Particulate matter-associated micronuclei frequencies in maternal and cord blood lymphocytes.

Studies associate particulate matter (PM) exposure with pulmonary, cardiovascular, and neurologic diseases. Elevated levels of coarse (PM10) and fine (PM2.5) PM have been reported in the Mexico City metropolitan area during the last two decades. There is limited information if these conditions affect newborns. We associated maternal exposure to PM reported by the monitoring stations considering the place of residence of each participant with the presence of genotoxic damage (cytome analysis) in maternal and umbilical cord blood (UCB) lymphocytes. Eighty-four healthy women in their last quarter of pregnancy met the inclusion criteria. Each volunteer exposure was estimated according to the average PM2.5 and PM10 levels during the last month of gestation. The micronuclei (MN) frequencies in UCB lymphocyte cultures ranged between 0 and 9. They also showed lower cell proliferation indexes than their mothers. There was a strong correlation between the maternal and the UCB MN frequency (ρ = 0.3767, P = 0.0002). Multiple regression analysis including PM10 and PM2.5 levels, maternal age, and occupation, showed a significant and positive association between UCB MN frequency and PM2.5. A statistically significant increase in the MN frequency in both maternal and UCB lymphocytes was observed in samples obtained during the dry season (higher PM levels) as compared with the MN frequency in blood samples obtained during the rainy season (lower PM levels). These results suggest that PM, mainly PM2.5 , can cross the placenta causing DNA damage in fetal cells which may increase the potential for diseases during childhood or adult life. Environ. Mol. Mutagen. 60:421-427, 2019. © 2019 Wiley Periodicals, Inc.

Prevalence and factors associated with supportive care needs among newly diagnosed Mexican breast cancer patients.

PURPOSE: Mexican breast cancer patients are generally diagnosed in advanced stages of the disease and often experience delays in cancer treatment delivery. Currently, little is known about these patients' psychological care needs. This study assessed levels and correlates of supportive care needs of Mexican breast cancer patients around the time of cancer diagnosis. METHODS: One hundred seventy-three newly diagnosed Mexican breast cancer patients participated in the study. Supportive care needs, anxiety, depression, and patients' sociodemographic and clinical characteristics were assessed. Multiple regression analyses were used to examine factors associated with care needs. RESULTS: Up to 44% of patients showed unmet care needs. Health system/information needs were the most prevalent (68%), while physical/daily living needs the least (19%). Level of depressive symptoms was most consistently related to care needs. Patients with higher levels of depressive symptoms had higher psychological (ß = 0.38), physical/daily living (ß = 0.43), patient care/support (ß = 0.17), and additional unmet care needs (ß = 0.30), than patients with lower levels of depressive symptoms. CONCLUSIONS: This study suggests that mainly health system/information needs arise at the time of cancer diagnosis among Mexican breast cancer patients. Patients suffering high levels of depressive symptoms reported the highest levels of unmet needs. Future studies should be conducted to elucidate the care needs throughout the disease trajectory, as such information can inform health care professionals and policy makers and lead to improvements in the organization and provision of health care services for Mexican breast cancer patients.

[Contraception in women with chronic diseases]. / Anticoncepción en mujeres con enfermedades crónicas.

BACKGROUND: Almost 10% of women in reproductive age had a chronic disease, and contraception is frequently ignored by these patients. The lack of use of contraceptives methods has a higher repercussion in these patients; if pregnant, the risk is increased in morbidity and feto-maternal mortality. OBJECTIVES: to know the contraceptive coverage in women with chronic degenerative diseases, the kind of contraceptive methods and the unsatisfied demand. MATERIAL AND METHODS: A descriptive study was made with the application of a survey from the one elaborated by the IMSS. It explores contraception socio-demographic data, causes of non-protection and also explores Medical Doctor (MD) participation. Sample size was calculated in 385 women in reproductive age with a chronic disease. RESULTS: 428 women about 30-49 years old were interviewed, 53% of them were married, they had various diseases, the contraceptive coverage was 84%. The definitive methods were the most used with 47%, followed by the condom with 20%, intrauterine device with 13% and others in minor proportion. 38.5% of patients with sexual life have risk of pregnancy for lack of use of method or for using one of low effectiveness and continuity. Of 45 (16%) patients with sexual life that did not use methods, 29% because they wish pregnancy, 18% by collateral effects and the rest for other causes. From this same patients 21 wished getting pregnant and 24 did not, this is an unsatisfied demand of 53%. The MD's informed about risks in case of pregnancy of 83.4% of the patients. CONCLUSIONS: The contraceptive coverage is low and the unsatisfied demand is higher than in the general population. It requires the effective participation of health personal in this group of high reproductive risk.

[Scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit]. / Histerectomía programada vs. histerectomía de urgencia en pacientes con placenta acreta, en una unidad médica de alta especialidad.

BACKGROUND: Patients with placenta accreta have a high frequency of complications and death risk. OBJECTIVE: The aim of this study was to compare the results of scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit. MATERIAL AND METHODS: An observational, comparative, cross-sectional study was conducted by reviewing patient records with confirmed diagnostic of placenta accreta, who attended in a one year period. They were divided into 2 groups based on the type of surgery, scheduled or urgent. Descriptive statistics were applied, with comparisons using Student t-test and chi squared tests. A value of P<.05 was considered significant. RESULTS: There were 4,592 births in the period of study, and 125 obstetric hysterectomies were performed, with 40 confirmed cases of accreta (8.7 per thousand births) with 20 in scheduled and 20 in urgent surgeries, with the most frequent type being placenta accreta. The mean maternal age was 32 years, with a mean of 5 hours operating time, total bleeding 3135 ml, and 3.5 units of packed cells transfused. There was no statistical difference when comparing these variables with re-interventions, hypovolaemic shock, and intensive care unit admission. Caesarean-hysterectomy with hypogastric artery ligation was the most frequent surgery performed. CONCLUSIONS: In this hospital, scheduled and urgent surgical treatment of patients with placenta accreta show similar results, probably because the constant availability of resources and the experience obtained by the multidisciplinary team in all shifts. Nevertheless, make absolutely sure to perform elective surgery while having all the necessary resources.

[Treatment results for different categories of vaginal intraepithelial neoplasia with electrocoagulation, 5-fluorouracil and combined treatment]. / Resultados del tratamiento con esferolisis, 5 fluorouracilo y mixto de pacientes con diferentes categorías de neoplasia intraepitelial vaginal.

BACKGROUND: Vaginal intraepithelial neoplasia (VAIN) represents a variety of changes that initiate as an intraepithelial squamous lesion with the possibility of resulting in cancer. OBJECTIVE: To compare the results of the treatment for the different categories of VAIN with electrocoagulation, 5-fluorouracil and combined treatment. MATERIALS AND METHODS: Observational an analytical study. We stablished groups according to the category of VAIN evaluating and comparing remission, persistence, recurrence, or progression of the disease ac- cording to the received treatment, with a 1-year follow up. The results were compared by chi2 and Kruskal Wallis. The statistics analysis was done with the SPSS program version 20. RESULTS: One hundred thirty seven patients between 20 and 81 years of age (mean age: 52.49 years) were included. Seventy-four percent of the patients had a history of premalignant or malignant cervical lesions. Seventy-four patients had VAIN I, 34 patients had VAIN II, 22 patients had VAIN III and there were seven cases of vaginal carcinoma in situ. Fifty-eight patients were treated with electrocoagulation, 55 patients were treated with 5-FU, 16 patients had combined treatment, and eight patients received expectant management. Sixty three percent of patients had total remission of the lesion, 34% had persistence and 3% showed progression, and there were no cases of recurrence. Results were better in patients with VAIN I treated with 5-FU (bigger percentage of remission P .026), for the remaining categories of VAIN, no treatment showed superior results. CONCLUSIONS: The superior response occurs in patients with VAIN I treated with 5-FU. None of the treatments achieves a 100% remission. The VAIN frequency is high, patients with a history of malignant or premalignant cervical pathology should undergo a closer surveillance through cytocolposcopic control with respect to the remaining population.

[Frequency factor Her-2/neu overexpression in patients with breast cancer]. / Frecuencia de sobrexpresión del factor Her-2/neu en pacientes con cáncer de mama.

BACKGROUND: Her-2/neu is an oncogen related with a poor prognosis and high agresivity when overexpressed in breast cancer. Main objective was analyze the frecuency of positivity or negativity ofller/neu in patients with breast cancer after surgery and their relationship with hormone receptors. We perfomed a longitudinal, retrospective, descriptive and observational trial in all patients included in the Patology Service with a determination of Her-2/neu and hormone receptors analysis, between January 1st 2007 and December 31 st 2009.We used descriptive stadistic and association tests with correlation coefficients. We analyze 893 patients. The age range was between 24 and 94 years. The 16.% of all cases overexpressed Her-2/neu (150 patients). The 4.8% (43 patients) were included in the FISII test resulting in 29 positives to Her-2/neu. There were a total of 179 cases overexpressed. Negative estrogen receptores cases were 23%, negative progesterone receptores cases were 28% and triple negative receptors cases were 19%. We analyzed independient variables with Student I resulting age with P = 0.294. We analyzed distribution variables with Pearson test resulting in negative estrogen receptors with a P = 0.0001 negative progesterone receptres with a P = 0.0001 and triple negative receptors P= 0.0001. Relationship between hormone receptors and Her-2/neu in proporlionaly inverse in other vvords when a high hormone receptors negativitvis present there is algo a Her-2/neu highly overexpressed.

Pleural effusion and ascites in severe preeclampsia: frequency and correlation with plasma colloid osmotic pressure and renal filtration function.

BACKGROUND: Capillary leak with pleural effusion and/or ascites in severe preeclampsia (SP) may be a reason for low plasma colloid osmotic pressure (PCOP) and deterioration of renal filtration function. The objective of this study was to report the frequency of pleural effusion and/or ascites in patients with SP and to compare the correlation with PCOP and renal filtration function. METHODS: We conducted a cross-sectional study that included 92 pregnant women with SP. In 52 patients, no fluid collections were demonstrated and in 40 patients the findings were positive. Correlation with PCOP and endogenous creatinine clearance (CrCl) was calculated. Student t test and Pearson correlation coefficient (r) were used for statistical analysis. RESULTS: Frequency of fluid collections was 43.48% (ascites, 16 cases; pleural effusion, 12 cases; and ascites with pleural effusion, 12 cases). PCOP in patients without and with collections were different (20.12 ± 2.16 vs. 18.78 ± 2.58 mm Hg, respectively; p = 0.009) as well as with endogenous CrCl (111.69 ± 37.61 vs. 95.27 ± 34.22 ml/min/1.73 m(2) SC × 0.85; p = 0.03). Correlation coefficient (r) of PCOP was negative with all the fluid collections (ascites -0.25, pleural effusion -0.29, ascites with pleural effusion -0.02 and -0.30) as well as the r of endogenous CrCl (ascites -0.01, pleural effusion -0.13, ascites with pleural effusion -0.27 and -0.67). CONCLUSIONS: Frequency of collections was very high (43.48%). A weak negative correlation with PCOP and endogenous CrCl was found.

[Eclampsia, obstetric hemorrhage and heart disease as a cause of maternal mortality in 15 years of analysis]. / Eclampsia, hemorragia obstétrica y cardiopatía como causa de mortalidad materna en 15 años de análisis.

BACKGROUND: It has been described that 70% of all maternal deaths are provoked by obstetrical hemorrhage, infections, abortions, hypertension and delivery dystocies. Poverty, social exclusion, low level education and violence are important causes of maternal mortality. OBJECTIVE: To establish the changes in the maternal mortality in a term of 15 years in a hospital of assistance obstetrical complicated. MATERIAL AND METHOD: A retrospective and descriptive study, in which the number and causes of obstetrical death was analyzed, occurred from 1991 to 2005. The comparison was done by five-year periods using descriptive statistics to analyze frequency of results. RESULTS: The number of maternal deaths was 105, 97 and 42 by each one of the three five-year periods, the mortality rate x 10,000 decreased from 28.7 to 16.4 in the last quinquennium and was found from 6.1 just including the last year. In the first and second quinquennia the eclampsia occupied the first place as cause of death, followed by the hemorrhage and the infections. In the third quinquennium the eclampsia also occupied the first place with a rate of 8.6, followed by the cardiopathy (2.3) and the infections (1.9), but the hemorrhage with a rate of 1.5 was displaced to the fourth place. CONCLUSIONS: The maternal mortality has diminished in a general way; the eclampsia has occupied the first place as cause of death from 1991 to 2005. The death by obstetrical hemorrhage has diminished in important form, possibly due to the specific groups of medical attention by modules, which has also helps the decrease of mortality by other causes. The increment of the deaths by cardiopathy should be considered as a possibility of risk, associate undoubtedly to the present style of life from our society.

[Clinical aptitude of residents that attend patients with the cervical intraepithelial neoplasia]. / Aptitud clínica de médicos residentes en la atención de pacientes con neoplasia intraepitelial cervical.

OBJECTIVE: To build, validate and apply an instrument to evaluate the clinical aptitude in intraepitelial cervical neoplasia (ICN) in residents. METHODS: The instrument included four clinical real cases, validated by experts and included 106 items using true, false and don't know answers. A pilot test and the 21 Kuder-Richardson formula were used to estimate consistency. It was applied to residents, in an observational, transversal, comparative and open study, including 11 second year residents, 13 third year residents and 12 fourth year residents. RESULTS: Consistency of 0.88 was obtained; 22% were located in the middle level, 39% were located in the low level and 39% in the very low level. There were no residents in the high or very high level or by chance answer level. The Kruskal-Wallis test showed significant differences among the three groups and with the U test of Mann Whitney there were no differences between groups. CONCLUSIONS: The year of residence did not show differences in the development of clinical aptitude in ICN. Most of the residents were located in the inferior level of clinical aptitude. This study makes evident the need to reframe our educative processes in a qualitative different manner.

[Clinical aptitude of gynecology and obstetrics residents to manage obstetric bleeding]. / Aptitud clínica de médicos residentes en el tratamiento de sangrados de la segunda mitad del embarazo.

OBJECTIVE: to build, validate and apply a test that explores and evaluates the clinical aptitudes of Gynecology and Obstetrics (Ob/Gyn) residents. MATERIAL AND METHODS: the test included five actual clinical cases representing the main obstetric conditions associated with obstetric bleeding. The validation process included rounds with experts and the final version of the test included 100 items in which the answers had the options "true." "false " and "don't know." A pilot study and the 21 Kuder-Richardson formula served to increase the consistency of the test. Then, 33 Ob/Gyn residents (8 of 2nd year; 14 of 3rd year and 11 of 4th year) answered the test. RESULTS: According to the 21 Kuder-Richardson formula the consistency of the test was 0.80; regarding the clinical aptitudes, 18 % of residents scored in the middle level, 66 % in the low level and 15 % in the very low level. No resident scored in the high or very high levels or by chance answers level. The Kruskal-Wallis test did not show statistically significant differences among the three groups and with the U test of Mann-Whitney no differences between groups were observed after comparing 2nd year versus 3rd year; 3rd year versus 4th year, and 2nd year versus 4th year residents. CONCLUSIONS: The years of residence did not show differences to developing clinical aptitudes. Most of the residents were located in the low level of these clinical aptitudes. This study underlined the need to reconsider our educative processes in a qualitative different manner.

[Therapeutic assessment of emergency cerclage. Analysis of a cases series]. / Evaluación terapéutica del cerclaje de urgencia. Análisis de una serie de casos.

BACKGROUND: Cervical incompetence is the incapacity of cervix to retain a pregnancy until term or until feasibility of the fetus. Patients present cervical enlargement without pain or contractions, vaginal strange sensation and membranes protrusion through most minimum degrees of enlargement. The cervical incompetence management can be rest in bed or cerclage. The emergency cerclage is carried out in patients with enlargement > or = 2cm with or without membranes prolapsus. OBJECTIVE: To evaluate the maternal and neonatal results of emergency cerclage with Espinosa-Flores modified technique in pregnancy from 13 to 28 weeks. PATIENTS AND METHODS: This series of cases was carried out as observational and prospective study, all patients with emergency cerclage and pregnancy from 13 to 28 weeks with cervical incompetence were included, during period of January 2000 to December 2003, in Gynecology and Obstetric Hospital from Medical Center La Raza, IMSS. Variables of study were gestational age at moment of cerclage, pregnancy prolongation, and maternal and neonatal complications. RESULTS: Ten patients were included, with age of 32.1 +/- 5.1 years. It was observed a mean prolongation of pregnancy 10 weeks after cerclage. The gestation was interrupted at 31.1 +/- 5.2 weeks. The most frequently complication was premature membranes rupture. Neonatal survival was 70%. CONCLUSIONS: The placement of emergency cerclage continuous being a therapeutic procedure to improve neonatal prognostic. The shortest prolongations of pregnancy were found in patients with greater enlargement (> or = 3cm) and who had membranes protrusion.

[Active management of the premature membrane rupture in pregnancies of 34 to 37 weeks]. / Manejo activo de la rotura prematura de membranas en embarazos de 34 a 37 semanas.

BACKGROUND: Premature rupture of membranes is considered an obstetrical emergency since it has been associated with an increment of sepsis and maternal-fetal morbidity. For this reason, controversy exists among conservative and active management for the obstetrical resolution. OBJECTIVE: To determine if active management of premature rupture of membranes in pregnancy of 34 to 37 weeks diminishes the cesarean section incidence and the maternal-fetal morbidity. PATIENTS AND METHODS: Two groups of patients with pregnancy of 34 to 37 weeks and premature rupture of membranes were compared. Group I with active management was integrated by 42 cases that initiated inductoconduction at their admission to the hospital, and in group II, with 26 cases on the conservative management, medication was used to induce fetal pulmonary maturity and spontaneous delivery was expected. Descriptive statistics was carried out by means of the statistical package SPSS-10. RESULTS: The mean age of the patients was 27.2 +/- 5.8 years. Pregnancy resolution within the first 12 hours was 23.8% in group I and 11.5% in group II. Cesarean section in group I was made in 28.5% of the cases and in group II in 65.3% of them (p < 0.05). The most common indication for cesarean section in group I was stationary labor (16.5%) and in group II unfavorable cervical conditions (26.9%). Maternal and newborn hospital stay was greater in group II (p < 0.01). The most frequent maternal complication in both groups was decidual infection, with 4.7 and 15.3%, respectively. General maternal and neonatal morbidity was greater in group II. CONCLUSIONS: Conservative management of premature rupture of membranes, when pregnancy is equal or greater than 34 weeks, does not offer fetal benefits, increases the incidence of cesarean sections, the hospital stay and the cost of the medical attention.

[Diagnostic and frequency of fetal heart disease by echocardiography in pregnancies with high-risk factors]. / Diagnóstico y frecuencia de cardiopatía fetal mediante ecocardiografía en embarazos con factores de alto riesgo.

BACKGROUND: Fetal heart diseases are increasingly frequent. These are part of birth defects and, therefore, appear in early phases of the gestation. Diagnosis or early detection of functional and structural abnormalities of the heart allows to the obstetrician and the pediatric cardiologist to plan, in a timely manner, the treatment and prenatal and postnatal monitoring with the purpose of preventing complications. OBJECTIVE: To determine the types and frequencies of heart diseases in pregnancies with high-risk factors. PATIENTS AND METHOD: It was analized an observational, descriptive and retrospective series of cases. From January 2003 to June 2006, fetal echocardiograms were made in women with pregnancies longer than 15 weeks and with high-risk factors. At childbirth was made a cardiovascular evaluation. Analysis was carried out through descriptive statistics. RESULTS: maternal age average was of 27.3 +/- 6.8 years; gestational age was of 31 +/- 5 weeks. In total, there were carried out 275 fetal echocardiograms (FE) in 208 patients; in 56 of them, was made one fetal ecocardiogram, two in 37 and three in 15. Risk factors of reference to the specialized medical unit were: abnormalities detected through obstetrical ultrasound (35.1%), tachycardia-bradycardia-arrhythmia (29.8%), probable chromosomic anomalies (13.9%), oligohydramnios or polyhydramnios (4.8%), familiar antecedents of congenital heart diseases (3.8%), others (12.6%). Heart disease was diagnosed by fetal echocardiogram in 55 patient (26.4%): unique ventricle (n = 5), hypoplastic right ventricle (n = 3), hypoplastic left ventricle (n = 4), congenital complete heart block (n = 1), Ebstein and dysplasia of the mitral and tricuspid valves (n = 12), tumor (n = 5), ectopia cordis (n = 2), auriculoventricular channel (= 1), supraventricular tachycardia (n = 4), supraventricular extrasystole (n = 3) and other. Diagnosis was confirmed at childbirth in 99.5% of the cases. The treatment was initiated in uterus for arrhythmia and cardiac insufficiency in 19 patients. The patients with high-risk cardiopathy (at birth) were evaluated at beginning through specialized cardiological treatment and then they were transferred to the service of pediatric cardiology. CONCLUSIONS: Frequency of fetal heart diseases in patients with high-risk factors is of 25.4%. In these patients, the fetal echocardiogram (prenatal and postnatal) allows planning the optimal cardiological and obstetric treatment as well as to inform to the relatives.