Hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation: experience in a pediatric oncological institution. / Cistitis hemorrágica tras trasplante alogénico de progenitores hematopoyéticos: experiencia en un centro oncológico pediátrico.

OBJECTIVE: To analyze the risk factors associated with hemorrhagic cystitis (HC) severity and the treatment strategies available in HC patients following allogeneic hematopoietic stem cell transplantation (AHSCT). MATERIALS AND METHODS: A retrospective study of medical records was carried out. Patients with HC following AHSCT treated from 2017 to 2021 were divided into two groups according to severity -mild and severe. Demographic data, disease-specific characteristics, urological sequelae, and overall mortality were compared between both groups. The hospital's protocol was used for patient management. RESULTS: 33 episodes of HC were collected in 27 patients, 72.7% of whom were male. HC incidence following AHSCT was 23.4% (33/141). 51.5% of HCs were severe (grades III-IV). Severe graft host disease (GHD) (grades III-IV) and thrombopenia at HC onset were associated with severe HC (p= 0.043 and p= 0.039, respectively). This group had longer hematuria times (p< 0.001) and required more platelet transfusions (p= 0.003). In addition, 70.6% required bladder catheterization, but only 1 case needed percutaneous cystostomy. None of the patients with mild HC required catheterization. No differences were found in terms of urological sequelae or overall mortality. CONCLUSIONS: Severe HC could be predicted thanks to the presence of severe GHD or thrombopenia at HC onset. Severe HC can be managed with bladder catheterization in most of these patients. A standardized protocol may help reduce the need for invasive procedures in patients with mild HC.

OBJETIVO: Analizar factores de riesgo asociados a la gravedad de la cistitis hemorrágica (CH) y estrategias de tratamiento en pacientes con CH tras trasplante alogénico de progenitores hematopoyéticos (TAPH). MATERIAL Y METODOS: Estudio retrospectivo de historias clínicas. Los pacientes con CH tras TAPH tratados entre 2017 y 2021 se dividieron en dos grupos según la gravedad del cuadro (leve y grave). Se compararon datos demográficos, características específicas de la enfermedad, secuelas urológicas y mortalidad global entre ambos grupos. Se utilizó el protocolo del hospital para el manejo de los pacientes. RESULTADOS: Se recogieron 33 episodios de CH en 27 pacientes, de los cuales el 72,7% fueron varones. La incidencia de CH tras TAPH fue del 23,4% (33/141). El 51,5% de las CH fueron graves (grados III-IV). La enfermedad de injerto contra huésped (EICH) grave (grados III-IV) y la trombopenia al inicio se asociaron a CH grave (p= 0,043 y p= 0,039, respectivamente). Este grupo tuvo mayor tiempo de hematuria (p< 0,001) y necesitó más transfusiones de plaquetas (p= 0,003). Además, el 70,6% precisó sondaje vesical, pero solo un caso cistostomía percutánea. Ningún paciente con CH leve precisó sondaje. No hubo diferencias en las secuelas urológicas ni en la mortalidad global. CONCLUSIONES: Una CH más grave podría predecirse por la presencia de EICH grave o trombopenia al inicio del cuadro. La CH grave puede manejarse con sondaje vesical en la mayoría de estos pacientes. Seguir un protocolo estandarizado puede reducir la necesidad de procedimientos invasivos en pacientes con CH leve.

Experiences of water immersion during childbirth: a qualitative thematic synthesis.

BACKGROUND: The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women's participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women's autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women's and midwives' experiences, values, and preferences regarding water immersion during childbirth. METHODS: A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. RESULTS: Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. CONCLUSIONS: The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

Brain activity in well-controlled perinatally HIV-infected young adults: a fMRI pilot study. / Actividad cerebral en jóvenes infectados por el virus de la inmunodeficiencia humana por transmisión vertical: estudio piloto de resonancia magnética funcional.

INTRODUCTION AND AIM: Perinatal transmission of human immunodeficiency virus (PHIV) is considered a chronic disease that has highlighted several cognitive deficits. From birth to early adulthood, cognition is known to play a fundamental role. However, although neurocognitive processes associated with PHIV have been extensively described by psychometric testing, data is scarce on neural activity from functional magnetic resonance imaging (fMRI) which provides in vivo physiological information. SUBJECTS AND METHODS: We studied described impaired cognitive processes using fMRI on a group of PHIV adolescents with good immunovirological indications and healthy matched controls. Psychological status and neurocognitive functions were also assessed. RESULTS: There were no significant differences between HIV+ and HIV- groups, either on neurocognitive testing nor in fMRI activity for phonological fluency tasks. Prolonged duration of cART was positively associated with greater brain activity in left inferior frontal gyrus (LIFG) which could indicate functional compensation. CONCLUSIONS: These results suggest that neural activity through fMRI in PHIV adolescents with good daily functioning and good immunovirological control may be similar to their peers.

TITLE: Actividad cerebral en jóvenes infectados por el virus de la inmunodeficiencia humana por transmisión vertical: estudio piloto de resonancia magnética funcional.Introducción y objetivos. La infección por el virus de la inmunodeficiencia humana de transmisión vertical (VIH-TV) constituye una enfermedad crónica que puede asociar múltiples alteraciones cognitivas que pueden influenciar el desarrollo de estos pacientes desde la infancia a la vida adulta. Sin embargo, aunque las alteraciones neurocognitivas vinculadas al VIH-TV están ampliamente descritas y valoradas mediante pruebas psicométricas, no existen apenas estudios de actividad neuronal medida a través de la resonancia magnética funcional (RMf). Sujetos y métodos. Analizar la utilidad de la RMf a través de la realización de tareas motoras y de fluidez verbal en un grupo de adolescentes y jóvenes con VIH-TV con buen control inmunovirológico y compararlo con un grupo control negativo de características similares. Se evaluaron también alteraciones psicológicas y funciones neurocognitivas. Resultados. No se encontraron diferencias significativas entre el grupo VIH+ y el grupo control para las tareas ejecutadas durante la RMf ni en la evaluación neurocognitiva. Un mayor tiempo de terapia combinada antirretroviral se asoció de forma directa con una mayor actividad en el giro frontal inferior izquierdo, lo cual podría indicar una posible compensación funcional. Conclusiones. Estos resultados sugieren que la actividad neuronal medida a través de la RMf en adolescentes con VIH-TV y buen control inmunovirológico es similar a la de sus pares.

Actividad cerebral en jóvenes infectados por el virus de la inmunodeficiencia humana por transmisión vertical: estudio piloto de resonancia magnética funcional / Brain activity in well-controlled perinatally HIV-infected young adults: a fMRI pilot study

Introducción y objetivos: La infección por el virus de la inmunodeficiencia humana de transmisión vertical (VIH-TV) constituye una enfermedad crónica que puede asociar múltiples alteraciones cognitivas que pueden influenciar el desarrollo de estos pacientes desde la infancia a la vida adulta. Sin embargo, aunque las alteraciones neurocognitivas vinculadas al VIH-TV están ampliamente descritas y valoradas mediante pruebas psicométricas, no existen apenas estudios de actividad neuronal medida a través de la resonancia magnética funcional (RMf). Sujetos y métodos:Analizar la utilidad de la RMf a través de la realización de tareas motoras y de fluidez verbal en un grupo de adolescentes y jóvenes con VIH-TV con buen control inmunovirológico y compararlo con un grupo control negativo de características similares. Se evaluaron también alteraciones psicológicas y funciones neurocognitivas. Resultados: No se encontraron diferencias significativas entre el grupo VIH+ y el grupo control para las tareas ejecutadas durante la RMf ni en la evaluación neurocognitiva. Un mayor tiempo de terapia combinada antirretroviral se asoció de forma directa con una mayor actividad en el giro frontal inferior izquierdo, lo cual podría indicar una posible compensación funcional. Conclusiones: Estos resultados sugieren que la actividad neuronal medida a través de la RMf en adolescentes con VIH-TV y buen control inmunovirológico es similar a la de sus pares.(AU)

Introduction and aim: Perinatal transmission of human immunodeficiency virus (PHIV) is considered a chronic disease that has highlighted several cognitive deficits. From birth to early adulthood, cognition is known to play a fundamental role. However, although neurocognitive processes associated with PHIV have been extensively described by psychometric testing, data is scarce on neural activity from functional magnetic resonance imaging (fMRI) which provides in vivo physiological information. Subjects and methods: We studied described impaired cognitive processes using fMRI on a group of PHIV adolescents with good immunovirological indications and healthy matched controls. Psychological status and neurocognitive functions were also assessed. Results: There were no significant differences between HIV+ and HIV– groups, either on neurocognitive testing nor in fMRI activity for phonological fluency tasks. Prolonged duration of cART was positively associated with greater brain activity in left inferior frontal gyrus (LIFG) which could indicate functional compensation. Conclusions: These results suggest that neural activity through fMRI in PHIV adolescents with good daily functioning and good immunovirological control may be similar to their peers.(AU)

Significant differences between verbal and non-verbal intellectual scales on a perinatally HIV-infected cohort: from pediatrics to young adults.

Delayed neurodevelopment is a common outcome in perinatally HIV-infected children. Our aim was to assess the intellectual profile of our cohort, considering both the infection and socio-environmental related variables. A cross-sectional cohort study was undertaken at seven major hospitals in Spain belonging to the CoRISpeS cohort (n = 97). Patients were followed up according to a standard protocol. Intellectual measures, psychosocial profile and HIV infection-related data have been analysed. The average patient age was 15 years. The median CD4 cell percentage was 35% (1,59). Viral load was undetectable in 80% of the patients and 27% were on AIDS category; 38% of whom had encephalopathy. The average composite score of both crystallized intelligence (CI) and intelligence quotient (IQ) for the cohort was lower than that of the general population (p < 0.001). Results revealed a significant difference of 38% between crystallized and fluid intelligence. There was a clear association between IQ and age of diagnosis (p = 0.022); CI and CDC classification (p = 0.035), CD4 count (p = 0.011) and CD4 nadir (p = 0.001). Higher parental education was associated with better performance across all intelligence scales (p < 0.002). A regression model showed that CI was influenced by the academic level of caregivers (p = 0.002), age at start of cART (p = 0.050) and primary language (p = 0.058). Findings revealed significant differences in verbal and non-verbal intellectual scales resulting in a misleading IQ Composite score. Crystallized intelligence demonstrated the highest level of impairment despite adequate treatment and good immunovirological status, while fluid intelligence results were average. Caregiver level of education was the strongest factor across all intelligence measures.

The value of international volunteers experience to the NHS.

BACKGROUND: Global Engagement works with health partnerships to establish workforce and educational translation on a global scale to support the National Health Service (NHS). There is growing evidence on how international experiences (through volunteering, exchanges and placements) benefit the NHS through an innovative workforce that develops international best practice and promotes lifelong learning. Most of this evidence has been captured though surveys to returned international volunteers. However, there is limited evidence about how to quantify the value that returned international healthcare volunteers bring back to their country of residence. METHODS: This paper identifies the various benefits to the NHS from returned international healthcare volunteers. The outcomes from returned international volunteers, which have been identified as relevant form a NHS perspective, are linked to three key areas in a multisector analytical framework used by the World Bank to evaluate labour market programmes: (1) Investment climate and Infrastructure, (2) Labor market regulations and institutions, and (3) Education and skills development. The monetary value of these outcomes is quantified through productivity indices which capture the economic value that the achievement of these outcomes have on the quality of the NHS labor force. This model is applied to a dataset of international volunteers provided by the Global Engagement health partnerships. RESULTS: The results suggest that international volunteering generates average productivity gains of up to 37% for doctors and up to 62% for nurses. Average productivity gains estimated from health partnerships data vary depending on duration of volunteering periods and occupational category mix. CONCLUSIONS: Our analysis offers a value for money rationale for international volunteering programmes purely from a domestic and NHS perspective. The valuation method considers only one of the aims of international volunteering programmes: the development of the existing and future NHS workforce. Broader benefits for health system strengthening at a global level are acknowledged but not accounted for. Overall, we conclude that if the acquisition of volunteering outcomes is realised, the NHS can accrue a productivity increase of between 24 and 41% per volunteer, with a value ranging from £13,215 to £25,934 per volunteer.

Environmental Variables Influence the Association of Eustenopus villosus and Larinus curtus (Coleoptera: Curculionidae) Adults With Different Growth Stages of the Invasive Thistle Centaurea solstitialis (Asteraceae: Cardueae) in Washington State.

A 2-yr (2014-2015) field study in eastern Washington State quantified the effect of environmental factors on the overwintered Eustenopus villosus (Boheman) and Larinus curtus (Hochhut) adults in relation to phenology of Centaurea solstitialis L. (Asteraceae: Cardueae), the feeding and breeding host for these two weevil biocontrol agents. We recorded in the study area: ambient and soil temperatures, soil moisture, percent cover and developmental stage of C. solstitialis, and presence of adults of each weevil species. Sampling took place from early May to mid-August. Weevil activity for both species in both years was segregated into three phases: 1 - a pre-appearance phase in which neither species was detected, 2 - appearance and increase in frequency, and 3 - decrease in frequency. Eustenopus villosus increase in frequency was most strongly associated with warming temperatures both years. Larinus curtus increase in frequency in 2014 was most associated with increasing C. solstitialis cover and in 2015 with warming temperatures and drying soils. In both years, both weevil species' decline in frequency was likely due to the advancing C. solstitialis phenology. This pattern indicates that the appearance and increase in frequency of the overwintered E. villosus and L. curtus adults was likely a function of warming temperatures. Both species' decline in frequency was likely a function of the weevils completing their life cycle in synchrony with the phenological advancement of C. solstitialis and decline of abundant breeding and foraging sites (buds and flowers).

Estudio multicéntrico no intervencional en pacientes con artritis reumatoidea tratados con tocilizumab / Non-interventional multicenter study in patients with arthritis rheumatoid treated with tocilizumab

Introducción: Tocilizumab es un anticuerpo monoclonal humanizado anti-receptor de IL-6 que ha demostrado eficacia y seguridad en artritis reumatoidea (AR). Métodos y objetivos: Estudio observacional de cohorte en pacientes con AR moderada a severa tratados con tocilizumab con 6 meses de seguimiento. El objetivo primario fue establecer la adherencia al tratamiento y secundariamente estudiar la efectividad y seguridad. Resultados: Cincuenta pacientes fueron tratados con tocilizumab (86% asociados a DMAR y 14% a monoterapia). La adherencia fue 42/50 (84%; IC 95%: 71-93%) y el porcentaje de respuesta luego de 6 meses según criterios de la ACR20/50/70/90 fueron 68,2%, 40,9%, 13,6% y9,1% respectivamente. El recuento de 28 articulaciones dolorosas (TJC28) e inflamadas (SJC28) se redujo significativamente de 12 y 8 en el momento basal a 5 y 2 a los 6 meses respectivamente (p <0,001). Se observó una reducción significativa en los parámetros de evaluación de actividad del médico y en las evaluaciones reportadas por el paciente. No se registraron eventos adversos de intensidad severa ni eventos adversos serios relacionados con la medicación. Conclusiones: Se observó que 42/50 pacientes adhirieron al tratamiento con una respuesta significativa en los parámetros de efectividad y adecuado perfil de seguridad consistente con los estudios publicados previamente

Fluid dynamic analysis of a continuous stirred tank reactor for technical optimization of wastewater digestion.

Continuous stirred tank reactors (CSTR) are widely used in wastewater treatment plants to reduce the organic matter and microorganism present in sludge by anaerobic digestion. The present study carries out a numerical analysis of the fluid dynamic behaviour of a CSTR in order to optimize the process energetically. The characterization of the sludge flow inside the digester tank, the residence time distribution and the active volume of the reactor under different criteria are determined. The effects of design and power of the mixing system on the active volume of the CSTR are analyzed. The numerical model is solved under non-steady conditions by examining the evolution of the flow during the stop and restart of the mixing system. An intermittent regime of the mixing system, which kept the active volume between 94% and 99%, is achieved. The results obtained can lead to the eventual energy optimization of the mixing system of the CSTR.

Chemiluminescent immunoassay as a microtiter system for the detection of Salmonella antibodies in the meat juice of slaughter pigs.

Chemiluminescent immunoassay (CLIA) was applied in the screening of swine meat juice samples obtained from different laboratories in Germany, using the indirect enzyme linked immunosorbent assay (ELISA) as test for comparison. Out of the 1350 samples tested, 987 were found acceptable for validation of results. A good level of agreement between the two tests was obtained with a kappa value of 0.824 at 20% cut-off and 0.798 at 40% cut-off. At 20% and 40% cut-off levels, a sensitivity of 96.2% and 97.3%, respectively, and a specificity of 94.6% and 95.1%, respectively, were demonstrated between CLIA and ELISA. The detecting lipopolysaccharide (LPS) antigen was tested for specificity and a cross-reaction with two Escherichia coli and Yersinia strains was found when tested with ELISA. This reaction was not observed in CLIA, possibly because of the broader measurement spectrum of this test, which allows a more distinctive definition of immunologic reactions. The same explanation can be given for the increased number of meat juice samples which were positively detected only in ELISA but not in CLIA. Because of the wide detection range in CLIA, a normalization scheme was necessary to obtain reproducible results in this test system. The samples positively classified in screening were further tested for reciprocal titres in both test systems, and a higher correlation between screening and titration results was obtained for CLIA. Based on the results of this study, CLIA can be used as a reference method in detecting Salmonella antibodies in the meat juice of slaughter pigs.

Simplified preparation of a specific S. enteritidis antigen for ELISA and other immunological techniques.

This study was conducted to prepare a specific S. enteritidis antigen (FG-Antigen) for the serological detection of S. enteritidis infections in chicken flocks. This antigen (FG-Antigen) consistent mainly of the flagellar fraction H:g and partly of the fimbrial fraction SEF14 from a S. enteritidis-phage type 4 strain. The initial steps followed in the preparation of this antigen were conducted based on a previously described procedure, which involved the application of heat at 60 degrees C. The purification process (filtration and concentration) enabled the exclusion of the cross-reaction causing LPS antigens from the preparation and allowed the retention of S. enteritidis-specific antigens composed of fimbria and H:g fractions. As a result, no cross-reaction with S. typhimurium nor with S. gallinarum was exhibited by the prepared FG-antigen. To characterize and determine its specificity, the following laboratory tests were conducted: indirect ELISA, immunoblotting and a SEF14 agglutination test. In these examinations, rabbit and chicken reference sera as well as chicken field sera and absorbed hyperimmune sera against H:g-carrying serovars were used.

Detection of antibodies to S. enteritidis in broilers by means of indirect ELISA and chemiluminescent immunoassay (CLIA).

This study was conducted to develop a serological detection system for the monitoring of broiler flocks for Salmonella enteritidis infections. A specific S. enteritidis antigen (FG-Antigen) was used to compare the sensitivity and the specificity of the chemiluminescent immunoassay (CLIA) with those of the indirect ELISA. This comparison was performed using a total of 578 sera, which, depending on the microbiological and vaccination history, were categorized into groups. Most of the serum samples which were classified as positive showed higher titers in CLIA than in ELISA. Using the prevalence of positive reactors, significant differences between Groups were additionally demonstrated. The absorbance values of the passively immunized group showed the highest and those of the Salmonella-negative group the lowest correlation-coefficient. Using the mean net absorbance of the prevalence group, the ELISA system exhibited a sensitivity of 100% and a specificity of 96.2%, while CLIA had a sensitivity and a specificity of 85.7% and 96.2%, respectively. ELISA and CLIA can be used in the examination of non vaccinated flocks for S. enteritidis-infections as alternative to the bacteriological culture method. CLIA is distinguished for its fast and convenient procedure as well as for its wider measurement spectrum, while the indirect ELISA is almost as efficient as CLIA and requires less investment.

Plásmido de virulencia en yersinia enterocolítica 0-3 de origen murino / Virulence plasmid in yersinia enterocolitica 0-3 of murine origin

Background: Pathogenic strains of Yersinia enterocolitica harbor a virulence plasmid of 45-48 megadalton that can be detected using different techniques. Rodents are important reservoirs of Y enterocolitica. Aim: To investigate the carrier status of Y enterocolitica in murine rodents. Material and methods: Two hundred sixty one mice and rats were captured in rural and urban areas of Valdivia. Y enterocolitica was cultured from viscera and fecal homogenates. Virulence plasmids were detected using crystal violet binding. Results: Thirteen Y enterocolitica strains were isolated from 11 rodents. Ten strains belonged to the biotype 1 and three to the biotype 4, serotype O:3. The most frequently infected rodent species were R norvergicus (20 per cent), followed by A longipilis (11 per cent), A olivaceus (2 per cent) and O longicaudatus (2 per cent). Conclusions: Rodents, and specially the domestic rat, can be an important source of Y enterocolitica infection for human and susceptible animal species

Prevalence of malnutrition in Mexican CAPD diabetic and nondiabetic patients.

Malnutrition is often present on continuous ambulatory peritoneal dialysis (CAPD), and contributes to morbidity and mortality. Diabetics (DM) have an increased risk for developing malnutrition. Our purpose was to assess the nutritional status (NS) of our CAPD population, to define NS differences between DM and nondiabetics (NoDM), and to identify NS-related factors. Patients were subjected to a nutritional assessment, which included a 24-hour dietary recall and a nutritional scoring system including anthropometric, biochemical, and subjective evaluation, and that classifies patients as: normal, and mildly, moderately, and severely malnourished. We studied 90 patients: 35 DM and 55 NoDM. In our whole population we observed a high frequency of malnutrition: NS was normal in 18%, and 20% had mild, 24% had moderate, and 38% had severe malnutrition. Ninety-one percent of DM and 76% of NoDM showed some degree of malnutrition. DM patients had significantly higher levels of malnutrition (p = 0.02), were significantly older, had more body fat, and spent less time on dialysis. There were 37 males and 53 females. Sex distribution was similar between DM and NoDM. Seventy-six percent of males and 86% of females had malnutrition. Moderate and severe malnourishment were more frequent in females. DM and female sex were the strongest predictors for moderate and severe malnutrition.

El consumo de alcohol y otras drogas en el Ministerio de Salud de Costa Rica / Alcohol consumption and another drugs in the Ministerio de Salud of Costa Rica

La temática del consumo de drogas y el medio ambiente laboral, tiene una importancia creciente, en virtud de que es en los trabajadores en quienes se encuentran algunas de las mayores prevalencias de consumo. Información nacional e internacional así lo confirma. Con el objetivo de explorar algunos aspectos del fenómeno en el Ministerio de Salud de Costa Rica, se desarrolló un trabajo colaborativo entre dicha entidad y el Instituto sobre Alcoholismo y Farmacodependencia, con el especial interés de definir, a corto plazo, acciones de tipo preventivo. Tal cometido fue posible mediante la selección de noventa y un informantes claves, que aportaron información acerca de mil setecientos setenta y un funcionarios, cifra que representa al 30 por ciento de la población institucional...

[Postpartum sterilization in a program of medical training]. / Esterilización postparto en un programa de adiestramiento médico.

PIP: This study presents information about the postpartum sterilization program of a teaching hospital in Nuevo Leon, Mexico, and compares results to data reported in the literature. 147 patients undergoing sterilization between February-August 1984 were included. 6 of the women were under 20 years old, 18 were 21-25, 63 were 26-30, 30 were 31-35, and 30 were 36 or over. 22 had had 1-3 children, 81 had 4-6, 27 had 7-9, and 17 had over 9. 96.6% were married. 92 had never used a contraceptive method, 47 had used pills, 7 had used IUDs, and 1 had used a barrier method. Only 29 had been born in the Nuevo Leon metropolitan area but 126 were current residents. 101 had incomplete or complete primary educations, 8 had secondary educations, 36 were illiterate, and 2 had professional educations. Only 38 had prenatal health care preceding the delivery. Hemoglobin levels in 20 cases were less than 9.0, 28 were 9.1-10.0, 45 were 10.1-11.0, 34 were 11.1-12.0, and 20 were 12.1 or above. 17.6% of patients required preoperative transfusions of packed blood. The indication for sterilization was multiparity in 96.6% of cases. 13 patients had epidural anesthesia during delivery, 1 had a subarachnoid block, and 133 had no anesthesia. 139 had epidural blocks during the sterilization operation, 6 had subarachnoid blocks, and 2 had general anesthesia. There was 1 case of cardiorespiratory arrest but recovery was satisfactory. The only obstetric complication was 1 perforation of the jejunum, which was repaired. There were no other cases of pre- or postoperative complications except for 21 cases of difficulty in providing epidural anesthesia. The Pomeroy technique was used in 139 sterilizations, fimbriectomy in 5, and salpingectomy in 5. Umbilical hernioplasties were done in 3 patients without complications. The interval between surgery and leaving the hospital was between 12-24 hours in 83.7% of cases. The interval between delivery and sterilization was 12-24 hours in 71.4% of cases. Only 9 cases required more than 4 days of hospitalization. The immediate postpartum is not considered the optimal moment for female sterilization because of the increased vulnerability of the patient. The experience with this series suggests that for some patients, tubal sterilization by minilaparotomy in the immediate postpartum is a valuable method because it meets the demand for definitive contraception among high parity women of low socioeconomic level and with limited access to medical care. It requires only brief hospitalization and involves very low rates of morbidity.^ieng