[Results of the application of modified Hamilton scale in the diagnosis of maternal anxiety during immediate puerperium]. / Resultados de la aplicación de la escala de Hamilton modificada en el diagnóstico de ansiedad materna durante el puerperio inmediato.

BACKGROUND: Anxiety during pregnancy is a risk factor of maternal and fetal morbidity with adverse results in newborn at short and long term. OBJECTIVE: To determine, with the modified Hamilton Anxiety Scale, the level of anxiety at the immediate postpartum and its association with maternal and fetal morbidity. MATERIAL AND METHOD: A cross-sectional study including 384 patients at the immediate postpartum to whom modified Hamilton Anxiety Scale was applied to determine the level of anxiety and its association with maternal factors and fetal and neonatal morbidity. Data were analyzed with statistical logistic regression analysis; an alpha value was set at 0.05. RESULTS: One hundred thirty-five patients had anxiety associated at immediate postpartum, the significant factors were scholarship (p = 0.0034), number of pregnancies (p = 0.0001), occupation (p = 0.0001). Women with anxiety had more frequency of threatened abortion (p = 0.0061), preterm labor (p = 0.0001), neonatal sepsis (p = 0.0123) and transient tachypnea of the newborn (p = 0.0016). CONCLUSIONS: A significant percentage of pregnant women had anxiety at immediate postpartum. Women with anxiety suffer more frequently maternal and fetal morbidity. It is recommended the opportune identification of this disorder in order to avoid the repercussion in the neonatal care.

Do craniopharyngioma molecular signatures correlate with clinical characteristics?

OBJECTIVE Exome sequencing studies have recently demonstrated that papillary craniopharyngiomas (PCPs) and adamantinomatous craniopharyngiomas (ACPs) have distinct genetic origins, each primarily driven by mutually exclusive alterations: either BRAF ( V600E), observed in 95% of PCPs, or CTNNB1, observed in 75%-96% of ACPs. How the presence of these molecular signatures, or their absence, correlates with clinical, radiographic, and outcome variables is unknown. METHODS The pathology records for patients who underwent surgery for craniopharyngiomas between May 2000 and March 2015 at Weill Cornell Medical College were reviewed. Craniopharyngiomas were identified and classified as PCP or ACP. Patients were placed into 1 of 3 groups based on their genomic mutations: BRAF mutation only, CTNNB1 mutation only, and tumors with neither of these mutations detected (not detected [ND]). Demographic, radiological, and clinical variables were collected, and their correlation with each genomic group was tested. RESULTS Histology correlated strongly with mutation group. All BRAF tumors with mutations were PCPs, and all CTNNB1 with mutations and ND tumors were ACPs. Preoperative and postoperative clinical symptoms and radiographic features did not correlate with any mutation group. There was a statistically significant relationship (p = 0.0323) between the age group (pediatric vs adult) and the mutation groups. The ND group tumors were more likely to involve the sella (p = 0.0065). CONCLUSIONS The mutation signature in craniopharyngioma is highly predictive of histology. The subgroup of tumors in which these 2 mutations are not detected is more likely to occur in children, be located in the sella, and be of ACP histology.

[Association of Doppler flowmetry with perinatal outcome in patients with oligohydramnios]. / Asociación de la flujometría Doppler con la evolución perinatal en pacientes con oligohidramnios.

BACKGROUND: Oligohydramnios is sometimes associated with poor perinatal outcome. Our aim was to determine the association of Doppler flowmetry with perinatal outcome in patients with oligohydramnios. METHODS: We carried out a prospective cross-sectional study that included 130 patients with pregnancy between 30 to 41 weeks of gestation; we compared the measurement of the resistance index in the umbilical artery by Doppler flowmetry and the measurement of amniotic fluid in patients with oligohydramnios. A follow-up of patients after birth was made, recording the Apgar score and whether they required special attention. The data were analyzed using descriptive statistics and we calculated the sensitivity, specificity, accuracy, and predictive values of the tests. RESULTS: Sensitivity, specificity and accuracy were obtained for oligohydramnios associated to perinatal death and for five-minute Apgar, with results of 100, 0, 50 % and 0, 0, 0 % respectively. The resistance index of umbilical artery related to perinatal death had sensitivity, specificity and accuracy of 100, 96 and 98 %, while in the Apgar were 0, 95 and 47.5 %, respectively. CONCLUSIONS: Doppler flowmetry of the umbilical artery showed a higher sensitivity, specificity and accuracy to diagnose perinatal death than the measurement of oligohydramnios and the Apgar score.

Introducción: el oligohidramnios en ocasiones se asocia a mala evolución perinatal. El objetivo fue determinar la asociación de la flujometría Doppler con la evolución perinatal en pacientes con oligohidramnios. Métodos: se realizó un estudio transversal en el que se analizaron 130 pacientes con embarazo de 30 a 41 semanas con oligohidramnios; se comparó la medición del índice de resistencia de la arteria umbilical por flujometría Doppler y la medición del líquido amniótico. Se hizo un seguimiento postnatal en el que se registró el Apgar y si los pacientes ameritaron cuidados especiales. Se utilizó estadística descriptiva y se calculó la sensibilidad, especificidad, exactitud y los valores predictivos de las pruebas. Resultados: para el oligohidramnios en muerte perinatal se obtuvo sensibilidad, especificidad y exactitud de 100, 0 y 50 %; y para Apgar de 0, 0 y 0 %, respectivamente. El índice de resistencia de la arteria umbilical referente a la muerte perinatal tuvo sensibilidad, especificidad y exactitud de 100, 96 y 98 %, en tanto que en el Apgar los valores fueron de 0, 95 y 47.5 %, respectivamente. Conclusiones: la flujometría Doppler de la arteria umbilical mostró mayor sensibilidad, especificidad y exactitud que la medición del oligohidramnios y la prueba de Apgar para diagnosticar muerte perinatal.