Double Myelomeningocele Repair by Fetal Surgery with a Single Micro-Hysterotomy.

INTRODUCTION: Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system. It is associated with severe neurodevelopmental delay, motor impairment, hydrocephalus, and bowel and bladder dysfunction. In selected cases, intrauterine spina bifida repair has been shown to improve neonatal outcomes. Rarely, the spine can have a double defect compromising two different segments and there is a lack of evidence on the feasibility and benefits of intrauterine repair in these cases. CASE PRESENTATION: We present a case with both cervicothoracic and lumbosacral myelomeningocele, Arnold-Chiari malformation type II and bilateral ventriculomegaly, that was treated successfully at 25 weeks with open micro-neurosurgery. Double myelomeningocele was successfully treated through a single 2-cm micro-hysterotomy, by performing external versions to sequentially expose and repair both defects. Weekly postoperative follow-up showed no progression of ventriculomegaly or complications attributable to the procedure. Preterm rupture of membranes prompted a conventional cesarean delivery at 32 weeks of gestation. Neurodevelopmental outcome at 20 months was within normal ranges, having achieved ambulation without orthopedic support and with no need for ventriculoperitoneal shunting. CONCLUSION: This report demonstrates for the first time the feasibility of double OSB repair through a single 2-cm micro-hysterotomy, suggesting that selected isolated cases of double myelomeningocele could be candidates for fetal intervention. Further prospective studies should be carried out to assess the potential benefit of double OSB intrauterine open repair.

Doppler de la arteria oftálmica: un modelo para predicción de preeclampsia / Ophthalmic artery Doppler: a model for the prediction of preeclampsia

Resumen ANTECEDENTES: En México, la preeclampsia sigue siendo un problema de salud pública; en la actualidad es la principal causa de muerte materna. Su incidencia es de 47.3 casos por cada 1000 nacimientos. La preeclampsia trae consigo repercusiones en la madre y el feto; de ahí la necesidad de la validación de modelos de tamizaje efectivos que permitan su diagnóstico oportuno. La evaluación Doppler de la arteria oftálmica sigue siendo motivo de diversas investigaciones porque aporta información valiosa de los cambios hemodinámicos intracraneales que suceden, incluso, antes del curso sintomático de la enfermedad. OBJETIVO: Analizar las recomendaciones emitidas por diferentes autores que han evaluado la utilización del Doppler de la arteria oftálmica como modelo de tamizaje para la predicción y diagnóstico tempranos de preeclampsia. METODOLOGÍA: Estudio retrospectivo basado en la búsqueda exhaustiva en diferentes bases de datos de metanálisis y estudios clínicos aleatorizados que describieran, detalladamente, la población estudiada y los parámetros de la arteria oftálmica evaluados. RESULTADOS: Se identificaron 22 publicaciones y en el cribado se excluyeron 8 artículos que estaban duplicados, 2 por no cumplir con los criterios de inclusión y 1 por encontrarse en otro idioma diferente al inglés; al final se revisaron 11 títulos y para complementar el tema de estudio se revisaron otros 60 artículos. CONCLUSIONES: La evaluación mediante Doppler de la arteria oftálmica es un examen simple, rápido, reproducible, seguro y no invasivo que puede incorporarse a la predicción y diagnóstico temprano de pacientes con alto riesgo de preeclampsia.

Abstract BACKGROUND: Preeclampsia remains a public health problem in Mexico and is currently the leading cause of maternal death. Its incidence is 47.3 cases per 1000 live births. Pre-eclampsia has consequences for the mother and the fetus, so there is a need to validate effective screening models for early diagnosis. Doppler assessment of the ophthalmic artery continues to be studied because it provides valuable information on intracranial hemodynamic changes that occur before the symptomatic course of the disease. OBJECTIVE: To analyze the recommendations of different authors who have evaluated the use of ophthalmic artery Doppler as a screening model in the prediction and early diagnosis of pre-eclampsia. METHODOLOGY: Retrospective study based on the search exhaustive search of different databases of meta-analyses and randomized clinical trials describing in detail the population studied and the ophthalmic artery parameters evaluated. RESULTS: Twenty-two publications were identified and after screening, 8 articles were excluded as duplicates, 2 for not meeting the inclusion criteria and 1 for being in a language other than English; finally, 11 titles were reviewed, and another 60 articles were reviewed to complement the study topic. CONCLUSIONS: Doppler evaluation of the ophthalmic artery is a simple, rapid, reproducible, safe, and noninvasive test that can be used to evaluate the ophthalmic artery.

Antimicrobial susceptibility of gram-negative bacilli isolated from intra-abdominal and urinary-tract infections in Mexico from 2009 to 2015: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART).

Antimicrobial resistance is an increasing worldwide concern, which poses unique challenges for the effective prevention and treatment of several infections, especially the ones triggered by organisms producing extended-spectrum ß-lactamases (ESBL). Here, we present the surveillance results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) of Gram-negative bacilli isolated from intra-abdominal infections (IAI, n = 1,235) and urinary-tract infections (UTI, n = 2,682), collected in Mexico from 2009 to 2015. Susceptibility and ESBL status were determined according to the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. Both E. coli (57%) and K. pneumoniae (12%) were the most frequently reported organisms, as well as the ones with the highest prevalence of ESBL-producing isolates (54% and 39%, respectively). The overall prevalence of ESBL-producing organisms was higher in nosocomial infections than in community-acquired infections (21% vs. 27%). The ESBL rates were 36% for IAI (953/2,682) and 37% for UTI (461/1,235). In addition, ertapenem, imipenem and amikacin were the antibiotics that mostly preserved bacterial susceptibility. Our results show consistency with global trends, although higher than the rates observed in Latin America.

Comer bien para crecer bien, estrategia de educación nutricional / Eating well to grow well, a nutritional education strategy

El presente escrito presenta la sistematización del diseño de la estrategia de educación para el cambio de comportamiento que ha sido trabajado en sus lineamientos generales como proyecto en Bolivia en el Instituto de Investigación y desarrollo(IINSAD) y los institutos pares de Perú (Instituto de Investigación Nutricional) y del Ecuador (Escuela de Salud Pública de Chimborazo) y adaptada a la realidad de los municipios con personal de instituciones que han participado apoyando la parte de producción de alimentos y de los establecimientos de salud de las redes municipales

[Diabetes mellitus and the use of syringes and needles]. / Diabetes mellitus e o descarte de seringas e agulhas.

Among the diseases that produce a great amount of garbage of health, the individuals bearers of diabetes insulino-dependent mellittus are important producers of solid garbage of health. The main objective of this study is to identify how the insulino-dependent diabetics do the discard of the syringes and needles used in their residences. The method of the research was the descriptive study. The researched population was constituted of 70 insulino-dependent individuals. The collection of data was accomplished through questionnaire, in the period of October of 2006 to March of 2007. Inside of the relevant results, in which 100% do not know what biological garbage is and 51.43% discard in the common garbage the needles and syringes and ignore the course of the garbage to the embankment, the importance is demonstrated by becoming aware and educating the population of the risks of this practice being fundamental for the environment.

A pele do recém-nascido prematuro sob a a avaliação do enfermeiro: cuidado norteando a manutenção da integridade cutânea / The skin of the premature newborn under the nurse's evaluation: orientating the manteinance of cutaneous integrity / La piel del recién nacido prematuro bajo la evaluación del enfermero: el cuidado direccionado para la manutención de la integridad cutánea

A prematuridade expressa relevância à saúde neonatal, demonstrando comprometimento ascendente com relação a morbimortalidade desta clientela, cuja maior incidência pode ser atribuída às práticas inadequadas com a pele do prematuro. Revisão da literatura sobre a interação benéfica entre a pele do Recém-Nascido Pré-Termo e o manuseio adequado, norteado pelo enfermeiro, que por meio da padronização dos cuidados de interferência direta e avaliação contínua da integridade cutânea e o assistir o prematuro. Divulga a importância do cuidado com a pele do Recém Nascido Prematuro, possibilitando não apenas a sobrevivência, mas a oportunidade de se integrar e desfrutar da vida com qualidade.

The prematurity expressed relevance to the health neonatal, demonstrating ascending compromising regarding morbi-mortality of this patients, whose larger incidence can be attributed to the inadequate practices with the skin of the premature. Revision of the literature about the beneficial interaction among the skin of premature infant newborn and the appropriate handling, orientated by the nurse, that through the standardization of the cares of direct interference and continuous evaluation of the cutaneous integrity and attending the premature. It publishes the importance of the care with the skin of the premature newbor, not just making possible the survival, but the opportunity to integrate and to enjoy of the life with quality.

La prematuridad expresa una relevancia para la salud neonatal, demonstando un comprometimiento ascendiente la relación de la morbimortalidade de esta clientela, cuya mayor incidencia puede ser atribuida a las prácticas inadecuadas con la piel del prematuro. Revisión de la literatura sobre la interacción beneficiosa entre la piel del recién nacido pré-termino y el manejo adecuado direccionado por el enfermero, que por medio de la padronización de los cuidados de interferencia directa y evaluación continua de la integridad cutánea y la asistencia al prematuro. Divulga la importancia del cuidado con la piel del recién nacido prematuro, posibilitando no apenas la sobreviviencía, como la oportunidad de integrar y disfrutar de la vida con cualidad

Diabetes mellitus e o descarte de seringas e agulhas / Diabetes mellittus and the use of syringes and needles

Entre as doenças que produzem uma grande quantidade de lixo de saúde, os indivíduos portadores de diabetes mellittus insulino-dependentes são importantes produtores de lixo sólido de saúde. O principal objetivo deste estudo é identificar como os diabéticos insulino-dependentes fazem o descarte das seringas e agulhas utilizadas nas suas residências. O método da pesquisa foi o estudo descritivo. A população pesquisada foi constituída de 70 indivíduos insulino-dependentes. A coleta de dados foi realizada por meio de questionário, no período de outubro de 2006 a março de 2007. Dentro dos resultados relevantes, nos quais 100% não sabem o que é lixo biológico e51,43% descartam no lixo comum as agulhas e seringas e desconhecem o percurso do lixo até o aterro, demonstra se a importância de conscientizar e educar a população dos riscos desta prática como fundamental para o meio ambiente.

[The skin of the premature newborn under the nurse's evaluation: orientating the manteinance of cutaneous integrity]. / A pele do recém-nascido prematuro sob a a avaliação do enfermeiro: cuidado norteando a manutenção da integridade cutânea.

The prematurity expressed relevance to the health neonatal, demonstrating ascending compromising regarding morbi-mortality of this patients, whose larger incidence can be attributed to the inadequate practices with the skin of the premature. Revision of the literature about the beneficial interaction among the skin of premature infant newborn and the appropriate handling, orientated by the nurse, that through the standardization of the cares of direct interference and continuous evaluation of the cutaneous integrity and attending the premature. It publishes the importance of the care with the skin of the premature newborn, not just making possible the survival, but the opportunity to integrate and to enjoy of the life with quality.

Síndrome HELLP en la altura / HELLP syndrome at high altitude

Objetivo: Estudiar la incidencia y manejo terapéutico del síndrome HELLP en altura. Diseño: Estudio de tipo descriptivo retrospectivo analítico. Resultados: Se estudió la incidencia del síndrome HELLP en pacientes atendidos en el Hospital III Huancayo de 1993 a marzo de 1996, encontrándose que de 3877 partos ocurrieron 4 defunciones, 1 por causa de síndrome HELLP. De los 10 casos internados en UCI por pre-eclampsia o eclampsia severa, 4 tuvieron criterios de síndrome HELLP, encontrándose los siguientes promedios: edad 33,6 años, paridad 4,6 asiste a CPN sólo el 4 por ciento. Presión arterial media de 114,6 mmHg, edad gestacional 29 sem., en todos se encontró anasarca, equimosis e ictericia; Hto 21 por ciento; plaquetas 70,400 por mmü TGO 166 U/L TGP 137 U/L; creatinina 6,8; todas presentaron oligo-anuria; el tratamiento fue en UCI con 1 paciente que fallece (20 por ciento); la mortalidad perinatal fue 100 por ciento: Conclusiones: el diagnóstico precoz, mediante adecuado control pre-natal y tratamiento oportuno, es esencial para disminuir la morbimortalidad en el síndrome de HELLP. Palabras clave: Síndrome HELLP, morbimortalidad materna y perinatal.