Podocituria y preeclampsia

El podocito es una célula altamente diferenciada localizada en la membrana basal del glomérulo. Entre sus múltiples funciones está garantizar la integridad y funcionalidad de la principal unidad de filtración del riñón, pero carece de la capacidad de dividirse bajo condiciones normales y en situaciones de estrés presenta el riesgo de separarse de la membrana basal, lo que conlleva la posibilidad de desarrollar proteinuria como primer paso de un daño renal que puede llegar a ser permanente. Una de estas situaciones de estrés es el embarazo y, en particular, los trastornos hipertensivos gestacionales, lo que coloca al podocito en la peculiar posición de poderse utilizar como prueba diagnóstica o como marcador de pronóstico renal a largo plazo. En esta revisión veremos el papel del podocito en estos escenarios. (provisto por Infomedic International)

The podocyte is a highly differentiated cell located in the basement membrane of the glomerulus. Among its multiple functions is to guarantee the integrity and functionality of the main filtration unit of the kidney, but it lacks the capacity to divide under normal conditions and in stressful situations it presents the risk of separating from the basement membrane, leading to the possibility of developing proteinuria as the first step of renal damage that may become permanent. One of these stressful situations is pregnancy and, in particular, gestational hypertensive disorders, which places the podocyte in the peculiar position of being able to be used as a diagnostic test or as a marker of long-term renal prognosis. In this review we will look at the role of the podocyte in these scenarios. (provided by Infomedic International)

Editorial - ¿Por qué investigamos?

Si buscan los orígenes del "ayuno intermitente", una forma de restricción calórica donde solo se ingieren alimentos por periodos cortos de tiempo (generalmente 8 horas), descubrirán algo interesante. A pesar de la popularidad del concepto y de que en los tiempos modernos muchos gurús de la alimentación, incluyendo médicos, lo apoyan y promueven, sus raíces datan de 1915. Estos ensayos iniciales culminaron con un capítulo publicado en el libro Obesity: its pathogenesis and management. El capítulo mencionaba ayunos de uno a catorce días, sugiriendo resultados espectaculares. Esta información, que requería un riguroso proceso de replicabilidad para demostrar su eficacia, saltó a las revistas culturales sin ser confirmada por otros expertos. Una vez algo pasa del terreno científico al popular, se convierte en conocimiento público y su uso crece de manera exponencial. Esto llevó a que, ya en los setenta, médicos e investigadores advirtieran del riesgo de estas terapias que buscaban soluciones rápidas a un problema mucho más profundo. (provisto por Infomedic International)

If you look up the origins of intermittent fasting, a form of calorie restriction where food is only eaten for short periods of time (usually 8 hours), you will discover something interesting. Despite the popularity of the concept and the fact that in modern times many food gurus, including physicians, support and promote it, its roots date back to 1915. These early trials culminated in a chapter published in the book Obesity: its pathogenesis and management. The chapter mentioned fasts of one to fourteen days, suggesting spectacular results. This information, which required a rigorous replication process to prove its efficacy, jumped into the cultural magazines without being confirmed by other experts. Once something moves from the scientific to the popular arena, it becomes public knowledge and its use grows exponentially. This led, as early as the 1970s, physicians and researchers to warn of the risk of these therapies that sought quick fixes to a much deeper problem. (provided by Infomedic International)

Incidence of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic.

Background: Incidence data of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRTI) are sparse in low- and middle-income countries (LMICs). We estimated RSV-LRTI incidence rates (IRs) in infants in LMICs using World Health Organization case definitions. Methods: This prospective cohort study, conducted in 10 LMICs from May 2019 to October 2021 (largely overlapping with the coronavirus disease 2019 [COVID-19] pandemic), followed infants born to women with low-risk pregnancies for 1 year from birth using active and passive surveillance to detect potential LRTIs, and quantitative reverse-transcription polymerase chain reaction on nasal swabs to detect RSV. Results: Among 2094 infants, 32 (1.5%) experienced an RSV-LRTI (8 during their first 6 months of life, 24 thereafter). Seventeen (0.8%) infants had severe RSV-LRTI and 168 (8.0%) had all-cause LRTI. IRs (95% confidence intervals [CIs]) of first RSV-LRTI episode were 1.0 (.3-2.3), 0.8 (.3-1.5), and 1.6 (1.1-2.2) per 100 person-years for infants aged 0-2, 0-5, and 0-11 months, respectively. IRs (95% CIs) of the first all-cause LRTI episode were 10.7 (8.1-14.0), 11.7 (9.6-14.0), and 8.7 (7.5-10.2) per 100 person-years, respectively. IRs varied by country (RSV-LRTI: 0.0-8.3, all-cause LRTI: 0.0-49.6 per 100 person-years for 0- to 11-month-olds). Conclusions: RSV-LRTI IRs in infants in this study were relatively low, likely due to reduced viral circulation caused by COVID-19-related nonpharmaceutical interventions. Clinical Trials Registration: NCT03614676.

Del Impacto de las Investigaciones

Cuando un investigador se plantea esa primera pregunta que se convertirá en un protocolo, no sabe lo que se encontrará al final del camino. Puede tener una hipótesis de trabajo, pero la realidad es que el mundo real es muy peculiar y las respuestas obtenidas pueden no ser las esperadas. Sin embargo, ese es el propósito de cualquier investigación: llegar a un descubrimiento, sin olvidar que trabajamos con probabilidades y no con verdades absolutas. Lo que fallamos en contemplar es que esta cadena de procesos y decisiones van más allá de la sección "Resultados" del artículo que esperamos escribir. Una vez plasmamos en papel el fruto de nuestro trabajo, lo estamos convirtiendo en un material de uso global y el mismo puede ser utilizado de muchas formas. Puede ser aprovechado por miembros del personal de salud en el manejo de sus pacientes o servir de elemento educativo en programas de residencia de todo el mundo. En ambos escenarios vemos una arista de las repercusiones y del alcance que tiene el esfuerzo emprendido al iniciar un proyecto de investigación. Sage Policy Profiles es parte de la red Social Science Space y publicaron hace poco una herramienta de gran utilidad (https://policyprofiles.sagepub.com) que puede ser usada para responder esa interrogante. Permite buscar los artículos de un investigador y determinar en qué documentos de políticas públicas se han mencionado los mismos. Este simple ejercicio les abrirá los ojos al mostrarles el inmenso alcance que tienes sus estudios y, a la vez, funciona como un recordatorio de la importancia de ejecutar sus protocolos de la mejor manera posible. Lo que se publica no es un grupo de páginas llenas de letras. Es un conocimiento destilado, plasmado para ayudar en el progreso de la ciencia. Como tal, no se quedará en la institución en la que labora. Se esparcirá por el mundo, atravesando fronteras y modificando la atención de personas que nunca conocerán su nombre. Cambiemos el mundo un artículo a la vez.

Sobre el método científico

Se conoce como Método Científico a la secuencia de pasos que se deben seguir para obtener un conocimiento que sea válido desde la perspectiva de las ciencias. Este método, que rige la forma como hacemos investigaciones, se apoya sobre dos grandes pilares: la reproducibilidad y la refutabilidad. La reproducibilidad implica que un determinado experimento debe ser capaz de ser reproducido por cualquier persona en cualquier lugar, aunque no necesariamente obteniendo los mismos resultados. Es por esto por lo que insistimos en que las conclusiones alcanzadas por un determinado investigador no pueden ni deben ser tomadas como ley absoluta, ya que las estadísticas nos dicen que dicho resultado puede ser fruto del azar y que solo repitiendo el mismo podemos estar seguros de la veracidad de las conclusiones alcanzadas. Uno de los mayores errores cometidos por los investigadores modernos es perseguir la primicia de un hallazgo y querer ser los primeros en decir o encontrar algo, lo que no es más que un intento de satisfacer el ego. Es igual de importante repetir los estudios ejecutados por otras personas y ver si se obtienen los mismos resultados en idénticas circunstancias. Son estas evaluaciones subsecuentes las que dan valor a los resultados de una investigación y las que nos permiten establecer la utilidad de aplicarlos de manera global en la población general. (provisto por Infomedic International)

The Scientific Method is the sequence of steps that must be followed to obtain knowledge that is valid from the perspective of science. This method, which governs the way we do research, rests on two main pillars: reproducibility and refutability. Reproducibility implies that a given experiment should be able to be reproduced by anyone anywhere, although not necessarily obtaining the same results. This is why we insist that the conclusions reached by a given researcher cannot and should not be taken as an absolute law, since statistics tell us that such a result may be the result of chance and that only by repeating it can we be sure of the veracity of the conclusions reached. One of the biggest mistakes made by modern researchers is to pursue the scoop of a finding and want to be the first to say or find something, which is nothing more than an attempt to satisfy the ego. It is just as important to repeat studies performed by others and see if the same results are obtained under identical circumstances. It is these subsequent evaluations that give value to the results of an investigation and that allow us to establish the usefulness of applying them globally in the general population. (provided by Infomedic International)

Safety and Immunogenicity of an Investigational Respiratory Syncytial Virus Vaccine (RSVPreF3) in Mothers and Their Infants: A Phase 2 Randomized Trial.

BACKGROUND: In a phase 1/2 study, a maternal respiratory syncytial virus vaccine candidate (RSVPreF3) demonstrated an acceptable safety profile and efficiently increased RSV-specific humoral immune responses in non-pregnant women. METHODS: In this phase 2 observer-blind, placebo-controlled, randomized clinical trial (NCT04126213), the safety of RSVPreF3 (60 or 120 µg), administered during late second or third trimester, was evaluated in 213 18- to 40-year-old healthy pregnant women through 6 months postdelivery and their offspring through infancy; immunogenicity was evaluated through day 43 postdelivery and day 181 postbirth, respectively. RESULTS: RSVPreF3 was well tolerated. No pregnancy-related or neonatal adverse events of special interest were considered vaccine/placebo related. In the 60 and 120 µg RSVPreF3 groups: (1) neutralizing antibody (nAb) titers in mothers increased 12.7- and 14.9-fold against RSV-A and 10.6- and 13.2-fold against RSV-B, respectively, 1 month postvaccination and remained 8.9-10.0-fold over prevaccination at day 43 postdelivery; (2) nAb titers were consistently higher compared to placebo recipients; (3) placental transfer ratios for anti-RSVPreF3 antibodies at birth were 1.62 and 1.90, respectively, and (4) nAb levels in infants were highest at birth and declined through day 181 postbirth. CONCLUSIONS: RSVPreF3 maternal vaccination had an acceptable safety risk profile and induced robust RSV-specific immune responses with successful antibody transfer to their newborns. CLINICAL TRIALS REGISTRATION: NCT04126213.

WHAT IS THE CONTEXT?: Infants, especially those less than 6 months of age, are at increased risk of lung infection caused by respiratory syncytial virus (RSV). However, this risk could be reduced with maternal vaccination against RSV during pregnancy. A previous clinical trial found that a vaccine candidate (named RSVPreF3) was well tolerated when given to non-pregnant women. WHAT IS NEW?: In pregnant women, RSVPreF3 was also well tolerated. Occurrence of unsolicited adverse events was similar between vaccine and placebo recipients. None of the serious adverse events or events of interest for pregnant women or newborns were considered related to the study intervention. One month after vaccination, mothers who received RSVPreF3 had 11­15 times higher levels of antibodies against RSV than before vaccination. These antibody levels remained similar until 43 days after delivery. In the infants born to mothers vaccinated during pregnancy with RSVPreF3, antibody levels were highest at birth, when levels were higher than in their mothers, and declined through day 181 postbirth. WHAT IS THE IMPACT?: RSVPreF3 had an acceptable safety risk profile in pregnant women and their babies. This vaccine induced potent immune responses against RSV, with maternal antibodies transferred to infants of the vaccinated mothers.

Entrecruzamiento de cordones en embarazo gemelar monoamniótico

Paciente de 30 años con embarazo gemelar monocorial monoamniótico de 33 4/7 semanas, que es admitida para interrupción del embarazo. Se envía para cesárea electiva y al momento del nacimiento, se descubre un entrecruzamiento de los cordones, como se muestra en la foto. (provisto por Infomedic International)

30 year old female patient with monochorionic monoamniotic twin pregnancy of 33 4/7 weeks, who is admitted for termination of pregnancy. She is sent for elective caesarean section and at the time of delivery, an intertwining of the cords is discovered, as shown in the picture. (provided by Infomedic International)

Editorial

Uno de los precios que se deben pagar al publicar un artículo es el de quedar en la mira de las "revistas depredadoras". Cuando el fruto de su esfuerzo se materializa en las redes sociales, es indexado o citado, su artículo queda disponible para todos aquellos con deseos aprender sobre el tema. Sin embargo, también quedan al alcance de personas cuyos propósitos no siempre son claros y pueden llevarlos a confiar en atractivas propuestas de trabajo que esconden nefastos intereses. (provisto por Infomedic International)

One of the prices to be paid for publishing an article is to be in the sights of predatory journals. When the fruit of your efforts materializes in social networks, is indexed or cited, your article is available to all those who wish to learn about the subject. However, they are also within the reach of people whose purposes are not always clear and may lead them to trust attractive work proposals that hide nefarious interests. (provided by Infomedic International)

Malaria cerebral

Paciente de 35 años, G3P3, indígena, que presenta un parto en casa. Al momento de su admisión con fiebre de 39°C y deterioro neurológico. Se sospechó un shock mix-to, el cual no respondió al manejo en la unidad de cuida-dos intensivos. Paciente fallece al poco tiempo de ser admitida. Autopsia revela múltiples lesiones, en diversos órganos, compatibles con una infección por Plasmodium falciparum. (provisto por Infomedic International)

35-year-old female patient, G3P3, indigenous, presenting with home delivery. On admission with fever of 39°C and neurological deterioration. Mixed shock was suspected, which did not respond to intensive care unit management. Patient died shortly after admission. Autopsy revealed mul-tiple lesions in various organs, compatible with Plasmo-dium falciparum infection. (provided by Infomedic International)

Factores de riesgo maternos y perinatales asociados a Apgar bajo en recién nacidos de término. Estudio retrospectivo de casos y controles

Objetivo: Cada año nacen, aproximadamente, 130 millones de niños a nivel mundial, de los cuales 3.3 millones nacen muertos y más de 4 millones fallecen en los primeros 28 días de vida. Según la Organización Mundial de la Salud, la mortalidad perinatal representa más de la mitad de la mortalidad infantil en el mundo. La medida usada de manera más consistente para determinar la salud neonatal a los pocos minutos de vida es la puntuación de Apgar, la cual proporciona al personal de salud una comprensión sobre el estado del recién nacido. Métodos: Se realizó un estudio retrospectivo de casos y controles, con una muestra de 303 registros de nacimientos de término (mayor o igual a 37 semanas), obtenidos de la base de datos de Historias Clínicas Perinatales de los años 2017-2018. La población de estudio fue distribuida en una proporción 1:2 (101 casos vs. 202 controles). Los casos fueron aquellos neonatos con puntajes de Apgar al quinto minuto menor a 7, mientras que los controles tuvieron en la misma medida puntajes mayores o iguales a 7. Se realizó un análisis estadístico de los datos, para determinar factores de riesgo de Apgar bajo. Resultados: Las variables que se presentaron como factores de riesgo para puntaje Apgar bajo al nacer fueron la presencia de diabetes [(5.9% vs. 0.49%, p=0.006); OR: 12.69; 95% IC: 1.51-106.93)] y el parto por cesárea [(52.6% vs. 26.28%, p=0.00007); OR: 3.11 (95% IC: 1.86-5.20)]. Conclusión: Después de analizar diversos factores de riesgo descritos en la literatura, la presencia de diabetes es un importante factor de riesgo para puntajes de Apgar bajo a los 7 minutos, por lo que especial atención se les debe prestar a los pacientes con esta patología durante la atención periparto. Aun cuando la interrupción vía cesárea también se reportó como un factor de riesgo, el procedimiento se debe analizar en el contexto de la causal de la misma, por lo que se requieren más estudios para determinar la relación entre la indicación del procedimiento y el puntaje Apgar bajo a los 7 minutos. (provisto por Infomedic Intl)

Objective: Every year, approximately 130 million infants are born worldwide, of which 3.3 million are stillborn and more than 4 million die in the first 28 days of life. According to the World Health Organization, perinatal mortality accounts for more than half of infant mortality worldwide. The most consistently used measure of neonatal health within minutes of birth is the Apgar score, which provides health care providers with an understanding of the newborn's condition. Methods: A retrospective case-control study was performed, with a sample of 303 term birth records (greater than or equal to 37 weeks), obtained from the Perinatal Medical Records database for the years 2017-2018. The study population was distributed in a 1:2 ratio (101 cases vs. 202 controls). Cases were those neonates with Apgar scores at the fifth minute less than 7, while controls had in the same measure scores greater than or equal to 7. Statistical analysis of the data was performed, to determine risk factors for low Apgar. Results: The variables that were presented as risk factors for low Apgar score at birth were the presence of diabetes [(5.9% vs. 0.49%, p=0.006); OR: 12.69; 95% IC: 1.51-106.93)] and cesarean delivery [(52.6% vs. 26.28%, p=0.00007); OR: 3.11 (95% IC: 1.86-5.20)]. Conclusion: After analyzing several risk factors described in the literature, the presence of diabetes is an important risk factor for low Apgar scores at 7 minutes, so special attention should be paid to patients with this pathology during peripartum care. Although termination via cesarean section was also reported as a risk factor, the procedure should be analyzed in the context of its causality, and further studies are needed to determine the relationship between the indication for the procedure and low Apgar score at 7 minutes. (provided by Infomedic Intl)

Editorial

Cuando un nombre aparece en el listado de autores de un determinado artículo científico, acepta de manera tácita las reglas del proceso de autoría. Su nombre, como coautor, indica que ha contribuido de manera significativa en el diseño, análisis y redacción del mismo. Si aparece como autor de correspondencia, no solo aplica todo lo anterior, sino que, además, será responsable de manejar todas las comunicaciones entre terceras personas y los autores, en los temas relacionados con la publicación. En los dos escenarios se espera que todos los autores hayan leído la versión final del artículo y, sobre todo, que estén de acuerdo con las conclusiones presentadas. Poner su nombre en un artículo no es la forma correcta de ganar créditos y, ciertamente, si alguien se le acerca y le ofrece poner su nombre en la lista de autores, con tal de una revisión rápida del manuscrito, le sugiero pensarlo dos veces. Recuerden que, al proceder de esta manera, aceptan cada palabra y conclusión presentada. Su nombre quedará ligado a un concepto plasmado en papel, que será distribuido entre pares para su escrutinio y posterior aplicación en el mundo real. El progreso de la ciencia depende de las investigaciones, pero, como en todo campo, siempre existirán personas más interesadas en la fama que en el progreso. Eviten quedar atrapados en una red de mentiras y fraudes, que no solo pondrán su prestigio en una balanza, sino que pueden ligarlos a un evento mayor con posibilidades de cambiar conductas. Cuando esto ocurre como resultado de un fraude científico, del impacto de un artículo inventado o manipulado, las consecuencias pueden ser duraderas y catastróficas. Desde la revista de la FECASOG incentivamos a todos los investigadores a ser transparentes en sus decisiones, a solo reclamar las contribuciones a las que tienen derecho y a mantener una comunicación clara entre todos los participantes. Solo así estaremos contribuyendo al avance de la ciencia y al beneficio que una investigación bien llevada y ejecutada puede representar.   (provisto por Infomedic International)

When a name appears in the list of authors of a given scientific article, it tacitly accepts the rules of the authorship process. His name, as co-author, indicates that he has contributed significantly to the design, analysis and writing of the article. If he/she appears as corresponding author, not only does all of the above apply, but he/she will also be responsible for handling all communications between third parties and the authors on issues related to the publication. In both scenarios, it is expected that all authors have read the final version of the article and, above all, that they agree with the conclusions presented. Putting your name on an article is not the right way to earn credit and certainly if someone approaches you and offers to put your name on the list of authors, for the sake of a quick review of the manuscript, I suggest you think twice. Remember that, by proceeding in this way, you accept every word and conclusion presented. Your name will be attached to a concept on paper, which will be distributed among peers for scrutiny and further application in the real world. The progress of science depends on research, but, as in any field, there will always be people more interested in fame than progress. Avoid getting caught in a web of lies and fraud, which will not only put your prestige in the balance, but may link you to a larger event with the potential to change behavior. When this occurs as a result of scientific fraud, the impact of a fabricated or manipulated article, the consequences can be long-lasting and catastrophic.From the FECASOG journal we encourage all researchers to be transparent in their decisions, to only claim the contributions to which they are entitled and to maintain clear communication among all participants. Only in this way will we be contributing to the advancement of science and to the benefit that a well conducted and executed research can represent. (provided by Infomedic International)

Preoperative vaginal cleansing with chlorhexidine vs placebo in patients with rupture of membranes: a prospective, randomized, double-blind, placebo-control study.

BACKGROUND: XXX OBJECTIVE: This study aimed to demonstrate that vaginal cleansing with a 4% chlorhexidine solution before cesarean delivery in patients with a history of rupture of membranes prevents postoperative infectious complications (endometritis, surgical site infections). STUDY DESIGN: A total of 204 patients with premature rupture of membranes or who were in labor for more than 6 hours after membranes ruptured were randomized before a cesarean delivery to preoperative vaginal cleansing with a chlorhexidine solution (n=97 patients) or to placebo cleansing with saline solution (n=107 patients). The management of the rupture of membranes and the cesarean delivery procedure were conducted according to standard local protocols for both groups, including the use of antibiotics. RESULTS: Vaginal cleansing with chlorhexidine reduced the risk for endometritis after cesarean delivery in patients with rupture of membranes when compared with placebo cleansing (chlorhexidine, 7.21% vs placebo, 18.8%; relative risk, 0.39; 95% confidence interval, 0.17-0.87; P=.015). Likewise, there was a statistically significant reduction in the number of cases of puerperal fever (chlorhexidine, 9.28% vs placebo, 19.8%; relative risk, 0.47; 95% confidence interval, 0.23-0.98; P=.037). There was a statistical difference between the groups in prolongation of hospitalization for >72 hours (chlorhexidine, 1.03% vs placebo, 7.55%; relative risk, 0.14; 95% confidence interval, 0.02-1.08; P=.02), although the confidence interval suggests that the effect was by chance. There were no statistical differences in surgical site infection at 7 days (chlorhexidine, 1.03% vs placebo, 0.94%; relative risk, 1.1; 95% confidence interval, 0.07-17.4; P=.94) and 15 days after the procedure (chlorhexidine, 1.03% vs placebo, 0%; relative risk, 3.31 [using a continuity correction]; 95% confidence interval, 0.14-80.21; P=.29). CONCLUSION: The use of chlorhexidine for vaginal cleansing before a cesarean delivery in patients with rupture of membranes reduced the risk for endometritis and puerperal fever. It also reduced the number of cases that required hospitalization for more than 3 days, but the confidence interval suggests that it could be by chance. It has no effect on the number of cases with surgical site infection.

Periviabilidad neonatal

La prematuridad es la primera causa de muerte a nivel mundial en menores de 5 años. Aquellos que logran sobrevivir y adaptarse a la vida extrauterina, según el grado de afección, pueden verse condenados a una larga vida de discapacidades y a una calidad de vida reducida. Cuando el parto pretérmino es extremadamente temprano, el grado de compromiso es mucho mayor. Eso obliga al médico tratante a plantearse dos escenarios: ser agresivo y darle todas las oportunidades al neonato, con la esperanza de que sobreviva sin un compromiso mayor, o darle un manejo de soporte mínimo, aceptando que la posibilidad de muerte es elevada y el riesgo de discapacidad demasiado alto como para condenar a todo el núcleo familiar a lidiar con el problema. La decisión no es fácil, ya que los médicos tienen visiones diferentes del problema, algunas veces sustentado en información errónea. Con este motivo en mente se hace una revisión del tema de periviabilidad y nos centramos en mostrar evidencia de los resultados a corto, mediano y largo plazo de estos neonatos. (provisto por Infomedic International)

Prematurity is the leading cause of death worldwide in children under 5 years of age. Those who manage to survive and adapt to extrauterine life, depending on the degree of the condition, may be condemned to a long life of disabilities and reduced quality of life. When the delivery is extremely preterm, the degree of compromise is much greater. In these cases, the attending physician should consider two scenarios: to be aggressive and give the newborn every chance, in the hope that he or she will survive without major compromise, or to provide minimal supportive management, accepting that the possibility of death is high and the risk of disability too great to condemn the entire family to deal with the problem. The decision is not easy, since physicians have different views of the problem, sometimes based on erroneous information. With this in mind, we review the issue of periviability, showing evidence of the short, medium and long term outcomes of these neonates. (provided by Infomedic International)

Patrón sinusoidal

Paciente de 26 años, G5P1O3 con gestación de 30 semanas. Hospitalizada a las 25 semanas por isoinmunización Rh, con títulos de Anti-D de 1:1024. Se le realizó dos transfusiones intrauterinas, con mejoría de los resultados de pico sistólico de la arteria cerebral media en la ultrasonografía doppler. Se complementó el manejo con uso de globulina inmune intravenosa y plasmaféresis, para reducir los títulos de anticuerpos circulantes. A pesar del manejo, a las 48 horas de la última transfusión y con elevación de títulos de anticuerpos a 1:512, presentó el siguiente trazo (Figura 1), que cumplía todos los criterios de un patrón sinusoidal.             El patrón sinusoidal es un trazo regular, suave, oscilante en forma de onda sinusoidal que se presenta con una frecuencia de dos a cinco ciclos por minutos y una amplitud en el rango de cinco a quince latidos por minuto. También se caracteriza con una frecuencia cardiaca fetal basal estable entre 120-160 latidos por minuto y ausencia de la variabilidad. Se asocia a anemia fetal severa o a hipoxia severa. (provisto por Infomedic International)

Patient 26 years old, G5P1O3 with gestation of 30 weeks. Hospitalized at 25 weeks due to Rh isoimmunization, with Anti-D titers of 1:1024. She underwent two intrauterine transfusions, with improvement of the results of the systolic peak of the middle cerebral artery in the Doppler ultrasonography. Management was complemented with intravenous immune globulin and plasmapheresis to reduce circulating antibody titers. Despite management, 48 hours after the last transfusion and with elevation of antibody titers to 1:512, she presented the following tracing (Figure 1), which met all the criteria of a sinusoidal pattern. The sinusoidal pattern is a regular, smooth, oscillating sine wave-shaped tracing that occurs with a frequency of two to five cycles per minute and an amplitude in the range of five to fifteen beats per minute. It is also characterized by a stable basal fetal heart rate between 120-160 beats per minute and absence of variability. It is associated with severe fetal anemia or severe hypoxia. (provided by Infomedic International)

Editorial

La publicación de artículos científicos sigue una serie de lineamientos que todos los autores deben cumplir. Cada revista tiene sus peculiaridades en cuanto a formato de presentación, pero los principios que rigen el fondo son similares en todo el mundo. La revista de la Federación se ha esforzado en adaptarse a los principios establecidos por grupos internacionales, como el Comité Internacional de Editores de Revistas Médicas, con el propósito de asegurar la calidad de los artículos que son publicados y que representan el rostro de la revista.

The publication of scientific articles follows a series of guidelines that all authors must comply with. Each journal has its own peculiarities in terms of submission format, but the principles that govern the substance are similar throughout the world. The Federation's journal has endeavored to adapt to the principles established by international groups, such as the International Committee of Medical Journal Editors, in order to ensure the quality of the articles that are published and that represent the face of the journal.

Presentación de cara

Paciente de 25 años, G1P0 con gestación de 38 semanas. Acude en labor de parto con dilatación completa y presentación de cara. Se pasa a expulsivo y se atiende parto vaginal de producto en presentación cefálica de cara, variedad mento anterior. Nace producto masculino, apgar 9/9, peso 3200g. Evolución neonatal satisfactoria. (provisto por Infomedic International)

Patient 25 years old, G1P0 with gestation of 38 weeks. She went into labor with complete dilatation and face presentation. She went into labor and vaginal delivery of a product in cephalic presentation of the face, anterior mento variety. Male product was born, apgar 9/9, weight 3,200g. Satisfactory neonatal evolution. (provided by Infomedic International)

Pancreatitis por hipertrigliceridemia en el embarazo

La pancreatitis aguda es una causa rara de dolor abdominal durante el embarazo, puede ser potencialmente mortal para la madre y el feto. Se presenta con mayor frecuencia durante el tercer trimestre debido a un aumento progresivo de los triglicéridos y el colesterol como cambios fisiológicos del embarazo. Sin embargo, estos niveles no logran sobrepasar los 300 mg/dL; pacientes con niveles de triglicéridos por encima de 1000 mg/dL están en riesgo incrementado de desarrollar pancreatitis severa. Los criterios diagnósticos y protocolos de manejo no son específicos para esta patología durante el embarazo. El Tratamiento con aféresis puede ser usado como manejo primario durante el embarazo logrando una disminución rápida y segura de los niveles plasmáticos de triglicéridos. (provisto por Infomedic International)

Acute pancreatitis is a rare cause of abdominal pain during pregnancy, it can be life threatening for the mother and fetus. It occurs more frequently during the third trimester due to a progressive increase in triglycerides and cholesterol as physiological changes in pregnancy. However, these levels do not exceed 300 mg / dL; patients with triglyceride levels above 1000 mg / dL are at increased risk of developing severe pancreatitis. The diagnostic criteria and management protocols are not specific for this pathology during pregnancy. Treatment with apheresis can be used as primary management during pregnancy, achieving a rapid and safe decrease in plasma triglyceride levels. (provided by Infomedic International)

Editorial

La pandemia tuvo un impacto innegable en todos los niveles de nuestra vida, pero sus efectos perdurarán mucho más allá del esperado fin de la misma. La llegada del SARS-CoV2 impulsó un cambio en el modo de hacer medicina, empujándolo hacia la transformación y adaptación digital a una velocidad que nadie tenía planeado. Lo que debió tomar años se convirtió en una carrera de semanas o días y sus consecuencias serán motivo de estudio y análisis en el futuro por venir. Tomemos, por ejemplo, qué hace el paciente promedio cuando tiene un problema de salud. En la última década la atención a nivel hospitalario se elevó un 30%. En lugar de buscar ayuda en el nivel primario, no era raro que el paciente acudiera al cuarto de urgencia de un hospital para encontrar la solución de sus dolencias, sobrecargando un sistema ya saturado. Eso, sin tomar en cuenta, que estamos enfocados en solucionar el problema, en lugar de prevenirlo. Con la llegada de la pandemia, el acudir al hospital se redujo notablemente, por el miedo al contagio entre muchas otras razones. La atención cambió a un modo virtual, la prevención tomó preponderancia y los hospitales regresaron a la función para la cual fueron diseñados. La atención de pacientes complicados que ameritan los servicios de un segundo, tercer o cuarto nivel. Si este cambio será algo permanente o una respuesta temporal a una situación puntual, queda por ver. Esperemos que los gobiernos aprovechen la coyuntura generada por una situación insospechada, para promover las agendas que beneficien en mayor medida a la población. Estos proyectos a corto y largo plazo deben enfocarse, no solo en la atención de salud, sino en todos los niveles. La educación médica, aprovechando el auge de las nuevas plataformas virtuales, y la investigación son solo unas de las tantas áreas abandonadas o relegadas a segundo plano y que la situación vivida nos ha llevado a considerar bajo un nuevo prisma. El de aceptar, como en el caso de la atención primaria, que la clave está en prevenir y no en tratar cundo ya el problema toca a nuestras puertas. (provisto por Infomedic International)

The pandemic had an undeniable impact on all levels of our lives, but its effects will linger far beyond its expected end. The arrival of SARS-CoV2 prompted a change in the way medicine is done, pushing it toward digital transformation and adaptation at a speed that no one had planned. What should have taken years became a race of weeks or days, and its consequences will be cause for study and analysis in the future to come.Take, for example, what the average patient does when he or she has a health problem. In the last decade, care at the hospital level has increased by 30%. Instead of seeking help at the primary level, it was not uncommon for patients to go to the emergency room of a hospital to find a solution to their ailments, overloading an already saturated system. This, without taking into account that we are focused on solving the problem, instead of preventing it. With the arrival of the pandemic, going to the hospital was significantly reduced, due to the fear of contagion among many other reasons. Care shifted to a virtual mode, prevention took precedence and hospitals returned to the function for which they were designed. The care of complicated patients who require the services of a second, third or fourth level. Whether this change will be permanent or a temporary response to a specific situation remains to be seen. Let us hope that governments take advantage of the situation generated by an unsuspected situation to promote agendas that will benefit the population to a greater extent. These short- and long-term projects should focus not only on health care, but on all levels. Medical education, taking advantage of the boom in new virtual platforms, and research are just some of the many areas that have been abandoned or relegated to the background and that the situation we have experienced has led us to consider under a new prism. That of accepting, as in the case of primary care, that the key is to prevent and not to treat when the problem is already knocking on our doors.   (provided by Infomedic International)

Restless Legs Syndrome and Severe Preeclampsia: A Case-Control Study.

OBJECTIVE: This study sought to determine whether there is an association between restless legs syndrome (RLS) and severe preeclampsia using a case-control study design. METHODS: A total of 147 patients with severe preeclampsia and 147 patients with normal pregnancies were evaluated for symptoms of RLS. In the first phase, before or immediately after delivery, participants were given a questionnaire on common complaints experienced during pregnancy. Mixed with these complaints were the symptoms that comprised the diagnostic criteria for RLS. If a participant indicated she met the diagnositic criteria, she was informed about RLS. In the second phase, a severity evaluation was performed in this population using the International Restless Legs Syndrome Study Group Rating Scale. RESULTS: Among the participants, independent of the presence of preeclampsia, 13.61% met the criteria for a diagnosis of RLS. There was no statistical difference between groups (severe preeclampsia: 12.93% vs. controls: 14.29%; odds ratio [OR] 0.89; 95% CI 0.46-1.74, P = 0.37). After analysis, 65% of patients with RLS had a score on the International Restless Legs Syndrome Study Group Rating Scale compatible with "very severe" or "severe" RLS. There was again no statistical difference between groups for the combination of "severe" and "very severe" scoring criteria (severe preeclampsia: 68.42% vs. controls: 61.90%; OR 1.33; 95% CI 0.36-4.93, P = 0.66) and "very severe" alone (severe preeclampsia: 21.05% vs. controls: 4.76%; OR 5.33; 95% CI 0.54-52.73, P = 0.11). CONCLUSION: The prevalence of RLS among pregnant women in our study was in accordance with the medical literature and avoided the probable bias caused by the high number of other symptoms experienced during pregnancy. There were no significant differences between normotensive participants and those with severe preeclampsia. In general, symptom severity was high, with a tendency toward greater severity in patients with severe preeclampsia, but this difference did not reach statistical significance.