Resultados perinatales tras prueba diagnóstica invasiva en el embarazo / Perinatal outcomes after invasive diagnostic test in pregnancy

Introducción: Las técnicas invasivas de diagnóstico prenatal nos permiten realizar pruebas genéticas. El desarrollo de técnicas no invasivas ha reducido su uso. Clásicamente se ha afirmado que, tras realizar la técnica invasiva, la tasa de pérdida fetal se sitúa en torno al 1%. Los datos publicados son heterogéneos, y aunque todo indica que se ha sobrestimado el riesgo, necesitamos realizar nuevos estudios. Material y métodos: En nuestro estudio retrospectivo unicéntrico analizamos los procedimientos realizados mediante técnicas invasivas de diagnóstico prenatal entre 2011 y 2019, incluyendo 832 técnicas invasivas realizadas. Los resultados perinatales se comparan con el grupo control de mujeres embarazadas (n=1.734). Resultados: La tasa de pérdida fetal temprana para las diferentes técnicas fue de 1,1% para amniocentesis, del 1,6% para biopsia corial transvaginal y del 0,5% para biopsia corial abdominal, con una tasa total del 1,1%, sin diferencias estadísticamente significativas entre ellas (p=0,57). Encontramos diferencias en el desenlace fetal, en cuanto a la variable pérdida fetal temprana, en relación con los intentos realizados (cuando se hacían tres intentos aumentaba el riesgo). Al comparar los resultados perinatales posparto del grupo sometido a técnicas con el grupo control, se encontró una mayor tasa de cesáreas en el grupo estudio (28,9% vs 20,5%), además de una menor edad gestacional media al parto (38,33 vs. 38,95 semanas). Discusión: Cuando la técnica invasiva se realiza en el momento adecuado y con no más de dos intentos, consideramos que el riesgo de pérdida fetal no se ve afectado por su realización, siendo igual al de la población general.(AU)

Introduction: Invasive prenatal diagnostic techniques allow us to conduct genetic tests. The development of non-invasive techniques has reduced their use. The foetal loss rate following an invasive procedure is considered to be around 1%. The published data is heterogeneous however, although everything indicates that the risk has been overestimated, we need to conduct further studies. Material and methods: In our single-centre retrospective study we analysed the procedures carried out using invasive prenatal diagnostic techniques between 2011 and 2019. A total of 832 invasive techniques were performed. Perinatal results are compared with a control group of pregnant women (n=1734). Results: The early foetal loss rate for the different techniques were 1.1% for amniocentesis, 1.6% for transvaginal chorionic biopsy and 5% for abdominal chorionic biopsy, with a total rate of 1.1%, without statistically significant differences between them (P=.57). We found differences in foetal outcome, in terms of variable early foetal loss, related to the attempts made (when three attempts were made, the risk increased). When comparing the perinatal outcomes after delivery of the group that underwent techniques with the control group, a higher rate of caesarean sections was found in the study group (28.9% vs 20.5%), in addition to lower mean gestational age at delivery (38.33 vs. 38.95 weeks). Discussion: When the invasive technique is performed at the right time and with no more than two attempts, we consider that the risk of foetal loss is not affected, and is equal to that of the general population.(AU)

Effect of CHX on the decalcifying effect of 10% citric acid, 20% citric acid, or 17% EDTA.

The objective of this study was to measure the demineralization capacity of 10% and 20% citric acid and 17% EDTA after three time periods and to determine whether it was modified by the addition of 1% of commercial chlorhexidine (CHX). Three slices of 2-mm thickness were cut from the cervical third of the root of ten bovine incisors and sectioned into two equal parts, obtaining six specimens per tooth. Specimens were assigned to one of six groups (n = 10) for immersion in 25 ml of the above mentioned solutions or 25 ml of these same solutions plus 1% CHX (Hibimax). At 3, 10, and 15 min of immersion, the concentration of Ca2+ was measured by atomic absorption spectrophometry. The demineralization effect of all solutions was time-dependent (F = 158,448; p < 0.001), without significant differences among them (p = 0.783). Addition of 1% CHX did not modify the demineralizing capacity of these solutions. In the first three minutes, significantly more [Ca2+] was obtained when 17% EDTA was used in comparison with the other solutions.

Tratamiento empírico de las eosinofilias.Prevenir las complicaciones de la estrongiloidiasis / Empirical treatment of eosinophilas. Prevent the complications of srongyloidiasis

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Lumbalgia crónica en un paciente con síndrome de Marfan / Chronic lumbar pain in a patient with Marfan's syndrome

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[Suicide attempts attended at a health centre]. / Intentos de suicidio atendidos en un centro de salud.

OBJECTIVE: To describe the characteristics of the suicide attempts attended in a health district over 10 years (June 1989 to December 1998). DESIGN: Cross-sectional, descriptive study. SETTING: Primary care, rural health district.Patients. Everyone attended after a suicide attempt (55 cases). MAIN MEASUREMENTS AND RESULTS: Data of the following variables were obtained from the legal reports: sex, age, place of residence, prognosis, means used and year of attempt. 51% were women and 49% men. Average age was 34.07, SD 3.82. 96% occurred in the health district. 38% had light prognosis, 49% serious, 7% very serious and 4% uncertain. The means used was ingestion of drugs in 44% of cases. 72% of the attempts occurred in the last 5 years. CONCLUSIONS: There were no differences between the sexes. Most of the patients were under 35. Drug overdose was the method of choice. Suicide attempts are on the up. Primary care authorities and doctors need to become more conscious of potentially suicidal conduct.

Intentos de suicidio atendidos en un centro de salud / Suicide attempts attended at a health centre

Objetivo. Describir las características de los intentos de suicidio producidos y atendidos en una zona básica de salud (ZBS) en 10 años (junio 1989-diciembre 1998).Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria, zona básica de salud de un área rural. Pacientes. Todos aquellos atendidos por intento de suicidio (55 casos).Mediciones y resultados principales. Los datos se obtuvieron de los partes judiciales recogiendo las siguientes variables: sexo, edad, localidad de residencia, pronóstico, medios utilizados y año del intento. Un 51 por ciento era mujer y el 49 por ciento varón. La edad media fue 34,07 (DE, 3,82). La localidad de origen en un 96 por ciento fue la ZBS. Por lo que atañe al pronóstico, leves, 38 por ciento; graves, 49 por ciento; muy graves, 7 por ciento, y reservado, 4 por ciento. El medio utilizado fue en un 44 por ciento la ingesta de medicamentos. En los 5 últimos años ocurrió el 72 por ciento de los intentos. Conclusiones. No hay diferencias en cuanto a sexos. La mayoría de los sujetos eran menores de 35 años. El medio preferido fue, sobre todo, la ingesta de fármacos. Los intentos de suicidio constituyen un fenómeno en aumento. Es necesario concienciar a las autoridades y a los médicos de atención primaria para poder detectar posibles conductas suicidas. (AU)

[Agricultural occupation and strongyloidiasis. A case-control study]. / Actividad laboral agrícola y estrongiloidiasis. Estudio caso-control.

BACKGROUND: In the last few years, Strongyloides stercoralis has been repeatedly recovered from indigenous farmers in the Safor area (Valencia Community). The relationship between the different occupational activities, mainly farming, and the presence of strongyloidiasis was investigated. PATIENTS AND METHODS: A paired case-control study was designed. The investigation was conducted at Oliva Centro de Salud, from October 1997 to October 1999. Diagnosis was established when Strongyloides stercoralis was observed in any of the three serial fecal samples requested when eosinophilia was observed in the hemogram. Controls were persons matched by sex and age (+/- 5) years, with no eosinophilia in the hemogram and in whom the presence of the parasite was excluded in fecal samples. RESULTS: Participants in the study were 47 cases and their respective controls. Each group included 39 (83%) men and 8 (17%) women. Forty-five cases (95%) and 42 controls (89%) had been born in Safor. Only two cases had travelled to endemic areas. Farming was the main activity in 32 (68%) cases and 31 (66%) controls. The only occupational activity which showed influence on strongyloidiasis was working in ricefields, with an OR of 2.97 (95% CI: 1.16-7.71). Dermatologic symptoms were significant for pruritus, OR 7.39 (95% CI: 2.29-27.60). One case with hyperinfection and another with larva currens were diagnosed. CONCLUSION: In our area, working in ricefields and chronic pruritus are associated with chronic strongylodiasis.

Actividad laboral agrícola y estrongiloidiasis. Estudio caso-control / Farming occupation and strongyloidiasis. Case control study

Fundamento. En los últimos años Strongyloides stercoralis ha sido aislado repetidamente en agricultores autóctonos de la comarca de la Safor (Comunidad Valenciana). Se estudia la relación entre las distintas actividades laborales, principalmente las agrícolas, y la presencia de estrongiloidiasis.Sujetos y métodos. Se diseñó un estudio casocontrol apareado. El trabajo se ha desarrollado en el Centro de Salud de Oliva desde octubre de 1997 a octubre de 1999. En los casos el diagnóstico se estableció al observar Strongyloides stercoralis en alguna de las tres muestras seriadas de heces solicitadas ante la presencia de eosinofilias en el hemograma. Los controles eran personas de igual sexo y edad ñ 5 años, sin eosinofilia en el hemograma y en los que se excluyó la presencia del parásito en las muestras de heces. Resultados. Participaron 47 casos y sus respectivos controles. En cada grupo había 39 (83 por ciento) varones y 8 (17 por ciento) mujeres. Habían nacido en la Safor 45 (95 por ciento) casos y 42 (89 por ciento) controles. Sólo dos casos habían viajado a países endémicos. La agricultura era la actividad principal en 32 (68 por ciento) de los casos y en 31 (66 por ciento) de los controles. La única actividad en la que mostró influencias sobre la estrongiloidiasis fue el trabajo en arrozales, que obtuvo una odds ratio (OR) de 2,97 [intervalo de confianza (IC) 95 por ciento: 1,16-7,71]. Los síntomas dermatológicos resultaron significativos para el prurito, OR de 7,39 (IC 95 por ciento: 2,29-27,60). Fueron diagnosticados un caso con síndrome de hiperinfección y otro con larva currens. Conclusión. En nuestra zona el trabajo en arrozales y el prurito crónico muestran relación con la estrongiloidiasis crónica (AU)

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Mutagenicity of airborne particulate organic material from urban and industrial areas of São Paulo, Brazil.

The mutagenicity of airborne particulate matter at three different sites within the São Paulo urban area and the Cubatão industrial area, São Paulo State, Brazil, was evaluated using the Salmonella mutagenicity assay over a year's period (June 1990-May 1991). Total suspended particles (TSP) were collected using a Hi-vol sampler and extracted with methylene chloride by ultrasonication. Pooled seasonal extracts were tested using S. typhimurium TA98 and TA100 with and without metabolic activation (S9) and TA98NR and TA98/1,8-DNP6 without metabolic activation. Organic extracts of the samples with the highest monthly TSP concentration were also assayed for mutagenicity. All samples collected at São Paulo and Cubatão showed mutagenicity with strain TA98, and in general the addition of S9 did not modify the mutagenic response, suggesting the prevalence of direct-acting frameshift mutagens in the atmosphere of these sites. The mutagenicity detected in the urban areas of São Paulo (mainly downtown) was much higher than in the Cubatão industrial area and similar to the more urbanized cities in the world, where vehicle emissions are the major pollution source. Results obtained with the strains TA98NR and TA98/1,8-DNP6 suggested the presence of mononitro- and dinitroarenes contributed to the mutagenicity of these atmospheric samples. A seasonal variation was observed with higher levels of frameshift mutagens during Spring in São Paulo and Summer in Cubatão. During the Winter, more significant responses were found with strain TA100 in the presence of S9 at all sites. Monthly samples presented high levels of mutagenicity during the period of June to November. Results from this research provide support for Air Pollution Control Programs in the detection of the more potent organic mutagenic compounds in the atmosphere and may help in the establishment of priorities for control and regulatory actions.