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1.
Rev. chil. obstet. ginecol. (En línea) ; 84(3): 231-235, jun. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1020641

RESUMO

RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.


ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

2.
Prog. obstet. ginecol. (Ed. impr.) ; 62(3): 243-246, mayo-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-185005

RESUMO

Objective: the main objective was to assess the rate of occurrence of adverse perinatal events in patients with low levels of PAPP-A in the first trimester of pregnancy. The secondary objectives were to identify the route of delivery and mean gestational age at the end of pregnancy, identify the reasons for cesarean delivery, and conduct a follow-up protocol in patients with low PAPP-A. Material and methods: we performed a longitudinal, observational, prospective, descriptive, and analytical study of 450 pregnant women with PAPP-A <0.4 MoM between January 2009 and December 2015 at Hospital Clínico San Carlos. Results: obstetric complications were detected in 71.6% of pregnant women with PAPP-A <0.4 MoM. The main complication was gestational diabetes (37.7%), followed by hypertensive disorders (20%) and impaired fetal growth (11.6%). The mean gestational age at the end of pregnancy was 37 weeks. With regard to the route of delivery, 70% of patients had a vaginal delivery, while 30% of patients had a cesarean delivery. The 3 main reasons for cesarean delivery were elective cesarean (9%), suspected loss of fetal wellbeing (8.7%), and HELLP syndrome (4.9%). Conclusions: adverse events were very frequent in patients with low levels of PAPP-A (70%). Low PAPP-A could be used as a predictor of obstetric complications, since it is now determined in almost all pregnant women. Interpretation of PAPP-A findings could favor the progress of pregnancy, with no increased cost per patien


Objetivo: evaluar el porcentaje de aparición de eventos adversos perinatales en pacientes con PAPP-A baja en el primer trimestre del embarazo. En segundo plano, identificar la vía y edad gestacional media de finalización de la gestación. Establecer las causas de las cesáreas. Realizar un protocolo de seguimiento en pacientes con PAPP-A baja. Material y métodos: Estudio longitudinal, observacional, prospectivo, descriptivo y analítico. Se evaluó a 450 gestantes con PAPP-A < 0,4 MoM, en el periodo comprendido entre Enero 2009 y Diciembre 2015 en el Hospital Clínico San Carlos. Resultados: El 71,6 % de las gestantes con PAPP-A < 0,4 MoM presentaron complicaciones obstétricas. La principal complicación fué la diabetes gestacional (37,7%), en segundo lugar trastornos hipertensivos (20%) y en tercer lugar, alteraciones del crecimiento fetal (11,6 %). La edad media fin de gestación fueron las 37 semanas. Con respecto a la vía de parto, el 70% de las pacientes tuvieron un parto vaginal, mientras que el 30% terminaron la gestación mediante cesárea. Las tres principales causas de la cesárea fueron cesárea electiva (9%), sospecha de pérdida de bienestar fetal (8,7%) y síndrome Hellp (4,9%). Conclusiones: El porcentaje de eventos adversos en nuestras pacientes con PAPP-A baja fué elevado, presentándolos aproximadamente 7 de cada 10 gestantes. La PAPP-A baja se podría utilizar como predictor de complicaciones gestacionales, ya que se determina hoy en día en casi todas las gestantes, y su interpretación podría favorecer la evolución de la gestación, sin un aumento del coste por embarazada


Assuntos
Humanos , Feminino , Proteína Plasmática A Associada à Gravidez/análise , Complicações na Gravidez/fisiopatologia , Cesárea/estatística & dados numéricos , Biomarcadores/análise , Assistência Perinatal/métodos , Hipertensão/epidemiologia , Diabetes Gestacional/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Estudos Prospectivos , Resultado da Gravidez , Pré-Eclâmpsia/epidemiologia
3.
Prog. obstet. ginecol. (Ed. impr.) ; 62(3): 292-295, mayo-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185012

RESUMO

Introducción: La mastocitosis es una enfermedad rara, con una prevalencia de 13/100.000 habitantes. La liberación de mediadores mastocitarios, puede cursar con complicaciones graves durante el embarazo, tanto fetales como maternas. Caso clínico: Primigesta de 36 años diagnosticada de urticaria pigmentosa. La gestación controlada en las consultas de alto riesgo, ha cursado con normalidad, empleándose en el momento del parto premedicación para evitar principalmente shock anafiláctico y muerte materna. Discusión: La mastocitosis no contraindica el embarazo y su curso puede ser muy variado. Las complicaciones de la mastocitosis durante el embarazo pueden suponer un riesgo para el feto (prematuridad, distrés respiratorio, bajo peso, mastocitosis fetal...) y para la madre (shock anafiláctico y muerte). La premedicación en el momento del parto es de gran ayuda


Background: The mastocytosis it's a rare syndrome with a prevalence of 13/100,000, characterized by the accumulation of mast cells in tissues. Mast cell mediator release may cause important damage during pregnancy, to the mother and the fetus. Case report: 36 year old woman, primigravida with Urticaria Pigmentosa. The pregnancy was followed in high risk pregnancy section, and the course ocurred normaly. Premedication was used before the delivery specially to prevent mothers anafilactic shock and death. Discussion: Mastocytosis does not contraindicate de pregnancy. Mastocytosis complications during pregnancy can produce a risk to the fetus (prematurity, respiratory distress, low birth weight, fetal mastocytosis...) and mother (anaphylactic shock and death). Premedication at the time of delivery is helpful


Assuntos
Humanos , Feminino , Gravidez , Adulto , Mastocitose/diagnóstico , Anafilaxia/diagnóstico , Urticaria Pigmentosa/complicações , Complicações na Gravidez/diagnóstico , Pré-Medicação/métodos , Fatores de Risco , Complicações do Trabalho de Parto/prevenção & controle , Doenças do Recém-Nascido/prevenção & controle
4.
An. pediatr. (2003. Ed. impr.) ; 88(3): 122-126, mar. 2018.
Artigo em Espanhol | IBECS | ID: ibc-172363

RESUMO

Introducción: La enfermedad de Chagas, causada por Trypanosoma cruzi (T. cruzi), es endémica en Latinoamérica y emergente en España, ligada a inmigración. La transmisión vertical se estima de alrededor del 5%. Se recomienda cribado selectivo en el embarazo para identificar al recién nacido infectado, permitiendo tratamiento precoz y curación de la enfermedad. Objetivo: El objetivo de este estudio fue estimar la prevalencia de serología positiva para T. cruzi en una cohorte de gestantes latinoamericanas y la tasa de transmisión vertical de la misma. Pacientes y métodos: Estudio observacional prospectivo de gestantes con serología positiva para T. cruzi en hospital terciario, desde enero del 2013 hasta abril del 2015. El seguimiento de recién nacidos se realizó con PCR al nacimiento, repetida al mes, y serología a los 9-12 meses. Se consideró infectado al niño con PCR positiva y no infectado al niño con PCR negativa y/o negativización de anticuerpos. Resultados: Se realizó cribado en 1.244 gestantes latinoamericanas, siendo positivas 40 (prevalencia 3,2%, IC del 95%: 2,4-4,4%), 85% procedentes de Bolivia. Solo un niño resultó infectado (transmisión vertical 2,8%, IC del 95%: 0-15%) con PCR positiva al nacimiento. La detección de la embarazada permitió estudiar a los hermanos, detectándose caso asintomático en paciente de 8 años. Ambos tratados con benznidazol con buena tolerancia, evolución favorable y negativización de PCR y anticuerpos. Conclusión: El cribado de embarazadas latinoamericanas ha permitido la detección de gestantes con enfermedad de Chagas. La transmisión vertical fue del 2,3%, coincidente con la literatura. El cribado ha permitido la detección y el tratamiento de casos familiares no identificados previamente (AU)


Background: Chagas disease, caused by Trypanosoma cruzi (T. cruzi), is endemic in Latin-America and is emerging in Spain due to immigration. The vertical transmission rate is around 5%. A routine prenatal screening with serology of all pregnant women from endemic areas is recommended to identify infected newborns, allowing early treatment and cure. Objective: The aim of this study was to estimate the prevalence of positive Chagas serology in a cohort of pregnant women from Latin-America and its vertical transmission. Patients and methods: An observational, prospective, follow-up study was conducted on women with positive serology to T. cruzi, as well as their newborns, from January 2013 to April 2015. Congenital Chagas was ruled out using a PCR technique at birth and at 1 month, and with serology at 9-12 months old. A child was considered infected when PCR was positive, and uninfected when PCR was negative, and/or it had a negative serology. Results: Screening was performed on 1244 pregnant women from Latin-America, and there were positive results in 40 (prevalence 3.2%, 95% CI: 2.4-4.4%), with 85% of them from Bolivia. There was only one infected newborn (rate of vertical transmission 2.8% (95% CI: 0-15%)), who had a positive PCR at birth. Relative studies enabled an 8-year-old sister with an asymptomatic disease to be diagnosed and treated. Both were treated successfully with benznidazole (later the PCR and serology were negative). Conclusion: Screening during pregnancy in Latin-American women helped to detect those with Chagas disease. The rate of vertical transmission was 2.8%, in keeping with literature. Screening led to the detection and treatment of previously unidentified familial cases (AU)


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Estudos Soroepidemiológicos , Programas de Rastreamento , Diagnóstico Pré-Natal , Reação em Cadeia da Polimerase
5.
An Pediatr (Barc) ; 88(3): 122-126, 2018 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-28411096

RESUMO

BACKGROUND: Chagas disease, caused by Trypanosoma cruzi (T. cruzi), is endemic in Latin-America and is emerging in Spain due to immigration. The vertical transmission rate is around 5%. A routine prenatal screening with serology of all pregnant women from endemic areas is recommended to identify infected newborns, allowing early treatment and cure. OBJECTIVE: The aim of this study was to estimate the prevalence of positive Chagas serology in a cohort of pregnant women from Latin-America and its vertical transmission. PATIENTS AND METHODS: An observational, prospective, follow-up study was conducted on women with positive serology to T. cruzi, as well as their newborns, from January 2013 to April 2015. Congenital Chagas was ruled out using a PCR technique at birth and at 1 month, and with serology at 9-12 months old. A child was considered infected when PCR was positive, and uninfected when PCR was negative, and/or it had a negative serology. RESULTS: Screening was performed on 1244 pregnant women from Latin-America, and there were positive results in 40 (prevalence 3.2%, 95% CI: 2.4-4.4%), with 85% of them from Bolivia. There was only one infected newborn (rate of vertical transmission 2.8% (95% CI: 0-15%)), who had a positive PCR at birth. Relative studies enabled an 8-year-old sister with an asymptomatic disease to be diagnosed and treated. Both were treated successfully with benznidazole (later the PCR and serology were negative). CONCLUSION: Screening during pregnancy in Latin-American women helped to detect those with Chagas disease. The rate of vertical transmission was 2.8%, in keeping with literature. Screening led to the detection and treatment of previously unidentified familial cases.


Assuntos
Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Transmissão Vertical de Doença Infecciosa , Complicações Infecciosas na Gravidez/epidemiologia , Anticorpos Antiprotozoários/sangue , Doença de Chagas/sangue , Feminino , Humanos , Recém-Nascido , América Latina/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/sangue , Prevalência , Estudos Prospectivos , Estudos Soroepidemiológicos , Espanha/epidemiologia , Centros de Atenção Terciária , Trypanosoma cruzi/imunologia , Saúde da População Urbana
6.
Rev. chil. obstet. ginecol. (En línea) ; 82(6): 603-609, Dec. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-899950

RESUMO

RESUMEN CASO CLÍNICO: la encefalitis anti receptor N-metil D-aspartato (NMDAR) es un trastorno autoinmune con un amplio espectro de síntomas neuropsiquiátricos. Se presenta el caso de una mujer de 22 años con una encefalitis anti-NMDA que cursó con amnesia, crisis parciales complejas y alteraciones del comportamiento asociado a un teratoma ovárico. La evolución fue adecuada con cirugía e inmunosupresores. A los tres años se objetivó un teratoma contralateral, sin recidiva de encefalitis; que fue extirpado tras estimulación ovárica para criopreservación de ovocitos. CONCLUSIONES: el teratoma ovárico debe ser sospechado ante la presencia de una encefalitis atípica. Antes de realizar cirugías ováricas repetidas, debe valorarse la opción de vitrificación ovocitaria si los deseos genésicos de la mujer no están cumplidos.


ABSTRACT CLINICAL CASE: anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is an autoimmune disorder with a wide sprectrum of neuropsyquiatric symtoms. A case of a 22 years old woman with NMDAR encephalitis presenting with amnesia, focal complex seizures and behavior disturbances associated with an ovarian teratoma is reported. Three years after the first episode, a contralateral teratoma was observed, with no recurrence of the encephalitis; teratoma excision was performed, after controlled ovarian stimulation for oocyte cryopreservation. CONCLUSIONS: ovarian teratoma must be suspected when atypical encephalitis occurs. Before performing repetead ovarian surgeries, oocyte vitrificaction must be considered as a fertility-sparing option in women who have not completed their childbearing wishes.

7.
J Trace Elem Med Biol ; 32: 122-34, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26302920

RESUMO

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.


Assuntos
Consenso , Exposição Ambiental/análise , Compostos de Metilmercúrio/efeitos adversos , Animais , Dieta , Peixes , Embalagem de Alimentos , Humanos , Espanha
8.
Nutr. hosp ; 31(1): 1-15, ene. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-132578

RESUMO

Los efectos beneficiosos del consumo de pescado son bien reconocidos. Sin embargo, existe preocupación a nivel mundial sobre los niveles de metilmercurio en el pescado, por lo que muchos países como Estados Unidos, Australia, Nueza Zelanda, Canadá y muchos países europeos han realizado recomendaciones de consumo de pescado a la población , especialmente a los grupos vulnerables con el fin de reducir la ingesta de metilmercurio. La sangre y el pelo son las mejores muestras biológicas para medir el metilmercurio. El método de análisis más empleado ha sido la espectroscopia de absorción atómica con la técnica del vapor frío, aunque existen también métodos directos que se basan en la descomposición térmica de la muestra. En los últimos años han aumentado los laboratorios que miden el mercurio por espectrometría de masas con plasma acoplado por inducción. Además, se puede diferenciar las distintas especies de mercurio acoplando métodos de separación cromatográficos. Es necesario que los laboratorios que analizan mercurio en muestras biológicas participen en programas de garantía externa de la calidad. Aunque se logre reducir las emisiones de mercurio, el mercurio del medio ambiente altodavía puede permanecer muchos años, por lo que es fundamental el consejo dietético para disminuir la exposición. No es aconsejable el uso de terapia quelante con fines diagnósticos o en pacientes asintomáticos. Es preciso proponer medidas de salud pública encaminadas a la disminución de la exposición al mercurio y que se evalúe también los beneficios de las mismas desde el punto de vista económico y social (AU)


The beneficial effects of fish consumption are well-known. Nevertheless, there is worldwide concern regard methylmercury concentrations in fish, which is why many countries such as the United States, Australia, New Zealand, Canada and numerous European countries have made fish consumption recommendations for their populations, particularly vulnerable groups, in order to México methylmercury intake. Blood and hair are the best biological samples for measuring methylmercury. The most widely-used method to analyse ethylmercury is cold vapor atomic absorption spectrometry, although there are also direct methods based on the thermal decomposition of the sample. In recent years, the number of laboratories that measure mercury by inductively coupled plasma mass spectrometry has increased. In addition, the different kinds of mercury can be distinguished by coupling chromatography methods of separation. Laboratories that analyse mercury in biological samples need to participate in external quality control programmes. Even if mercury emissions are reduced, mercury may remain in the environment for many years, so dietary recommendations are fundamental in order to reduce exposure. It is necessary to propose public health measures aimed at decreasing mercury exposure and to evaluate the benefits of such measures from the economic and social standpoints (AU)


Assuntos
Humanos , Animais , Compostos de Metilmercúrio/análise , Compostos de Metilmercúrio/toxicidade , Compostos de Metilmercúrio/economia , Contaminação de Alimentos/análise , Contaminação de Alimentos/economia , Peixes , Análise Custo-Benefício
9.
Nutr. hosp ; 31(1): 16-31, ene. 2015. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-132579

RESUMO

Los efectos beneficiosos del consumo de pescado tanto en niños como en adultos han sido bien reconocidos. Sin embargo, la ingesta de metilmercurio principalmente a través del pescado y marisco contaminado puede producir efectos adversos en la salud. El grupo de estudio para la prevención de la exposición al metilmercurio (GEPREM-Hg), constituido por representantes de diferentessociedades científicas españolas, ha elaborado un documento de consenso donde se recogen en forma de preguntas y respuestas las principales conclusiones, recomendaciones y propuestas planteadas en el grupo. El objetivo del documento es profundizar en el conocimiento de los factores asociados a la exposición al metilmercurio, los posibles efectos sobre la salud en la población española, los métodos de análisis, la interpretación de los resultados, el coste económico y establecer finalmente recomendaciones de consumo de pescados y mariscos. El grupo considera acertadas todas las iniciativas encaminadas a reducir o prohibir el uso del mercurio y la necesidad de conocer los resultados de los análisis de contaminantes que se realizan en los pescados y mariscos que se comercializan en España. Además, opina que se deberían establecer sistemas de biomonitorización para conocer la evolución de la exposición al metilmercurio en niños y adultos y realizar estudios diseñados para conocer los posibles efectos sobre la salud de las concentraciones halladas en la población española, teniendo en cuenta el estilo de vida, los patrones de consumo alimentarios y la dieta mediterránea (AU)


The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group’s main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, ta combusking into account the lifestyle, eating patterns and the Mediterranean diet (AU)


Assuntos
Humanos , Adulto , Criança , Compostos de Metilmercúrio/efeitos adversos , Compostos de Metilmercúrio/análise , Frutos do Mar/efeitos adversos , Frutos do Mar/análise , Contaminação de Alimentos/análise , Espanha/epidemiologia , Consenso , Dieta Mediterrânea
10.
Nutr. clín. diet. hosp ; 34(3): 105-123, sept.-dic. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-131757

RESUMO

Los efectos beneficiosos del consumo de pescado tanto en niños como en adultos han sido bien reconocidos. Sin embargo, la ingesta de metilmercurio principalmente a través del pescado y marisco contaminado puede producir efectos adversos en la salud. El grupo de estudio para la prevención de la exposición al metilmercurio (GEPREM-Hg), constituido por representantes de diferentes sociedades científicas españolas, ha elaborado un documento de consenso donde se recogen en forma de preguntas y respuestas las principales conclusiones, recomendaciones y propuestas planteadas en el grupo. El objetivo del documento es profundizar en el conocimiento de los factores asociados a la exposición almetilmercurio, los posibles efectos sobre la salud en la población española, los métodos de análisis, la interpretación de los resultados, el coste económico y establecer finalmente recomendaciones de consumo de pescados y mariscos. El grupo considera acertadas todas las iniciativas encaminadas a reducir o prohibir el uso del mercurio y la necesidad de conocer los resultados de los análisis de contaminantes que se realizan en los pescados y mariscos que se comercializan en España. Además, opina que se deberían establecer sistemas de biomonitorización para conocer la evolución de la exposicional metilmercurio en niños y adultos y realizar estudios diseñados para conocer los posibles efectos sobre la salud de las concentraciones halladas en la población española, teniendo en cuenta el estilo de vida, los patrones de consumo alimentarios y la dieta mediterránea (AU)


The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methyl mercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methyl mercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methyl mercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methyl mercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet (AU)


Assuntos
Humanos , Compostos de Metilmercúrio/envenenamento , Contaminação de Alimentos/análise , Fatores de Risco , Frutos do Mar/efeitos adversos , Produtos Pesqueiros/efeitos adversos
11.
Nutr Hosp ; 30(5): 969-88, 2014 Nov 01.
Artigo em Espanhol | MEDLINE | ID: mdl-25365001

RESUMO

Mercury is an environmental toxicant that causes numerous adverse effects on human health and natural ecosystems. The factors that determine the existance of adverse effects, as well as their severity are, among others: the chemical form of mercury (elemental, inorganic, organic), dosis, age, period of exposure, pathways of exposure and environmental, nutritional and genetic factors. In the aquatic cycle of mercury, once it has been deposited, it is transformed into methylmercury due to the action of certain sulphate-reducing bacteria, which bioaccumulates in the aquatic organisms and moves into the food chain. The methylmercury content of large, long-lived fish such as swordfish, shark, tuna or marlin, is higher. Methylmercury binds to protein in fish and is therefore not eliminated by cleaning or cooking the fish. Fetuses and small children are more vulnerable to the neurotoxic effects of methylmercury from the consumption of contaminated fish. Methylmercury is absorbed in the gastrointestinal tract and crosses the blood-brain barrier and the placenta. The intake of certain dietary components such as polyunsaturated fatty acids, selenium, fiber, thiol compounds, certain phytochemicals and other nutrients can modify methylmercury bioaccesibility and its toxicity. Apart from environmental factors, genetic factors can influence mercury toxicity and explain part of the individual vulnerability.


Assuntos
Intoxicação por Mercúrio/genética , Intoxicação por Mercúrio/patologia , Compostos de Metilmercúrio/farmacocinética , Compostos de Metilmercúrio/toxicidade , Estado Nutricional , Envelhecimento , Animais , Feminino , Peixes , Humanos , Masculino , Mercúrio/metabolismo , Mercúrio/farmacocinética , Alimentos Marinhos , Caracteres Sexuais , Toxicocinética
12.
Nutr Hosp ; 30(5): 989-1007, 2014 Nov 01.
Artigo em Espanhol | MEDLINE | ID: mdl-25365002

RESUMO

The benefit of fish consumption in children and adults is well-known. However, it has been pointed out that excessive methylmercury intake due to consumption of contaminated fish leads to neurological toxicity in children, affecting cognitive function, memory, visual-motor function and language. After the intoxications in Minamata and Iraq, wide-ranging epidemiological studies were carried out in New Zealand, the Faroe Islands and the Seychelles and international recommendations were established for fish consumption in pregnant women and small children. In Spain, the Childhood and Environmental project (INMA, its Spanish acronym) has studied the effects of diet and the environment on fetal and childhood development in different geographic areas of Spain. National and international sudies have demonstrated that mercury concentrations are mainly dependent on fish consumption, although there are variations among countries which can be explained not only by the levels of fish consumption, but also by the type or species of fish that is consumed, as well as other factors. Although the best documented adverse effects of methylmercury are the effects on nervous sytem development in fetuses and newborns, an increasing number of studies indicate that cognitive function, reproduction and, especially, cardiovascular risk in the adult population can also be affected. However, more studies are necessary in order to confirm this and establish the existance of a causal relationship.


Assuntos
Peixes , Intoxicação por Mercúrio/epidemiologia , Compostos de Metilmercúrio/toxicidade , Alimentos Marinhos/efeitos adversos , Adulto , Animais , Feminino , Humanos , Lactente , Recém-Nascido , Intoxicação por Mercúrio/etiologia , Compostos de Metilmercúrio/envenenamento , Gravidez , Alimentos Marinhos/análise
13.
Nutr. hosp ; 30(5): 969-988, nov. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-132303

RESUMO

El mercurio es un tóxico ambiental que causa numerosos efectos adversos en la salud humana y en los ecosistemas naturales. Los factores que determinan la aparición de efectos adversos y su severidad son entre otros: la forma química del mercurio (elemental, inorgánico, orgánico), la dosis, la edad, la duración de la exposición, la vía de exposición y los factores ambientales, nutricionales y genéticos. En el ciclo acuático del mercurio, una vez que se ha depositado, se transforma en metilmercurio por la acción de determinadas bacterias sulfato reductoras y se bioacumula en los organismos acuáticos incorporándose a la cadena trófica de alimentos. El contenido de metilmercurio es mayor en las especies depredadoras de mayor tamaño y que viven más años como el emperador, pez espada, tiburón, atún o marlín. El metilmercurio se halla unido a las proteínas del pescado por lo que no se elimina mediante la limpieza ni el cocinado del mismo. El feto en desarrollo y los niños pequeños son los más vulnerables a los efectos neurotóxicos del metilmercurio procedente de la ingesta de pescado contaminado. El metilmercurio se absorbe en el tracto gastrointestinal y atraviesa la barrera hematoencefálica y la placenta. Algunos componentes de la dieta como los ácidos grasos poliinsaturados, el selenio, la fibra, los compuestos tiol, algunos fitoquímicos y otros nutrientes pueden modificar la bioaccesibilidad del mercurio y su toxicidad. Además de los factores ambientales, los factores genéticos pueden influir en la toxicidad del mercurio y explicar parte de la vulnerabilidad individual (AU)


Mercury is an environmental toxicant that causes numerous adverse effects on human health and natural ecosystems. The factors that determine the existance of adverse effects, as well as their severity are, among others: the chemical form of mercury (elemental, inorganic, organic), dosis, age, period of exposure, pathways of exposure and environmental, nutritional and genetic factors. In the aquatic cycle of mercury, once it has been deposited, it is transformed into methylmercury due to the action of certain sulphate-reducing bacteria, which bioaccumulates in the aquatic organisms and moves into the food chain. The methylmercury content of large, long-lived fish such as swordfish, shark, tuna or marlin, is higher. Methylmercury binds to protein in fish and is therefore not eliminated by cleaning or cooking the fish. Fetuses and small children are more vulnerable to the neurotoxic effects of methylmercury from the consumption of contaminated fish. Methylmercury is absorbed in the gastrointestinal tract and crosses the blood-brain barrier and the placenta. The intake of certain dietary components such as polyunsaturated fatty acids, selenium, fiber, thiol compounds, certain phytochemicals and other nutrients can modify methylmercury bioaccesibility and its toxicity. Apart from environmental factors, genetic factors can influence mercury toxicity and explain part of the individual vulnerability (AU)


Assuntos
Humanos , Masculino , Feminino , Compostos de Metilmercúrio/síntese química , Compostos de Metilmercúrio , Compostos de Metilmercúrio/uso terapêutico , Farmacocinética , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados/métodos , Selênio/administração & dosagem , Selênio/análise , Compostos de Metilmercúrio/administração & dosagem , Compostos de Metilmercúrio/análise , Compostos de Metilmercúrio/farmacologia , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados/instrumentação , Selênio , Selênio
14.
Nutr. hosp ; 30(5): 989-1007, nov. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-132304

RESUMO

Los efectos beneficiosos del consumo de pescado tanto en niños como en adultos han sido bien reconocidos. Sin embargo, se ha referido que la ingesta excesiva de metilmercurio procedente del pescado contaminado produce toxicidad neurológica en los niños afectando a la función cognitiva, la memoria, la función visual-motora y al lenguaje. Después de las intoxicaciones de Minamata e Iraq, se realizaron grandes estudios epidemiológicos en Nueva Zelanda, las islas Féroe y las islas Seychelles y se establecieron recomendaciones internacionales sobre el consumo de pescado y marisco en las mujeres embarazadas y niños pequeños. En España, el proyecto Infancia y Medio Ambiente (INMA) ha estudiado los efectos del medio ambiente y de la dieta sobre el desarrollo fetal e infantil en diversas zonas geográficas de España. Los estudios realizados nacionales e internacionales muestran que la concentración de mercurio depende principalmente del consumo de pescado, aunque existe una variabilidad entre los países que podría explicarse no solo por la cantidad de pescado consumida, sino también por el tipo o especies de pescados que se consumen, así como por otro tipo de factores. Aunque los efectos perjudiciales del metilmercurio mejor documentados son los que se producen sobre el desarrollo del sistema nervioso en el feto y en el recién nacido, cada vez hay más estudios que indican que también puede afectar a la función cognitiva, reproducción y especialmente al riesgo cardiovascular en la población adulta. Sin embargo, son necesarios más estudios para confirmarlo y establecer la existencia de una relación causal (AU)


The benefit of fish consumption in children and adults is well-known. However, it has been pointed out that excessive methylmercury intake due to consumption of contaminated fish leads to neurological toxicity in children, affecting cognitive function, memory, visual-motor function and language. After the intoxications in Minamata and Iraq, wide-ranging epidemiological studies were carried out in New Zealand, the Faroe Islands and the Seychelles andinternational recommendations were established for fish consumption in pregnant women and small children. In Spain, the Childhood and Environmental project (INMA, its Spanish acronym) has studied the effects of diet and the environment on fetal and childhood development in different geographic areas of Spain. National and international sudies have demonstrated that mercury concentrations are mainly dependent on fish consumption, although there are variations among countries which can be explained not only by the levels of fish consumption, but also by the type or species of fish that is consumed, as well as other factors. Although the best documented adverse effects of methylmercury are the effects on nervous sytem development in fetuses and newborns, an increasing number of studies indicate that cognitive function, reproduction and, especially, cardiovascular risk in the adult population can also be affected. However, more studies are necessary in order to confirm this and establish the existance of a causal relationship (AU)


Assuntos
Humanos , Feminino , Criança , Adulto , Animais , Recém-Nascido , Gravidez , Compostos de Metilmercúrio/toxicidade , Peixes , Intoxicação por Mercúrio , Alimentos Marinhos , Compostos de Metilmercúrio/envenenamento , Intoxicação por Mercúrio/etiologia , Alimentos Marinhos/análise , Alimentação
15.
Nutr Hosp ; 31(1): 1-15, 2014 Nov 04.
Artigo em Espanhol | MEDLINE | ID: mdl-25561094

RESUMO

The beneficial effects of fish consumption are well- known. Nevertheless, there is worldwide concern regard methylmercury concentrations in fish, which is why many countries such as the United States, Australia, New Zealand, Canada and numerous European countries have made fish consumption recommendations for their populations, particularly vulnerable groups, in order to México methylmercury intake. Blood and hair are the best biological samples for measuring methylmercury. The most widely-used method to analyse methylmercury is cold vapor atomic absorption spectrometry, although there are also direct methods based on the thermal decomposition of the sample. In recent years, the number of laboratories that measure mercury by inductively coupled plasma mass spectrometry has increased. In addition, the different kinds of mercury can be distinguished by coupling chromatography methods of separation. Laboratories that analyse mercury in biological samples need to participate in external quality control programmes. Even if mercury emissions are reduced, mercury may remain in the environment for many years, so dietary recommendations are fundamental in order to reduce exposure. It is necessary to propose public health measures aimed at decreasing mercury exposure and to evaluate the benefits of such measures from the economic and social standpoints.


Assuntos
Compostos de Metilmercúrio/análise , Compostos de Metilmercúrio/toxicidade , Animais , Análise Custo-Benefício , Peixes , Contaminação de Alimentos/análise , Contaminação de Alimentos/economia , Humanos , Compostos de Metilmercúrio/economia
16.
Nutr Hosp ; 31(1): 16-31, 2014 Nov 21.
Artigo em Espanhol | MEDLINE | ID: mdl-25561095

RESUMO

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, ta king into account the lifestyle, eating patterns and the Mediterranean diet.


Assuntos
Compostos de Metilmercúrio/efeitos adversos , Compostos de Metilmercúrio/análise , Alimentos Marinhos/efeitos adversos , Alimentos Marinhos/análise , Adulto , Criança , Consenso , Dieta Mediterrânea , Contaminação de Alimentos/análise , Humanos , Espanha/epidemiologia
17.
Prog. obstet. ginecol. (Ed. impr.) ; 56(5): 261-265, mayo 2013. ilus
Artigo em Espanhol | IBECS | ID: ibc-112012

RESUMO

La eclampsia, síndrome clínico definido clásicamente por la aparición de convulsiones y/o coma en gestantes con hipertensión y proteinuria, se presenta frecuentemente como un síndrome de encefalopatía posterior reversible (PRES), entidad clínico radiólogica caracterizada por cefalea, alteraciones visuales, convulsiones y/o alteración de conciencia, junto a un patrón radiológico de edema cerebral vasogénico reversible localizado en territorio posterior. Discutimos dos casos de gestantes pretérmino que ingresaron en el Servicio de Urgencias de nuestro hospital tras debutar en su domicilio con cefalea y status epiléptico, sin antecedentes de enfermedad hipertensiva del embarazo ni proteinuria. Ambas presentaron en las pruebas de neuroimagen, criterios de síndrome de encefalopatía posterior reversible (PRES), lo que facilitó el diagnóstico diferencial y la toma de decisiones terapéuticas. Dada la estrecha asociación entre eclampsia y síndrome de encefalopatía posterior reversible (PRES), los estudios de neuroimagen constituyen una herramienta valiosa para el diagnóstico y tratamiento oportuno de estas pacientes, favoreciendo su recuperación neurológica completa sin secuelas posteriores(AU)


Eclampsia, a clinical syndrome classically defined by the occurrence of seizures and/or coma in pregnant women with hypertension and proteinuria, is often presented as a posterior reversible encephalopathy syndrome (PRES), a clinical-radiological entity characterized by headache, visual disturbances, seizures and/or alteration of consciousness, besides a radiological pattern of reversible vasogenic cerebral edema located in posterior territory. We discuss two cases of preterm pregnant women admitted to the Emergency Department of our hospital after debuting at their home with headache and status epilepticus, with no history of hypertensive disease of pregnancy or proteinuria. Both presented in neuroimaging criteria for posterior reversible encephalopathy syndrome (PRES), which facilitated the differential diagnosis and therapeutic decision making. Given the close association between eclampsia and posterior reversible encephalopathy syndrome (PRES), neuroimaging studies are a valuable tool for the diagnosis and treatment of these patients, favouring complete neurological recovery without sequelae(AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Eclampsia/diagnóstico , Encefalopatias/complicações , Complicações na Gravidez/diagnóstico , Epilepsia/complicações , Edema Encefálico/complicações , Fenitoína/uso terapêutico , Ceftriaxona/uso terapêutico , Betametasona/uso terapêutico , Imagem por Ressonância Magnética , Cesárea/métodos , Encefalopatias/fisiopatologia , Encefalopatias , Convulsões/complicações , Edema Encefálico/fisiopatologia , Edema Encefálico , Transtornos da Cefaleia/complicações , Eclampsia/fisiopatologia
18.
Prog. obstet. ginecol. (Ed. impr.) ; 55(5): 239-242, mayo 2012.
Artigo em Espanhol | IBECS | ID: ibc-99864

RESUMO

Los síndromes talasémicos son trastornos hereditarios de la biosíntesis de la globina alfa o la beta. La disponibilidad reducida de globina disminuye la producción de tetrámeros de hemoglobina, lo que da lugar a hipocromía y microcitosis. Se produce una acumulación desequilibrada de subunidades alfa o beta porque las síntesis de las globinas no afectadas continúan a una velocidad normal. La acumulación desequilibrada de cadenas domina el fenotipo clínico. La gravedad clínica varía mucho, dependiendo del grado de trastorno de la síntesis de la globina afectada, de la síntesis alterada de otras cadenas de globina y de la herencia simultánea de otros alelos anormales de la globina. La incidencia de estos síndromes durante el embarazo en todas las razas es de uno en 300 a 500 (AU)


Thalassemia syndromes are inherited disorders of alpha- or beta-globin biosynthesis. The reduced availability of globin decreases the production of hemoglobin tetramers, giving rise to hypochromia and microcytosis. There is unbalanced accumulation of alpha or beta subunits because the synthesis of unaffected globins continues at a normal speed. This unbalanced accumulation dominates the clinical phenotype. The clinical severity varies widely, depending on the degree of disorder of the synthesis of the affected globin, the altered synthesis of other globin chains and simultaneous inheritance of other abnormal globin alleles. The incidence of these syndromes during pregnancy in all races is one in 300 to 500 (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Talassemia beta/complicações , Talassemia beta/diagnóstico , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Talassemia beta/sangue , Talassemia beta/fisiopatologia , Talassemia beta , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/fisiopatologia , Ultrassonografia/métodos , Programas de Rastreamento/métodos
19.
Prog. obstet. ginecol. (Ed. impr.) ; 53(10): 412-415, oct. 2010. ilus
Artigo em Espanhol | IBECS | ID: ibc-82146

RESUMO

Las cistoplastias de ampliación con segmento intestinal se emplean en el tratamiento de ciertas patologías urológicas, en pacientes con vejiga de baja capacidad y mala acomodación en los cuáles el tratamiento conservador ha fallado (mielomeningocele, lipomeningocele, lipoma intradural, quiste dermoide, agenesia sacra, lesiones traumáticas de médula espinal). El caso clínico corresponde a una gestante de 20 años con antecedentes de mielomeningocele y vejiga neurógena, tratados mediante derivación ventrículo-peritoneal y cistoplastia. La ecografía informó de feto en cefálica, con biometría fetal dentro de la normalidad y oligoamnios grave. La resonancia magnética informa de vejiga ampliada con asa de intestino grueso. Ante el oligoamnios severo y la monitorización fetal no estresante poco reactiva, se indica inducción del parto, que fracasa, realizándose cesárea con histerotomía corporal fúndica de cara anterior (AU)


Augmentation cystoplasties with intestinal section are used to treat some urological diseases in patients with low bladder capacity and deficient adaptation (myelomeningocele, lipomeningocele, intradural lipoma, dermoid cyst, sacrum agenesia, traumatic lesions of the spinal cord) in whom conservative measures have failed. We report the case of a 20-year-old pregnant woman with a history of myelomeningocele and neurogenic bladder, treated by ventriculoperitoneal shunt and cystoplasty. Ultrasonography showed a fetus in cephalic presentation, with normal biometric findings and severe oligoamnios. Magnetic resonance imaging revealed an augmented bladder with large bowel loop. Given the severe oligoamnios and unreactive fetal non-stress test, labor induction was started with unsuccessful results and cesarean section was performed (AU)


Assuntos
Humanos , Feminino , Adulto , Meningomielocele/complicações , Meningomielocele/diagnóstico , Complicações na Gravidez/diagnóstico , Bexiga Urinaria Neurogênica/complicações , Cesárea/métodos , Histerotomia/métodos , Meningomielocele/terapia , Monitorização Fetal/métodos , Biometria/métodos
20.
Ginecol Obstet Mex ; 77(8): 380-6, 2009 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-19902629

RESUMO

Renal angiomyolipomas are uncommon tumours during pregnancy, but it's important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, specially during pregnancy. Their characteristics are different depending on if the tumour is associated or not with facomatosis. To show both possibilities, we describe two cases of pregnant women with angiomyolipomas: the first one presented with bleeding of the tumour (Wünderlich's syndrome), but surveillance without treatment was possible until 37th week of gestation, and embolization of the tumour was performed afterwards. The second patient had multiple well known angiomyolipomas, associated to tuberous sclerosis; even though she had required two previous embolizations, she had an uneventful pregnancy, without any episodes of bleeding. Both pregnancies ended successfully by means of a cesarean section. Since there are few papers available in the literature, there is not an agreement about therapeutic management when pregnant women present with bleeding angiomyolipomas (Wünderlich's syndrome). Treatment options include partial or total nephrectomy (with cesarean section simultaneously in patients at 28 weeks of gestation or later), transcateter selective arterial embolization (which can also be preventive), and sometimes, conservative management. If this last option is possible, there's still discussion about the risk of vaginal delivery compared with that of cesarean section, in terms of bleeding of the tumour.


Assuntos
Angiomiolipoma/complicações , Neoplasias Renais/complicações , Complicações Neoplásicas na Gravidez , Esclerose Tuberosa/complicações , Adulto , Angiomiolipoma/terapia , Feminino , Humanos , Neoplasias Renais/terapia , Gravidez , Complicações Neoplásicas na Gravidez/terapia
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