17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that investigated the clinical benefits of 17-alpha hydroxyprogesterone caproate (17OHPC) in the prevention of recurrent preterm birth (PTB) among singleton pregnant women with a previous history of PTB. We searched four major databases up till April 2021 and assessed the risk of bias in the included studies. We meta-analyzed various maternal-neonatal endpoints (n=18) and pooled them as mean difference or risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Six RCTs met the inclusion criteria, comprising 2,573 patients (17OHPC=1,617, control=956). RCTs revealed an overall low risk of bias. The rates of PTB <35 weeks (n=5 RCTs; RR, 0.77; 95% CI, 0.63-0.93; P=0.008), PTB <32 weeks (n=3 RCTs; RR, 0.68; 95% CI, 0.51-0.91; P=0.009), neonates with low birth weight (<2.5 kg) at delivery (n=3 RCTs; RR, 0.63; 95% CI, 0.5-0.79; P<0.001), and neonatal death (n=4 RCTs; RR, 0.41; 95% CI, 0.20-0.84; P=0.02) were significantly reduced in the 17OHPC group compared with the control group. Moreover, 17OHPC treatment correlated with a significantly decreased rate of retinopathy (n=2 RCTs; RR, 0.42; 95% CI, 0.18-0.97; P=0.004). However, there were no significant differences in the rates of neonatal intensive care unit admission, cesarean delivery, and other pretermrelated complications between both the groups. Among singleton pregnant women with a prior history of PTB, 17OHPC may favorably decrease the risks of recurrent PTB and reduce the rate of neonatal death.

En busca de la imagen corporal deseada después de la cirugía bariátrica / In search of the desired corporal image after bariatric surgery / Na busca da imagem corporal desejada depois da cirurgia bariátrica

Las terapias médicas y nutricionales no siempre producen una pérdida de peso significativa y sostenida, por lo que la cirugía bariátrica es una alternativa y el método más efectivo en el tratamiento para la obesidad; se ha relacionado con una mejoría de las patologías asociadas, la calidad de vida, la autoestima, los estados de ansiedad y depresión. Con la cirugía bariátrica se pretende reducir la morbimortalidad ligada a la obesidad. Enfermería requiere un mayor conocimiento científico, tecnológico y práctico para brindar un cuidado con calidad frente a estos nuevos procedimientos y tecnologías, y para colaborar en la prevención de complicaciones. Objetivo: Presentar la categoría en busca de la imagen corporal deseada después de la cirugía bariátrica. Métodos: Estudio cualitativo con 23 participantes (9 hombres y 14 mujeres), se realizaron entrevistas semiestructuradas; para el análisis de los datos se utilizaron las herramientas de la teoría fundamentada hasta alcanzar la saturación de la información. Resultados: La categoría en busca de la imagen corporal deseada está compuesta por las siguientes subcategorías: cumplimiento de los requisitos para la reconstrucción; aunque todo se cae no siempre se quiere la cirugía reconstructiva; complicándome con la reconstrucción; los vestigios: vanidad y adicción a las cirugías estéticas. Conclusiones: Realizarse la cirugía bariátrica no garantiza una imagen corporal esbelta, pues esto requiere de nuevas intervenciones para alcanzarla. Con la reconstrucción de la imagen corporal después de la cirugía bariátrica no siempre se queda satisfecho, quedan vestigios que afectan diferentes dimensiones del individuo.

Medical and nutritional therapies do not always produce a significant and sustained weight loss; and because of this, the bariatric surgery is an alternative and the most effective method in the treatment of obesity. Bariatric surgery has been associated with improvements in obesity related pathologies, quality of life, selfesteem, and anxiety and depression. Bariatric surgery is intended to reduce the obesity related morbidity and mortality. The profession of nursing needs to address the issue with enhanced scientific, technological, and practical knowledge to foster the prevention of complications. Objective: To present the category In search of the desired corporal image after bariatric surgery. Methods: This is a qualitative study with 23 participants (9 men and 14 women). Semi-structured interviews were conducted. Data were collected until theoretical saturation. Results: The category In search of the desired corporal image after bariatric surgery is constituted by the following sub-categories: fulfilling the requisites for the reconstruction; although everything is flaccid, reconstructive surgery is not always advisable; making my life more difficult with the reconstruction; the vanity and addiction to esthetical surgeries. Conclusions: Bariatric surgery does not guarantee a thin corporal image, and the reconstruction of the corporal image does not guarantee a complete satisfaction. There are always diverse affectations left on the individuals.

As terapias médicas e nutricionais não sempre produzem uma perda de peso significativa e sustentada, pelo que a cirurgia bariátrica é uma alternativa e o método mais efetivo no tratamento de obesidade, tem se relacionado com uma melhoria das patologias associadas, a qualidade de vida, a autoestima, os estados de ansiedade e depressão. Com a cirurgia bariátrica se pretende reduzir a morbimortalidade ligada à obesidade. A enfermagem requer um maior conhecimento científico, tecnológico e prático para brindar um cuidado com qualidade frente a estes novos procedimentos e tecnologias, e para colaborar na prevenção de complicações. Objetivo: Apresentar a categoria na busca da imagem corporal desejada após da cirurgia bariátrica. Métodos: Estudo qualitativo com 23 participantes (9 homens e 14 mulheres), realizaram-se entrevistas semiestruturadas, para a análise dos dados utilizaram-se as ferramentas da teoria fundamentada até atingir a saturação da informação. Resultados: A categoria na busca da imagem corporal desejada está composta pelas seguintes subcategorias: cumprimento dos requisitos para a reconstrução, ainda que tudo caia não sempre se quer a cirurgia reconstrutiva, complicando-se com a reconstrução, os vestígios, vaidade e adição às cirurgias estéticas. Conclusões: Realizar a cirurgia bariátrica não garante uma imagem corporal magra, pois isto requer de novas intervenções para ating-ila. Com a reconstrução da imagem corporal depois da cirurgia bariátrica não sempre se satisfaz, ficam vestígios que afeitam diferentes dimensões do individuo.

Malformación vascular de bajo flujo sinovial de la rodilla (hemangiolinfangioma): Reporte de caso / Low-low synovial vascular malformation of the knee (hemangiolymphangioma): Case report

Introducción: La malformación vascular venosa de bajo lujo se desarrolla generalmente durante la primera infancia y puede ser una causa poco frecuente de derrame recurrente de larodilla. La clínica, las pruebas de laboratorio y las radiografías suelen ser inespecíficas. Objetivo: Describir una patología infrecuente en pediatría, para enfatizar en la correcta clasificación y sospecha. Caso Clínico: Paciente de 2 años con historia de episodios de derrame articular de la rodilla derecha que requirió múltiples hospitalizaciones y tratamientos antibióticos. Exámenes de laboratorio normales. La radiografía simple de la rodilla no mostró cambios óseos. La resonancia magnética reportó malformación vascular de bajo lujo. Se realizó resección quirúrgica que evidenció lesión vascular entre las fibras musculares del vasto lateral del cuádriceps con extensión hasta la cápsula de la rodilla y disección de las fibras hasta el vasto lateral de la pierna derecha. El estudio histológico fue compatible con malformación vascular de bajo lujo. Ante el hallazgo benigno y la evolución favorable, continuó con tratamiento ambulatorio. Conclusiones: Aunque la malformación vascular de bajo lujo sinovial es una patología poco frecuente en la población pediátrica, debería considerarse la realización de un diagnóstico diferencial en pacientes con aparición repetida de hemartrosis sin historia de coagulopatía ni hemofilia.

Introduction: Low-low vascular malformation, which usually develops during the first stage of infancy, is a rare cause of recurrent effusion of the knee. History, laboratory and X-rays are usually non-specific. Objective: To describe a rare disease in pediatrics, emphasizing the correct classification and suspicion. Case Report: A case is presented of a two-year-old patient with a history of effusion of the right knee who required multiple hospitalizations and antibiotic treatments. Laboratory work-up was normal. Plain X-rays of the knee revealed no bone changes. MR imaging reported low-low vascular malformation. Surgical resection was performed, evidencing vascular lesion among the muscle fibers of the vastus lateralis of quadriceps until the capsule of the knee, as well as dissection of the fibers until the vastus lateralis of the right leg. Histology was consistent with low-low vascular malformation. Due to the benign outcome and favorable evolution, an outpatient management was possible. Conclusions: Although low-low synovial vascular malformation is a rare disease among the pediatric population, it should be considered in the differential diagnosis of patients with repeated hemarthrosis and no history of either coagulopathy or hemophilia.

Mitogenic response of rat lung and tracheal epithelial cells in monolayer primary cultures—Modulation of TNF-α expression.

Epithelial cells isolated from rat lung and trachea were grown on monolayers and their response to a number of hormones and growth factors were studied. Maximum proliferative response in serum containing media was observed when insulin, cholera toxin and cortisol were present together. However, these additives when present independently showed a marginal response. The synergism, due to these factors in promoting growth was seen very early in culture (day 4) as shown by thymidine labelling studies, On examining the indices of early mitogenesis, such as the expression of c-myc, our data suggests that these factors stimulate the expression of c-myc within 4 h. With respect to expression of TNF-α mRNA, this study suggests a possible modulation of TNF-α expression in response to these mitogens that stimulate proliferation maximally. Whether this expression of TNF-α by these epithelial cells is due to a maximal proliferative stimulus and/or is an early step in the cascade of intracellular signalling events is to be investigated in detail.

Agentes químicos y teretogenesis / Chemical agents and teratogenesis

Se presenta una exposición de las tendencias ocupacionales de la mujer en la actualidad; se especifican los criterios necesarios para considerar a una sustancia química como teratógena y finalmente se exponen los agentes químicos más importantes en el campo de la teratología como el plomo, mercurio, bifenilos policlorinados, los pesticidas, el denominado agente naranja y la dioxina. Se recalca la tendencia a una teratología postnatal del desarrollo mental de los fetos expuestos...

Actinomicetoma / Actinomycetoma

Se presenta el caso de un actinomicetoma localizado en la rodilla de un paciente de 17 anos; la sospecha diagnostica se concreto gracias a la presencia simultanea de edema, fistulas y granulos en el examen directo del material purulento; el agente etiologico fue la N. Brasiliensis. El tratamiento combinado de TMP - SMT y cirugia ortopedica trajo gran mejoria del paciente