Oral versus intravenous maternal hydration in isolated third trimester oligohydramnios

Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria.  Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al.  In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method.

La reemergencia del dengue: un gran desafío para el sistema sanitario latinoamericano y caribeño en pleno siglo XXI / Reemergence of dengue: a great challenge for the health Latin American and Caribbean system, in the middle of XXI century

Se efectuó una revisión actualizada sobre el dengue, fundamentalmente centrada en los países de la Región, teniendo en cuenta de que se trata de una enfermedad infecciosa reemergente, que continúa representando un problema de salud pública a escala universal, cada vez más común y disperso en áreas tropicales y subtropicales, debido a sus condiciones demográficas y climatológicas

An up-dated review on dengue was carried out, fundamentally centered in the Region countries, keeping in mind that it is a reemerging infectious disease, which still represents a public health problem of universal scale, more and more common and disseminated in tropical and subtropical areas, due to its demographic and climatological conditions

Signos de alarma en pacientes cubanos con dengue según nueva clasificación revisada de la Organización Mundial de la Salud / Warning signs in Cuban patients with dengue fever according to new reviewed classification of the World Health Organization

Se realizó un estudio observacional, descriptivo y transversal en el Instituto de Medicina Tropical Pedro Kourí de La Habana, donde estuvieron ingresados 485 pacientes desde enero hasta diciembre de 2012 con diagnóstico de infección por dengue, de los cuales se escogió una muestra de 247. Entre los signos de alarma más comunes sobresalieron la cifra ascendente del hematocrito (54,6 por ciento y el dolor abdominal intenso o mantenido o de ambos tipos (46,1 por ciento . Las señales de alarma aparecieron por lo general al ceder la fiebre; del total de pacientes que las presentaron en algún momento de su evolución, 81,2 por ciento fueron tratados con hidratación intravenosa precoz y ninguno evolucionó hacia la forma grave de la enfermedad. La terapia hidratante parenteral se inició tardíamente en 18,8 por ciento de los afectados, incluidos todos aquellos en estado grave.

An observational, descriptive and cross sectional study was carried out in Pedro Kourí Tropical Medicine Institute from Havana, where 485 patients were admitted from January to December, 2012 with diagnosis of infection due to dengue fever, from whom a sample of 247 was chosen. Among the most common warning signs there were the increasing values of hematocrit (54.6 percent), and the intense or sustained abdominal pain or both types (46.1 percent). The warning signs generally appeared when fever ceased, and of the total of patients that presented it, 81.2 percent at some moment of their clinical course were treated with early intravenous hydration, and none developed the serious form of the disease. The parenteral hydration therapy began belatedly in 18.8 percent of the affected, including all those in severe state.

Must we do immediate appendectomy for acute appendicitis?

1. In a 2-year period starting January, 1970, we embarked on a program of delayed or semi-elective appendectomy for acute appendicitis. Sixty patients of the senior author were admitted with acute appendicitis but only 50 patients were finally selected to qualify for our study2. Regardless of the duration of illness or the time of admission, no immediate operation was done. Instead, the patient was scheduled for appendectomy not until the following day, included among the elective operations3. During this period before operation, the patient was prepared for elective surgery sparing the patient, the nursing and hospital staff and the surgical staff from unnecessary stress and strain of emergency procedure4. Antibiotics and intravenous hydration were among the principal preoperative preparations. Combination penicillin and streptomycin and also chloramphenicol were the antibiotics of choice5. In all cases the clinical diagnosis of acute appendicitis was confirmed at operation and on histopathological examination of the specimen. There was no single instance of perforation nor abscess6. No complication developed in any of the 50 patients who were all followed up for 30 days, at the minimum. There was no single fatality7. This study tends to justify a delayed or semi-elective approach to acute appendicitis. We also believe that this delayed surgical action with safety was mainly made possible by antibiotics among others. (Summary and Conclusions)