Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial.

Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed.

Detection of the most influential variables for preventing postpartum urinary incontinence using machine learning techniques.

Background: Postpartum urinary incontinence is a fairly widespread health problem in today's society among women who have given birth. Recent studies analysing the different variables that may be related to Postpartum urinary incontinence have brought to light some variables that may be related to Postpartum urinary incontinence in order to try to prevent it. However, no studies have been found that analyse some of the intrinsic and extrinsic variables of patients during pregnancy that could give rise to this pathology. Objective: The objective of this study is to assess the most influential variables in Postpartum urinary incontinence by means of machine learning techniques, starting from a group of intrinsic variables, another group of extrinsic variables and a mixed group that combines both types. Methods: Information was collected on 93 patients, pregnant women who gave birth. Experiments were conducted using different machine learning classification techniques combined with oversampling techniques to predict four variables: urinary incontinence, urinary incontinence frequency, urinary incontinence intensity and stress urinary incontinence. Results: The results showed that the most accurate predictive models were those trained with extrinsic variables, obtaining accuracy values of 70% for urinary incontinence, 77% for urinary incontinence frequency, 71% for urinary incontinence intensity and 93% for stress urinary incontinence. Conclusions: This research has shown that extrinsic variables are more important than intrinsic variables in predicting problems related to postpartum urinary incontinence. Therefore, although not conclusive, it opens a line of research that could confirm that the prevention of Postpartum urinary incontinence could be achieved by following healthy habits in pregnant women.

Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial.

Perineal massage increases elasticity of myofascial perineal tissue and decreases the burning and perineal pain during labour, thus optimising child birth, although an application protocol has not been standardised yet. The objective of this study is to determine the efficiency of massage in perineal tear prevention and identification of possible differences in massage application. Total of 90 pregnant participants were divided into three groups: perineal massage and EPI-NO® device group, applied by an expert physiotherapist, self-massage group, where women were instructed to apply perineal massage in domestic household, and a control group, which received ordinary obstetric attention. Results: The results showed significant differences among the control group and the two perineal massage groups in perineal postpartum pain. Correlations in perineal postpartum pain, labour duration and the baby's weight were not statistically significant. Lithotomy posture was significantly less prevalent in the massage group than in the other two; this variable is known to have a direct effect on episiotomy incidence and could act as a causal covariate of the different incidence of episiotomy in the groups. Perineal massage reduces postpartum perineal pain, prevalence and severity of perineal tear during delivery.

Hábitos bucales deformantes y maloclusiones dentarias en niños de 5-11 años. Matanzas, 2006 / Deforming buccal habits and dental malocclusions in children aged 5-11 years

Introducción: los hábitos bucales pueden alterar el normal desarrollo del sistema estomatognático, provocar un desequilibrio entre las fuerzas musculares y provocar la aparición de una deformación. Estos hábitos modifican la posición de los dientes, la relación y la forma que guardan las arcadas dentarias entre sí, interfiriendo en el crecimiento normal y en la función de la musculatura bucofacial. El propósito de este trabajo es identificar los niños afectados por prácticas de hábitos no nutritivos y su relación con la presencia de maloclusiones dentarias. Método: se realizó un estudio descriptivo y transversal en niños de 6 a 11 años, pertenecientes a las escuelas primarias del área de salud Policlínico de Milanés, en la ciudad de Matanzas. El universo estuvo integrado por 2 300 niños de los cuales fue seleccionada una muestra de tipo no aleatoria estratificada según edades, constituida por 506 escolares de ambos sexos matriculados en las escuelas primarias José A Echeverría y Manuel Ascunce, curso 2005-2006, que reciben atención en la Clínica Estomatológica Docente III Congreso del PCC. Se identificaron los hábitos: respiración bucal, succión digital y deglución atípica, y fue determinada su relación con las maloclusiones dentarias. Resultados: el 58,7 % de niños fue identificado con hábitos bucales deformantes. La mayor prevalencia detectada estuvo en la deglución atípica (25,3 %), seguidos por la respiración bucal (19,4 %) y la succión digital (14,0 %). Las maloclusiones de Clase II división 1 predominaron en los identificados con hábitos, cuyos valores fueron: 34,7 %, 39,4 % y 32 % en los que presentaron respiración bucal, succión digital y deglución atípica, en ese orden. Hubo una disminución progresiva de los hábitos a medida que se incrementaron las edades. Conclusiones: la mayoría de los niños identificados con hábitos bucales deformantes, estuvieron relacionados con la presencia de maloclusiones dentarias. En ellos, las anomalías se incrementaron conjuntamente con la edad. Prevalecieron las maloclusiones de Clase II división 1, por sobre las restantes entidades clínicas estudiadas, hecho que alerta sobre la necesidad de interceptar estas prácticas nocivas en edades tempranas y exigir el cumplimiento de los programas de prevención e intercepción de anomalías dentofaciales en el nivel primario de atención.

Introduction: buccal habits may alter the stomatognathic system normal development; provoke disequilibrium among the muscular forces and cause deformation. These habits modify teeth position, the relation and form the dental arches keep between them, interfering in the normal grow and function of the buccal-facial muscles. The purpose of this term is identifying children affected by non-nutritive habits practices and their relation with dental malocclusion presence. Method: we carried out a cross sectional descriptive research in children aged 5-11 years, assisting to primary schools located in the health area of the Milanes policlinic, in Matanzas. The universe was formed by 2 300 children from which we selected an age-stratified, non-randomized sample of 506 male and female students assisting to Jose A. Echeverría and Manuel Ascunce Domenech primary schools, 2005-2006 school years, treated at the Teaching Stomatologic Clinic “III Congreso del PCC”. We identified the following habits: buccal breathing, digital suction and atypical swallowing, and we determined their relation with dental malocclusions. Results: 58,7 % of the children practiced deforming buccal habits. Atypical swallowing showed the highest prevalence (25,3 %), followed by buccal breathing (19, 4 %) and digital suction (14,0 %). Class II, division 1 malocclusions predominated in the children identified with deforming habits, and their values were: 34,7 %. 39,4 % and 32 % in those practicing buccal breathing, digital suction and atypical swallowing, in that order. There it was a progressive habit decrease proportional to age increase. Conclusions: most of the children identified with buccal deforming habits were related with the presence of dental malocclusions. In them, the anomalies increased with age. Class II, division 1 malocclusions prevailed over the rest of the studied clinical entities. This fact warns us about the necessity of preventing these harmful practices in early ages, and demanding the fulfillment of the dental-facial anomalies prevention and interception program at the primary health care level.

Hábitos bucales deformantes y maloclusiones dentarias en niños de 5-11 años, Matanzas, 2006 / Deforming buccal habits and dental malocclusions in children aged 5-11 years

Introducción: los hábitos bucales pueden alterar el normal desarrollo del sistema estomatognático, provocar un desequilibrio entre las fuerzas musculares y provocar la aparición de una deformación. Estos hábitos modifican la posición de los dientes, la relación y la forma que guardan las arcadas dentarias entre sí, interfiriendo en el crecimiento normal y en la función de la musculatura bucofacial. El propósito de este trabajo es identificar los niños afectados por prácticas de hábitos no nutritivos y su relación con la presencia de maloclusiones dentarias.Método: se realizó un estudio descriptivo y transversal en niños de 6 a 11 años, pertenecientes a las escuelas primarias del área de salud Policlínico de Milanés, en la ciudad de Matanzas. El universo estuvo integrado por 2 300 niños de los cuales fue seleccionada una muestra de tipo no aleatoria estratificada según edades, constituida por 506 escolares de ambos sexos matriculados en las escuelas primarias José A Echeverría y Manuel Ascunce, curso 2005-2006, que reciben atención en la Clínica Estomatológica Docente III Congreso del PCC. Se identificaron los hábitos: respiración bucal, succión digital y deglución atípica, y fue determinada su relación con las maloclusiones dentarias.Resultados: el 58,7 por ciento de niños fue identificado con hábitos bucales deformantes. La mayor prevalencia detectada estuvo en la deglución atípica (25,3 por ciento), seguidos por la respiración bucal (19,4 por ciento) y la succión digital (14,0 por ciento). Las maloclusiones de Clase II división 1 predominaron en los identificados con hábitos, cuyos valores fueron: 34,7 por ciento, 39,4 por ciento y 32 por ciento en los que presentaron respiración bucal, succión digital y deglución atípica, en ese orden. Hubo una disminución progresiva de los hábitos a medida que se incrementaron las edades...(AU)

Introduction: buccal habits may alter the stomatognathic system normal development; provoke disequilibrium among the muscular forces and cause deformation. These habits modify teeth position, the relation and form the dental arches keep between them, interfering in the normal grow and function of the buccal-facial muscles. The purpose of this term is identifying children affected by non-nutritive habits practices and their relation with dental malocclusion presence. Method: we carried out a cross sectional descriptive research in children aged 5-11 years, assisting to primary schools located in the health area of the Milanes policlinic, in Matanzas. The universe was formed by 2 300 children from which we selected an age-stratified, non-randomized sample of 506 male and female students assisting to Jose A. Echeverría and Manuel Ascunce Domenech primary schools, 2005-2006 school years, treated at the Teaching Stomatologic Clinic III Congreso del PCC. We identified the following habits: buccal breathing, digital suction and atypical swallowing, and we determined their relation with dental malocclusions.Results: 58,7 per cent of the children practiced deforming buccal habits. Atypical swallowing showed the highest prevalence (25,3 per cent), followed by buccal breathing (19, 4 per cent) and digital suction (14,0 per cent). Class II, division 1 malocclusions predominated in the children identified with deforming habits, and their values were: 34,7 per cent. 39,4 per cent and 32 per cent in those practicing buccal breathing, digital suction and atypical swallowing, in that order. There it was a progressive habit decrease proportional to age increase...(AU)

Dentin matrix protein 1 induces membrane expression of VE-cadherin on endothelial cells and inhibits VEGF-induced angiogenesis by blocking VEGFR-2 phosphorylation.

Dentin matrix protein 1 (DMP1) is a member of the small integrin-binding ligand N-linked glycoprotein (SIBLING) family, a group of proteins initially described as mineralized extracellular matrices components. More recently, SIBLINGs have been implicated in several key steps of cancer progression, including angiogenesis. Although proangiogenic activities have been demonstrated for 2 SIBLINGs, the role of DMP1 in angiogenesis has not yet been addressed. We demonstrate that this extracellular matrix protein induced the expression of vascular endothelial cadherin (VE-cadherin), a key regulator of intercellular junctions and contact inhibition of growth of endothelial cells that is also known to modulate vascular endothelial growth factor receptor 2 (VEGFR-2) activity, the major high-affinity receptor for VEGF. DMP1 induced VE-cadherin and p27(Kip1) expression followed by cell-cycle arrest in human umbilical vein endothelial cells (HUVECs) in a CD44-dependent manner. VEGF-induced proliferation, migration, and tubulogenesis responses were specifically blocked on DMP1 pretreatment of HUVECs. Indeed, after VE-cadherin induction, DMP1 inhibited VEGFR-2 phosphorylation and Src-mediated signaling. However, DMP1 did not interfere with basic fibroblast growth factor-induced angiogenesis. In vivo, DMP1 significantly reduced laser-induced choroidal neovascularization lesions and tumor-associated angiogenesis. These data enable us to put DMP1 on the angiogenic chessboard for the first time and to identify this protein as a new specific inhibitor of VEGF-induced angiogenesis.

Tumoral and choroidal vascularization: differential cellular mechanisms involving plasminogen activator inhibitor type I.

An adequate balance between serine proteases and their plasminogen activator inhibitor-1 (PAI-1) is critical for pathological angiogenesis. PAI-1 deficiency in mice is associated with impaired choroidal neovascularization (CNV) and tumoral angiogenesis. In the present work, we demonstrate unexpected differences in the contribution of bone marrow (BM)-derived cells in these two processes regulated by PAI-1. PAI-1(-/-) mice grafted with BM-derived from wild-type mice were able to support laser-induced CNV formation but not skin carcinoma vascularization. Engraftment of irradiated wild-type mice with PAI-1(-/-) BM prevented CNV formation, demonstrating the crucial role of PAI-1 delivered by BM-derived cells. In contrast, the transient infiltration of tumor transplants by local PAI-1-producing host cells rather than by BM cells was sufficient to rescue tumor growth and angiogenesis in PAI-1-deficient mice. These data identify PAI-1 as a molecular determinant of a local permissive soil for tumor angiogenesis. Altogether, the present study demonstrates that different cellular mechanisms contribute to PAI-1-regulated tumoral and CNV. PAI-1 contributes to BM-dependent choroidal vascularization and to BM-independent tumor growth and angiogenesis.

[Right Bochdalek hernia and liver situs solitus in an adult. A clinical case]. / Hernia de Bochdalek derecha del adulto con situs solitus de hígado. Presentación de un caso.

The Bochdaleck's hernia is an anatomical defect of posterolateral region of the diaphragm that lets abdominal structures go inside the thorax. It has an incidence of 1 in 2000 to 5000 of newborn alive, without difference of sex. This defect is very common in the neonatal period and rare in adult age. We present a case of a male patient 32 years old, with the definitive diagnosis of Bochdalek hernia. The diagnosis was made by radiographic findings, with a few digestive symptoms. Confirmatory diagnosis was made by axial tomography computerized that found part of bowel in right hemithorax and pulmonary hypoplasy, with liver in situs solitus. The patient received medical treated only. The patient did not receive surgical treatment because it is supposed that this kind of treatment has more risks than benefits.

Tamizaje de cáncer cervicouterino en trabajadoras de la salud: un análisis comparativo con derechohabientes / Cervical cancer screening test in health workers and insured women in a healath instution: a comparative analysis

Objetivo. Describir la proporción de práctica de tamizaje para CaCu y características epidemiológicas en trabajadoras de la salud a fin de comparar estas variables con las mostradas por derechohabientes de una institución de salud. Material y método. Estudio transversal analítico que describe los resultados de una encuesta aplicada a derechohabientes y trabajadoras de un hospital (96 por grupo) seleccionadas en forma aleatoria. Análisis estadístico. X2 con corrección de Yates. Resultados. Las características de derechohabientes y trabajadoras, respectvamente, fueron: edad 35 ñ 10 vs. 41 ñ 5 años (p < 0.001), escolaridad: 8.3 ñ 5 vs. 12.0 ñ 1 años (p < 0.001), número de pruebas de tamizaje realizadas en los últimos dos años: 1.2 ñ 0.4 vs. 1.0 ñ 0.1 (p < 0.001), tiempo transcurrido del último examen: 13.6 ñ 15 vs. 12.2 ñ 13 meses (p= 0.52), apego adecuado a la realización del tamizaje según se indicó por un médico 55 (57 por ciento) vs. 72 (75 por ciento), (p < 0.001). Las derechohabientes y trabajadoras que no se realizaron el tamizaje fue por indolencia 13 (14 por ciento) vs. 13 (14 por ciento) y falta de tiempo 7 (7 por ciento) vs. 2 (2 por ciento) respectivamente. Conclusiones. Las trabajadoras se realizan el tamizaje para CaCu en mayor proporción que las derechohabientes. Los motivos para no someterse al tamizaje son similares entre ambos grupos.