Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn's disease patients?

The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn's disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.

Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn's disease patients?

The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn's disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.

Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score / Assessment of foetal nutrition status at birth using the CANS score

INTRODUCCIÓN: La malnutrición fetal (MF) traduce una pérdida o fallo de adquisición intrauterina de la cantidad adecuada de grasa y masa muscular, asociando connotaciones pronósticas a corto y largo plazo. Siendo el diagnóstico de MF esencialmente clínico, el objetivo de este trabajo es detectar la incidencia MF mediante el Clinical Assessment of Nutritional Status score(CANS score), y comparar los resultados con los parámetros antropométricos clásicos. PACIENTES Y MÉTODOS: Estudio retrospectivo poblacional de recién nacidos a término entre 2003 y 2014 (n = 14.477). Se clasificaron en recién nacidos de peso adecuado, pequeño y grande para la edad gestacional. Se realizó el CANS score y se calculó el índice ponderal (IP) a todos los recién nacidos incluidos, considerándose MF los puntos de corte: CANS score < 25 e IP < 2,2 g/cm3. RESULTADOS: Mediante el CANS score el 7,6% (n = 1.101) de la población presentó MF, el 50,3% (n = 538) de los recién nacidos de peso pequeño para la edad gestacional, el 76,2% (n = 193) del subgrupo < p3 y el 4,67% (n = 559) de los recién nacidos de peso adecuado para la edad gestacional. El CANS score fue < 25 en el 7,26% (n = 1.043) de los recién nacidos con IP ≥ 2,2 g/cm3 (n = 14.356), y el CANS score fue > 24 en el 49% con IP < 2,2 g/cm 3 (n = 109). CONCLUSIONES: Es conveniente identificar todos aquellos recién nacidos con MF por los riesgos que pueden presentar a corto y largo plazo. La valoración mediante CANS score permite una mejor identificación del estado nutricional de los recién nacidos que empleando únicamente las curvas de peso según la edad gestacional

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI < 2.2 g/cm3. RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n = 538) of SGA, 76.2% (n = 193) subgroup = 559) of AGA. The CANS score was < 25 in 7.26% (n = 1,043) of newborns with PI ≥ 2.2 g/cm3 (n = 14.356), and the CANS score was > 24 in 49% with PI < 2.2 g/cm3 (n = 109). CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age

Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires(R) / Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires(R)

INTRODUCCIÓN: La ausencia de protocolos específicos de seguimiento dificulta el conocimiento de la repercusión de la prematuridad tardía en el desarrollo psicomotor. El objetivo es evaluarlo a los 4 años y compararlo con los nacidos a término (AT). Población y método: Estudio de cohortes retrospectivo de 90 prematuros tardíos (PT) y 89 AT sanos, a los 48 meses, evaluados mediante el Ages & Stages Questionnaires(R) (ASQ-3). Las variables continuas se describen mediante media±DE comparadas con el test de la t de Student para muestras independientes; las variables categóricas, mediante frecuencias y proporciones, comparadas con el test de independencia de la chi al cuadrado. Se determinó un punto de corte para la puntuación total del ASQ-3 capaz de discriminar el riesgo de déficit del desarrollo mediante un análisis ROC. Una selección step-wise para el modelo de regresión logística determinó los factores de riesgo asociados. RESULTADOS: Las puntuaciones medias de cada dominio y de la puntuación global del ASQ-3 no mostraron diferencias entre ambos grupos. Sin embargo, al analizar la densidad de probabilidades para la puntuación global del ASQ-3 ≤ 251 puntos, 15 PT (16,6%) y 4 AT (4,5%) mostraban riesgo de déficit psicomotor, y la prematuridad tardía y la ausencia de lactancia materna resultaron factores asociados significativamente. CONCLUSIONES: Hubo una mayor prevalencia de riesgo de déficit en el desarrollo en los PT, lo que justifica considerar esta población de riesgo y establecer programas de seguimiento eficientes. Debe seguirse investigando si este riesgo corresponde a toda la población o si existen factores biológicos o antecedentes perinatales que los hacen más vulnerables

INTRODUCTION: Lack of specific monitoring protocols hinders the knowledge of the impact of late prematurity on delayed psychomotor development. The objective of this study is to evaluate this at 48 months and compare it with those born at term. Population and methods: A retrospective cohort study was conducted on 90 late preterm (PT) and 89 term (AT) healthy children at 48 months, assessed by the Ages & Stages Questionnaires(R) (ASQ-3). Continuous variables described using mean and standard deviation compared with the t Student t test for independent samples. The categorical variables were described as frequencies and proportions, compared with the Chi-square test of independence. A cut-off was determined for the total score of ASQ-3 able to discriminate the risk of developmental deficit by a ROC analysis. A step-wise logistic regression model identified the associated risk factors. RESULTS: The mean scores for each domain and overall ASQ-3 score showed no differences between groups. However, when analyzing the probability density for the ASQ-3 total score of ≤251 points, 15 PT (16.6%) and 4 AT (4.5%) showed risk of psychomotor deficits, and late prematurity and lack of breastfeeding were significantly associated factors. CONCLUSIONS: There is an increased prevalence of risk of development deficit in the PT, which justifies considering this population at risk and establishing effective monitoring programs. It should be further investigated whether this risk corresponds to the entire population, or if there are biological factors or perinatal history that makes them more vulnerable

[Assessment of foetal nutrition status at birth using the CANS score]. / Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score.

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI <2.2g/cm(3). RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n=538) of SGA, 76.2% (n=193) subgroup 24 in 49% with PI <2.2g/cm(3) (n=109) CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

[Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires®]. / Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires®.

INTRODUCTION: Lack of specific monitoring protocols hinders the knowledge of the impact of late prematurity on delayed psychomotor development. The objective of this study is to evaluate this at 48 months and compare it with those born at term. POPULATION AND METHODS: A retrospective cohort study was conducted on 90 late preterm (PT) and 89 term (AT) healthy children at 48 months, assessed by the Ages & Stages Questionnaires® (ASQ-3). Continuous variables described using mean and standard deviation compared with the t Student t test for independent samples. The categorical variables were described as frequencies and proportions, compared with the Chi-square test of independence. A cut-off was determined for the total score of ASQ-3 able to discriminate the risk of developmental deficit by a ROC analysis. A step-wise logistic regression model identified the associated risk factors. RESULTS: The mean scores for each domain and overall ASQ-3 score showed no differences between groups. However, when analyzing the probability density for the ASQ-3 total score of ≤251 points, 15 PT (16.6%) and 4 AT (4.5%) showed risk of psychomotor deficits, and late prematurity and lack of breastfeeding were significantly associated factors. CONCLUSIONS: There is an increased prevalence of risk of development deficit in the PT, which justifies considering this population at risk and establishing effective monitoring programs. It should be further investigated whether this risk corresponds to the entire population, or if there are biological factors or perinatal history that makes them more vulnerable.

Morbilidad neonatal en los recién nacidos a término precoz / Neonatal morbidity in early-term newborns

INTRODUCCIÓN: En las últimas décadas ha aumentado de forma significativa el nacimiento de niños de 37 y 38 semanas de gestación, período denominado a término precoz, paralelamente al aumento de partos inducidos y el incremento en la tasa de cesáreas. Pacientes y método: Estudio retrospectivo poblacional de cohortes, en el que se incluyó a los nacidos entre las 37 y 41 semanas de gestación en el período 1992-2011 (n=35.539). Esta población se dividió en 2 cohortes, los recién nacidos a término precoz (RNTP), de 37-38 semanas (n=11.318), y los recién nacidos a término completo (RNTC), de 39-41 semanas (n=24.221). Se analizan la tasa de cesárea, el ingreso en unidad neonatal, la morbilidad respiratoria, la apnea y la necesidad de asistencia respiratoria, hiperbilirrubinemia que requiere fototerapia, hipoglucemia, convulsiones, encefalopatía hipóxico-isquémica, necesidad de nutrición parenteral y sepsis precoz. RESULTADOS: Se observa un aumento progresivo del número de cesáreas a lo largo del período estudiado (del 30,9% al 40,3%). En los RNTP la tasa de cesárea fue superior que en los RNTC (38,3% vs. 31,3%; p < 0,0001). En la comparación de ambos grupos, se encontraron diferencias significativas en la tasa de ingreso en unidad neonatal, 9,1% vs. 3,5% (p < 0,0001); la morbilidad respiratoria (membrana hialina 0,14% vs. 0,007%; [p < 0,0001]; la taquipnea transitoria, 1,71% vs. 0,45% [p < 0,0001], la ventilación mecánica, 0,2% vs. 0,07% [p < 0,009]; la presión positiva continua en la vía respiratoria, 0,11% vs. 0,01% [p < 0,0001]); la fototerapia, 0,29% vs. 0,07% (p < 0,0001); la hipoglucemia, 0,54% vs. 0,11% (p < 0,0001), y la nutrición parenteral, 0,16% vs. 0,04% (p < 0,0001). No se encontraron diferencias significativas en la tasa de sepsis precoz, neumotórax, síndromes aspirativos, convulsiones y encefalopatía hipóxico-isquémica. CONCLUSIONES: En nuestro medio, existe un número importante de RNTP, que presentan una morbilidad significativamente superior a los recién nacidos catalogados de RNTC. Tras individualizar cada caso, es aconsejable no finalizar un embarazo antes de las 39 semanas de gestación, salvo por condicionamientos maternos, placentarios o fetales que indiquen que continuar el embarazo comporte un mayor riesgo para el feto y/o la madre

INTRODUCTION: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. PATIENTS AND METHOD: Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. RESULTS: There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<0.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<0.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<0.0001], transient tachypnea 1.71% vs 0.45% [P<0.0001], mechanical ventilation 0.2% vs 0.07% [P<0.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<0.0001), hypoglycemia 0.54% vs 0.11% (P<0.0001), parenteral nutrition 0.16% vs 0.04% (P<0.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. CONCLUSIONS: In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother

[Neonatal morbidity in early-term newborns]. / Morbilidad neonatal en los recién nacidos a término precoz.

INTRODUCTION: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. PATIENTS AND METHOD: Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. RESULTS: There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. CONCLUSIONS: In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother.

Selection of reference genes in Hedysarum coronarium under various stresses and stages of development.

The cultivation of Hedysarum coronarium has generated interest recently for its high yield as a fodder crop, its high protein content, and the presence of condensed tannins in its leaf and stem tissues. Gene expression studies can lead to a better understanding of the biological processes of live organisms. Specifically, reverse transcription followed by quantitative polymerase chain reaction (PCR) represents the most powerful technology for comparing the expression profiles of target genes. The use of reference genes as internal controls to normalize messenger RNA (mRNA) levels is a requirement of quantitative PCR (qPCR). Few studies on reference genes have been performed in plants, and no studies have been performed in H. coronarium. Therefore, the aim of this study was to identify and evaluate reference genes to use in qPCR in H. coronarium. Sulla tissues under two conditions of abiotic stress and at various stages of development were studied to determine adequate reference genes. To optimize the identity and number of reference genes, geNorm and BestKeeper software programs were employed. Based on the results of both analyses, TUA1, TUA2, and UBQ were found to be the most suitable reference genes, and the combination of these three genes was suggested for the accurate normalization of gene expression in sulla tissues.

Anal cytology in patients with AIDS.

The objective of the present study was to study the prevalence of abnormal anal cytology in patients with AIDS. Anal smears, obtained with a cytobrush, of 102 HIV-positive patients of the Emilio Ribas Institute (Sao Paulo, Brazil) were collected, and only after that, the patients were submitted to anoscopy. Thirty-two patients had LSIL and 14 others had HSIL. Squamous intra-epithelial lesions were also observed in 38% of the patients without condyloma (18/47): in 9 of the 33 patients without history of condyloma (27%) and in 9 of the 14 patients who had previously treated condyloma (64%). An invasive squamous cell carcinoma was observed in one patient without history of condyloma. In all 13 patients with HSIL, biopsies guided by high resolution anoscopy confirmed high grade dysplasia. Our findings suggest that anal cytology is mandatory in AIDS even in patients without macroscopic anal lesions or without previous history of anal condyloma.

Prematuros tardíos: una población de riesgo infravalorada / Late preterm infants: A population at underestimated risk

Introducción y objetivo: La tasa de prematuridad ha experimentado un incremento progresivo en los últimos años, a costa casi exclusivamente de los prematuros tardíos (34 a 36 semanas). Es una población que, si bien con menor riesgo que los prematuros de menor edad gestacional, tiene una tasa de morbimortalidad significativamente mayor que los recién nacidos a término. Sin embargo, hay una cierta infravaloración respecto a su evolución a corto y a largo plazo. El objetivo de este trabajo es revisar la incidencia de prematuridad en este centro y analizar la morbimortalidad en los prematuros tardíos comparada con los recién nacidos a término. Población y métodos: Revisión retrospectiva de los recién nacidos en el hospital desde el 1 de enero de 1992 hasta el 31 de diciembre de 2008. Entre las 340/7 y las 366/7 semanas de gestación formaron el grupo de prematuros tardíos (n=2.003), y los de 37 a 42 semanas cumplidas de gestación conformaron el grupo de recién nacidos a término (n=32.015). Se formaron 2 subgrupos según 2 períodos de tiempo (de 1992 a 1998 y de 2000 a 2008). Se analizaron las tasas de morbimortalidad, para cada uno de los grupos y subgrupos, y se compararon, así como la morbilidad semana a semana desde la semana 34 a la semana 42. Resultados: Durante el período estudiado, la tasa de prematuridad aumentó del 3,9 al 9,8%, a expensas exclusivamente de los prematuros tardíos (el 79% del total).La tasa de mortalidad en los prematuros tardíos fue del 5% comparada con el 1,1% en los a término (p<0,0001; odds ratio de 4,71; intervalo de confianza del 95%: 2,3 a 9,5). La incidencia de ingreso en la Unidad de Neonatología, tasa de cesáreas, gemelaridad, trastornos respiratorios, necesidad de asistencia respiratoria en forma de presión positiva continua en la vía respiratoria nasal o ventilación mecánica, incidencia de apneas, ictericia que precisó fototerapia, hipoglucemia y necesidad de nutrición parenteral fueron significativamente superiores (p<0,0001) en el grupo de pretérminos tardíos comparado con los recién nacidos a término. La tasa de morbilidad fue descendente a medida que aumentaba la edad gestacional, con el valor más bajo a partir de las 39 semanas. Conclusiones: La morbimortalidad en los prematuros tardíos es significativamente superior a la de los recién nacidos a término. Es necesario revisar las pautas ante estos prematuros nacidos cerca de término, buscar las posibles causas de su prematuridad, intentar reducir su incidencia y elaborar un cuidadoso protocolo de atención y vigilancia para minimizar la morbimortalidad asociada. Sería aconsejable establecer un seguimiento a largo plazo, a fin de conocer cuáles son las consecuencias sobre su desarrollo psicomotor. El colectivo obstétrico debe sensibilizarse del verdadero riesgo del nacimiento en estas edades gestacionales cercanas a término (AU)

Background and objective: There has been a gradual rise in prematurity rates recent years, almost exclusively at the expense of the late preterm (34 to 36 weeks). This population, although with less risk than smaller preterm gestational age, has a morbidity rate significantly higher than term infants. However, there is some underestimation regarding developments in the short and long term. The aim of this study was to look at the incidence of prematurity in our institution and to analyze morbidity and mortality in late preterm compared with term infants. Subjects and methods: We performed a retrospective review of newborns in our Hospital from January 1992 until December 31, 2008. Late preterm group was defined as between 340/7 and 366/7 weeks gestation (N=2003) and term infants from 37 to 42 weeks gestation (N=32015). We formed 2 subgroups according two time periods (1992–1998 and 2000–2008). The morbidity and mortality for each of the groups and subgroups, and the morbidity from week 34 to 42, were analysed and compared. Results: During the period studied, the prematurity rate increased from 3.9% to 9.8%, exclusively at the expense of the late preterm (79%). The rate of mortality in late preterm was 5 ‰ compared to 1.1 ‰ in the term (P <0.0001, OR 4.71, 95% CI 2.3–9.5). The incidence of admission to the Neonatal Unit, Cesarean rate, twin, respiratory disorders, need for respiratory support in the form of nasal CPAP or mechanical ventilation, incidence of apnea, jaundice requiring phototherapy, hypoglycaemia and need for parenteral nutrition were significantly higher (P<0.0001) in the late preterm group compared with term infants. The morbidity rate decreased significantly as gestational age increased, with the lowest value from 39 weeks. Conclusions: Morbidity and mortality in late preterm infants is significantly higher than in term infants. The guidelines for these near term premature babies need to be reviewed, looking for possible causes of prematurity, and trying to reduce their impact, as well as developing a protocol for their care and close monitoring to minimize the associated morbidity. There should be long-term monitoring to find out the consequences on their psychomotor development. The obstetrics group should be made aware of the true risks of births in the near-term gestational ages (AU)

[Late preterm infants: A population at underestimated risk]. / Prematuros tardíos: una población de riesgo infravalorada.

BACKGROUND AND OBJECTIVE: There has been a gradual rise in prematurity rates recent years, almost exclusively at the expense of the late preterm (34 to 36 weeks). This population, although with less risk than smaller preterm gestational age, has a morbidity rate significantly higher than term infants. However, there is some underestimation regarding developments in the short and long term. The aim of this study was to look at the incidence of prematurity in our institution and to analyze morbidity and mortality in late preterm compared with term infants SUBJECTS AND METHODS: We performed a retrospective review of newborns in our Hospital from January 1992 until December 31, 2008. Late preterm group was defined as between 34(0/7) and 36(6/7) weeks gestation (N=2003) and term infants from 37 to 42 weeks gestation (N=32015). We formed 2 subgroups according two time periods (1992-1998 and 2000-2008). The morbidity and mortality for each of the groups and subgroups, and the morbidity from week 34 to 42, were analysed and compared. RESULTS: During the period studied, the prematurity rate increased from 3.9% to 9.8%, exclusively at the expense of the late preterm (79%). The rate of mortality in late preterm was 5 per thousand compared to 1.1 per thousand in the term (P <0.0001, OR 4.71, 95% CI 2.3-9.5). The incidence of admission to the Neonatal Unit, Cesarean rate, twin, respiratory disorders, need for respiratory support in the form of nasal CPAP or mechanical ventilation, incidence of apnea, jaundice requiring phototherapy, hypoglycaemia and need for parenteral nutrition were significantly higher (P<0.0001) in the late preterm group compared with term infants. The morbidity rate decreased significantly as gestational age increased, with the lowest value from 39 weeks. CONCLUSIONS: Morbidity and mortality in late preterm infants is significantly higher than in term infants. The guidelines for these near term premature babies need to be reviewed, looking for possible causes of prematurity, and trying to reduce their impact, as well as developing a protocol for their care and close monitoring to minimize the associated morbidity. There should be long-term monitoring to find out the consequences on their psychomotor development. The obstetrics group should be made aware of the true risks of births in the near-term gestational ages.

[Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age]. / Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación.

BACKGROUND AND OBJECTIVE: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. PATIENTS AND METHOD: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23-42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. RESULTS: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. CONCLUSIONS: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors.

Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación / Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age

Introducción y objetivo: la clasificación del recién nacido según peso, longitud y perímetro occipitofrontal al nacer en relación con la edad gestacional se ha utilizado como indicador de morbimortalidad neonatal, así como factor pronóstico de enfermedades de la edad adulta. Las diferentes poblaciones analizadas y metodologías en la recogida de datos hacen que los resultados sean dispares entre publicaciones. El objetivo es establecer los valores antropométricos de referencia para nuestro hospital, que atiende a una población caracterizada por un nivel socioeconómico medio-alto, distinta, probablemente, de otras publicadas recientemente en nuestro entorno, y compararlas. Pacientes y método: análisis del peso, la longitud y el perímetro occipitofrontal al nacimiento de 31.397 recién nacidos vivos consecutivos en SCIAS-Hospital de Barcelona, de 1992 a 2006, con edades gestacionales entre 23 y 42 semanas. Se seleccionaron las gestaciones únicas y se separaron según sexo. Todos ellos de raza caucásica. No hubo exclusiones por enfermedad materna, fetal o neonatal. Se obtuvieron los valores en percentiles, media y desviación estandar, y se compararon según sexo. Se realizaron curvas según la edad gestacional a partir de las 35 semanas. Se compararon con los resultados de publicaciones recientes referidas a poblaciones de nuestro entorno geográfico. Resultados: se aprecian diferencias significativas en el peso, la longitud y el perímetro occipitofrontal al nacer según sexo a partir de las 36 semanas, con valores más altos en los varones. Se observa una tendencia a valores más altos en nuestra población al compararlos con otras de nuestro entorno geográfico. Conclusiones: la influencia del factor socioeconómico sobre el crecimiento fetal parece evidente. Sin embargo, es difícil asegurar que las diferencias observadas sean debidas, exclusivamente, a las características poblacionales o a las diferentes metodologías en la selección de la muestra. Es recomendable disponer de valores antropométricos poblacionales de referencia de la zona geográfica a la que pertenecemos, obtenidos a partir de metodologías epidemiológicas, para clasificar al recién nacido de forma adecuada y poder establecer comparaciones con sectores poblacionales diferenciados según factores raciales, socioeconómicos o por enfermedades (AU)

Background and objective: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. Patients and method: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23–42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. Results: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. Conclusions: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors (AU)

Selection of housekeeping genes for normalization by real-time RT-PCR: analysis of Or-MYB1 gene expression in Orobanche ramosa development.

Real-time PCR has become the method of choice for accurate and in-depth expression studies of candidate genes. To avoid bias, real-time PCR is referred to one or several internal control genes that should not fluctuate among treatments. A need for reference genes in the parasitic plant Orobanche ramosa has emerged, and the studies in this area have not yet been evaluated. In this study, the genes 18S rRNA, Or-act1, Or-tub1, and Or-ubq1 were compared in terms of expression stability using the BestKeeper software program. Among the four common endogenous control genes, Or-act1 and Or-ubq1 were the most stable in O. ramosa samples. In parallel, a study was carried out studying the expression of the transcription factor Or-MYB1 that seemed to be implicated during preinfection stages. The normalization strategy presented here is a prerequisite to accurate real-time PCR expression profiling that, among other things, opens up the possibility of studying messenger RNA levels of low-copy-number-like transcription factors.

[Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity]. / Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal.

INTRODUCTION: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. PATIENTS AND METHOD: Descriptive and prospective study in newborns with gestational ages (GA) < or = 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. RESULTS: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score > or = 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. CONCLUSIONS: IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers.

Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal / Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity

Introducción: La incidencia de prematuridad en nuestro país es aproximadamente del 8-9 %. A pesar del descenso de la mortalidad en este grupo de pacientes durante las últimas décadas, la morbilidad en el período neonatal y las secuelas posteriores siguen siendo elevadas. Se sabe que la respuesta inflamatoria fetal tiene un papel importante en la presencia de morbilidad neonatal. El objetivo de este estudio es determinar si la interleucina 6 (IL-6) en sangre de cordón es un parámetro útil para identificar a los prematuros que tienen mayor probabilidad de presentar morbilidad neonatal. Pacientes y método: Estudio descriptivo, prospectivo en recién nacidos con edad gestacional (EG) de hasta 34 semanas. Se determina IL-6 en sangre de cordón; recuento leucocitario y proteína C reactiva (PCR) a las 0, 12, 24 y 72 h de vida, y hemocultivo al ingresar. Se recogen factores perinatológicos, clínica en el momento del ingreso y evolución posterior hasta el alta o fallecimiento. Resultados: Se incluyen 99 recién nacidos con EG entre 23 y 34 semanas y peso al nacer entre 480 y 2.855 g. Los valores de IL-6 > 10 pg/ml muestran una correlación significativa con el antecedente de fiebre y/o corioamnionitis materna (p = 0,005), correlación débil pero significativa (p = 0,05; r = 0,3) con valores elevados de PCR a las 24 h de vida y con valores de la puntuación del índice de riesgo clínico para niños (CRIB) ≥ 4 (p = 0,003; r = 0,2) y correlación significativa (p = 0,04) con la presencia de leucomalacia periventricular (LPV) y con los días de ingreso (p = 0,015). En los pacientes con menor EG se observa una tendencia a mostrar valores de IL-6 más elevados. Conclusiones La IL-6 puede ser un marcador útil y precoz de morbilidad neonatal. Su precocidad para predecir morbilidad supone una ventaja frente a los marcadores analíticos clásicos (AU)

Introduction: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. Patients and method: Descriptive and prospective study in newborns with gestational ages (GA) ≤ 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. Results: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score ≥ 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. Conclusions IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers (AU)

First Report of Orobanche crenata on Sulla (Hedysarum coronarium) in Andalusia, Southern Spain.

Crenata broomrape (Orobanche crenata Forsk.), an obligate chlorophyll-lacking root parasite, is the major constraint for growing legume crops in infested soils in southern Spain. Peas (Pisum sativum L), faba beans (Vicia faba L.), and narbon bean (Vicia narbonensis L.) are seriously affected (1,2,4). However, no information is available regarding its ability to attack sulla (Hedysarum coronarium L.), which is an important fodder legume grown in rain-fed conditions, yielding as much as 10,000 kg/ha of dry matter. In 2008, we found broomrape shoots infecting 4 to 5% of sulla plants in a trial field (two land races, P-26 and P-3, in a 500-m2 area) in Cordoba (Andalusia, southern Spain). The shoots developed numerous fertile flowering stalks throughout the field. The previous crop, narbon bean, was heavily infected during 2007 by O. crenata. Infection of sulla plants was confirmed by digging up the plant to verify the attachment of the broomrape plant to the sulla roots. The level of infection was low with only one to two emerged broomrape shoots per sulla plant infested. Morphology was typical of O. crenata. The calyx of the flowers was 13 to 18 mm long with free, bidentate segments. The white corolla of the flowers was 18 to 28 mm long and glandular pubescent. The lips were divergent, large, not ciliate, and filaments inserted 2 to 3 mm above the base of the corolla are hairy at base with glandular hair at the apex. The anthers were brown (3). Specimens were deposited in the Herbarium of the University of Córdoba (identification number COA 45358). To our knowledge, this first report of O. crenata parasitizing sulla shows that control methods for O. crenata will be needed if sulla is to be used as an alternative legume fodder in the infested soils of southern Spain. References: (1) J. I. Cubero and M. T. Moreno. Page 41 in: Some Current Research on Vicia faba in Western Europe. D. A. Bond et al., eds. Luxembourg, 1979. (2) S. Nadal et al. Plant Breed. 126:110, 2007. (3) A. J. Pujadas-Salvá. Page 187 in: Resistance to Orobanche: The State of the Art. Junta de Andalucía, Sevilla, Spain, 1999. (4) D. Rubiales et al. Crop Prot. 22:865, 2003.

[Neonatal withdrawal syndrome to selective serotonin reuptake inhibitors: case report and literature review]. / Síndrome de abstinencia neonatal a inhibidores selectivos de la recaptación de serotonina: a propósito de un caso y revisión de la bibliografía.

INTRODUCTION: The treatment with selective serotonin reuptake inhibitors (SSRIs) is widely prescribed in pregnant women. Its gestational use is not associated with an increased risk of major foetal anomalies when used in their recommended doses. A SSRI-related neonatal syndrome has been described secondary to withdrawal in infants exposed to these drugs during the last trimester of pregnancy. However, little is known about neonatal psychopharmacology. CASE REPORT: An infant whose mother received treatment with paroxetine (20 mg/kg/day) during the third trimester was born prematurely and presented withdrawal symptoms within few days after birth. Symptoms were irritability with constant crying, shivering, increased muscle tone, coreiform movements and feeding problems. Only supportive care was needed and symptoms disappeared by two weeks of age. CONCLUSIONS: In utero exposure to SSRIs during the last trimester through delivery may result in a self-limited neonatal behavioural syndrome that can be managed with supportive care. Its increasing incidence in neonates may be due to a greater frequency of its gestational use. All these neonates should be followed-up closely looking forward withdrawal symptoms in the first days of life. We need a better understanding of SSRIs effects and pharmacokinetics, and further research should focus on whether it is safe to use SSRIs during the last trimester.