[Vertical transmission of Covid - 19. What does the evidence say?] / Transmisión vertical de COVID-19. ¿Qué dice la evidencia?

INTRODUCTION: Vertical transmission of SARS-CoV-2 from the infected mother to the newborn is still uncertain and the definitive answer is under evaluation. THE OBJECTIVE: of this review was to evaluate the evidence available in the literature regarding whether the pregnant woman infected by SARS-CoV-2 represents a potential risk of vertical transmission to the fetus and/or newborn. MATERIAL AND METHOD: A scoping review was performed using Science Direct, PubMed, and Cochrane library to search for research papers. INCLUSION CRITERIA: published studies of pregnant mothers with COVID-19, with perinatal outcomes reported in the first 72 hours after birth. RESULTS: 569 studies were found; 65 of them were repeated. Therefore, 504 were evaluated, of which 460 were excluded. Finally, 42 research papers that met the inclusion criteria were analyzed. 334 pregnant women with COVID-19 and 335 new borns were described; of which 20 presented SARS-CoV-2 infection confirmed by Polymerase chain reaction (PCR) from nasopharyngeal swab. Of these, 18 were identified in the first 48 hours after birth and 12 presented with symptoms. The most frequent route of delivery was cesarean section in 76.2%, and the gestational age range of the newborns was between 26 and 40 weeks. In 86.8% of the cases, mother-child pairs were isolated. CONCLUSION: Vertical transmission of COVID-19 is possible, although infrequent. Prospective studies are required to establish the possibility of in utero maternal- fetal transmission and its consequences.

Experiencias de terapia ocupacional en salud mental infanto juvenil: una aproximacióna prácticas de derecho y participación / Occupational therapy experiences of child and youth mental health: an approach to rights and participation practices

El presente artículo corresponde a un ensayo que tiene por objetivo mostrar experiencias de intervención de terapiaocupacional en el ámbito de la salud mental infanto juvenil. Se pretende reflexionar en cómo esta disciplina desde su quehacer práctico profesional contribuye a garantizar los derechos, desde las atenciones en dispositivos de salud. El documento está conformado por cuatro experiencias de Intervención en contextos de salud pública que se vinculan con los principios rectores de la Convención internacional de los Derechos del Niño, los cuales se constituyen en los pilares para el ejercicio de todos los derechos que se establecen en el tratado. Como parte del análisis de este documento se concluye lo relevante que resulta la generación de políticas públicas atingentes a las necesidades de esta población, ya que de no ser así se reproducen prácticas normalizantes que atentan contra la autonomía de sujetos. En este sentido es fundamental realizar intervenciones situadas que promuevan la inclusión y participación de niños, niñas y jóvenes como actores sociales.

This article corresponds to an essay that has for purpose to show occupational therapy experiences of intervention in child and adolescent mental health. It is intended to reflect how this discipline, from the professional practice, contributes to guarantee rights, from health care devices. The document has four intervention experiences in public health context, that are bound to the founding principles of the international Convention of Children Rights, which constitute the pillars for the exercise of the rights established in the treaty. As part of the analysis of this document, it is concluded how relevant it results the development of public politics related to the needs of this population; because if not, “normal practices” are reproduced, and they affect the autonomy of the subject. In this way, it is important to develop located interventions, to promote the inclusion and participation of boys, girls and young boys as social actors.

Identificación delictual juvenil: una propuesta de intervención ocupacional / Identificacion offender teenagers: a proposed occupational intervention

La presente revisión bibliográfica tiene por objetivo entrelazar prácticas de intervención desarrolladas a partir de la puesta en marcha de la Ley de Responsabilidad Penal Adolescente, con los modelos disciplinares de Terapia Ocupacional con el fin de otorgar abordaje integral en este contexto. Al indagar en las historias de vida de los jóvenes privados de libertad nos encontramos con trayectorias de vulneración de derechos impactadas por la segregación social, económica, cultural y ocupacional. Lo anterior genera identidades ocupacionales marcadas por experiencias con connotaciones negativas por lo que quienes trabajan en el abordaje de estos sujetos deben comprender dichos procesos socioculturales para entregar las herramientas necesarias que contribuyan a la autonomía y al desarrollo de conductas prosociales. Como estrategia desde Terapia ocupacional se visualiza la identificación del joven con una ocupación significativa no asociada a la actividad delictual que favorezca la autonomía, sentido de pertenencia y empoderamiento de los sujetos para su inclusión social.

The objective of this bibliographic revision is to bring together intervention practices developed out of the enactment of the AdolescentPrison Responsibility Law with disciplinary models of occupational therapy in order to execute an integrated approach in this context/ area. Upon studying/investigating the life histories of encarcerated youth, we discovered trajectories of infringement of rights - affected by social, economic, cultural, and occupational segregation.The former generates occupational identities characterized by experiences with negative connotations. Thus, people working to approach these subjects should understand these sociocutural processes to give them the tools necessary to contribute to autonomy and the development of positive social conduct. One occupational therapy strategy is to have the young person visualize his/her identification with a meaningful occupation not associated with criminal activity - one that favors autonomy, a sense of belonging, and empowerment for his/her social inclusion.

Evaluación multidimensional de los servicios de salud para adolescentes en centros de Atención Primaria en una comuna de Santiago / Multidimensional assessment of public health care services for adolescents in Chile

Background: Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. Aim: To assess the quality of health services provided to teenage users in Primary Health Care. Material and Methods: A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. Results: In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. Conclusions: Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care.

Asociación entre el consumo de macronutrientes de la dieta y caries en adultos y adultos mayores diabéticos tipo 2 / Association between dietary macronutrients and caries in type 2 diabetic adults and elderly

Objetivos: Se ha reportado una mayor tasa de caries en pacientes con diabetes mellitus tipo 2 (DM), probablemente debido a cambios en los patrones de dieta. El objetivo de este estudio fue determinar si existe una asociación entre la composición de macronutrientes de la dieta y la caries en sujetos con DM. Métodos: Una muestra compuesta por 33 sujetos con DM y 37 controles sin la patología fue examinada para determinar la experiencia de caries mediante el índice COPD y la prevalencia de caries radiculares con ICDAS II. Se aplicó una encuesta de dieta de reporte de 24 horas. Para determinar la composición de la dieta, los alimentos fueron clasificados acorde al contenido de macronutrientes; carbohidratos, proteínas y lípidos (gramos/día, kilocalorías y porcentaje del nutriente/día). Resultados: Los resultados fueron analizados mediante Kruskal-Wallis y Mann-Whitney. Un análisis de correlación y un modelo de regresión lineal se utilizaron para analizar la asociación entre composición de macronutrientes y la tasa de caries coronales y radiculares, con un nivel de significancia del 95 por ciento. Resultados: Los pacientes diabéticos tipo 2 mostraron mayor número de dientes perdidos por caries, más dientes obturados y más caries radiculares (p<0.05) que los controles sin DM. Los diabéticos presentaron menor consumo de carbohidratos (p=0.021), pero mayor consumo de proteínas (p=0.0405) que los controles. Se verificó una asociación directa entre un mayor consumo de proteínas con una tasa mayor de caries radiculares en pacientes con DM (p<0.001). Conclusión: Las diferencias en el consumo de macronutrientes en pacientes con DM no se relacionan con tasas diferenciales de caries coronales, pero un mayor consumo de proteínas se asocia con una mayor prevalencia de caries radiculares.

Objectives: Higher caries rates have been reported for type 2 diabetes mellitus patients (DM). Changes in dietary patterns may be partly responsible. The aim of this study was to examine a potential association between dietary macronutrient composition and caries experience in DM patients. Methods: Thirty three adults with DM and thirty seven controls, not affected by DM, were examined to assess coronal caries through DMFT index and root caries by ICDAS II. A 24-hr diet recall survey was used to determine dietary macronutrient composition supplemented with standardized tables and expressed as grams /day, kilocalories/nutrient and percentage of nutrient/day. Results were compared using Kruskal-Wallis and Mann-Whitney. A correlation analysis was performed and a linear regression model was built for a potential association between macronutrient composition and coronal or root caries. A 95 percent significance level was set. Results: DM patients showed lower remaining teeth, more fillings and more root caries (p<0.05) than controls. Lower carbohydrate consumption (p=0.021), but higher protein intake (p=0.0405) was observed in DM patients as compared with controls. A statistically significant association between an increased protein consumption and higher percentage of root caries was found in DM patients (p<0.001). Conclusion: Although differences in macronutrient consumption in DM patients are not correlated with differential rates of coronal caries, higher protein consumption appears to be associated with higher prevalence of root caries.

Perfil de deserciones infantiles y adolescentes del Centro Comunitario de Salud Mental de Quinta Normal, Región Metropolitana, entre los años 2006–2007 / Drop profile of children and adolescents of Community Mental Health Center Quinta Normal, in the period 2006-2007

Objetivo: Describir las deserciones (DS) de pacientes infantiles y adolescentes en un centro comunitario de salud mental. Pacientes y Método: Estudio descriptivo y retrospectivo realizado en el Centro Comunitario de Salud Mental de la Comuna de Quinta Normal (COSAM). Se revisaron un total de 816 fichas clínicas (FC entre Enero del 2006 y Diciembre del 2007, de éstas, 222 fichas corresponden a menores de 18 años, de los cuales 27,2 por ciento son niños y 13,5 por ciento adolescentes. Se registraron aspectos demográficos generales, diagnóstico y acciones realizadas, seleccionando aquellas de pacientes con DS. Resultados: De la totalidad DS, un 35,5 por ciento son infantiles y 13,9 por ciento adolescentes. La mayor cantidad de consultas se presentó en la población masculina siendo un 58 por ciento. El lugar de procedencia más frecuente correspondió a atención primaria (51,4 por ciento) y el principal motivo de consulta a los problemas conductuales con 44,8 por ciento. Se encontraron casos sin registro en el motivo de derivación en un 48 por ciento, diagnóstico de referencia en un 28,8 por ciento y en los diagnósticos por COSAM un 11 por ciento. Discusión: Es importante recalcar el alto porcentaje de pacientes que poseen un “no registrado” en el motivo de derivación, diagnóstico de referencia y diagnóstico COSAM. Además, considerando que la mayoría de los pacientes son derivados de la atención primaria, se concluye que las políticas de intervención se deben basar en un correcto manejo de ésta, primer eslabón en la atención de salud.

Objective: Describe infantile and teen patient drop outs (DS) at a community mental health center. Patients and Methods: Descriptive and retrospective study made at the Community Mental Health Center of Quinta Normal (COSAM). 816 medical records were reviewed between january, 2006 and December, 2007, 222 of these med records belonged to under age patients, 27,2 percent were children and 13,5 percent teenagers. General demographic aspects, diagnosis and therapeutic actions were registered, choosing those patients with DS. Results: 35,5 percent of DS were infants and 13,9 percent were teenagers. The male population had the major rate of consultation with a 58 percent. Primary care was the most frequent place of origin (51,4 percent) and the main reason of consultation was because of behavioral problems with 44,8 percent. Out of all the main reason of derivation 48 percent of patients had a non registered diagnosis, 28,8 percent of patients had a non registered reference diagnosis and 11 percent of patients that came from COSAM had a non registered diagnosis. Discussion: It’s important to highlight that number of patients that had a “non registered”diagnosis in their reason of referral, reference diagnosis and COSAM´s diagnose. Considering that most patients are referred from primary care, the policies of intervention must be basedon a correct management from primary care, the first link at the health’s attention.

Tratamiento de las plastrones apendiculares en pediatría: conservador v/s quirúrgico: ¿cuál es la mejor alternativa? / Treatment of appendiceal mass in children: conservative versus surgical management

Introducción: Existe discusión con respecto al manejo conservador versus quirúrgico en el tratamiento de los plastrones apendiculares, así como la necesidad de la apendicectomía diferida. Objetivo: Describir nuestra experiencia en el manejo de los plastrones apendiculares. Demostrar la utilidad del manejo médico conservador inicial y la validar la realización de la apendicectomía diferida. Material y método: Revisión de las fichas clínicas de los pacientes egresados con diagnóstico de plastrón apendicular entre enero 2000 a septiembre 2009. Se aplicó análisis estadístico a los resultados. Resultados: 107 pacientes, edad promedio de 8,50 años (2 a 14 años). 68 hombres y 39 mujeres. Se establecieron 2 grupos. El Grupo I constituido por 34 pacientes que se operaron al ingreso. Tiempo de evolución clínica 5,14 días en promedio. En 9 se palpó masa abdominal. Ningún paciente de este grupo contó con ecografía. Tiempo quirúrgico promedio 83 minutos. En 8 casos se presentaron complicaciones como abscesos residuales, obstrucción intestinal y necrosis con perforación intestinal. Tiempo de hospitalización 8,97 días en promedio. El Grupo II, 73 pacientes no se operaron y se manejaron con tratamiento antibiótico (endovenoso y oral). Días de evolución promedio de 6,6 días. 46 presentaban masa palpable y ecografía confirmatoria el 100 por ciento. No hubo complicaciones en este grupo. Tiempo de hospitalización promedio de 9,1 días. Se han realizado exploración laparoscópica diferida en 52 pacientes. Tiempo quirúrgico promedio 48,9 minutos promedio. Dentro de los hallazgos operatorios, en el 57,6 por ciento el apéndice se encontró con adherencias y posición anómala. La mayoría de las biopsias (68 por ciento) se informaron como normal y/o con inflamación. 13 pacientes presentaron un segundo episodio de apendicitis mientras esperaban la intervención diferida, siendo operados de urgencia. Conclusión: El tratamiento médico conservador inicial es de elección en los...

Rendimiento aeróbico en niños obesos de 6 a 10 años / Aerobic performance in obese children of 6 to 10 years old

Objective: To study the relationship between aerobic performance and nutritional state in children of 6-10 years old. Method: Observational and cross-sectional design. A sample of 98 children (78 girls) attending school in the Metropolitan Region was taken. Of these, 47 were diagnosed as obese, 51 were used as controls. Aerobic performance was determined by distance walked (DW) in 6 minutes walk test (6MWT). Continuous measures of reserve heart rate (RHR) and subjective sense of fatigue (SSF) were taken. / or Wilcoxon tests were used for comparison between groups, Pearson coefficient for correlations and multiple regression to evaluate control variables. Significance level was set at p < 0.05. Results: DW in 6MWT shows differences according to nutritional state (p < 0.0001), with a mean distance of 627.6 +/- 24.5 m in control children vs 560 +/- 26.8 m in obese children; but these differences are independent of the gender and age variables. Values for RHR and SSF were similar for both groups except for SSF on the first minute. WD and body mass index showed inverse correlation (r = -0,58; p < 0.0001). Conclusions: The performance in 6MWT was lower among obese children, showing an independent relationship with nutritional state and limited cardiorespiratory efficiency, restricting functional activities in daily life.

Objetivo: Estudiar la relación entre rendimiento aeróbico y estado nutricional (EN) en escolares de 6 a 10 a±os. Método: Diseño observacional, corte transversal. Muestra: 98 escolares (78 mujeres), 51 controles (C) y 47 obesos (OB), de colegios de la Región Metropolitana. El rendimiento aeróbico se evaluó con distancia recorrida (DR) en el test de marcha en 6 minutos (TM6). Se estimó continuamente frecuencia cardíaca de reserva (FCR) y sensación subjetiva de fatiga (SSF). Para comparar medias, se usó test / o Wilcoxon; como índice de correlación, Pearson y para variables de control, regresión lineal múltiple; nivel de significancia, p < 0,05. Resultados: La DR en el TM6 se relacionó con EN (p < 0,0001), con media de DR 627,6 +/- 24,5 vs 560 +/- 26,8 m, en niños C y OB, respectivamente, asociación que no fue modificada por edad y género. Los valores de por ciento FCR y SSF fueron similares en los grupos, excepto la SSF del minuto 1. DR e IMC mostraron asociación inversa moderada (r = -0,58; p < 0,0001). Conclusión: El rendimiento en el TM6 fue menor en OB, mostrando una relación independiente con EN y limitada eficiencia cardiorrespiratoria, lo cual puede restringir la capacidad funcional en actividades de la vida diaria.

[Atypical antipsychotic induced weight gain and metabolic disorders]. / Alteraciones metabólicas asociadas al uso de terapia antipsicótica.

The advent of new antipsychotic drugs has improved the treatment of schizophrenic patients as well as those suffering from other severe psychiatric disorders. Its widespread use, however, has been associated to the development of obesity and metabolic disturbances such as diabetes mellitus, dyslipidemia and increased coronary risk. This has caused a serious concern, due to the high cardiovascular mortality that prematurely affects these patients. The etiology of these abnormalities is still a matter of debate, although it is generally believed that the new antipsychotic drugs have a control stimulating effect on appetite, and their use is associated to an increased level of cortisol and to an insulin-resistance state. In addition, there is an increase in inflammatory mediator and cytokine production, induced by the pathophysiology of the schizophrenic process itself and also caused by the direct action of the antipsychotic drugs. In spite of the mounting evidence, the metabolic management of these patients is still deficient. A close follow-up in the initial stages of the antipsychotic treatment is recommended, as well as giving advice about diet and physical exercise. Finally, when obesity or other conditions associated to metabolic syndrome appear, the recommendation is to switch to drugs with less secondary effects or to add adjuvant medications to improve the overall evolution of these patients.

Alteraciones metabólicas asociadas al uso de terapia antipsicótica: [revisión] / Atypical antipsychotic induced weight gain and metabolic disorders: [revision]

The advent of new antipsychotic drugs has improved the treatment of schizophrenic patients as well as those suffering from other severe psychiatric disorders. Its widespread use, however, has been associated to the development of obesity and metabolic disturbances such as diabetes mellitus, dyslipidemia and increased coronary risk. This has caused a serious concern, due to the high cardiovascular mortality that prematurely affects these patients. The etiology of these abnormalities is still a matter of debate, although it is generally believed that the new antipsychotic drugs have a control stimulating effect on appetite, and their use is associated to an increased level of cortisol and to an insulin-resistance state. In addition, there is an increase in inflammatory mediator and cytokine production, induced by the pathophysiology of the schizophrenic process itself and also caused by the direct action of the antipsichotic drugs. In spite of the mounting evidence, the metabolic management of these patients is still deñcient. A cióse follow-up in the initial stages of the antipsychotic treatment is recommended, as well as giving advice about diet and physical exercise. Finally, when obesity or other conditions associated to metabolic syndrome appear, the recommendation is to switch to drugs with less secondary effects or to add adjuvant medications to improve the overall evolution of these patients.

Crisis de pánico en un paciente con acné tratado con isotretinoína: Caso clínico / Panic attacks in a patient treated with isotretinoin for acne: Report of one case

The use of isotretinoin as a treatment for acne is related to psychiatric syndromes such as psychosis and depression. On the other hand, several drugs have been identified as causing panic attacks. A relationship between dermatologic and psychiatric disease has also been established. We report a 20 year-old male who started to suffer panic attacks after using isotretinoin for acne.

[Panic attacks in a patient treated with isotretinoin for acne. Report of one case]. / Crisis de pánico en un paciente con acné tratado con isotretinoína. Caso clínico.

The use of isotretinoin as a treatment for acne is related to psychiatric syndromes such as psychosis and depression. On the other hand, several drugs have been identified as causing panic attacks. A relationship between dermatologic and psychiatric disease has also been established. We report a 20 year-old male who started to suffer panic attacks after using isotretinoin for acne.

Dural ectasia: a likely cause of inadequate spinal anaesthesia in two parturients with Marfan's syndrome.

We report two cases of Caesarean section in patients with Marfan's syndrome where continuous subarachnoid anaesthesia failed to provide an adequate surgical block. This was possibly because of dural ectasia, which was confirmed by a computed tomography scan in both cases.

Plasma prolactin/oestradiol ratio at 38 weeks gestation predicts the duration of lactational amenorrhoea.

BACKGROUND: Fully breastfeeding women experience an amenorrhoea of variable duration. Our aim was to identify in pregnancy, endocrine markers that could predict the duration of subsequent lactational amenorrhoea. METHODS: We studied 17 healthy women at 34 and 38 weeks gestation, and 1 and 3 months post-partum. The women fully breastfed until 6 months post-partum. During pregnancy, prolactin (PRL), oestrogens (total oestradiol, unconjugated oestrone, unconjugated oestriol), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEA-S), progesterone and placental lactogen, and during post-partum PRL, oestrogens and SHBG, were measured. Free oestradiol in pregnancy and post-partum was calculated. RESULTS: Ten women experienced long (>6 months) and seven experienced short (<6 months) lactational amenorrhoea. At 38 weeks gestation, the women who experienced a long lactational amenorrhoea had twice as much PRL, about half the total oestradiol, lower SHBG concentration (P < 0.05, Student's t-test, Bonferroni modification) and similar free oestradiol concentration, compared with those who experienced short lactational amenorrhoea. The difference in PRL concentration persisted in post-partum postsuckling samples. CONCLUSION: At 38 weeks gestation, the ratio PRL/oestradiol identified all individual women according to the subsequent duration of their lactational amenorrhoea, suggesting that duration of lactational amenorrhoea is conditioned during pregnancy.

Fetal and maternal white cells and B- and T-lymphocyte subpopulations in pregnant women with recent infection.

OBJECTIVE: To study maternal and fetal white cell counts, B- and T-lymphocyte subpopulations in pregnant women with evidence of recent infection. METHODS: Thirty-seven pregnant women with recent infection and 38 controls were studied. All were referred for fetal blood sampling to exclude congenital infection, or to perform fetal chromosome analysis. There were 16 infected fetuses: 9 cytomegalovirus (CMV), 4 rubella, and 3 toxoplasmosis. Maternal and fetal blood was taken and white cell counts, the percentage of CD3+, CD4+, CD8+, CD56+, HLADR+CD3+ T-lymphocyte subpopulations and CD19+ B lymphocytes were measured. RESULTS: The percentage of CD3+, CD8+, and HLADR+CD3+ lymphocytes were significantly higher in infected mothers compared to controls, while CD19+ and the CD4+/CD8+ ratio were lower. Infected mothers carrying infected fetuses had significantly lower white blood cell counts compared to those infected mothers without fetal infection. The percentage of HLADR+CD3+ T lymphocytes was significantly higher and the CD4+/CD8+ ratio lower in infected fetuses compared to controls and noninfected fetuses of infected mothers. Abnormal CD4+/CD8+ ratios and/or increased HLADR+CT3+ T lymphocytes were found in 8 of 10 fetuses with structural abnormalities and/or hematological/biochemical signs of systemic damage, and in 7 of 27 without (RR = 3.1, 95% CI = 1.5-6.3). CONCLUSION: Both infected fetuses and their mothers have significant identifiable changes in white cell counts and T-lymphocyte subpopulations compared to controls. These tests may help in diagnosing maternal and fetal infection.

Materiales quirúrgicos que un médico general debe conocer / Surgical materials that a general physician should know

La siguiente revisión desarrolla en forma simple un tema ausente de la mayoría de los libros de cirugía: el instrumental quirúrgico básico, además de los tipos y características de las suturas que un médico general debe conocer y manejar para poder resolver una patología quirúrgica en forma temporal o permanente

Complicated monochorionic twin pregnancies: experience with bipolar cord coagulation.

OBJECTIVE: The purpose of the study was to evaluate our experience with ultrasound-guided bipolar diathermy forceps for cord occlusion in complicated monochorionic twin pregnancies. STUDY DESIGN: Seventeen consecutive cases were included: 9 cases were twin-to-twin transfusion syndrome; 2 cases were twin reversed arterial perfusion syndrome, and 6 cases were discordant for fetal abnormality. Bipolar diathermy was performed under local anesthetic with the use of 3-mm forceps with ultrasound guidance. RESULTS: Cord occlusion was successfully accomplished in all cases between 18 and 27 weeks' gestation. There were 2 deaths of the co-twin within 12 hours; 1 death was due to cord hemorrhage, and 1 death was unexplained. One neonatal death occurred after delivery at 27 weeks, and 1 woman with twin-to-twin transfusion syndrome elected termination of pregnancy when hydrocephaly was diagnosed 7 days after the procedure (probably related to the underlying pathologic condition). All other co-twins are alive and well, although 2 pregnancies were complicated by preterm delivery and premature rupture of membranes before 30 weeks' gestation. CONCLUSION: Bipolar diathermy is an effective procedure for cord occlusion, although it still has significant morbidity and mortality rates.

Ulceras orales: claves diagnósticas / Oral ulcers: diagnostic guidelines

Las úlceras orales(UO) son motivo de consulta relativamente frecuente. Pueden ser la primera manifestación de una enfermedad de mayor gravedad o con compromiso multisistémico. Se revisa de manera esquemática las causas de estas lesiones y las claves para ayudar al diagnóstico de estos pacientes. Se revisan medicamentos involucrados en la patogenia de estas lesiones y las medidas terapéuticas generales

A new approach to prenatal treatment of extralobar pulmonary sequestration.

Fetal hydrothorax and hydrops is a frequent complication of extralobar pulmonary sequestration which is associated with a high perinatal mortality and severe respiratory insufficiency in the newborn. In a 27-week-old fetus with this condition, injection of 1 ml of pure alcohol and pleuro-amniotic shunting achieved resolution of hydrops. The pregnancy progressed to term and a healthy neonate was delivered who did not require postnatal surgery.