Aspectos clínicoepidemiológicos de pacientes con cáncer de mama del Policlínico 28 de septiembre / Clinical-Epidemiological Aspects of Patients with Breast Cancer and from the Policlínico 28 de Septiembre of Santiago de Cuba

Introducción: El cáncer de mama es considerado como un serio problema de salud pública por la alta prevalencia tanto en países desarrollados como en desarrollo. Son escasos los estudios clínico-epidemiológicos actualizados en el área de salud del Policlínico 28 de septiembre relacionados con dicha entidad clínica. Objetivo: Caracterizar desde el punto de vista clínico y epidemiológico a pacientes con cáncer de mama del área de salud perteneciente al Policlínico 28 de septiembre. Métodos: Estudio descriptivo en una serie de 35 mujeres mayores de 30 años con diagnóstico confirmado de cáncer de mama. Las variables estudiadas comprendieron edad, antecedentes familiares de cáncer de mama, factores de riesgo generales y hormonales, signos y síntomas clínicos, resultados de estudio ecográfico y diagnóstico histopatológico. Se utilizó el porcentaje como medida de resumen. Resultados: El 42,8 por ciento de la muestra objeto de estudio estuvo comprendido en el grupo de edad de 40-49 años. El 65,7 por ciento del total de mujeres tenía antecedentes familiares de cáncer de mama. La menarquía precoz (54,2 por ciento) y la nuliparidad (48,5 por ciento) representaron los factores de riesgo de mayor incidencia. El 57,1 por ciento de las lesiones diagnosticadas correspondieron a carcinomas en estadío I y IIa. Conclusiones: El cáncer de mama constituye un serio problema de salud en mujeres mayores de 30 años pertenecientes al Policlínico 28 de septiembre del municipio Santiago de Cuba(AU)

Introduction: Breast cancer is considered a serious public health concern due to its high prevalence in both developed and developing countries. There are few updated clinical-epidemiological studies carried out in the health area of the Policlínico Docente 28 de Septiembre related to this clinical entity. Objective: To characterize, from the clinical and epidemiological point of view, the patients with breast cancer and from the health area belonging to the Policlínico Docente 28 de Septiembre. Methods: A descriptive study was carried out with a series of 35 women aged more than 30 years and with a confirmed diagnosis of breast cancer. The variables studied included age, family history of breast cancer, general and hormonal risk factors, clinical signs and symptoms, ultrasound findings and histopathological diagnosis. Percentage was used as summary measure. Results: 42.8 percent of the study sample was in the age group 40-49 years old. Of the total number of women, 65.7 percent had a family history of breast cancer. Early menarche (54.2 percent) and nulliparity (48.5 percent) represented the risk factors with the highest incidence. 57.1 percent of the diagnosed lesions corresponded to stage I and IIA carcinomas. Conclusions: Breast cancer is a serious health problem in women older than 30 years and belonging to the Policlínico Docente 28 de Septiembre, of Santiago de Cuba Municipality(AU)

Is it possible to predict massive bleeding in nulliparous women with placenta previa?

Abstract Objective We evaluated risk factors to determine if there were specific risk factors that could predict massive bleeding in nulliparous women with placenta previa. Methods The participants were classified into two groups. Women with a calculated blood loss ≥ 1,000mL were included in the massive bleeding group. Women without any signs or symptoms related with hypovolemia or with a calculated bleeding volume < 1,000 mL were categorized into the non-massive bleeding group. Results There were 28 patients (40.6%) with massive bleeding and 41 cases (59.4%) with non-massive bleeding. The calculated blood loss and number of cases that required red cell transfusions were statistically different between the groups (< 0.005 and 0.002, respectively). There were no statistically significant differences in terms of maternal or fetal factors, placental location, or delivery characteristics between the two groups. Conclusion We could not determine the predictive features for massive hemorrhage based on clinical features, delivery features, or placental location.

Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Hyaluronidase in Preventing Perineal Trauma in Nulliparous Women

Caracterización de la enfermedad hipertensiva gestacional en pacientes de la Policlínica Máximo Gómez Báez / Gestational Hypertensive Disease Characterization in Patients of Máximo Gómez Báez Polyclinic

Introducción: los estados hipertensivos del embarazo son una de las complicaciones con mayor repercusión en la salud materna. Objetivo: caracterizar el comportamiento de la enfermedad hipertensiva gestacional en pacientes de la Policlínica Máximo Gómez Báez en Holguín durante el año 2009. Métodos: se realizó un estudio de serie de casos sobre el comportamiento de la enfermedad hipertensiva gestacional. El universo estuvo constituido por 35 gestantes que presentaron la enfermedad en el año objeto de estudio y la muestra por 28 embarazadas que recibieron atención prenatal en el área de salud referida. La información se obtuvo mediante la revisión de los registros estadísticos del Programa Materno Infantil y las historias clínicas obstétricas. Se interrogó además a las pacientes sobre los factores de riesgo asociados con la enfermedad hipertensiva del embarazo. Resultados: predominaron las edades de las gestantes de más de 36 años en un 46,42% y factores maternos asociados como: antecedentes patológicos personales de hipertensión arterial crónica en el 39,28% de los casos y la nuliparidad en el 42,85%. La enfermedad apareció con el 60,71% en el tercer trimestre de la gestación. El nivel de conocimiento de las gestantes estudiadas sobre la enfermedad se evaluó de regular en el 53,57% de las pacientes. Conclusiones: la enfermedad hipertensiva gestacional apareció con mayor frecuencia en el tercer trimestre del embarazo y en mujeres mayores de 36 años, donde la hipertensión arterial crónica y la nuliparidad constituyeron factores asociados con esta enfermedad.

Introduction: the pregnancy hypertensive states are complications of more repercussion in the maternal health. Objective: to characterize the behavior of gestational hypertensive disease in patients of Maximo Gomez Baez Polyclinic in Holguin. Methods: a case series study on the gestational hypertensive disease behavior it carried out. The universe comprised 35 pregnant women with the disease and the sample 28 of them, who received prenatal care in their health area. The statistical registrations of the Maternal Program and the obstetric clinical histories proportioned the necessary information. The patients were interviewed on the risk factors associated with gestational hypertensive disease. Results: pregnant women over 36 years prevailed (46. 42%) and associated maternal factors such as medical history of chronic hypertension in 39.28% of cases and nulliparity in 42.85 % of them. The illness appeared in the third trimester of the gestation in 60.71% of women. The women´s level of knowledge on the disease was medium in 53.57% of them. Conclusions: gestational hypertensive disease frequently appeared in the third trimester of pregnancy and in women over 36 years, where chronic hypertension and nulliparity.constituted factors associated with this disease.

Cesariana primária em nulíparas: fatores de risco em hospital público universitário / Primary cesarean delivery in nulliparous women: risk factors at a public university hospital

Objetivo: Identificar fatores determinantes para risco de cesariana primária em nulíparas. Métodos: Estudo de coorte prospectivo desenvolvido em hospital público universitário. Foram incluídas todas primíparas atendidas na emergência obstétrica de dezembro/2006 a junho/2007. Informações sociodemográficas e doenças prévias foram obtidas na admissão; o desfecho principal foi a via de parto. Para análise estatística utilizou-se o modelo de regressão de Poisson e as variáveis com significância de associação ≤ 0,2 entraram no modelo múltiplo. Resultados: As variáveis determinantes da cesariana primária entre nulíparas foram: apresentação fetal não cefálica (RR=2,8; IC95 %=1,9 ­ 4,2); emergências obstétricas (RR=2,4; IC95 %=1,7 ­ 3,2); macrossomia fetal presumida (RR=1,9; IC95%=1,2 ­ 3,2); doenças fetais (RR=1,6; IC95%=1,2 ­ 2,2); idade gestacional igual ou maior de 40 semanas (RR=1,5; IC95%=1,1 ­ 2,0); distúrbios hipertensivos (RR=1,33; IC95%=1,01 ­ 1,76) e idade materna (RR=1,05; IC95%=1,03 - 1,07). Conclusões: Os resultados indicaram que os principais fatores determinantes para cesariana primária são condições potencialmente modificáveis. A apresentação fetal não-cefálica pode ser alterada com utilização mais frequente da versão cefálica externa; a idade gestacional ≥ 40 semanas, com datação criteriosa da gestação e protocolos previamente definidos para indução do parto; a macrossomia fetal presumida, com treinamento em avaliação clínica e/ou ecográfica do peso fetal no termo (AU)

Aim: To identify the factors associated with the increased incidence of primary cesarean delivery among nulliparous women. MethodS: Prospective cohort study at a public university hospital in Porto Alegre, Brazil. All primiparous women who gave birth at Hospital de Clínicas de Porto Alegre between December 2006 and June 2007 were eligible. Sociodemographic and clinical data were obtained on admission. The primary endpoint was mode of delivery. Results: a Poisson regression analysis showed that the determinants for primary cesarean section in this population of nulliparous women were: non-cephalic presentation (RR=2.8; 95%CI=1.9- 4.2); obstetric emergencies (RR=2.4;95%CI=1.7 ¬­ 3.2); suspected macrosomia (RR=1.9; 95%CI=1.2 ­ 3.2); fetal disease (RR=1.6; 95%CI=1.2 ­ 2.2); gestational age ≥40 weeks (RR 1.5; 95%CI=1.1 ­ 2.0); hypertensive disorders (RR=1.33; 95%CI=1.01 ­ 1.76) and maternal age (RR=1.05; 95%CI=1.03 ­1.07). Conclusions: this study shows that the main factors behind the incidence of cesarean sections in nulliparous women can be solved without a cesarean. The noncephalic presentation can be changed with external cephalic version; gestational age ≥ 40 weeks can be avoided with careful timing of pregnancy and pre-defined protocols for labor induction; and assumed fetal macrosomia can be minimized with training in clinical and/or sonographic fetal weight assessment (AU)

Factores de riesgo de la preeclampsia severa en gestantes del Hospital Nacional Almanzor Aguinaga Asenjo, de 2006 a abril de 2010 / Risk factors severe preeclampsia in pregnant women in Almanzor Aguinaga Asenjo National Hospital, 2006 to April 2010

Introducción. La preeclampsia es la primera causa de mortalidad materna en hospitales Essalud y la segunda causa de la misma en el Perú. Es un síndrome que se presenta habitualmente alrededor o después de la semana 20 de gestación. La preeclampsia severa se define por una presión sistólica mayor o igual de 160 mmHg y/o diastólica mayor o igual de 110 mmHg; presencia de proteinuria superior o igual a 5 g en orina de 24 horas; o mayor o igual a 3+ en tira reactiva. Los principales síntomas fueron cefalea, alteraciones visuales y dolor en la parte alta del abdomen. Objetivo principal. Determinar los factores de riesgo de la preeclampsia severa en gestantes del Hospital Nacional Almanzor Aguinaga Asenjo en el periodo de enero de 2006 a abril de 2010. Material y Método. Retrospectivo, de casos y controles (un control por caso), con una muestra de 200 gestantes seleccionadas aleatoriamente. Se empleó una ficha de recolección de datos con variables relacionadas a los factores de riesgo de la preeclampsia severa. Resultados. De los factores de riesgo considerados resultaron significativos a nivel 0,05 las edades menores a 18 años y mayores a 35 años (OR: 2,278, IC: 95% 1,178­4,405), el sobrepeso (OR: 4,681, IC: 95% 2,572-8,519), la obesidad (OR: 3,580, IC: 95% 1,294-9,906) y la nuliparidad (OR:2,583, IC:95% 1,291-5,171)(AU)

Introduction. Preeclampsia is the first cause of maternal mortality in Essalud hospitals and the second cause of maternal mortality in Perú. This syndrome appears around or after 20 weeks of gestation. Severe preeclampsia defines by 160 mmHg or greater systolic pressure and 110 mmHg or greater diastolic pressure; presence of proteinuria superior or equal to 5 g in tinkles of 24 hours; or greater or equal to 3+ in reactive strip, main symptoms of severe preeclampsia are headache, visual disturbances, and pain in the upper abdomen. Principal objective. To determinate the risk factors of severe preeclampsia in pregnant of the Almanzor Aguinaga Asenjo in period January 2006 to April 2010. Material and Methods. Restrospective, Cases and Controls (one case by control) with a sample of 200 pregnant women randomly selected. We used a data collection sheet with variables related to risk factors for severe preeclampsia. Results.The factors of risk that results significant are ages lower than 18 and greater than 35(ORA:2,278, IC: 95% 1,178­4,405), overweigth (ORA:4,681, IC: 95% 2,572­8,519), obesity (ORA:3,580, IC: 95% 1,294­9,906) and nulliparity (ORA:2,583, IC:95% 1,291-5,17,1).(AU)

Serum selenium level and other risk factors for breast cancer among patients in a Malaysian hospital

<p><b>OBJECTIVE</b>The aim of this study is to investigate the association between breast cancer and serum selenium level as well as other risk factors for breast cancer.</p><p><b>METHODS</b>A matched case-control study was conducted in a hospital in Malaysia from July 2000 to January 2001 and from May 2001 to June 2001. Sixty-two newly diagnosed breast cancer patients were selected as the cases. Each control, selected from the same hospital population was matched to each case according to age, ethnic group, and menopausal status.</p><p><b>RESULTS</b>The mean selenium concentration among the cases was significantly lower than that among the control. There was a significant association (p<0.05) between breast cancer and low selenium serum level, nulliparity (OR=5.5,95% CI=1.22 to 24.81), exposure to cigarette smoke (OR=2.2, 95% CI=1.04 to 4.65) and use of oral contraceptives (OR=3.0, 95% CI=1.09 to 8.25) as determined by the McNemar test. Multivariate analysis showed that nulliparity (OR=10.08, 95% CI=1.48 to 68.52) and use of oral contraceptives (OR=3.66, 95% CI=1.36 to 9.87) were associated with increased breast cancer risk. An increased selenium concentration contributes to a reduced risk of breast cancer (OR=0.89, 95% CI=0.84 to 0.94).</p><p><b>CONCLUSION</b>The results suggest that use of oral contraceptive pills, being nulliparous, and a low serum selenium level are associated with breast cancer.</p>

Serum Selenium Level and Other Risk Factors for Breast Cancer among Patients in a Malaysian Hospital

Objective: The aim of this study is to investigate the association between breast cancer and serum selenium level as well as other risk factors for breast cancer. Methods: A matched case-control study was conducted in a hospital in Malaysia from July 2000 to January 2001 and from May 2001 to June 2001. Sixty-two newly diagnosed breast cancer patients were selected as the cases. Each control, selected from the same hospital population was matched to each case according to age, ethnic group, and menopausal status. Results: The mean selenium concentration among the cases was significantly lower than that among the control. There was a significant association (p<0.05) between breast cancer and low selenium serum level, nulliparity (OR=5.5, 95% CI=1.22 to 24.81), exposure to cigarette smoke (OR=2.2, 95% CI=1.04 to 4.65) and use of oral contraceptives (OR=3.0, 95% CI=1.09 to 8.25) as determined by the McNemar test. Multivariate analysis showed that nulliparity (OR=10.08, 95% CI=1.48 to 68.52) and use of oral contraceptives (OR=3.66, 95% CI=1.36 to 9.87) were associated with increased breast cancer risk. An increased selenium concentration contributes to a reduced risk of breast cancer (OR=0.89, 95% CI=0.84 to 0.94). Conclusion: The results suggest that use of oral contraceptive pills, being nulliparous, and a low serum selenium level are associated with breast cancer.