Follow-Up Study of 17-ß Estradiol, Prolactin and Progesterone with the Kinetics and Prevalence of T. gondii Infection in Pregnant Women.

Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. One-third of the world's population has come into contact with this parasite. In Mexico, the prevalence is between 15% and 50% in the general population and 34.9% in women with high-risk pregnancies. In pregnancy, the highest incidence of infection occurs in the third trimester and fetal damage is inversely proportional to gestational age. Maternal hormones play a fundamental role in the immune response. There are very few studies, with controversial results, on the levels of increased hormones and their relationship to the kinetics of T. gondii infections during pregnancy. The aim was to determine the serum levels of 17-ß estradiol, prolactin, and progesterone, and their association with anti-T. gondii antibodies' kinetics in pregnancy. Fifty-two pregnant patients were studied. A questionnaire with sociodemographic and clinical aspects was used. Afterward, 10 mL of venous blood was collected by venipuncture every trimester. The concentrations of 17-ß estradiol, progesterone, and prolactin were measured, using the ELISA method. In addition, anti-Toxoplasma IgG and IgM antibodies were also determined in the first, second, and third trimester. The prevalence of anti-Toxoplasma IgG antibodies was 26.92% in the first and second trimester and 32.7% in the third trimester. In seropositive women, 17-ß estradiol increased in the second and third trimesters of pregnancy. Progesterone increased significantly p < 0.039 in the third trimester in these women, while prolactin increased in the second trimester with a statistical significance of p < 0.021. In addition, 17-ß estradiol, progesterone, and prolactin are associated with T. gondii infection during pregnancy. New studies are necessary to clarify the specific mechanisms of immune response related to these hormones during pregnancy.

Obstetric pulmonary embolism and long-term cardiovascular symptoms: a cross-sectional study in Western Mexico.

OBJECTIVES: Pulmonary embolism (PE) is an important cause of maternal mortality. There are several guidelines for its diagnosis and management, but there is little information regarding follow-up and frequency of long-term complications. The aim of the study was to determine the frequency of long-term cardiovascular symptoms in patients who had obstetric PE. METHODS: Cross-sectional study including patients who had PE during pregnancy or the puerperium. A telephone interview was conducted at least one year after PE, to determine the frequency of cardiovascular symptoms, general health, and COVID-19 infection, considering the study was conducted during the 2020 pandemic. RESULTS: In five years (2015-2019) there were eleven patients with PE, two died during the acute phase, and the rest (nine) were alive and able to answer our interview. Cardiovascular symptoms were common (6, 67 %), the most frequent were fatigue, edema, and mild dyspnea. Four patients (44 %) had slight limitation of physical activity and one (11 %) had PE recurrence. Of the six symptomatic patients four had obesity and one was overweight. CONCLUSIONS: There is a high frequency of long-term cardiovascular symptoms in patients who had PE during pregnancy or the puerperium. Stronger evidence is needed to design a long-term care pathway after obstetric PE.

Factores relacionados con la histerectomía ginecológica por patología benigna en un hospital escuela del occidente de México / Factors related to gynecological hysterectomy for benign pathology in a teaching hospital in western Mexico

Resumen OBJETIVO: Determinar las características clínicas y los desenlaces asociados con las diferentes vías de acceso elegidas para la histerectomía. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo y transversal consistente en el análisis de la información asentada en los expedientes de pacientes atendidas en el servicio de Ginecología del Hospital Civil de Guadalajara entre el 1 de marzo del 2019 y el 28 de febrero del 2020. En todas las pacientes se estableció la asociación entre la vía de acceso y las complicaciones. RESULTADOS: Se revisaron 790 expedientes de los que 413 reunieron los criterios de inclusión. Se practicaron 262 histerectomías abdominales, 107 por vía vaginal y 44 mediante laparoscopia. La frecuencia de complicaciones fue de 9.2%, el 54% se registró durante el procedimiento quirúrgico. La frecuencia de conversión fue de un caso para histerectomía vaginal (0.9%) y de otro para la laparoscópica (2.2%). La complicación más frecuente fue el sangrado transquirúrgico seguida del reingreso por infección del sitio quirúrgico. La cirugía vaginal fue la que menos complicaciones porcentuales registró; sin embargo, la lesión vesical fue la más común y la única en la que sucedió una defunción, secundaria a choque hipovolémico. La asociación entre la vía de acceso abdominal y las complicaciones muestra que las pacientes con histerectomía abdominal tuvieron tres veces más probabilidades de alguna complicación en comparación con el resto de los grupos. CONCLUSIONES: El riesgo de complicaciones es mayor en la histerectomía abdominal, sobre todo en pacientes con peso uterino ≥ 500 g e IMC ≥ 30. Es necesario reforzar las competencias para incrementar la frecuencia de la histerectomía vaginal. Cada vez es más necesario estar a la vanguardia en la aplicación de técnicas de mínima invasión por su ventaja de menor frecuencia de complicaciones.

Abstract OBJECTIVE: To determine the clinical characteristics and outcomes associated with the different access routes chosen for hysterectomy. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study consisting of the analysis of the information recorded in the records of patients attended in the Gynecology service of the Civil Hospital of Guadalajara between March 1, 2019 and February 28, 2020. The association between the access route and complications was established in all patients. RESULTS: 790 files were reviewed of which 413 met the inclusion criteria. A total of 262 abdominal hysterectomies were performed, 107 vaginally and 44 laparoscopically. The frequency of complications was 9.2%, 54% of which occurred during the surgical procedure. The frequency of conversion was one case for vaginal hysterectomy (0.9%) and another for laparoscopic hysterectomy (2.2%). The most frequent complication was trans-surgical bleeding followed by readmission for surgical site infection. Vaginal surgery had the lowest percentage of complications; however, bladder injury was the most common and the only one in which a death occurred, secondary to hypovolemic shock. The association between abdominal access route and complications shows that patients with abdominal hysterectomy were three times more likely to have some complication compared to the rest of the groups. CONCLUSIONS: The risk of complications is higher in abdominal hysterectomy, especially in patients with uterine weight ≥ 500 g and BMI ≥ 30. Skills need to be strengthened to increase the frequency of vaginal hysterectomy. It is increasingly necessary to be at the forefront in the application of minimally invasive techniques because of their advantage of lower frequency of complications.

Procedimiento clínico-quirúrgico en una paciente embarazada con una derivación urológica compleja. Reporte de un caso / Clinical-surgical approach in a pregnant patient with complex urological diversion. A case report

Resumen ANTECEDENTES: El mielomeningocele es el defecto del tubo neural más frecuente; se registra un caso por cada 1000 nacidos vivos. Es más frecuente en mujeres, que resultan con secuelas discapacitantes, entre ellas las urológicas. Pueden subsanarse con diferentes técnicas quirúrgicas y derivaciones urológicas complejas que las predispone a infecciones de vías urinarias de repetición y, cuando hay embarazo, complicaciones materno-fetales y dificultad para el acceso quirúrgico, en caso de cesárea. CASO CLÍNICO: Paciente con 14 semanas de embarazo, 27 años de edad, con diagnóstico de mielomeningocele y vesicoplastia, con múltiples infecciones urinarias y ruptura de membranas pretérmino. Finalización del embarazo por cesárea a las 33 semanas, por indicación de las condiciones fetales. La técnica de la cesárea se modificó para no dañar la cistoplastia y evitar complicaciones con las adherencias en la pelvis. CONCLUSIONES: El mejor pronóstico materno-fetal en pacientes con derivación urológica compleja se consigue con la búsqueda intencionada de infecciones urinarias y tratamiento oportuno y adecuado, además de una planificación multidisciplinaria al momento de la finalización del embarazo.

Abstract BACKGROUND: Myelomeningocele is the most common neural tube defect; one case per 1000 live births is reported. It is more frequent in females, resulting in disabling sequelae, including urological sequelae. They can be corrected with different surgical techniques and complex urological derivations that predispose them to repeated urinary tract infections and, when there is pregnancy, maternal-fetal complications and difficulty for surgical access, in case of cesarean section. CLINICAL CASE: Patient 14 weeks pregnant, 27 years old, diagnosed with myelomeningocele and vesicoplasty, with multiple urinary tract infections and preterm rupture of membranes. Termination of pregnancy by cesarean section at 33 weeks, due to fetal conditions. The cesarean section technique was modified so as not to damage the cystoplasty and to avoid complications with adhesions in the pelvis. CONCLUSIONS: The best maternal-fetal prognosis in patients with complex urologic diversion is achieved with the intentional search for urinary tract infections and timely and adequate treatment, in addition to multidisciplinary planning at the time of termination of pregnancy.

Birth weight percentiles in Western-Mexico.

Not available.

Effect of supplementation with 5,000 IU of vitamin D on the glycemic profile of women with gestational diabetes mellitus.

OBJECTIVES: The frequency of GDM and vitamin D insufficiency in Mexico is high. Vitamin D supplementation in GDM patients has shown favorable but non-homogeneous results regarding improvement of glycemic profile. The aim of the study was to assess the effects of supplementing with 5,000 IU of vitamin D on the glycemic profile of women with GDM. METHODS: A randomized clinical trial was conducted on women with GDM who received 5,000 IU of vitamin D (n=27) or a placebo (n=27) for eight weeks. Changes in vitamin D levels and metabolic parameters before and after the intervention were analyzed. RESULTS: Vitamin D vs. placebo: 25-OHD (32 vs. 26 ng/mL, p=0.006), HbA1c (6.0 vs. 6.1%, p=0.29), glucose (99 vs. 87 mg/dL, p=0.29), insulin (14 vs. 13 µIU/mL, p=0.79), HOMA-IR (3.6 vs. 2.6, p=0.55), QUICKI (0.31 vs. 0.33, p=0.55). CONCLUSIONS: Supplementation with 5,000 IU of vitamin D for eight weeks had no significant effect on the glycemic profile.

SARS-CoV-2 infection among Mexican healthcare workers.

Dear editor: Healthcare workers (HCW) have been the first-line defense against pandemic SARS-CoV-2 infection, for this reason, they are highly exposed and possibly have the greatest risk of contagion...

Indicaciones del factor VII recombinante activado en hemorragia obstétrica grave / Use of recombinant activated Factor VII in severe obstetric hemorrhage

Resumen OBJETIVO: Describir la situación final de salud de las pacientes con hemorragia obstétrica grave (≥ 1000 mL) en quienes se indicó factor VII recombinante activado como parte del tratamiento e identificar las complicaciones atribuibles a este medicamento. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo efectuado en pacientes con hemorragia obstétrica grave atendidas en el Hospital Civil de Guadalajara Dr. Juan I Menchaca entre 2001 y 2017 y tratadas con factor VII recombinante activado. Se identificaron los antecedentes de importancia y se calculó la dosis promedio y cantidad de dosis de factor VII recombinante activado; se valoró la respuesta hemostática y se determinó si la diferencia en cantidad de sangrado, administración de hemoderivados y parámetros hematológicos antes y después de utilizar factor VII recombinante activado fue significativa. RESULTADOS: Se identificaron 10 pacientes en quienes se aplicó factor VII recombinante activado. La causa de hemorragia obstétrica grave fue atonía uterina en seis casos. La dosis promedio de factor VII recombinante activado fue de 91 mcg/kg. En 8 pacientes se administró una dosis y 2 dosis en 2 pacientes. En todas las pacientes se logró la hemostasia; el sangrado disminuyó significativamente posterior a la administración del factor VII recombinante activado (5075 vs 928 mL; p = 0.000) lo mismo que la cantidad de concentrados eritrocitarios trasfundidos (7 vs 3; p = 0.006). Una paciente no requirió histerectomía, otra tuvo tromboembolia pulmonar, que se trató sin problemas y ninguna paciente falleció. CONCLUSIÓN: El factor VII recombinante activado como hemostático en hemorragia obstétrica grave mostró resultados favorables y evitó la histerectomía en una paciente. Requiere vigilancia estrecha de las complicaciones trombóticas.

Abstract OBJECTIVE: To describe outcome of patients with severe obstetric hemorrhage (≥ 1000 mL) treated with rFVIIa as part of the management and to detect complications related to its use. MATERIALS AND METHODS: Retrospective, cross-sectional and descriptive study carried out in patients with severe obstetric hemorrhage treated at the Hospital Civil de Guadalajara Dr. Juan I Menchaca between 2001 and 2017 and treated with activated recombinant factor VII. We identified relevant antecedents, average dose and number of doses of rFVIIa, and hemostatic response. We determined if quantity of bleeding, administration of blood products and hematological parameters before and after using rFVIIa was significantly different. RESULTS: We identified ten patients with rFVIIa administration. The cause of severe obstetric hemorrhage was uterine atony in six cases. The average dose of rFVIIa was 91 mcg/kg; one dose was administered in eight patients and two doses in two patients. Hemostasis was achieved in all patients, bleeding decreased significantly after administration of rFVIIa (5075 mL vs 928 mL, p = 0.000) and the number of erythrocyte concentrates required 7vs 3, p = 0.006). One patient did not require a hysterectomy after rFVIIa administration; one patient presented pulmonary thromboembolism and recovered without complications, no patient died. CONCLUSION: rFVIIa administration as a hemostatic in severe obstetric hemorrhage had favorable results, preventing hysterectomy in one patient. Follow-up requires close monitoring of thrombosis.

Concentraciones de 25-hidroxivitamina D en embarazadas con y sin diabetes gestacional / Levels of 25-hydroxyvitamin D in pregnant womens with and without gestational diabetes mellitus

Resumen Objetivo: Comparar las concentraciones de 25-hidroxivitamina D (25[OH]D) en pacientes con y sin diabetes gestacional. Materiales y métodos: Estudio observacional, transversal y analítico consistente en la toma de muestras sanguíneas para determinar y comparar las concentraciones de 25-hidroxivitamina D. El tamaño de la muestra se determinó previamente con base en una prevalencia de 35% para la deficiencia de vitamina D, un error alfa de 0.05 y un error beta de 0.80. Resultados: Se reclutaron 784 embarazadas, 394 con diabetes gestacional y 390 sin este padecimiento. En este último grupo 51% (n = 199) tuvieron concentraciones suficientes, 33% (n = 129) concentraciones insuficientes y 16% (n = 62) concentraciones deficientes. En el grupo de mujeres con diabetes gestacional, 12% (n = 47) tuvieron concentraciones suficientes, 67% (n = 264) concentraciones insuficientes y 21% (n = 83) concentraciones deficientes. Los resultados obtenidos muestran que 88.9% (n = 350) de las mujeres con diabetes gestacional tenían concentraciones inferiores a 30 ng/mL vs 48.5% (n = 189) del grupo sin diabetes gestacional (p < 0.00001; RM: 7.69; IC95%: 5.3-11). Conclusiones: Las concentraciones inferiores a 30 ng/mL de vitamina D total son más frecuentes en pacientes con diabetes gestacional.

Abstract Objective: To compare the levels of vitamin (25[OH]D) between patients with or without gestational diabetes. Materials and methods: Analytical cross-sectional study that consisted in taking blood samples to determine and compare the concentrations of (25[OH]D) vitamin D. The sample size was previously determined considering a prevalence of 35% for vitamin D deficiency, an alpha error of 0.05 and a beta error of 0.80 for which 784 pregnant women were recruited, 394 patients with gestational diabetes and 390 without gestational diabetes. Results: In the group of patients without gestational diabetes, 51% (n = 199) had sufficient levels, 33% (n = 129) insufficient levels and 16% (n = 62) deficient levels. In the group of patients with gestational diabetes, 12% (n = 47) had sufficient levels, 67% (n = 264) insufficient levels and 21% (n = 83) deficient levels. The results obtained show that 88.9% (n = 350) of women with gestational diabetes present with levels lower than 30 ng/mL vs 48.5% (n = 189) of the group without gestational diabetes [p <0.00001 OR 7.69 (IC95%: 5.3 - 11)]. Conclusions: Levels below 30 ng/mL of total vitamin D are more frequent in patients with gestational diabetes.

[Oxytocin, the hormone that everyone uses and that few know]. / Oxitocina, la hormona que todos utilizan y que pocos conocen.

BACKGROUND. Oxytocin is a well known drug most commonly used in obstetrics for induction or augmentation of labor. Due to its essential role in labor, and the overall effect in the body, oxytocin must be deeply understood by all obstetricians who use it and prescribe it. There is relevant data listed about oxytocin and has reviewed the evidence in 31 full text articles of indexed journals between 1999 and 2013. In search engines like MEDLINE, MedicLatina, PUBMED, Wolters Kluwer Healt, with keywords like: oxytocin, oxytocin receptor, oxytocin vasopressin, oxytocin postpartum, oxytocin review, oxytocin labor, oxytocin release. The best evidence from the literature based on the methodology they used is included. The word oxytocin comes from the Greek words omega Chi upsilon xi, tau omicron Chi omicron chi xi, which means "swift birth". It is synthesized in the paraventricular and supraoptic nuclei of the hypotalamus is mainly released from the neurohypophysis and nerve terminals. It travels from the brain to the heart and the whole body, activating or modulating a wide range of functions and emotions. Mainly cause myometrial contractions and myoepithelial cells of the breast for milk ejection. Its adverse effects are dose-related. No one knows exactly the minumum and maximum dose of oxytocin. More research is needed about central and peripheral receptors, coupled with the use to which they currently gives to agonists and antagonists of oxytocin and its receptor. As of 2013, the documented adverse effects to date have been undervalued.