Efectos perinatales de la metformina en diabetes gestacional / Perinatal effects of metformin in gestational diabetes

Antecedentes: La diabetes gestacional es una condición en la que una mujer sin diabetes previa desarrolla intolerancia a la glucosa en cualquier momento del embarazo y puede o no resolverse al término de la gestación. La metformina, del grupo de las biguanidas, se considera manejo alternativo de la diabetes gestacional, incluido en el listado de los medicamentos esenciales por la OMS. El objetivo del presente fue identificar la incidencia de complicaciones obstétricas y perinatales en mujeres con diabetes gestacional que son sometidas a tratamiento con metformina. Material y método: Estudio transversal, con análisis comparativo de los resultados perinatales del tratamiento de diabetes gestacional. Donde el grupo 1 corresponde a pacientes que realizaron únicamente dieta y ejercicio y el grupo 2 a pacientes a las que además se les pautó metformina. Resultados: Fueron incluidas un total de 104 pacientes, edad materna promedio de 35 años, con ganancia ponderal de 10kg, media de peso al nacimiento de 3082 gramos. En el grupo 1 45,2%(n=47) con mayor ganancia ponderal materna y aumento en la incidencia de enfermedades hipertensivas del embarazo (9 casos de hipertensión gestacional y una preeclampsia con criterios de severidad); en contraste con el grupo 2, 54,8%(n=57) donde se reporta menor edad gestacional al nacimiento y un nacimiento pretérmino. Conclusiones: Con los resultados observados se demuestra que el uso de metformina para lograr el control metabólico de las pacientes con diabetes gestacional es una opción viable.(AU)

Background: Gestational diabetes is a condition in which a woman without previous diabetes develops glucose intolerance at any time during pregnancy, and may or may not be resolved at the end of gestation. Metformin, from the biguanide group, is considered as an alternative for the management of gestational diabetes, and is listed in essential drugs by the WHO. The objective of this study was to identify the incidence of obstetric and perinatal complications in women with gestational diabetes undergoing treatment with metformin. Material and method: A cross-sectional study was carried out, with comparative analysis of the perinatal outcomes of Gestational Diabetes treatment with lifestyle modification with and without metformin. Group 1 corresponded to patients who only performed exercise and diet, and Group 2 to patients who were also prescribed metformin. Results: A total of 104 patients were included. The mean maternal age was 35.05 years, with weight gain of 10kg. The mean birth weight was 3082 grams. Group 1, 45.2% (n=47) with greater maternal weight gain and increased incidence of hypertensive diseases of pregnancy (9 cases of gestational hypertension and 1 pre-eclampsia with severity criteria); in contrast to group 2, 54.8% (n=57) where 1 preterm birth and a lower gestational age at birth was reported. Conclusions: With the results observed, it is shown that the use of metformin to achieve metabolic control of patients with gestational diabetes is a viable option.(AU)

Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial.

The objective was to evaluate whether preoperative administration of dexamethasone improved postoperative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a preoperative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05). Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional postoperative analgesic and antiemetic drugs.