinar la prevalencia del síndrome metabólico en trabajadores de un hospital de segundo nivel. Métodos: estudio transversal con 160 trabajadores de un hospital de Monterrey, México. Se obtuvieron datos sociodemográficos, antropométricos y bioquímicos para calcular la prevalencia del síndrome metabólico. Se realizó análisis bivariado y de regresión logística múltiple para evaluar la relación entre el síndrome metabólico y variables sociodemográficas y laborales. Resultados: la prevalencia de síndrome metabólico fue del 38.1 %; el personal de enfermería fue el más afectado con un 32.8 %. El sobrepeso y la obesidad fueron prevalentes en un 78 %. El 69 % de los hombres y el 85 % de las mujeres presentaron obesidad central. En la regresión logística hubo una relación significativa entre el síndrome metabólico y la variante no tener pareja (RM 3.98, IC 95 % [1.54-10.25]) y obesidad (RM 4.69, IC 95 % [1.73-12.73]). Conclusiones: la prevalencia del síndrome metabólico y la obesidad son preocupantes; deben tomarse acciones oportunas para disminuir el riesgo de enfermedad cardiovascular en esta población.

[Estimation of overweight and obesity in preschoolers according to national and international normativity]. / Estimación de sobrepeso y obesidad en preescolares. Normatividad nacional e internacional.

BACKGROUND: Prevalence of overweight and obesity in children under 5 years can be affected by type of anthropometric indicator and selected threshold values. We assessed variation on estimates according to national and international regulations (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 and GPC-IMSS-029-08; WHO-2006, CDC-2000 and IOTF, respectively). METHODS: Cross-sectional study in all the daycare centers (100 %) affiliated to Instituto Mexicano del Seguro Social-Nuevo León during June-December, 2010 (n = 11 141 children). Overweight and obesity were defined on the basis of each regulation, and total and stratified prevalences by age and sex were estimated. RESULTS: According to national regulation, overweight/obesity estimates varied from 12 to 22 %, and to international normativity, from 3 to 14 %. The highest prevalence was given by NOM-008-SSA3-2010 and GPC-SSA-025-08; and the lowest by WHO-2006. There were no differences by sex, but they existed by age; the highest discrepancy occurred in the 3.0-3.9 age group with 28 %. CONCLUSION: Health personnel and health policy makers should be aware of variation on estimates according to the definition employed. We recommend to standardize national regulation for pointing out overweight/obesity in preschoolers.

INTRODUCCIÓN: la prevalencia de sobrepeso/obesidad en menores de 5 años se puede ver afectada por tipo de indicador antropométrico y punto de corte aplicado. Se evaluó la variación en las estimaciones según la normatividad nacional (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 y GPC-IMSS-029-08) y la internacional (OMS-2006, CDC-2000 e IOTF). MÉTODOS: estudio transversal en 100 % de guarderías afiliadas al Instituto Mexicano del Seguro Social-Nuevo León durante junio-diciembre de 2010 (n = 11 141 infantes). Se definió sobrepeso y obesidad con base en cada normatividad y se estimaron las prevalencias totales y estratificadas por edad y sexo. RESULTADOS: de acuerdo con la normatividad nacional, el sobrepeso/obesidad varió entre 12 y 22 %; y con la normatividad internacional, entre 3 y 14 %. La mayor prevalencia fue con la NOM-008-SSA3-2010 y GPC-SSA-025-08; y la menor, con OMS-2006. No hubo diferencias por sexo, pero sÍ por edad; la mayor discrepancia ocurrió en niños entre 3.0 y 3.9 años, con 28 puntos porcentuales. CONCLUSIÓN: el personal y las personas relacionadas con la generación de políticas de salud tienen que estar conscientes de la variación de las estimaciones según la definición utilizada. Se recomienda estandarizar la normatividad nacional para señalar sobrepeso/obesidad en preescolares.

[Prevalence of overweight and obesity in children from Monterrey, Nuevo León]. / Prevalencia de sobrepeso y obesidad en niños de Monterrey, Nuevo León.

BACKGROUND: Pediatric obesity is a major health problem around the globe. It has increased in the last decades up to 30 % (in 2010). The aim of this study was to establish the prevalence of overweight and obesity in children from zero to 14 years from three family medicine units and one school. METHODS: A prospective study of prevalence, which included children of both sexes who assisted to three family medicine units and a junior high school. We assessed the somatometry and compared it in accordance to the World Health Organization 2006-2007 references and standards. RESULTS: The overall overweight and obesity prevalence in 1624 children was 45.5 % (15.5 % of overweight and 29.9 % of obesity, respectively). A total of 354 of 840 women (42.1 %) and 385 of 784 men (49 %) had overweight and obesity (p < 0.05). In both sexes, we did not observed a difference in overweight (15.7, women; 15.4, men). However, with regards to obesity, women showed 26.4 versus 33.6 of men (p < 0.05). We observed only one family unit with major obesity prevalence, which probably had an initial overestimation. CONCLUSIONS: We found one of the highest prevalences of overweight and obesity in children at a national level: up to 45 % in a state of Mexican northwestern. Obesity doubled overweight, and it was almost 10 % higher in men than in women.

INTRODUCCIÓN: la obesidad infantil es un problema de salud pública mundial y se ha incrementado en forma alarmante en las últimas décadas hasta en 30 % en el 2010. El objetivo de este estudio fue establecer la prevalencia de sobrepeso y obesidad en niños de cero a 14 años de tres unidades de medicina familiar (UMF). MÉTODOS: estudio prospectivo, de prevalencia, que incluyó a niños de ambos sexos que acudieron a tres UMF y una escuela primaria. Se evaluó la somatometría y se comparó de acuerdo con estándares y referencias de crecimiento de la Organización Mundial de la Salud (OMS) 2006-2007. RESULTADOS: la prevalencia de sobrepeso y obesidad en todo el grupo fue de 45.5 % en los 1624 niños de 0 a 14 años (15.5 %, sobrepeso; 29.9 %, obesidad). Un total de 354 de 840 mujeres (42.1 %) y 385 de 784 hombres (49 %) tuvieron sobrepeso u obesidad (p < 0.05). En las mujeres no se observó diferencia en cuanto a sobrepeso en relación con los hombres (15.7 frente a 15.4 %), pero sí en relación con la obesidad: 26.4 frente a 33.6 % (p < 0.05). Solo se observó una de las UMF con mayor prevalencia de obesidad, lo que probablemente se relacione con un sesgo de sobrerregistro. Conclusiones: se encontró una de las prevalencias de sobrepeso y obesidad infantiles más altas reportadas a nivel nacional, hasta en 45 %, en un estado del noreste mexicano. La obesidad fue dos a uno mayor al sobrepeso y casi 10 % mayor en hombres que en mujeres.

[Chromosomal abnormalities in patients from Obstetrics and Gynaecology hospital]. / Anormalidades cromosómicas en pacientes de un hospital de ginecoobstetricia.

BACKGROUND: Chromosomal abnormalities are present in 2-4 % of all newborns, and they cause 20 % of deaths in the first year of life. The estimated prevalence of chromosomal abnormalities is one for each 500-1000 newborns. These abnormalities can be numerical or structural, and they can affect autosomal or sexual chromosomes. They affect from 1 to 3 % of general population, and from 6 to 7 % of individuals with congenital anomalies. METHODS: Descriptive study, which included all the registries of cytogenetic analysis (of adults and newborns) made in a genetic laboratory in a period of 14 years. The prevalence of polymorphisms and chromosomal abnormalities in the patients from the Hospital de Ginecoobstetricia 23, Instituto Mexicano del Seguro Social (Monterrey, Nuevo León) was assessed. RESULTS: Of 4006 cytogenetic studies, 253 (6.3 %) did not show in vitro growth, 2667 (66.5 %) were normal, and 1175 (29.3 %) were abnormal. Of these, 614 (52.2 %) had polymorphisms, and 561 (47.7 %) structural or numerical chromosomal abnormalities. In regards to these chromosomopathies (561), trisomy 21 was observed in 429 (36.5 %); Turner's syndrome, in 84 (7.1 %); trisomy 18, in 57 (4.8 %); and trisomy 13, in 32 (2.7 %). With G-band technique, we found 93 % of in vitro cell growth. CONCLUSIONS: Of these studies, 55 % was performed due to non-numerical abnormalities; 14.4 %, due to structural abnormalities; and the rest, due to polymorphisms.

INTRODUCCIÓN: las anormalidades cromosómicas se presentan en 2 a 4 % de los recién nacidos y causan 20 % de las muertes en el primer año de vida. Su prevalencia es de uno por cada 500 a 1000 recién nacidos vivos. Pueden ser numéricas o estructurales y afectar a los cromosomas autosómicos o sexuales. Se presentan en 1 a 3 % de la población general y en 6 a 7 % de los individuos con anomalías congénitas. MÉTODOS: estudio descriptivo en el que se incluyeron todos los resultados citogenéticos de cariotipos tomados de sangre periférica de adultos y neonatos. Se evaluó la prevalencia de polimorfismos y alteraciones cromosómicas en derechohabientes del Hospital de Ginecoobstetricia 23 del Instituto Mexicano del Seguro Social, en Monterrey, Nuevo León. RESULTADOS: de 4006 estudios citogenéticos, en 253 no se obtuvo crecimiento de linfocitos (6.3 %), 2667 fueron normales (66.5 %) y 1175, anormales (29.3 %); de estos últimos, en 614 (52.2 %) se identificaron polimorfismos cromosómicos y en 561 (47.7 %), aberraciones cromosómicas estructurales o numéricas. De las cromosomopatías (561, 47.7 %), la trisomía 21 se observó en 429 (36.5 %), el síndrome de Turner en 84 (7.1 %), la trisomía 18 en 57 (4.8 %) y la trisomía 13 en 32 (2.7 %). Con la técnica de bandeo G se obtuvo un crecimiento celular in vitro de 93 %. CONCLUSIONES: 55 % de los estudios se realizó por anormalidades diferentes a las numéricas, 14.4 % por alteraciones estructurales y el resto se debió a polimorfismos.

[Risk factors of prematurity. A case control study]. / Factores de riesgo para la prematurez. Estudio de casos y controles.

BACKGROUND: Prematurity is the most frequent cause of perinatal morbidity and mortality, and is responsible with 75% of neonantal deaths not related to congenital defects. OBJECTIVE: The aim of this study was to know risk factors that influence premature delivery in a third level attention in a Gyneco-Obstetric Unit. MATERIAL AND METHODS: In a case-control study, was conducted an interview with 300 mothers who had their delivery at 28 and 36 gestational weeks in group of cases and 600 mothers from 37 to 41 weeks in controls, who assisted for attention from April to September 2011. RESULTS: The factors associated eighth higher risk for prematurity were: maternal age above 35 years was more frequent in cases (14.6%), previous placenta occurred more frequent in cases (9.3%), Infectious disease were highly present in cases such as: urinary tract infection (46%). But association of 2 or more factors such as premature rupture of membranes and cervicovaginitis, were more frequent significantly in study group (76%). CONCLUSIONS: The prematurity risk factor more freqeunt were: infectouse disease in study group. A deficient prenatal attention can be increased in order to prevent premature delivery. When 2 or more factors associated in a gestation the risk also increase, and should increase the following and medical attention to reduce premature risk.

Diagnóstico prenatal de cierre prematuro del foramen oval e hidrops fetal / Prenatal diagnosis of foramen ovale premature closure and hydrops fetalis

A case of premature closure of foramen ovale (PCFO) is presented. The patient was sent to the Fetal Maternal Unit after 30 weeks of gestation due to hydrops fetalis. A Doppler ultrasound performed after 34 weeks of gestation showed no interatrial flow and led to the confirmation of PCFO, associated to pleural effusion and ascitis. No evidence of hydrops, pleural effusion, ascitis, cardiac failure, cardiac defects nor chromosomal abnormalities were present in the newborn baby. Since prenatal diagnosis of PCFO is a life threatening condition, detection improves fetal and neonatal life expectancy (AU)

Se reporta el cierre prematuro de foramen oval (CPFO) en un embarazo de 30 semanas de gestación, enviado con hidrops fetal a Unidad de Medicina Materno Fetal. A las 34 semanas se evaluó con Ultrasonido Doppler y se observó falta de flujo entre aurículas, confirmando el CPFO, presencia de derrame pleural y ascitis. Después del nacimiento, al neonato se le descartó la presencia de hidrops, derrame o ascitis, insuficiencia cardiaca, defectos cardiacos o cromosomopatía, y egresó sano. El CPFO pone en riesgo la vida. Cuando es detectado prenatalmente mejora la expectativa de vida fetal y neonatal (AU)

[Risk factors of birth obstetric trauma]. / Factores de riesgo de trauma obstétrico.

BACKGROUND: The proper prenatal care for pregnant women is crucial to quickly identify risk factors for birth trauma. OBJECTIVE: To identify risk factors for neonatal birth trauma. PATIENTS AND METHOD: Case-control study that included a patient in the case group for every two controls. The following risk factors were identified: cephalopelvic disproportion, macrosomia, use of forceps, precipitated or prolonged labor, malpresentation, and the most common types of birth trauma. We used descriptive statistics and odds ratios. RESULTS: Statistically significant risk factors for birth trauma were: maternal age < or = 20 years (OR = 16) and > or = 30 years (OR = 2.5), first pregnancy (OR = 4.0), cephalopelvic disproportion (OR = 8.3), forceps delivery (OR = 9.4), birth weight greater than 3,800 g (OR = 6.6), and non-cephalic presentation (OR = 8.3). Found birth trauma types were: ecchymosis (40.4%), caput succedaneum (25%), erosion (15.4%), clavicle fracture (5.9%), brachial plexus paralysis (4.7%), inter alia. The perinatal outcome of 79 infants with birth trauma were compared to 158 healthy newborns. CONCLUSION: Risk factors associated with birth injuries were: Maternal (age, pregnancy), newborn (weight), and birth care (presentation, instrumentation and pelvic sufficiency).

[Prenatal diagnosis of choledochal cyst]. / Quiste de colédoco detectado prenatalmente.

The choledocal cyst is a defect of the biliary extrahepatic route, the incidence is 1 in 100-150,000 newborns. This paper reports the case of a female newborn with choledocal cyst detected prenatally, from a 32-year-old mother, 2nd term pregnancy, who was diagnosed in the routine obstetric ultrasound as an abdominal fetal cyst. An anatomic obstetric ultrasound confirmed the diagnosis that was defined of a probable hepatic origin. Newborn was delivered at 39 weeks by caesarean section, with weight of 3,980 g and Apgar score 9-9 in conventional time. Newborn presented a maxim bilirubin level of 16 mg, controlled with phototherapy; the hepatic function was normal. Ultrasound showed a choledocal cyst which measured 50 x 49 x 48 mm, with dilatation of the hepatic common conduct, the gall bladder was normal. The abdominal scan reported a cystic mass in the middle abdominal region of 44 x 53 x 52 mm confirming a choledocal cyst. The diagnosis was confirmed after surgery. Patient had a satisfactory post-surgical evolution.

Obesidad central única y combinada con sobrepeso/obesidad en preescolares mexicanos

La circunferencia de cintura (CC) constituye una herramienta útil para identificar niños con mayor riesgo de complicaciones relacionadas con grasa abdominal. Se determinó la magnitud de obesidad central, única y combinada con sobrepeso/obesidad en infantes 1-5 años de edad. También se identificaron valores percentilares suavizados de CC específicos para edad y sexo, y se compararon con datos disponibles de otros países. Se realizó un estudio transversal en niños de 8 guarderías en Monterrey, México (n=903; 431 niños y 472 niñas). Debido a que el riesgo por obesidad abdominal inicia con CC en percentil 75, se consideraron dos puntos de corte, percentil 75 y 90. Se definió sobrepeso con base en índice de masa corporal para edad y sexo en percentil 85-94; y obesidad, en percentil ≥95. El análisis consistió de prevalencias puntuales e intervalos de confianza de 95%. El software LMS Chart Maker Light se utilizó para suavizar los valores percentilares de CC. La media de edad de la población fue 2,7±1,0 años. Los mexicanos registraron diferencias de 1 cm de CC más que los afro-americanos; y hasta 4 cm menos que los méxico-norteamericanos. La combinación de obesidad central con CC percentil ≥75 con sobrepeso/obesidad, fue 25,1% (IC95% 22,3-28,0) y única 15,4% (IC95% 13,0-17,8). La prevalencia de obesidad abdominal única con CC percentil ≥90, fue de 4.4% (IC95% 3.0, 5.8). Las estancias infantiles representan una oportunidad para desafiar la obesidad central. La CC puede ser utilizada desde edad temprana para tamizaje y atención a niños con mayor riesgo cardiovascular.

Central: single and combined with overweight/ obesity in preeschool Mexican children. Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n=903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile ≥75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile ≥95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7±1.0 years. Mexican children’s WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95%CI 22.3-28.0) and single, 15.4% (95CI% 13.0- 17.8). Prevalence of single abdominal obesity with WC at percentile ≥90 was 4.4% (IC95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.

[Perinatal outcome of pregnancies in advanced maternal age]. / Hallazgos perinatales de embarazos en edad materna avanzada.

BACKGROUND: Traditionally an advanced maternal age have been associated with a higher risk of unfavorable perinatal results. OBJECTIVE: to know the perinatal outcomes in women giving birth at age 40 or older during a year in a concentration hospital located at Monterrey, Nuevo León. PATIENTS AND METHODS: In a retrospective, cross-sectional, study. RESULTS: 163 women and 170 newborn were included. A newborn death (5.8 x 1000 RN) and no one maternal death was observed. The most frequent maternal associated disease was gestational diabetes (16%) followed by the hypertensive disorders (10%). The cesarean rate was 71.1% and the most frequent indication was previous cesarean. The most frequent hospitalization cause was early premature labour (4.2%). Premature membrane was observed in 11% of patients. The mean delivery time was at 38 weeks with a mean body weight of 3032 g. There were 5 newborn with congenital malformations (2.9%). 21 newborns were hospitalized (12%) and the most frequent indication was prematurity. CONCLUSION: Women giving birth at age 40 or older observed a higher gestational diabetes incidence followed by the pregnancy-induced hypertension. The cesarean delivery was the most frequent mode of delivery. We consider that the perinatal outcomes in this study were favorable for both mother and child.

[Single central obesity and combined with overweight/obesity in preeschool Mexican children]. / Obesidad central única y combinada con sobrepesolobesidad en preescolares mexicanos.

Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n = 903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile > or = 75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile > or = 95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7 +/- 1.0 years. Mexican children's WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95% CI 22.3-28.0) and single, 15.4% (95 CI% 13.0-17.8). Prevalence of single abdominal obesity with WC at percentile > or = 90 was 4.4% (IC 95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.

[Pituitary tumor detected prenatally]. / Tumor hipofisiario detectado prenatalmente.

INTRODUCTION: Brain tumors are present in 2.9 per 100,000 newborn. Craniopharyngioma is a benign and slow growing brain tumor, frequently localized in the sellar and suprasellar region. There are few reports of pituitary tumor detected prenatally. CASE REPORT: We report a neonate with a craniopharyngioma detected prenatally as a pituitary tumor. In a 23 year old mother, second gestation, with no important history, was detected a sellar tumor at 31 gestation weeks, the obstetric ultrasound reported a suprasellar tumor of 2 per 3 cm diameter. Pregnancy ended in a vaginal delivery at 39 weeks, and obtained a 3.9 kg female, with cephalic diameter of 37.5 cm, the Apgar score was 8-9 at 1st and 5th minutes. In early neonatal period was scanned and confirmed a 3.2/2.3/2.9 cm suprasellar tumor with calcium deposits. The Paediatric Oncology department suggested a surgery and was realized a craniotomy at 3rd week of age. The surgery allowed to obtain 30% of the tumor and confirmed by histology craniopharyngioma. Patient had favourable evolution and was discharged at 3 months of age. CONCLUSIONS: We report a neonate in who was detected by prenatal ultrasound the presence of a suprasellar solid tumor, scan and magnetic resonance images in neonatal period defined its size and location and a craniopharyngioma was confirmed by histology. Patient had a satisfactory postsurgical evolution and was discharged at 3 months of age.

[Analysis and perinatal outcome after intravascular transfusion]. / Análisis y resultados perinatales posteriores a una transfusión intravascular.

INTRODUCTION: the leading cause of fetal anemia is Rh isoimmunization. The timely diagnosis by ultrasound and intravascular transfusion improves the prognosis. OBJECTIVE: to evaluate the increase in hemoglobin in the fetus and correlate the red cell transfusion volume with elevation of hemoglobin and perinatal outcome. PATIENTS AND METHODS: prospective, case series study. We included 17 patients with fetal anemia detected by measuring the peak systolic velocity of middle cerebral artery and determination of fetal hemoglobin before and after cordocentesis. After confirmation of fetal anemia (Hb <10 g/dL), was held fetal transfusion with 50 mL/kg estimated fetal weight, with packed red blood cells type O Rh negative. RESULTS: In 17 cases fetal anemia was diagnosed, of which 11 (64%) had Rh isoimmunization and 6 (36%) were not immune. The 17 cases received 27 intravascular transfusions, in 75% hemoglobin rose to 10 g/dL, 45% in the first transfusion, 25% in the second and 10% in the third transfusion. Fetal hemoglobin between before and after transfusion was 6.5 and 12.9 g/dl, respectively (p<0.001) and allowed to continue the pregnancy from 3 to 12 weeks from the first transfusion. There were 4 deaths (2 stillbirths and 2 neonatal), but only one was related to the procedure. the survival rate was 76%, mortality in the presence of hydrops was 30% and no deaths in patients without hydrops. CONCLUSIONS: Mortality in fetal anemia was 23.6% and only one case was related to intravascular transfusion. In cases of survival to birth, pregnancy lasted >30 weeks gestation. Hemoglobin rose from 27 to 300% of the initial fetal hemoglobin. The presence of fetal hydrops significantly increases mortality.

[Epidemiological profile of ovarian cancer]. / Perfil epidemiológico del cancer de ovario.

BACKGROUND: In Mexico, ovarian cancer represents 5.3% of cancer diagnoses in all age groups and 21% of gynecologic cancers. The states with the highest incidence of this disease Nuevo León, Mexico State and Federal District. OBJECTIVE: To determine the epidemiological profile of ovarian cancer. PATIENTS AND METHODS: A retrospective cross-sectional study that included all patients with complete records, diagnosed with ovarian cancer treated at the Oncology department UMAE Monterrey No. 23, January 2009 to 31 December 2009. RESULTS: We identified 40 patients with ovarian cancer. The average age of menarche was 12.7 years, 40% were of reproductive age, 25% were nulliparous, 15% had a pregnancy and 37.5% had two pregnancies. Of the total patients, 17% had a history of breast cancer, 40% used a contraceptive method, 37% used oral contraceptives. The tumor marker CA 125 was found in 40% of patients, 63.1% had ultrasound markers for cancer. The most frequent clinical stage 1A in which they found 32% of cases. Papillary serous adenocarcinoma was diagnosed in 25% of patients, endometroid adenocarcinoma and mucinous tumor of low malignant potential was diagnosed borderline at 20%, poorly differentiated adenocarcinoma in 18% tumor granulosa cells in 7% and papillary adenocarcinoma ring cell adenocarcinoma in 5%. In total, 43% of patients received chemotherapy. CONCLUSION: The majority of cases tenia50 years or more. The background was the most frequent hereditary breast cancer. There were no deaths during the study.

Infarto cerebral espontáneo en un recién nacido de término / Spontaneous cerebral infarction in a full-term neonate

Introducción. Un accidente cerebro-vascular de origen isquémico y/o hemorrágico aumenta la morbi-mortalidad neonatal. Se estima que ocurre en 1:4,000 recién nacidos. En este trabajo se reporta un recién nacido de término con un accidente cerebro-vascular aparentemente espontáneo. Caso Clínico. Se trata de un recién nacido, madre de 31 años, segunda gesta de término que cursó con diabetes gestacional y fue tratada sólo con dieta. Inició con trabajo de parto a las 41.5 semanas de gestación por FUM; se efectuó cesárea por desproporción céfalo pélvica. Se obtuvo producto femenino de 3,640 g calificado con Apgar 8-9, se le aplicaron sólo pasos iniciales de reanimación. En el primer día de vida presentó desviación de la comisura labial a la derecha y movimientos tónico-clónicos en hemicuerpo derecho en 2 ocasiones; se inició fenobarbital. Los resultados de laboratorio para glucemia, sodio, calcio, potasio, creatinina, tiempos de coagulación y biometría hemática fueron normales; los cultivos de líquido cefalo-raquídeo fueron negativos, la punción lumbar se consideró traumática. El ultrasonido fontanelar no mostró alteraciones sugestivas de un evento hemorrágico ni alteraciones a nivel ventricular; sin embargo, al tercer día de vida se practicó tomografía axial computarizada de cráneo simple visualizándose una zona hipodensa con un patrón geográfico hacia la región tempo-parietal izquierda con aspecto de evento vascular isquémico en el territorio de la arteria cerebral media. Conclusiones. Se continuó con fenobarbital y ácido acetilsalicílico. Permaneció asintomática por lo que se egresó al séptimo día de vida. Se citó a consulta externa en Neurología Pediátrica.

Background. Cerebral vascular accident (CVA) is an important cause of hemorrhagic or ischemic cerebral injury and increases neonatal morbidity and mortality. It occurs in 1/4000 term neonates. We report a case of a neonate with a spontaneous CVA. Case report. We present the case of a newborn (NB) who was delivered from a 31-year old mother. It was the second pregnancy with 41.5 gestation weeks. The mother presented gestational diabetes controlled only by dietary therapy. A 3640 g, apparently healthy female was obtained by cesarean delivery that was indicated due to cephalopelvic disproportion. Apgar scores were 8-9 according to the conventional time points. The pediatrician used only initial steps of reanimation. During the first day of life, the infant presented a deviation of the right mouth commissure and tonic-clonic movements on the right half of the body two times. The newborn was treated with phenobarbital intravenous infusion. Laboratory tests were all normal, and cultures of cerebrospinal fluid and blood were considered negative. A head sonogram showed no evidence of hemorrhage or ventricular distortion but a cranial CT reported a low-density zone suggesting a cerebral infarction in the left parietal and temporal regions. Conclusions. We continued to treat with phenobarbital and acetylsalicylic acid and the patient remained asymptomatic prior to discharge at the 7th day of life, recommending follow-up with a pediatric neurologist.

Pseudosindactilia y amputación como principales signos del síndrome de bandas amnióticas / Pseudosyndactyly and amputation as the main features of the amniotic band syndrome

Introducción. Las bandas amnióticas causan un espectro muy amplio de malformaciones fetales, desde labio-paladar hendido e hidrocefalia hasta estrangulación y amputación de extremidades; presenta una prevalencia que va de 1:1,200 a 1:15,000 nacimientos. El siguiente caso clínico se reporta con el objetivo de describir los principales signos del síndrome de bandas amnióticas. Caso clínico. Madre de 21 años, primigesta, con antecedente de vulvovaginitis en el primer trimestre, sin tratamiento; control prenatal irregular sin ultrasonidos obstétricos. El embarazo culminó en cesárea a las 30 semanas por presentar oligohidramnios severo. Se obtuvo producto femenino de 1,200 g y Apgar 7-8. A la exploración física se encontró pseudosindactilia con zona de anillo uniendo a las falanges por el vértice, pie equino varo izquierdo y pierna derecha amputada desde la región tibial media terminando en punta, con escara en porción distal. Además, en estudio radiológico se observaron las falanges del segundo, tercer y cuarto dedos unidas al centro en vértice y peroné hipoplásico. Conclusiones. Los anillos de constricción, la amputación de una o más extremidades y la pseudosindactilia son signos importantes y consistentes que apoyan el diagnóstico del síndrome de bandas amnióticas, con un mal pronóstico para la función aunque bueno para la vida.

Background. Amniotic band syndrome causes a wide spectrum of congenital defects such as cleft lip, hydrocephalus, and growth restriction of limbs, with or without amputation. The condition occurs in every 1:1,200 to 1:15,000 deliveries. The objective of this report is to define the most important features of amniotic band syndrome. Case report. We report the case of a 21 -year-old female with a first pregnancy. No prenatal care or ultrasound studies were carried out, but the patient reported experiencing vaginal discharge during the first trimester. The pregnancy resulted in cesarean section at 30 gestational weeks because of severe oligohydramnios. A 1200-g female was delivered with Apgar 7-8. The newborn presented congenital amputation of the right leg and pseudosyndactyly of the left hand with a ring constriction of the third phalange of the second, third and fourth finger, a left equinovarus foot and amputation of the right leg from the middle third of the tibial region. These findings were confirmed by x-ray. Conclusions. Constriction rings, limb amputation and pseudosyndactyly are important and consistent features with the amniotic band syndrome. Functional prognosis is nonfavorable, but prognosis for life productivity is good.

[Prenatal dexametasone and periventricular leucomalacia in prematures]. / Uso prenatal de dexametasona para leucomalacia periventricular en niños prematuros.

BACKGROUND: Prematurity is observed in 5-8% of deliveries, and is frequent cause of handicap. Premature have 5-24% risk for developing periventricular leukomalacia (PLM). The use of antenatal steroids (AS) is controversial for preventing PLM. METHODS: We studied 110 premature neonates < 1500 g, divided in 2 groups: control (group 1, n = 55), and group 2 (n = 55) who received antenatal dexamethasone. We registered clinical data, evolution and use of oxygen or mechanical ventilation. At one month age a transfontanelar ultrasound was done looking specific PLM. RESULTS: In group 1, found 6/55 (10.9%) with PLM and 3/55 (5.4%) in group 2, RR = 0.5, CI 95% (0.13-1.90). In group 1: 30/55 (54.54%) the ultrasound was normal; in 16 (29%) had intraventricular haemorrhage, and in 3 cases (5.45%) had severe hydrocephalus. In group 2: 32/55 (58.18%) ultrasound was normal, 16/55 (29%) had intraventricular haemorrhage, 4/55 (7.27%) had severe hydrocephalus. We did not find significant difference between other variables in both groups. CONCLUSIONS: There was no significant difference in PLM incidence between patients who did or did not received antenatal dexamethasone.

[Impact of perinatal mortality in multiple pregnancies over total perinatal mortality in a hospital in Monterrey, Nuevo León]. / Repercusión de la mortalidad perinatal de los embarazos múltiples en la mortalidad perinatal total en un hospital de Monterrey, Nuevo León.

BACKGROUND: The incidence of multiple pregnancies has increased on the last decade resulting in a rise of premature and underweight newborns infants, with increase of the perinatal morbidity and mortality. OBJECTIVE: To determine the impact of perinatal mortality of multiple pregnancies in the total perinatal mortality. PATIENTS AND METHOD: perinatal mortality rate of multiple pregnancies treated in the Unidad Médica de Alta Especialidad No. 23, Monterrey, Nuevo León (Mexico) were analized, from 2002 to 2008. The prevalence of multiple pregnancies, the rate of premature births, the incidence of low-birth weight products and perinatal mortality was estimated. The difference between overall mortality and multiple pregnancy rate was measured by chi2. RESULTS: Of the 144,114 births, there were 1076 (0.8%) fetal deaths and 1,617 (1.10%) neonatal deaths. There were 110 high-order fetal pregnancies (more than three fetuses): 92 triplets, 14 quadruplets, 3 quintuplets and 1 sextuplet, producing a total of 353 newborns. Multiple pregnancies represent 2.8% (59/2093) of the total perinatal mortality (p = 0.3). 79.9% (1674/2093) of the total perinatal mortality were newborns weighing less than 2500 g. In the group of multiple pregnancies, all perinatal deaths occurred in products weighing less than 2500 g. CONCLUSIONS: The perinatal mortality of multiple pregnancies does not impact significantly overall perinatal mortality.

[Difference between perinatal mortality in multiple pregnancies obtained spontaneously versus assisted reproduction]. / Diferencia entre la mortalidad perinatal de los embarazos múltiples obtenidos de forma espontánea versus por reproducción asistida.

BACKGROUND: Recently assisted reproduction techniques are more common, which increases multiple pregnancies and adverse perinatal outcomes. Some authors report increased mortality in multiple pregnancies products obtained by techniques of assisted reproduction vs. conceived spontaneously, although other authors found no significant difference. OBJECTIVE: To evaluate mortality rate of multiple pregnancies comparing those obtained by assisted reproduction vs. spontaneous conception. PATIENTS AND METHOD: Retrospective, observational and comparative study. We included pregnant women with 3 or more products that went to the Unidad Médica de Alta Especialidad No. 23, IMSS, in Monterrey, NL (Mexico), between 2002-2008. We compared the number of complicated pregnancies and dead products obtained by a technique of assisted reproduction vs. spontaneous. RESULTS: 68 multiple pregnancies were included. On average, spontaneously conceived fetuses had more weeks of gestation and more birth weight than those achieved by assisted reproduction techniques (p = ns). 20.5% (14/68) of multiple pregnancies had one or more fatal events: 10/40 (25%) by assisted reproduction techniques vs. 4/28 (14%) of spontaneous multiple pregnancies (p = 0.22). 21/134 (16%) of the products conceived by assisted reproduction techniques and 6/88 (7%) of spontaneous (p < 0.03) died. CONCLUSIONS: 60% of all multiple pregnancies were obtained by a technique of assisted reproduction and 21% of the cases had one or more fatal events (11% more in pregnancies achieved by assisted reproduction techniques). 12% of the products of multiple pregnancies died (9% more in those obtained by a technique of assisted reproduction).

Diagnóstico de estenosis esofágica congénita a los 10 meses edad / Congenital esophageal stenosis diagnosed at 10 months of age

Introducción. La estenosis esofágica congénita (EEC) se presenta en 1/25-50 000 nacidos vivos. Inicia con vómito postprandial desde el nacimiento y debe diferenciarse con el reflujo gastroesofágico (RGE). Caso clínico. Lactante menor con vómito postprandial desde su nacimiento, tuvo casi ahogamiento en 3 ocasiones, se manejó como RGE con procinéticos y diferentes fórmulas lácteas. A los 10 meses de edad se practicó esofagograma y endoscopia; al segundo intento de dilatación con balón presentó sangrado, por lo que se realizó resección del sitio de estenosis y anastomosis término-terminal. En el estudio histológico se confirmó EEC variedad fibromuscular. Conclusiones: Este paciente fue tratado como RGE hasta los 10 meses edad, se sospechó EEC debido a persistencia del vómito postprandial e intolerancia a semisólidos. Los estudios de imagen, como esofagograma y endoscopia, confirmaron el diagnóstico. La corrección quirúrgica fue realizada después de la dilatación endoscópica fallida.

Background. Congenital esophageal stenosis (CES) occurs in 1/25-50 000 live births. It is a rare diagnosed and must be differentiated from gastroesophageal reflux disease (GERD). Case report. We present the case of a 10-months old female with vomiting and regurgitations since the first day of life. The patient was treated as having GERD. She was administered different infant formulas including elemental formulas. On three occasions she had imminent bronchial aspiration. The patient's weight was normal because she received a diluted diet and elemental formula until 10 months of age. Esophagogram and endoscopy confirmed CES diagnosis. Surgery was done after the second endoscopic dilatation failure. End-to-end anastomosis was done at 11 months. Histopathological findings reported fibromuscular type of CES. Conclusion. CES is a rare entity with a frequently delayed diagnosis. Patients are often treated according to diagnosis of GERD until intolerance to semisolid diet appears and CES is suspected. Esophagogram and esophageal endoscopy followed by balloon dilatation prior to end-to-end anastomosis is the treatment of choice.