The cytokine profile of women with severe anxiety and depression during pregnancy.

BACKGROUND: Controversial findings regarding the association between pro-inflammatory cytokines and depression have been reported in pregnant subjects. Scarce data about anxiety and its relationships with cytokines are available in pregnant women. To understand the association between anxiety and cytokines during pregnancy, we conducted the present study in women with or without depression. METHODS: Women exhibiting severe depression (SD) and severe anxiety (SA) during the 3rd trimester of pregnancy (n = 139) and control subjects exhibiting neither depression nor anxiety (n = 40) were assessed through the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Serum cytokines were measured by a multiplex bead-based assay. Correlation tests were used to analyze the data and comparisons between groups were performed. A general linear model of analysis of variance was constructed using the group as a dependent variable, interleukin concentrations as independent variables, and HDRS/HARS scores and gestational weeks as covariables. RESULTS: The highest levels of Th1- (IL-6, TNF-α, IL-2, IFN-γ), Th17- (IL-17A, IL-22), and Th2- (IL-9, IL-10, and IL-13) related cytokines were observed in women with SD + SA. The SA group showed higher concentrations of Th1- (IL-6, TNF-α, IL-2, IFN-γ) and Th2- (IL-4, and IL-10) related cytokines than the controls. Positive correlations were found between HDRS and IL-2, IL-6, and TNF-α in the SA group (p < 0.03), and between HDRS and Th1- (IL-2, IL-6, TNF-α), Th2- (IL-9, IL-10, IL-13) and Th17- (IL-17A) cytokines (p < 0.05) in the SD + SA group. After controlling the correlation analysis by gestational weeks, the correlations that remained significant were: HDRS and IL-2, IL-6, IL-9, and IL-17A in the SD + SA group (p < 0.03). HARS scores correlated with IL-17A in the SA group and with IL-17A, IL-17F, and IL-2 in the SD + SA group (p < 0.02). The linear model of analysis of variance showed that HDRS and HARS scores influenced cytokine concentrations; only IL-6 and TNF-α could be explained by the group. CONCLUSIONS: We found that the cytokine profiles differ when comparing pregnant subjects exhibiting SA with comorbid SD against those showing only SA without depression.

Cerebellar abscesses caused by dog bite: a case report.

INTRODUCTION: Bites by house pets can be lethal or cause a series of catastrophic events with severe sequels, such as the loss of a limb or a systemic infection which may be life-endangering, especially in the case of children being bitten. PRESENTATION: A 2-year-old girl was attacked by a dog, causing lesions at the occipital region. This was treated initially as a superficial wound that became further complicated with two cerebellar abscesses. These abscesses required neurosurgical and antimicrobial treatment, with a satisfactory outcome. CONCLUSION: The precise and diligent evaluation of a lesion caused by an animal bite may prevent further life-endangering complications. To the best of our knowledge, there are no reports about cerebellar abscess caused by a dog bite. When cranial lesions are penetrating, an abscess must to be considered. We insist on the importance of medical evaluation and adequate treatment of such lesions.

Prenatal and perinatal low level lead exposure alters brainstem auditory evoked responses in infants.

Wave III latency and the III-V interpeak interval of brainstem auditory evoked responses in infants in the first weeks of life decreased and increased, respectively, in association with mid-pregnancy maternal blood lead levels (2.5-35 micrograms/dl) in a group of 30 prospectively followed healthy pregnancies and deliveries. The rapid myelination of brainstem auditory pathways occurring around mid-pregnancy and the lengthening of the III-V interpeak interval with increased mid-pregnancy maternal lead suggest that brain structures involved in spatial localization of sound may be compromised by prenatal lead exposure. The data also indicate that maternal blood lead measurements during pregnancy provide an adequate surrogate index of fetal exposure.

Use of prenatal phenobarbital in the prevention of subependymal/intraventricular hemorrhage in premature infants.

BACKGROUND: Subependymal/intraventricular hemorrhage (SE/IVH) is a frequent cause of disability and mortality. METHODS: This is a prospective, randomized, double-blind study which included 100 pregnant Mexican women who need to interrupt their pregnancy within 28-32 weeks of gestation. One group was given a single dose of intravenous (IV) phenobarbital 10 micrograms/kg (phenobarbital group, n = 50), and the other was provided with diluted distilled water (control group). Measurements of phenobarbital serum concentrations were taken by both mother and newborn, and head sonograms were applied during the first 24 hours, at the 3rd and 7th days of life. RESULTS: The sample was made up of 42 newborns in the phenobarbital group, and 46 in the control group; the newborns had phenobarbital levels of 11.5 5.7 g/microliter at birth, and of 9.5 +/- 5.9 g/microliter 24 hours later. SE/IVH was found in 12 patients from the phenobarbital group and in 29 from the control group (p < 0.005), the first group were 11 mild SE/IVH (2 grade I, and 9 grade II), and 26 in the control group (4 grade I, and 22 grade II), p < 0.005. Severe hemorrhages were similar between groups. A larger frequency of SE/IVH was found in the newborn group which received mechanical ventilation (p = 0.0008). CONCLUSIONS: Prenatal phenobarbital can reduce the SE/IVH frequency in premature infants younger than 32 weeks at birth. Its main effect could be shown in patients with mechanical ventilation.

Facial anthropometric measurements in offspring of epileptic mothers.

BACKGROUND: Minor facial anomalies in 14-33% of exposed fetuses have been associated with the teratogenic effect of antiepileptic drugs (AED) since 1968. The purpose of this article is to describe the facial characteristics of offspring of epileptic mothers with and without exposure to AED by means of 22 anthropometric measurements, for the purpose of comparison with the measurements of offspring of non-epileptic women previously described in the literature, and to correlate the facial anomalies with the specific drug. METHODS: An interval was defined where 95% of the central values were considered as "common values" and the remaining 5% as "uncommon values" (UV) or as being in the "alert zone"; the odds ratio with Wolf modification was used and then Fisher's test for comparison with healthy newborns. Full-term eutrophic newborns of epileptic mothers who received attention at the epilepsy clinic of a gyneco-obstetric center were included. RESULTS: During the study period, 72 eutrophic, full-term newborns were included; in 70 cases at least one measurement was found in the alert zone, with a predominance of the mid-line area. No differences were found between neonates who received monotherapy vs. polytherapy. The groups exposed to phenobarbital, clonazepam and multiple AED showed more uncommon values (p < 0.05), identified as minor dysmorphisms by other authors. It seems to be a particular susceptibility of the mid-line of the face to show the effects of AED and, additionally, of environmental agents. CONCLUSIONS: No differences were found in the facial values among the different AED used in monotherapy form. It is suggested that the choice of drug used during pregnancy must be decided on according to the clinical diagnosis of each mother's epilepsy, and not on the basis of potential teratogenic risk.

[A randomised open trial comparing monotherapy with topiramate versus carbamazepine in the treatment of paediatric patients with recently diagnosed epilepsy]. / Estudio abierto aleatorio y comparativo de monoterapia con topiramato frente a carbamacepina en el tratamiento de pacientes pediátricos con epilepsia de reciente diagnóstico.

INTRODUCTION: In some studies in children, topiramate showed efficacy. AIM: To evaluate efficacy, tolerability and safety of topiramate in monotherapy in newly diagnosed epilepsy vs carbamazepine in children. PATIENTS AND METHODS: In a multicentre, open-label, comparative and randomized study patients with partial epilepsy, were randomized to received topiramate or carbamazepine treatment. Patients with degenerative disease were excluded. Data were analysed by SPSS statistical program v. 11.0, and non parametric test. Comparisons between groups were made with chi square test and t Student's test. RESULTS: In total were included 88 patients, 33 in group 1 (topiramate), 32 group 2 (carbamazepine), 23 were drop-outs because adverse events and lost in follow-up (13 in group 1 y 10 group 2). In both groups were observed good efficacy, in month 6 and 9 of follow-up, the average of seizures in group 1 were better than group 2 (p = 0.01, t Student's test). The percentage of free seizure patients was greater in group 1 than group 2 (statistical significance p = 0.02 chi square test). The adverse events were similar in both groups and mild, somnolence 9%, weight loss 6% in group 1 and somnolence 19%, dizziness 3% and seizure discontrol 3% in group 2. CONCLUSIONS: Good efficacy in both groups, and topiramate in good treatment choice in newly diagnosed epilepsy in children because it's the efficacy and tolerability in comparison with the gold standard carbamazepine.

[Epilepsy and pregnancy. Prospective study of 100 cases]. / Epilepsia y embarazo. Estudio prospectivo de 100 casos.

The association between epilepsy and pregnancy trace a problem for possible complications for the mother and the foetus by toxicity of antiepileptic drugs (AED) on the epilepsy itself. A group of 100 pregnant epileptic women were prospectively studied (clinically and by measurement of serum levels (SL) of AED. Mothers participating lived in the Valley of Mexico, 61 patients received monotherapy and 18 received no drugs. The most commonly used were phenytoin (41), carbamazepine (35) and valproate. The SL of AED were into or under the range recommended for seizures control, only 10 patients have increased their seizures (sleepless and AED medication were common causes). Obstetric complications in our patients do not differ from healthy pregnant women. The 50% of deliveries were resolved by cesarean section (only by neurologic recommendation). No major malformations were observed and the 12% showed minor dysmorphic features. This work show the Obstetric and Neurologic follow-up of 100 mexican women with epilepsy during pregnancy, treated in a third level attention hospital, their complications, pharmacologic recommendations and risk of teratogenicity.

[Pharmacokinetic variations in anticonvulsants in Mexican epileptic women during different stages of the postpartum period]. / Variaciones farmacocinéticas de anticonvulsivantes en mujeres epilépticas mexicanas durante las diferentes etapas del postparto.

During pregnancy, there are several physiological changes that influence the kinetics of medication administrated during this time. These physiological changes are not reestablished immediately during delivery; so, its concentration in biologic fluids is different when is administered immediately after delivery, than several weeks after. The purpose in this work was to identify the changes of pharmacocinetics constants for fenitoin and carbamacepine, in epileptic patients. When the same dose is maintained, during different times of postpartum. In 20 Mexican epileptic women, the plasma and milk concentrations of fenitoina during 60 day postpartum and in 14 carbamacepine was determined. In all the patients pharmakocinetics of anticonvulsivant, in each study period (5, 15, 30, 45 y 60 days postpartum). Excretion index of maternal milk was determined. Maximal plasmatic concentration of fentoine had no variation; however, carbamacepine was higher during the late period. There were no differences in the areas under curve and life all the middle of elimination and in excretion index.

[Multidisciplinary assessment of the fetus with hydrocephalus: study protocol and results]. / Evaluación multidisciplinaria del feto con hidrocefalia: protocolo de estudio y resultados.

The objective was to make the confirmation-exclusion diagnosis of fetal hydrocephaly, to study its etiology and identify associated anomalies. 67 cases with suspected fetal hydrocephaly were studied at 30 weeks of mean gestational age. Serial studies of ultrasonography, TORCH serology and fetal karyotype were made. Postnatal correlation was made. 14 cases were not confirm and 53 were. 6 cases (11.3%) were classified as isolated hydrocephaly and 47 (88.7%) with associated anomalies. In this group, 15 with only intracranial anomalies and 32 intracranial and extracranial anomalies. All chromosomic anomalies were found in this latter group. Proved in all the cases of hydrocephaly and most of its associated anomalies were documented. Fetal hydrocephaly can be accurately diagnosed with the technology presently available. The diagnosis of associated anomalies is more difficult to obtain, but can be reached using serial studies and multidisciplinary approach.

[Risk factors for hypoacusis and audiometric findings in preschool children who had been admitted to neonatal intensive care units]. / Factores de riesgo para hipoacusia y hallazgos audiométricos en una población preescolar egresada de cuidados intensivos neonatales.

Thirty preschool children who survived from a neonatal intensive care unit were studied with pure tone audiometry between 125 to 8000 Hertz. Examinations were performed in a cross-sectional study at 36 to 72 postnatal months of age. Hypoacusis was found in three patients. Risk factors most frequently found in hypoacusic children were hyperbilirubinemia, hypoxia neonatorum and ototoxic exposure. All hypoacusic children had a history of preterm birth, one suffered hypoxia neonatorum, and two hyperbilirubinemia. The patients' group had an average of 2.26 risk factors. These data suggest that perinatal auditory damage occurs in the presence of additional hearing damage risk factors leading to hypoacusis.

[Auditory provoked potentials in children with neonatal risk for hypoacusia]. / Potenciales provocados auditivos en niños con riesgo neonatal de hipoacusia.

Auditory evoked potentials of the brain stem (AEPBS) provide a simple noninvasive method of evaluating hearing function and have been widely used for early detection of hypoacusis in children. Between April 1992 and May 1994, a study was done of 400 Mexican children who presented at least one neonatal risk factor for hearing impairment. The average age of the children studied was 6.6 months and their average gestational age at birth was 35.1 weeks. Just over half of them (51%) had been treated with amikacin. The study found 1427 risk factors (3.5 per child), the most common ones being exposure to ototoxic substances, hyperbilirubinemia, and birthweight of less that 1500 g. In 27% of the children, peripheral auditory changes were found, and 13% did not respond to auditory stimuli. Low birthweight and young gestational age at birth, high serum concentration of bilirubin, sepsis, subependymal or intraventricular hemorrhage, mechanical ventilation, and exposure to ototoxic substances were significantly associated with the presence of severe or profound hypoacusis.

[Alterations in neuro-development in the 1st year of life in newborn infants weighing 2000 grams or less at birth]. / Alteraciones del neurodesarrollo en el primer año de vida en neonatos que pesaron 2.000 gramos o menos al nacer.

The infants with low weight at birth have great chance of exhibiting early death or neurodevelopmental sequelae. We prospectively evaluated the neurological and psychological development during the first year of life in 118 infants who weighted less than 2,000 g at birth. All patients were examined with the Amiel Tison and Grenier test (neurologic evaluation), Gesell test (psychological) and Brunette-Lezine test (Psychomotor scale). Mean gestational age was 33 weeks (SD = 3.1) and birth mean weight was 1495 g (SD = 291). Seventy per cent were delivered by cesarean section. Neurological abnormalities were found in 20 infants (alteration of muscular tone in all and motor deficit in 50%). Twenty five per cent had abnormal Gesell test and 17% psychomotor retardation (13% mild and 4% severe).

[Subependymal/intraventricular hemorrhage in preterm newborn infants. Neurodevelopmental course during the first year of life]. / Hemorragia subependimaria/intraventricular en neonatos pretérmino. Evolución del neurodesarrollo durante el primer año de vida.

Subependymal/intraventricular hemorrhage (SE/IVH) is the most frequently encountered type of hemorrhage in the neonatal period. Premature infants often develop SE/IVH which remains is one of most serious neonatal events. We studied a group of 96 premature newborn infants: half of which were diagnosed with SE/IVH. We evaluated the babies at six and 12 months of age which++ a battery of neurobehavioral exams, including neurological, psychological, motor an audiological test. In 52 of infants with SE/IVH showed some type of neurobehavioral abnormality, compared with 13% of non-SE/IVH infants. In 56% of SE/IVH infants had neurological abnormalities at 12 months (P < 0.0001) difference with non-SE/IVH), predominantly in areas of muscle tone and reflex. Motor abnormalities were encountered in 42% of SE/IVH children, and in 4% of non-SE/IVH children at 12 months. Psychometric abnormalities at 12 months were noted in 53% of the SE/IVH group. Hypocusis were noted in 38% of the SE/IVH group and in 15% of the non-SE/IVH group.

Variaciones farmacocinéticas de anticonvulsivantes en mujeres epilépticas mexicanas durante las diferentes etapas del postparto / Pharmakocinetic variation of anticonvulsants in Mexican epileptic women during different parts of puerperium

Durante el embarazo existen una serie de cambios fisiológicos que influyen en la cinética de los medicamentos administrativos durante esta etapa: Estos cambios fisiológicos no se restauran inmediatamente en el parto, de tal manera que su concentración en los fluidos biológicos es diferente cuando se administra inmediatamente después del parto que varias semanas posterior al mismo. El presente trabajo tiene como propósito identificar los cambios en las constantes farmacocinéticas de fenitoína y carbamacepina, en pacientes epilépticas cuando se mantiene una misma dosis durante diferentes etapas del postparto. En 20 mujeres mexicanas epilépticas se determinó la concentración en plasma y leche de fenitoína durante 60 días postparto y en 14 se determinó carbamacepina. A todas las pacientes se les realizó la farmacocinética de los anticonvulsivantes en cada periodo de estudio (5, 15, 30, 45 y 60 días posparto) y se determinó el índice de excreción en leche materna. Las concentraciones plasmáticas de fenitoína no presentaron variaciones, sin embargo la carbanacepina fue más alta en el periodo tardió, también se observaron diferencias en las áreas bajo la curva y vida media de eliminación y en los índices de excreción