Systematic review of prostaglandin analogues for retained placenta.

BACKGROUND: Medical management of retained placenta could be a safe alternative to manual removal. OBJECTIVE: To evaluate the efficacy of prostaglandin analogues for retained placenta. SEARCH STRATEGY: MEDLINE, EMBASE, CENTRAL, ICTRP, LILACS, and OpenSIGLE were searched without language restrictions from inception to January 31, 2017, by combining terms for retained placenta and prostaglandin analogues. SELECTION CRITERIA: Randomized controlled trials comparing prostaglandin analogues with any other intervention. DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses. GRADE was used to evaluate the quality of data. MAIN RESULTS: Seven randomized controlled trials (851 patients) were included. Prostaglandins did not increase the placenta expulsion rate (relative risk [RR] 1.40, 95% confidence interval [CI] 0.83-2.36) or decrease maternal transfusion (RR 0.72, 95% CI 0.43-1.22). In comparison with oxytocin, prostaglandins did not modify the expulsion rate (RR 1.26, 95% CI 0.90-1.78), maternal transfusion (RR 1.05, 95% CI 0.27-4.09), or time for delivery of placenta (mean difference -1.56 minutes, 95% CI, -9.25-6.13). Three trials comparing prostaglandins with oxytocin agonists, ergometrine, and manual removal reported similar results. CONCLUSIONS: Prostaglandin analogues do not offer an effective alternative for management of retained placenta.

Serum Adipsin Levels throughout Normal Pregnancy and Preeclampsia.

Adipsin is a protease produced at high levels by adipose tissue. It is involved in complement activation and metabolic control. The objective of this study was to determine the changes in adipsin levels during different stages of normal pregnancy, and its association with obstetric outcomes, such as preeclampsia. This nested case-control study in a longitudinal cohort included normal pregnant (n = 54) and preeclamptic (n = 18) women, both followed throughout pregnancy. Additionally, some of the normal pregnant women were followed up three months postpartum (n = 18). Healthy non-pregnant women were also studied during their menstrual cycle (n = 20). The results of this study show that in healthy non-pregnant women, adipsin levels did not change significantly during the menstrual cycle. In normal pregnant women, adipsin levels were lower (p < 0.01) when compared with non-pregnant healthy women, but these serum levels increased again during postpartum (p < 0.001). Adipsin levels were significantly elevated in preeclamptic women in late pregnancy (P < 0.01). A significant correlation was not found between leptin and adipsin during the three periods of gestation studied in healthy pregnant and preeclamptic women. Our results suggest that adipsin may be involved in pregnancy-associated metabolic changes. Moreover, the increase of adipsin levels towards late gestation in preeclamptic women could be related to the pathophysiology of this disease.

Características operativas del diagnóstico clínico con y sin pruebas de consultorio (ph y pruebas de aminas) para el diagnóstico de vaginosis bacteriana, en pacientes sintomáticas en Bogotá, Colombia / Operational characteristics of the clinical diagnosis in the office, with and without tests (pH and amine test), for diagnosing bacterial vaginosis in symptomatic patients in Bogotá, Colombia

Evaluar las características operativas del diagnóstico clínico (síntomas y signos) solo y con pruebas de diagnóstico en el consultorio (pH y prueba de aminas), teniendo como patrón de oro el puntaje de Nugent, para el diagnóstico de vaginosis bacteriana.Materiales y métodos: estudio de validez diagnóstica, ensamblado en un estudio de corte transversal en pacientes con síntomas de infección del tracto genital inferior, quienes consultaron a tres centros de Bogotá en 2010. Se calculó un tamaño de muestra de 1400 participantes. Se realizó un muestreo secuencial. Se tomaron muestras de la pared vaginal para medición de pH, prueba de aminas y tinción de Gram para puntaje de para puntaje de Nugent, considerado como patrón de oro de la entidad. Las bacteriólogas estaban enmascaradas con respecto al diagnóstico clínico y a las pruebas de consultorio. Se midieron la sensibilidad y especificidad, razón de probabilidades RP (+) y RP (-). Se presentan como proporciones con su respectivo intervalo de confianza del 95%.Resultados: la prevalencia de VB fue de 39.6 %, las características operativas de las pruebas con sus respectivos IC 95 %, con el puntaje de Nugent como patrón de oro, fueron: diagnóstico clínico, sensibilidad 75 % (71-78), especificidad 54 % (51-57), pH≥ 5 sensibilidad 99,3 % (98,2-99.8), especificidad 0,57 % (0,2-1,3); prueba de aminas, sensibilidad 99,3 % (98,2-99,8 %), especificidad 99,8 % (99,2-100 %); diagnóstico clínico, más prueba de aminas,más pH ≥ 5,0, sensibilidad 74 % (71-78), especificidad 100 % (99-100).Conclusiones: el diagnóstico clínico es una estrategia sensible para el diagnóstico de VB; la especificidad mejora cuando se combina con la prueba de aminas y el pH vaginal. La prueba de aminas presentó excelente sensibilidad y especificidad, y es útil para mejorar el diagnóstico de VB...

To assess the operational characteristics of the clinical diagnosis (signs and symptoms) alone and with diagnostic tests in the office (pH and amine test), using the Nugent score as the gold standard for diagnosing bacterial vaginosis.Materials and methods: Diagnostic validity study assembled in a cross sectional study in patients with symptoms of lower genitourinary tract infection seen in 3 centres in Bogota in 2010. The calculated sample size was 1400 participants, and a sequential sampling was used. Samples were taken from the vaginal wall for pH measurement, amine test and Gram staining in order to derive the Nugent score, considered the gold standard in this disease. The lab technicians were blinded to the clinical diagnosis and to the office tests. Sensitivity, specificity ad odds ratio OR (+) and OR (-) were measured, and they are presented as proportions with their respective 95% confidence intervals.Results: The prevalence of bacterial vaginosis was 39.6 %, and the operational characteristics of the tests with their respective 95 % CI were as follows: sensitivity and specificity of the clinical diagnosis were 75 % (71-78) and 54 % (51-57), respectively; sensitivity and specificity of pH ≥ 5 were 99.3 % (98.2-99.8), and 0.57 % (0.2-1.3); amine test sensitivity 99.3 % (98.2-99.8 %) and specificity 99.8 % (99.2-100 %); clinical diagnosis plus amine test and pH ≥ 5.0, sensitivity 74 % (71-78), specificity 100 % (99-100).Conclusions: Clinical diagnosis showed a good sensitivity for diagnosing strategy for diagnosing bacterial vaginosis; specificity is improved when clinical findings are combined with amine test and vaginal pH. The amine test was shown to have excellent sensitivity and specificity, and it is useful to improve the diagnosis of bacterial vaginosis...

Maternal Serum Meteorin Levels and the Risk of Preeclampsia.

BACKGROUND: Meteorin (METRN) is a recently described neutrophic factor with angiogenic properties. This is a nested case-control study in a longitudinal cohort study that describes the serum profile of METRN during different periods of gestation in healthy and preeclamptic pregnant women. Moreover, we explore the possible application of METRN as a biomarker. METHODS AND FINDINGS: Serum METRN was measured by ELISA in a longitudinal prospective cohort study in 37 healthy pregnant women, 16 mild preeclamptic women, and 20 healthy non-pregnant women during the menstrual cycle with the aim of assessing serum METRN levels and its correlations with other metabolic parameters. Immunostaining for METRN protein was performed in placenta. A multivariate logistic regression model was proposed and a classifier model was formulated for predicting preeclampsia in early and middle pregnancy. The performance in classification was evaluated using measures such as sensitivity, specificity, and the receiver operating characteristic (ROC) curve. In healthy pregnant women, serum METRN levels were significantly elevated in early pregnancy compared to middle and late pregnancy. METRN levels are significantly lower only in early pregnancy in preeclamptic women when compared to healthy pregnant women. Decision trees that did not include METRN levels in the first trimester had a reduced sensitivity of 56% in the detection of preeclamptic women, compared to a sensitivity of 69% when METRN was included. CONCLUSIONS: The joint measurements of circulating METRN levels in the first trimester and systolic blood pressure and weight in the second trimester significantly increase the probabilities of predicting preeclampsia.

Imiquimod for anogenital warts in non-immunocompromised adults.

BACKGROUND: 30% of people with anogenital warts (AGW) have spontaneous regression of lesions but there is no way to determine whether a specific lesion will remain. There are a wide range of options available for treating people with AGW and selection is based on clinician's experience, patient preferences and adverse effects. The imiquimod could offer the advantages of patient-applied therapies without incurring the limitations of provider-administered treatments. OBJECTIVES: To assess the effectiveness and safety of imiquimod for the treatment of AGW in non-immunocompromised adults. SEARCH METHODS: We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (15 April 2014), CENTRAL (1991 to 15 April 2014), MEDLINE (1946 to 15 April 2014), EMBASE (1947 to 15 April 2014), LILACS (1982 to 15 April 2014), World Health Organization International Clinical Trials Registry (ICTRP) (15 April 2014), ClinicalTrials.gov (15 April 2014), Web of Science (2001 to 15 April 2014) and OpenGrey (15 April 2014). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing the use of imiquimod with placebo, any other patient-applied or any other provider-administered treatment (excluding interferon and 5-fluorouracil which are assessed in other Cochrane Reviews) for the treatment of AGW in non-immunocompromised adults. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: Ten RCTs (1734 participants) met our inclusion criteria of which six were funded by industry. We judged the risk of bias of the included trials as high. Six trials (1294 participants) compared the use of imiquimod versus placebo. There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression (RR 4.03, 95% CI 2.03 to 7.99; RR 2.56, 95% CI 2.05 to 3.20, respectively). When compared with placebo, the effects of imiquimod on recurrence (RR 2.76, 95% CI 0.70 to 10.91), appearance of new warts (RR 0.76, 95% CI 0.58 to 1.00) and frequency of systemic adverse reactions (RR 0.91, 95% CI 0.63 to 1.32) were imprecise. We downgraded the quality of evidence to low or very low. There was low quality evidence that imiquimod led to more local adverse reactions (RR 1.73, 95% CI 1.18 to 2.53) and pain (RR 11.84, 95% CI 3.36 to 41.63).Two trials (105 participants) compared the use of imiquimod versus any other patient-applied treatment (podophyllotoxin and podophyllin). The estimated effects of imiquimod on complete regression (RR 1.09, 95% CI 0.80 to 1.48), partial regression (RR 0.77, 95% CI 0.40 to 1.47), recurrence (RR 0.49, 95% CI 0.21 to 1.11) or the presence of local adverse reactions (RR 1.24, 95% CI 1.00 to 1.54) were imprecise (very low quality evidence). There was low quality evidence that systemic adverse reactions were less frequent with imiquimod (RR 0.30, 95% CI 0.09 to 0.98).Finally, two trials (335 participants) compared imiquimod with any other provider-administered treatment (ablative methods and cryotherapy). There was very low quality of evidence that imiquimod did not have a lower frequency of complete regression (RR 0.84, 95% CI 0.56 to 1.28). There was very low quality evidence that imiquimod led to a lower rate of recurrence during six-month follow-up (RR 0.24, 95% CI 0.10 to 0.56) but this did not translate in to a lower recurrence from six to 12 months (RR 0.71, 95% CI 0.40 to 1.25; very low quality evidence). There was very low quality evidence that imiquimod was associated with less pain (RR 0.30, 95% CI 0.17 to 0.54) and fewer local reactions (RR 0.55, 95% CI 0.40 to 0.74). AUTHORS' CONCLUSIONS: The benefits and harms of imiquimod compared with placebo should be regarded with caution due to the risk of bias, imprecision and inconsistency for many of the outcomes we assessed in this Cochrane Review. The evidence for many of the outcomes that show imiquimod and patient-applied treatment (podophyllotoxin or podophyllin) confer similar benefits but fewer systematic reactions with the Imiquimod, is of low or very low quality. The quality of evidence for the outcomes assessing imiquimod and other provider-administered treatment were of very low quality.

Prostaglandins for management of retained placenta.

BACKGROUND: Retained placenta affects 0.5% to 3% of women following delivery and it is a major cause of maternal death due to postpartum haemorrhage. Usually, retained placenta has been managed by manual removal or curettage under anaesthesia, which may be associated with haemorrhage, infection and uterine perforation. Medical management to facilitate the delivery of the retained placenta could be a safe alternative avoiding surgical intervention. OBJECTIVES: To assess the effectiveness and safety of prostaglandins for the management of retained placenta. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013), LILACS (1982 to 1 December 2013), SciELO (1998 to 1 December 2013), Web of Science (2001 to 1 December 2013), openSIGLE (1997 to 1 December 2013), World Health Organization International Clinical Trials Registry Platform (ICTRP) (1 December 2013) and the metaRegister of Controlled Trials (mRCT) (1 December 2013). We also contacted authors of included studies and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled clinical trials comparing the use of prostaglandins (or prostaglandin analogues) with placebo, expectant management, tocolytic drugs, any other prostaglandins or surgical interventions for the management of retained placenta after vaginal delivery of singleton live infants of 20 or more weeks of gestation. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. Any disagreements were resolved through consensus or consultation with a third review author when required. Authors of the included studies were contacted for additional information. MAIN RESULTS: We included three trials, involving 244 women. The studies were considered to be at high risk of bias.The prostaglandins used were PG E2 analogue (sulprostone) in 50 participants and PG E1 analogue (misoprostol) in 194 participants at a dose of 250 mcg and 800 mcg respectively. The prostaglandins compared with placebo, were not superior in reducing the rate of manual removal of placenta (average risk ratio (RR) 0.82; 95% confidence interval (CI) 0.54 to 1.27), severe postpartum haemorrhage (RR 0.80; 95% CI 0.55 to 1.15), need for blood transfusion (RR 0.72; 95% CI 0.43 to 1.22), mean blood loss (mean difference (MD) -205.26 mL; 95% CI -536.31 to 125.79, random-effects) and the mean time from injection to placental removal (MD -7.00 minutes; 95% CI -21.20 to 7.20). Side-effects were no different between groups (vomiting, headache, pain and nausea between injection and discharge from the labour ward), with the exception of shivering, which was more frequent in women receiving prostaglandins (RR 10.00; 95% CI 1.40 to 71.49). We did not obtain any data for the primary outcomes of maternal mortality and the need to add another therapeutic uterotonic. AUTHORS' CONCLUSIONS: Currently there is limited, very low-quality evidence relating to the effectiveness and the safety using prostaglandins for the management of retained placenta. Use of prostaglandins resulted in less need for manual removal of placenta, severe postpartum haemorrhage and blood transfusion but none of the differences reached statistical significance. Much larger, adequately powered studies are needed to confirm that these clinically important beneficial effects are not just chance findings.Similarly, no differences were detected between prostaglandins and placebo in mean blood loss or the mean time from injection to placental removal (minutes) or side-effects (vomiting, headache, pain and nausea between injection and discharge from the labour ward) except for 'shivering' which was more frequent in women who received prostaglandin. The included studies were of poor quality and there is little confidence in the effect estimates; the true effect is likely to be substantially different. We can not make any recommendations about changes to clinical practice. More high-quality research in this area is needed.

Irisin levels during pregnancy and changes associated with the development of preeclampsia.

CONTEXT: Irisin is a recently discovered adipomyokine that regulates the differentiation and phenotype of adipose tissue. OBJECTIVE: In this study, we investigated the levels of irisin over the three trimesters of gestation in healthy and preeclamptic women and during the follicular and luteal phase of the menstrual cycle in a cohort of healthy eumenoherric women. METHODS: Serum irisin was measured by an ELISA in a longitudinal prospective cohort study in 40 healthy pregnant women, 10 mild preeclamptic women, and 20 healthy eumenoherric women during the menstrual cycle to assess irisin levels and correlations with other metabolic parameters. We identified the protein expression of fibronectin type III domain-containing protein 5, the irisin precursor, in human placenta using immunohistochemical approaches in humans. RESULTS: Serum irisin levels are higher in the luteal than in the follicular phase in eumenorrheic women. Fibronectin type III domain-containing protein 5, the irisin precursor, is expressed in human placenta, and its serum levels are higher during the entire pregnancy when compared with nonpregnant women. Serum irisin correlates positively with the homeostasis model assessment of estimated insulin resistance in the first trimester of normal pregnancy. Serum irisin levels do not change throughout gestation in preeclamptic women; however, there were lower irisin levels during the third trimester when compared with the normal pregnant group. CONCLUSION: Our results suggest that irisin may be involved in reproductive function and in the pregnancy-associated metabolic changes, and this condition may be an irisin-resistant state during gestation.

Brain-derived neurotrophic factor is expressed in rat and human placenta and its serum levels are similarly regulated throughout pregnancy in both species.

OBJECTIVE: Pregnancy is characterized by several metabolic changes that promote fat gain and later onset of insulin resistance. As Brain-derived neurotrophic factor (BDNF) decreases hyperglycaemia and hyperphagia, we aimed to investigate the potential role of placental and circulating BDNF levels in these pregnancy-related metabolic changes in rats and humans. DESIGN AND METHODS: We identified the mRNA and protein expression of placental BDNF and its receptor TrkB using real-time PCR, Western blot and immunohistochemical approaches in both rat and humans. Serum BDNF was measured by ELISA. We also did a longitudinal prospective cohort study in 42 pregnant women to assess BDNF levels and correlations with other metabolic parameters. RESULTS: We found that BDNF and TrkB are expressed in both rat and human placenta. In rat, both placental mRNA and serum levels are increased throughout pregnancy, whereas their protein levels are significantly decreased at the end of gestation. Serum BDNF levels in pregnant women are significantly lower in the first trimester when compared to the second and third trimester (P < 0·0148, P < 0·0012, respectively). Serum BDNF levels were negatively correlated with gestational age at birth and fasting glucose levels. CONCLUSION: Our findings suggest that both BDNF and its receptor TrkB are expressed in rodent and human placenta being regulated during pregnancy. Taken together, these findings support a role of BDNF in the regulation of several metabolic functions during pregnancy.

Serum chemerin levels during normal human pregnancy.

During gestation there are important changes in maternal metabolism and an increase in insulin resistance, coinciding with an increase in adiposity. Chemerin is an adipocytokine which is expressed and secreted in various tissues, including placenta, and may play an important role in metabolic regulation during pregnancy. The aim of this study was to determine serum levels of chemerin during gestation and compare them to other indicators of insulin resistance. A cross-sectional study was carried out analyzing serum chemerin levels of 20 pregnant women during three gestational periods, early, middle, and late (between the 10th and 14th, the 23rd and 26th, and the 34th and 37th week) and 20 non-pregnant women were used as a control group. An analysis of chemerin levels during the menstrual cycle was performed in an eumenorrheic group (n=16) in the early follicular (cycle day 4±1) and the midluteal phase (cycle day 22±1), demonstrating that serum chemerin levels did not fluctuate significantly. Serum levels of chemerin were significantly elevated during late gestation when compared to early (P<0.001) and middle (P=0.001) gestation and a negative correlation between serum chemerin and adiponectin levels (r=-0.1643) became more significant when the non-pregnant group was included in the calculations (r=-0.2471). There was no significant association of triglycerides, total cholesterol, LDL, HDL, insulin, and HOMA levels with chemerin. Although chemerin rose significantly and is negatively associated with adiponectin levels, it is not correlated with other markers of insulin sensitivity, suggesting that more study is needed to determine whether chemerin is useful in predicting insulin resistance during gestation.

Unplanned reoperations: is emergency surgery a risk factor? A cohort study.

BACKGROUND: Unplanned reoperations have been proposed as a quality indicator in surgery but have not been studied extensively, especially concerning risk factors. METHODS: This was a prospective cohort study in a third-level general surgery service. Data regarding patients operated on between July 2007 and February 2008 and followed up for 30 postoperative days were collected. Unplanned reoperations were the primary end point. The secondary end points were 30-d mortality and length of stay. A multivariate logistic regression analysis evaluated the hypothesis that patients operated on in emergency conditions had a greater chance of being reoperated on, after adjusting for relevant covariates. RESULTS: There was a 5.9% cumulative incidence of unplanned reoperations. Patients operated on in emergency conditions had a 1.79 crude relative risk (RR) (95% confidence interval [CI], 1.15-2.78) of reoperation. Reoperated patients' RR of mortality was 8.94 (95% CI, 6.11-13.07). The mean postoperative hospital stay was 3d for patients who were not reoperated on and 19d for those who were reoperated on (P=0.00001). The logistic regression model gave a 2.83 odds ratio (95% CI, 1.65-4.87) for reoperation on emergency patients when adjusted for age, gender, body mass index, American Society of Anesthesiology classification, intraoperative inotropic use, and operation complexity. CONCLUSIONS: Tertiary general surgery service patients had a significantly increased risk of being reoperated on if the initial surgery was an emergency surgery compared with elective surgery. Unplanned reoperations led to a significantly increased mortality risk and a longer postoperative hospital stay, which could be regarded as warning signs in the care of surgical patients.

Prevalencia y factores asociados a la infección por C. trachomatis, N. gonorrheae, t. vaginalis, C. albicans, sífilis, VIH y vaginosis bacteriana en mujeres con síntomas de infección vaginal en tres sitios de atención de Bogotá, Colombia, 2010 / The prevalence of and factors associated with C. trachomatis, N. gonorrheae, t. vaginalis, C. albicans infection, syphilis, Hiv and bacterial vaginosis in females suffering lower genital tract infection symptoms in three healthcare attention sites in bogotá, colombia, 2010

Objetivo: estimar la prevalencia y etiología de las infecciones de transmisión sexual, y de las infecciones endógenas en mujeres en edad reproductiva con síntomas de infección del tracto genital inferior sintomáticas, y describir los factores asociados.Materiales y métodos: estudio de corte transversal en tres centros de atención en Bogotá. Se realizó el diagnóstico etiológico mediante puntaje de Nugent para vaginosis bacteriana (VB), cultivo para Candida, y frotis en fresco para trichomonas. En un subgrupo de pacientes se realizó cultivo In Pouch TM para T. vaginalis (TV), PCR para C. trachomatis (CT) y N. gonorroheae (NG), y pruebas serológicas para sífilis y VIH. Los factores de riesgo fueron evaluados comparando los dos grupos por medio del Odds Ratio (OR) y el intervalo de confianza del 95 por ciento. Resultados: 1385 mujeres fueron incluidas, de ellas 115 (8,3 por ciento) eran trabajadoras sexuales. Se confirmó la presencia de alguna infección del tracto genital (ITG) en 731 (52,7 por ciento) de las mujeres; 560 (40,4 por ciento) presentaron infecciones endógenas y 170 (12,3 por ciento) infecciones de transmisión sexual (ITS). La etiología más frecuente fue la VB en 549 (39,6 por ciento), seguida por candidiasis en 153 (11 por ciento). CT fue detectada en 134 (9,7 por ciento y NG en 19 (1,4 por ciento). TV fue detectada por frotis en fresco en 11 (0,8 por ciento) y por cultivo en 8 de 634 (1,2 por ciento), sífilis en 12 (0,8 por ciento) y VIH en 1 (0,07 por ciento). Las mujeres trabajadoras sexuales tuvieron mayor riesgo de presentar cualquier ITS (OR: 2,0; IC 95 por ciento 1,2-3,3). Las mujeres con ITS tuvieron una edad promedio de 27,9 (± 7,8), y aquellas que no tenían ITS de 31,9 (± 8,9) años. El consumo de licor con frecuencia entre diaria y semanal fue mayor en las mujeres con ITS (OR: 2,6; IC 95 por ciento: 1,4-4,5). Conclusiones: se identificó la etiología en el 52,7 por ciento de las mujeres que consultaron por síntomas de infección del tracto genital inferior. La infección más frecuente fue vaginosis bacteriana, y clamidia dentro de la infecciones de transmisión sexual. No se identificó ninguna etiología infecciosa específica en el 47,3 por ciento de las mujeres aun cuando se utilizó el patrón de oro diagnóstico para los diferentes microorganismos.

Objective: Determining the prevalence and aetiology of sexually-transmitted infections and endogenous infections in women of childbearing age having lower genital tract infection symptoms and describing the pertinent risk factors. Materials and methods: This cross-sectional study was carried out at three outpatient healthcare centres in Bogotá, Colombia. Etiologic diagnosis was made using Nugent’s criteria for bacterial vaginosis, blood agar culture for Candida and wet mount for T. vaginalis. The In-pouch culture technique was used for T. vaginalis, the polymerase chain reaction for C. trachomatis and N. gonorroheae and serological tests for syphilis (RPR, TPHA) and HIV on a sample of the afore mentioned population. Results: 1,385 females were recruited in 2010. 115 (8.3 percent) were sex workers. An LGTI was confirmed in 731 (52.7 percent); 560 (40.4 percent) had an endogenous infection and 170 (12.3 percent) a sexually-transmitted infection (STI). The most frequent aetiology were bacterial vaginosis (39.6 percent), candidiasis (11 percent), C. trachomatis (9.7 percent) and N. gonorroheae (1.4 percent); Trichomona was detected by wet mount (0.8 percent) and culture (1.2 percent), as were syphilis (0.8 percent) and HIV (1 case). Sex workers had a higher risk of having an STI (2.0 OR; 1.2-3.3 95 percent CI), as were younger females (28 ± 7.8 cf 32 ± 8.9) (p = 0.001) and alcohol users (2.6 OR; 1.4-4.5 95 percent CI). Conclusions: Aetiology was identified for 52.7 percent of the females who consulted for lower genital tract infection symptoms; bacterial vaginosis was the most common and Chlamydia the most frequent sexually-transmitted infection. No specific aetiology was identified in almost the same number of females (47.3 percent), even when using gold-standard diagnostic technology for each microorganism.

Determinación de valores de referencia para la microtécnica de fagocitosis y muerte intracelular de Cándida álbicans en un grupo de población sana en Bogotá / Determination of reference values for the microtechnique of phagocytosis and intracellular death of Candida albicans in a group of healthy population in Bogota

La función de las células fagocíticas es un eficiente mecanismo de protección no específico contra agentes infecciosos y de eliminación de células muertas o seniles. Este proceso lo realizan células de la inmunidad innata como los macrófagos y los polimorfonucleares neutrófilos que son especialmente efectivos durante el inicio de infecciones por bacterias extracelulares Gram positivas y Gram negativas. Los macrófagos participan en etapas más tardías de la inflamación fagocitando bacterias y restos celulares. Las técnicas de evaluación de la capacidad fagocítica han mostrado ser muy laboriosas, requieren gran cantidad de muestra sanguínea y excesiva manipulación de las células analizadas. Por el contrario, la microtécnica de muerte intracelular de Cándida para el análisis de la función fagocítica es una técnica rápida, poco dispendiosa y que requiere de muy poca cantidad de sangre. En este trabajo se analizaron 56 muestras de personas sanas con la microtécnica de muerte intracelular de Candida albicans, para hallar valores normales del índice de fagocitosis y el porcentaje de muerte intracelular, indicadores que evalúan la capacidad fagocítica de los polimorfonucleares neutrófilos. El índice de fagocitosis fue de 2.70 +/- 0.43 (media +/ - DE) con un rango de 2.03 a 3.92 y el porcentaje de muerte Intracelular fue de 31.31 +/- 5.10 (media +/- DE) con un rango de 21 a 39. No hubo diferencias por grupos de edad, género, recuento de leucocitos o porcentaje de polimorfonucleares.