El aumento del calcio ionizado intracelular depende de algún factor presente en el suero de las pacientes preeclámpticas / The intracellular increase of ionized calcium depend on some factor present in pre-eclamptic patient sera

En trabajos previos nuestro grupo ha demostrado que la concentración intracelular de calcio ionizado es mayor en pacientes con preeclampsia que en embarazadas normotensas y que estas cifras correlacionan con la tensión arterial. Ambos indicadores se normalizan 6 semanas después del parto. Con el fin de investigar la posibile participación de factores solubles en el plasma, en el aumento del calcio libre intracelular, se estudiaron 8 pacientes preeclámpticas diagnosticadad por los criterios del Colegio Americano de Ginecólogos y Obstetras. Como grupo testigo se incluyeron 8 embarazadas normotensas pareadas por edad cronológica y gestacional. Para medir flujos de calcio transmembrana se utilizaron plaquetas de varones sanos. Las plaquetas fueron incubadas durante 0, 15, 30 y 60 minutos en suero de pacientes preeclámpticas o de embarazadas normotensas marcado con Ca. Las diferencias en el transporte de calcio se evaluaron con análisis de varianza de Kruskal Wallis. El transporte de calcio fue mayor cuando las plaquetas se incubaron en suero de pacientes preeclámpticas, Md = 1.475 ñ 0.311 nanomolas que cuando fueron incubadas en suero de embarazadas normotensas, Md = 0.9725 ñ 0.58 nanomolas, p < 0.02. Este hallazgo sugiere que en el suero de las pacientes preeclámpticas existe algún factor que facilicita la entrada de calcio a la célula, que provoca un aumento en la concentración de calcio libre y participa en la hipertensión gestacional.

[Quality circles as a strategy of a medical care quality assurance program at the Perinatology National Institute]. / Círculos de calidad como estrategia de un programa de garantía de calidad de la atención médica en el Instituto Nacional de Perinatología.

The present article shows the methodology of implantation of a quality guarantee program of medical attention through quality circles at the National Institute of Perinatology and it's results. Among them emphasize the following: organization's structure effects. The optimum on resources in it's own process of attention on the satisfaction of the patients and in the learning implicated in the adaptation of the technology to the hospital environment and the characteristics of a different culture from which that technology emerged. The project, conceived as investigation-action, was advised by Public Health Investigation Center and was created with the purpose to secure that the organized conditions under which the medical attention are given were those permitting to raise the quality as much in the among personal dimension as in the technical, through the participation of the personnel directly responsible of the services given. This led to the use of quality circles as participant technical of quality control and as main quality guarantee program of medical attention. Seven stages can be identified in the implantation of the quality assurance program using the quality circles: 1) to elaborate the proposal document and work protocol; 2) negotiation; 3) drawing of a guide for the elaboration of a quality guarantee manual; 4) selection the point of starting; 5) elaboration of the quality guarantee manual by service; 6) to operate the quality circles; 7) evaluation of the program. This experience has demonstrated it's feasible using the quality circles as fundamental components of a quality guarantee program of medical attention and permits to secure that, in general, it is possible to use this technology in the health services.

[Factors associated with breast feeding. II Study of women with no prenatal control]. / Factores asociados a la practica de lactancia II. Estudio de mujeres sin control prenatal.

PIP: This prospective study on breastfeeding practices sought to identify if factors that intervene or determine breastfeeding practices are those influenced by women themselves, promoted by institutions such as hospitals or is a combination of both factors. The methodology included 582 women who did not attend prenatal consultations and only attended the 3 hospitals included in the study to deliver their babies. Hospital A studied 252 women, supported breastfeeding practices and gave patients milk samples; hospital B studied 80 women, did not support breastfeeding and gave milk samples; and hospital C interviewed 250 women, did not support breastfeeding and did not give women milk samples. Invitations to attend the study explained that 12 hours postpartum a questionnaire would be given and 15 days postpartum a session would be held to verify if they were breastfeeding. The independent variables were: place of birth, residence of the new mothers and that their own mothers age, educational level, status of relationship with the father of the baby, number of pregnancies, number of live children, background and number of previous stillbirths, were they living with the father of the baby and was he supporting her, was the pregnancy planned, previous problems with breastfeeding, was previous baby breastfed number of previous babies breastfed, reasons for not breastfeeding, and prior to the study what were other sources of information on breastfeeding. Results demonstrated that the sociocultural and demographic differences between each of the 3 populations attending the 3 hospitals were found to have stronger effects on breastfeeding practices than hospital policies.^ieng

[Exercise test and differential diagnosis of fetal arrhythmia]. / Pruebas de esfuerzo y diagnóstico diferencial de arritmias fetales.

The cases here reported show in the first place that external fetal ECG is useful to detect fetal distress and should therefore be included as a prenatal control from the second trimester of pregnancy on, specially in cases where there is a past history of fetal death of unknown origin, or a family history of congenital heart defects. A fetal tolerance test to exercise should also be done in those cases with a past history of fetal death, distress or whenever chronic fetal distress may be suspected to take place because of the presence of maternal pathology (endocrine, cardiovascular, or infectious diseases, etc.). Fetal tolerance test to uterine contractions should also be done whenever possible to evaluate the tolerance of these fetuses to uterine contractility during labor. More studies are needed to establish standard guides of this method for the practical obstetrical management of products of high risk pregnancies.