[Human immunodeficiency virus infection in pregnant women. The importance of recognizing the infection during pregnancy and risk factors for perinatal transmission]. / Infección por virus de inmunodeficiencia humana en la embarazada. Importancia del conocimiento de la infección en el embarazo y factores de riesgo en la transmisión perinatal.

BACKGROUND: Using adequate infection control measures, the rate of vertical transmission of human immunodeficiency virus (HIV) during pregnancy, has been reduced to 3% in Chile. AIM: To determine vertical transmission rate and risk factors associated to perinatal infection in pregnant women with known (KI) and unknown HIV infection (UI). PATIENTS AND METHODS: HIV infected pregnant women whose deliveries were attended at the San Borja Arriaran Hospital were included. Antiretroviral therapy (ART) has been used since 1995 (Zidovudine 13 patients, biOtherapy 4 and triple therapy 14 patients). Newborns have received ART since 1995. Premature labor without evident cause, premature rupture of membranes, and rupture of membranes over 4 h before delivery were evaluated. Delivery was by elective cesarean section since 1993. Breast feeding was avoided. Pregnant women with UI (suspected disease after delivery due to child or mother pathology) did not received ART. Delivery and breast feeding were managed with common obstetrical-neonatal criteria. RESULTS: Fifty three HIV infected pregnant women were studied (43 with KI and 10 with UI). Four children (36.4%) from the KI group and seven (63.6%) from the UI group became infected. The global rate of vertical transmission among KI group was significantly lower than UI group: 9.5% (4/42) vs 70.0% (7/10) p < 0.001. Using ART, this rate was further reduced to 6.5% (2/31) and with bitherapy or triple therapy to 0% (0/18). Breast feeding, vaginal delivery, premature delivery with no clinical cause, premature rupture of membranes, rupture of membranes longer than 4 h and lack of ART, were significantly more common in the UI group, compared with KI group. CONCLUSIONS: Vertical transmission in pregnant women with KI is significantly lower compared with UI. Risk factors increasing HIV perinatal infection are: breast feeding, lack of ART, vaginal delivery, premature rupture of membranes, rupture of membranes > 4 h and premature labor without a clinical cause.

Hernias complicadas: estudio retrospectivos de 369 casos / Complicated hernias: retrospective studies of 369 cases

Introducción: Las hernias complicadas constituyen una causa comun de consulta siendo su resolución muchas veces quirurgica. El presente trabajo tiene como objetivo estudiar la presentación clínica, distribución por sexo, grupo etario y mortalidad de las hernias complicadas en una serie nacional. Métodos: Se analizaron los casos de los pacientes hospitalizados que presentaban el diagnóstico de hernia complicada atendidos en Hospital de Urgencia Asistencia Publica durante el a¤o 2000 y se tabularon los siguientes datos para cada uno: días de hospitalización, sexo, edad, tipo de hernia (inguinal, incisional, crural, umbilical y epigástrica), complicaciones y estado al alta. Resultados: Se obtuvo un n de 369 pacientes. La relación hombre: mujer fue de 1:1,3, con un promedio de edad de 60,0 a¤os: El 82,11 por ciento fue a cirugía para su resolución. La hernia inguinales fueron las más frecuentes con 35.97 por ciento, mientras que la incisional fue 29,37 por ciento, la crural 17,82 por ciento, la umbilical 13,53 por ciento y la epigástrica 3,30 por ciento. Conclusiones: El cuadro de hernia abdominal complicada es frecuente, requiriendo muchas veces tratamiento quirurgico. Afecta en su mayoría a adultos mayores y mujeres. El tipo de hernia más frecuente es la inguinal