Naturalization of the microbiota developmental trajectory of Cesarean-born neonates after vaginal seeding.

BACKGROUND: Early microbiota perturbations are associated with disorders that involve immunological underpinnings. Cesarean section (CS)-born babies show altered microbiota development in relation to babies born vaginally. Here we present the first statistically powered longitudinal study to determine the effect of restoring exposure to maternal vaginal fluids after CS birth. METHODS: Using 16S rRNA gene sequencing, we followed the microbial trajectories of multiple body sites in 177 babies over the first year of life; 98 were born vaginally, and 79 were born by CS, of whom 30 were swabbed with a maternal vaginal gauze right after birth. FINDINGS: Compositional tensor factorization analysis confirmed that microbiota trajectories of exposed CS-born babies aligned more closely with that of vaginally born babies. Interestingly, the majority of amplicon sequence variants from maternal vaginal microbiomes on the day of birth were shared with other maternal sites, in contrast to non-pregnant women from the Human Microbiome Project (HMP) study. CONCLUSIONS: The results of this observational study prompt urgent randomized clinical trials to test whether microbial restoration reduces the increased disease risk associated with CS birth and the underlying mechanisms. It also provides evidence of the pluripotential nature of maternal vaginal fluids to provide pioneer bacterial colonizers for the newborn body sites. This is the first study showing long-term naturalization of the microbiota of CS-born infants by restoring microbial exposure at birth. FUNDING: C&D, Emch Fund, CIFAR, Chilean CONICYT and SOCHIPE, Norwegian Institute of Public Health, Emerald Foundation, NIH, National Institute of Justice, Janssen.

Ovarian Stromal Hyperplasia: A Rare Cause of Postmenopausal Hyperandrogenism.

Ovarian hyperthecosis and ovarian stromal hyperplasia (OSH) are two uncommon non-neoplastic causes of ovarian hyperandrogenism, whose etiology is still unknown. These conditions are characterized by obesity, hyperinsulinemia, acanthosis nigricans, and even virilization, mainly in postmenopausal women. Here we have reported the case of a 67-year-old patient with a diagnosis of OSH, which was resolved after bilateral laparoscopic oophorectomy. In this case report, we have discussed two different conditions posing a diagnostic challenge and requiring a high index of suspicion.

MAMI: a birth cohort focused on maternal-infant microbiota during early life.

BACKGROUND: Early microbial colonization is a relevant aspect in human health. Altered microbial colonization patterns have been linked to an increased risk of non-communicable diseases (NCDs). Advances in understanding host-microbe interactions highlight the pivotal role of maternal microbiota on infant health programming. This birth cohort is aimed to characterize the maternal microbes transferred to neonates during the first 1000 days of life, as well as to identify the potential host and environmental factors, such as gestational age, mode of delivery, maternal/infant diet, and exposure to antibiotics, which affect early microbial colonization. METHODS: MAMI is a prospective mother-infant birth cohort in the Spanish-Mediterranean area. Mothers were enrolled at the end of pregnancy and families were follow-up during the first years of life. Maternal-infant biological samples were collected at several time points from birth to 24 months of life. Clinical and anthropometric characteristics and dietary information is available. Specific qPCR and 16S rRNA gene sequencing as well as short chain fatty acid (SCFAs) profile would be obtained. Multivariable models will be used to identy associations between microbiota and clinical and anthropometric data controlling for confounders. MAMI would contribute to a better understanding of the interaction between diet, microbiota and host response in early life health programming, enabling new applications in the field of personalized nutrition and medicine. TRIAL REGISTRATION: The study is registered on the ClinicalTrial.gov platform NCT03552939. (June 12, 2018).

Implementation of the Robson 10-Group Classification System at Hospital de Manises: Optimization of the cesarean delivery rate / Aplicación de los diez grupos de Robson en el hospital de Manises: racionalización de la tasa de Cesárea

Background: In view of the excessive increase in the incidence of cesarean delivery in recent decades, the World Health Organization proposes the 10-Group Classification System of Robson et al as a global standard for the classification of cesarean delivery in order to achieve optimal cesarean delivery rates of between 10% and 15%. Objective: To evaluate the implementation of the 10-Group Classification System in Hospital de Manises as an objective criterion for identifying groups of pregnant women at the highest risk of cesarean delivery and the clinical conditions that most affect the overall rate. Methods: A retrospective cohort study was performed of all deliveries attended at Hospital de Manises from January 1, 2015 to December 31, 2016. Results: There were 3171 deliveries with a total cesarean delivery rate of 16.08%. The highest rate of cesarean delivery (97.6%) was located in group 6 (all nulliparous breeches). The largest contribution to the total cesarean delivery rate was in group 2 (nulliparous, single cephalic, ≥37 weeks, induced or cesarean before labor), which accounted for 4.5% of the total. Conclusions: The 10-Group Classification System is easily implemented and enables identification of risk groups for cesarean delivery and of the clinical conditions that most impact this approach (AU)

Antecedentes: ante el incremento desmesurado en la incidencia de cesáreas durante las últimas décadas, la Organización Mundial de la Salud en el año 2014 propuso el sistema de clasificación de los diez grupos de Robson como estándar global para comparar la tasa de cesáreas. Objetivo: evaluar la implantación del modelo de clasificación de los diez grupos de Robson en el hospital de Manises como criterio objetivo para identificar los grupos de gestantes con mayor riesgo de cesárea y las condiciones clínicas más relevantes en la tasa global. Método: se realiza un estudio observacional de cohortes retrospectivo de todos los partos atendidos en el hospital de Manises desde el 1 de enero de 2015 al 31 de diciembre de 2016. Resultados: se han registrado 3.171 partos con una tasa total de cesárea de 16,08%. La mayor tasa de cesárea se localiza en el grupo 6 ("nulípara con un feto único en presentación podálica") con un total de 97,6%. La mayor contribución a la tasa total de cesárea la proporciona el grupo 2 ("nulíparas con un feto único en presentación cefálica, de 37 semanas o más de embarazo, que han sido sometidas a inducción o cesárea antes del inicio del parto") con un 4,5%. Conclusiones: la aplicación de la clasificación de los diez grupos de Robson es sencilla y permite identificar los grupos de riesgo de cesárea y las condiciones clínicas que más repercusión tienen en esta (AU)

Síndrome de varón 46, XX (SRY +) asociado a Enfermedad de Crohn. A propósito de un caso / 46, XX (SRY +) male syndrome associated with Crohn disease. A case report

OBJETIVO: Presentar el caso de un paciente de fenotipo masculino con testículos y pene de tamaño ligeramente disminuido diagnosticado de azoospermia no obstructiva. Revisión de la literatura. MATERIAL Y MÉTODOS: Exploración física, perfil hormonal, espermiograma, ultrasonografía genital, cariotipo y análisis citogenético mediante microarrays KaryoNIM. RESULTADOS: La exploración clínica mostró un fenotipo masculino con testes y pene disminuidos de tamaño y obesidad. Las determinaciones hormonales evidenciaron un hipogonadismo hipergonadotropo. El estudio seminal mostró una azoospermia y la ecografía genital un aparato genital masculino normal. El cariotipo fue 46,XX, normal de mujer, y el estudio citogenético mostró la traslocación de material genético del cromosoma Y al cromosoma X, incluyendo el gen SRY. La biopsia testicular evidenció la presencia de hialinización tubular con células de Sertoli maduras, sin línea germinal y acusada hiperplasia de células de Leydig. Comentarios y conclusión: El síndrome de varón con cariotipo 46,XX es una etiología inusual de azoospermia. Su asociación a patologías autoinmunes no está actualmente bien aclarada. Aunque la única opción disponible para tratar el problema reproductivo es el uso de semen de donante, el abordaje de estos pacientes debe ser multidisciplinar

OBJECTIVES: To present the case of a patient showing male phenotype with testes and penis size slightly decreased, which was diagnosed with non-obstructive azoospermia. Review of the literature. MATERIAL AND METHODS: Physical examination, hormonal profile, semen analysis, genital ultrasound scan, karyotype and cytogenetic microarray analysis (KaryoNIM). RESULTS: Clinical examination showed a male phenotype with decreased size of testes and penis and obesity. Hormonal determinations evidenced hypergonadotropic hypogonadism. The seminal study showed azoospermia and genital ultrasound a normal male genital tract. Karyotype 46,XX, normal woman, and the cytogenetic study showed the translocation of genetic material from chromosome Y to chromosome X, including the SRY gene. Testicular biopsy showed the presence of tubular hyalinization with mature Sertoli cells, absent germ line and pronounced hyperplasia of Leydig cells. Comments and conclusion: 46,XX male is a rare genetic condition of non-obstructive azoospermia. The association to autoimmune diseases needs to be clarified. Although sperm donation remains the only fertility treatment currently available multidisciplinary approach should be adopted in the management of 46,XX individuals

Gestación ectópica del segundo trimestre / Second trimester ectopic pregnancy

La incidencia global del embarazo ectópico es del 1-2% de las gestaciones. Es infrecuente su diagnostico en el segundo trimestre, ya que por lo general los síntomas aparecen durante el primer trimestre. Presentamos el caso de una mujer que acude a urgencias con dolor en la fosa ilíaca de varios días de evolución y mediante la ecografía se le diagnostica embarazo tubárico derecho, con feto de biometría concordante con las 13 semanas de amenorrea de la paciente (AU)

The global incidence of ectopic pregnancy is around 1-2%. Its diagnosis is rare in the second trimester as symptoms usually appear during the first trimester. We present the case of a woman who was seen in the emergency room with a right lower quadrant pain of a few days duration. A transvaginal ultrasound confirmed an ectopic right pregnancy with a 13-week embryo (AU)