Microbiota y perfil inmunológico vaginal de la embarazada propensa a parto prematuro por infección bacteriana ascendente: revisión narrativa / Microbiota and vaginal immunological profile of pregnant women prone to premature birth due to ascending bacterial infection: narrative review

El parto prematuro (PP) es la principal causa de morbilidad/mortalidad perinatal en el mundo. La infección intrauterina es el origen más frecuente del PP espontáneo (PPE) en un hospital público de Chile. Existe evidencia de que la infección bacteriana ascendente (IBA) produce la infección/inflamación intraamniótica, el PPE y los resultados adversos maternos y perinatales. Esta revisión narrativa incluye revisiones sistemáticas y estudios de cohorte o de caso-control sobre la microbiota y el perfil inmunológico existente en el tracto genital inferior (TGI) de la embarazada propensa a PPE por IBA. Existe consenso en que en la microbiota del TGI de esta gestante hay colonización vaginal con baja abundancia de lactobacilos y/o disminución de su calidad, por diferencias raciales y/o geográficas o genéticas y una desregulación de los mecanismos inmunológicos del TGI. Estas respuestas se presentan con mayor intensidad en pacientes con factores de riesgo del huésped, como diabetes, obesidad, estrés, ansiedad y depresión, originando infecciones recurrentes del TGI, responsables del PPE y de los resultados perinatales. El conocimiento del comportamiento de la microbiota y del sistema inmunitario en estos casos permitirá tener terapias eficaces para prevenir el PPE y la morbilidad/mortalidad neonatal por IBA.

Preterm delivery (PD) is the leading cause of perinatal morbidity/mortality in the world. Intrauterine infection is the most frequent origin of spontaneous PD (SPD) in a public hospital in Chile. There is evidence that vaginal ascending bacterial infection (ABI) causes intra-amniotic infection/inflammation, SPD, and adverse maternal and perinatal outcomes. This narrative review includes systematic reviews and cohort or case-control studies on the microbiota and immunological profile existing in the lower genital tract (LGT) of pregnant women prone to SPD due to ABI. There is consensus that in the LGT microbiota of this pregnant woman there is vaginal colonization with low abundance of Lactobacilli and/or decreased quality, due to racial and/or geographic, or genetic differences and dysregulation of immunological mechanisms of the LGT. These responses occur with greater intensity in patients with host risk factors, such as diabetes, obesity, stress, anxiety, and depression, causing recurrent LGT infections responsible for SPD and perinatal outcomes. Knowledge of the behavior of the microbiota and the immune system in these cases will allow effective therapies to prevent SPD and neonatal morbidity/mortality due to ABI.

Role of vulvovaginal candidiasis infection in infertility: systematic review and meta-analysis.

OBJECTIVE: To evaluate the relationship between fungal infection in the female genital tract and infertility. DATA SOURCES: A systematic review was carried out, and the search was conducted in Medline, Embase, Web of Science, Google Scholar, and Cochrane Library databases until August 2022. The search strategy used standardized keywords such as "candidiasis" and "infertility," combined with their respective synonyms. The search was limited to human studies, with no language restrictions. STUDY ELIGIBILITY CRITERIA: Primary articles that evaluated women of reproductive age with and without infertility and related to the presence or absence of candidiasis were included. STUDY APPRAISAL AND SYNTHESIS METHODS: For the analyses, the odds ratio association measure was used with a confidence interval of 95% using RevMan software (version 5.4). RESULTS: Eight studies, published between 1995 and 2021 in different countries around the world, were included in this systematic review. Two studies were excluded after sensitivity analysis. A total of 909 participants were included in the group of infertile women and 2363 women in the control group. The age of the evaluated women varied between 18 and 50 years. The random effect model was used and showed no significant difference when comparing candidiasis between fertile and infertile women (odds ratio: 1.44; 95% confidence interval 0.86, 2.41 p= 0.17). CONCLUSIONS: There was no association between candidiasis and female sterility.

Successful treatment of experimental murine vulvovaginal candidiasis with gentian violet.

Aim: This study evaluated the antifungal efficacy of gentian violet (GV) in an experimental vulvovaginal candidiasis (VVC) model. Materials & methods: In vitro susceptibility and cytotoxicity assays were performed to validate the antifungal potential and safety of GV. The antifungal efficacy was then evaluated in vivo through comparative analysis of the fungal burden following treatment with GV or nystatin, as well as assessment of the vaginal tissue by histology and electron microscopy. Results: GV demonstrated a safe antifungal profile against C. albicans, with a significant decrease in fungal burden and an improvement in the inflammatory process evaluated histologically. Conclusion: The results of this study motivate further assessment of GV as a promising alternative for VVC therapy.

Factores de riesgo asociado al bajo peso al nacer. Municipio Guisa. Enero- diciembre 2019 / Risk factors associated with the low birth weight. Guise municipality. January - December 2019 / Fatores de risco associados ao baixo peso ao nascer. Municipio Guisa. Enero- diciembre 2019

RESUMEN Introducción: la reducción del bajo peso al nacer constituye una prioridad en el país por ser determinante para disminuir la mortalidad infantil. Objetivo: determinar los principales factores de riesgo asociados al bajo peso al nacer Guisa, Granma. Métodos: se realizó un estudio descriptivo de corte transversal, incluyó a 37 gestantes que aportaron los nacimientos con bajo peso en el periodo de estudio. Se analizaron las variables edad materna, evaluación nutricional al inicio del embarazo, edad gestacional al momento del parto, tipo de bajo peso, antecedentes personales y enfermedades asociadas al embarazo. Resultados: se produjeron 511 nacimientos, 37 mostraron un peso inferior a 2500 g. El mayor número de nacimientos ocurrió en edades fértiles de la vida, predominando la evaluación nutricional normopeso al inicio del embarazo. La edad gestacional entre 37-42 semanas fueron las que más aportaron bajo peso, no ocurrieron nacimientos en gestantes con menos de 32 semanas. Predominaron los crecimientos intrauterinos restringidos. Entre los antecedentes patológicos resalta, la hipertensión arterial, seguida por el asma bronquial, la anemia ligera. Conclusiones: el bajo peso al nacer es un problema de salud en el municipio Guisa y por consiguiente su influencia negativa sobre la calidad de vida de los infantes. Las edades extremas no resultaron factores de incidencia en el bajo peso al nacer al igual que el estado nutricional. Las principales causales son el crecimiento intrauterino restringido y el parto pretérmino. La identificación precoz de los factores de riesgo y la adopción de medidas efectivas permitirá disminuir la incidencia de estas causas.

ABSTRACT Introduction: reducing low birth weight is a priority in the country as it is decisive for reducing infant mortality. Objective: to determine the main risk factors associated with low birth weight Guisa, Granma. Methods: a descriptive cross-sectional study was carried out, it included 37 pregnant women who provided births with low birth weight in the study period. The variables maternal age, nutritional evaluation at the beginning of pregnancy, gestational age at delivery, type of low weight, personal history and diseases associated with pregnancy were analyzed. Results: there were 511 births, 37 showed a weight less than 2500 g. The highest number of births occurred in fertile ages of life, predominating the normal weight nutritional assessment at the beginning of pregnancy. Gestational ages between 37-42 weeks were the ones that contributed the most to low weight, there were no births in pregnant women with less than 32 weeks. Restricted intrauterine growths predominated. Among the pathological antecedents, arterial hypertension stands out, followed by bronchial asthma, mild anemia. Conclusions: low birth weight is a health problem in the Guisa municipality and therefore its negative influence on the quality of life of infants. Extreme ages were not factors of incidence in low birth weight as well as nutritional status. The main causes are restricted intrauterine growth and preterm delivery. The early identification of risk factors and the adoption of effective measures will reduce the incidence of these causes.

RESUMO Introdução: a redução do baixo peso ao nascer é uma prioridade no país, pois é decisiva para a redução da mortalidade infantil. Objetivo: determinar os principais fatores de risco associados ao baixo peso ao nascer Guisa, Granma. Métodos: foi realizado um estudo transversal descritivo, com 37 gestantes que realizaram partos com baixo peso ao nascer no período do estudo. Foram analisadas as variáveis ​​idade materna, avaliação nutricional no início da gestação, idade gestacional no parto, tipo de baixo peso, antecedentes pessoais e doenças associadas à gravidez. Resultados: ocorreram 511 nascimentos, 37 apresentavam peso inferior a 2.500 g. O maior número de nascimentos ocorreu em idades férteis de vida, predominando a avaliação nutricional de peso normal no início da gestação. As idades gestacionais entre 37-42 semanas foram as que mais contribuíram para o baixo peso, não ocorrendo partos em gestantes com menos de 32 semanas. Predominaram crescimentos intrauterinos restritos. Dentre os antecedentes patológicos, destaca-se a hipertensão arterial, seguida da asma brônquica, anemia leve. Conclusões: o baixo peso ao nascer é um problema de saúde no município de Guisa e, portanto, influencia negativamente na qualidade de vida dos lactentes. As idades extremas não foram fatores de incidência no baixo peso ao nascer, bem como no estado nutricional. As principais causas são o crescimento intrauterino restrito e o parto prematuro. A identificação precoce dos fatores de risco e a adoção de medidas eficazes irão reduzir a incidência dessas causas.

Vaginal Microbiota Evaluation and Lactobacilli Quantification by qPCR in Pregnant and Non-pregnant Women: A Pilot Study.

Pregnancy outcomes and women's health are directly affected by vaginal microbiota. This microbiota consists of a dynamic ecosystem of various microbes in different ratios, which in healthy conditions protect the vaginal epithelium from infections. However, cases of vaginal infection are regularly diagnosed in women of reproductive age, contributing to more severe outcomes. Therefore, our main goal was to determine the prevalence of bacterial vaginosis (BV), aerobic vaginitis (AV), and vulvovaginal candidiasis (VVC) among Ecuadorian pregnant and non-pregnant women. A cross-sectional study was conducted among 217 women between 13 and 40 years old seeking primary healthcare in Carlos Andrade Marin Hospital (HCAM), Gynecological-Obstetric Hospital Isidro Ayora (HGOIA) and Center for Teaching Health Cipriana Dueñas during October 2018 to February 2019. The classical characterization of the vaginal microbiota was performed through microscopy by the Nugent criteria to evaluate the presence of BV, healthy and intermediate microbiota, by the criteria of Donders to determine the presence of AV and by the Marot-Leblond criteria to diagnose VVC. DNA extraction from vaginal samples and Polymerase Chain Reaction (PCR) analysis was performed to characterize the presence of Gardnerella spp., Mobiluncus mulieris, Escherichia coli, Enterococcus spp., and Lactobacillus spp. Finally, quantification of the lactobacilli was performed by quantitative real-time PCR (qPCR) for samples from women with normal vaginal microbiota and women with AV. Our results showed 52% of women with healthy microbiota, 7% with intermediate microbiota, and 41% with vaginal dysbiosis, comprising 27% with AV, 8% with BV and 4% with VVC and 2% with co-infections or co-dysbiosis. Additionally, a higher amount of lactobacilli were found in pregnant women when compared to non-pregnant women, while AV cases were characterized by a significant drop of Lactobacillus spp., more precisely, between 1E3 and 1E5 colony forming units (CFU)/ml. Finally, women with normal vaginal microbiota showed an average load of lactobacilli between 1E6 and 1E7 CFU/ml. This pilot study showed no statistically significant differences between pregnant and non-pregnant women, pointing to the possibility to use lactobacilli quantification for the prevention of future vaginal infections.

Factores de riesgo asociados al bajo peso al nacer en un área de salud de Santiago de Cuba / Risk factors associated with low birth weight in an health area from Santiago de Cuba

Introducción: El bajo peso al nacer constituye en todo el mundo y grupos de poblaciones el índice más importante para determinar las posibilidades que tiene el recién nacido de sobrevivir y tener un crecimiento sano. Objetivo: Identificar algunos factores de riesgo sociobiológicos asociados al bajo peso al nacer en el área de salud del Policlínico Docente 30 de Noviembre de Santiago de Cuba durante el 2016. Métodos: Se realizó un estudio analítico, de casos y controles. Se escogieron como controles a las 8 puérperas que aportaron igual cantidad de recién nacidos con bajo peso y como controles a 16 de las madres cuyo producto de la concepción tuvo un peso normal en igual período. Entre las variables analizadas figuraron: edad materna, antecedentes obstétricos desfavorables, enfermedades previas asociadas y propias del embarazo, edad gestacional en el momento del parto y estado nutricional. Resultados: En la serie predominaron las enfermedades previas y propias del embarazo, fundamentalmente la anemia y la infección vaginal; mientras que el parto pretérmino tuvo alta significación estadística. Conclusiones: Los factores de riesgos biológicos con mayor fuerza de asociación fueron la malnutrición por defecto durante la captación, las enfermedades previas y asociadas al embarazo; en tanto, entre los factores con significación estadística predominaron la prematuridad y el período intergenésico corto, no así los antecedentes obstétricos desfavorables. Existió correlación entre la edad gestacional, el bajo peso al nacer, la presencia de partos pretérminos y el crecimiento intrauterino retardado.

Introduction: Low birth weight constitutes in the entire world and populational groups the most important index to determine the possibilities that the newborn has to survive and to have a healthy growth. Objective: To identify some social and biological risk factors associated with low birth weight in the health area from 30 de Noviembre Teaching Polyclinic in Santiago de Cuba during 2016. Methods: An analytic study of cases and controls was carried out. The 8 postpartum women who contributed with the same quantity of underweight newborns and as controls 16 of the mothers whose product of the conception had a normal weight in same period were chosen. Among the analyzed variables there were: maternal age, unfavorable obstetric history, associated previous diseases and diseases characterizing pregnancy, gestational age at childbirth and nutritional state. Results: Previous diseases and diseases characterizing pregnancy, fundamentally anemia and vaginal infection prevailed in the series; while preterm childbirth had a high statistical significance. Conclusions: Biological risk factors with greater association force were malnutrition defect during registration, the previous diseases and those associated with pregnancy; as long as, among the factors with statistical significance prematurity and the short intergenesis prevailed, what did not occur with the unfavorable obstetric history. Correlation existed between gestational age, low birth weight, the presence of preterm childbirths and the slowed intra-uterine growth.

Qualitative and quantitative analysis of bacteria from vaginitis associated with intravaginal implants in ewes following estrus synchronization / Análise qualitativa e quantitativa de bactérias da vaginite associadas com implante intravaginal em ovelhas após sincronização de estro

ABSTRACT: This study evaluated the presence of vaginitis and the bacterial load associated with different intravaginal implants in ewes. Twenty-four Dorper and crossbred ewes were allocated into three groups and received intravaginal implant containing 0.3g progesterone (CIDR(r)), 60mg MAP or sponges without progesterone (CONTROL) for six days. Then, CIDR and MAP treated-ewes received 12.5mg dinoprost and 300IU eCG. Vaginal mucus samples were collected at four times: before device insertion, at the day of its removal, 24 and 48 hours after. The samples were cultured and the colonies were counted (CFU/mL) and identified. The results obtained from the counting of CFU mL-1 were submitted to Kruskal-Wallis H test, with P<0.05 being considered significant. Before device insertion, 68.2% of the samples yielded Staphylococcus spp. and 60.0% of them were Staphylococcus aureus. After implant removal, 100% of ewes had clinical signs of vaginitis. However, the level of local infection in the CONTROL-ewes was lower (P>0.05) in comparison with MAP and CIDR-treated ewes. During the occurrence of vaginitis, the predominant isolates belonged to the coliform group, mainly Escherichia coli (72.7%). Such infection was not determined by the members of the vaginal microbiota that were present before implant insertion and normal microbiota was restored between 24 to 48 hours after insert removal.

RESUMO: Este estudo avaliou a presença de vaginite e contagem bacteriana associada ao uso de diferentes dipositivos intravaginais em ovelhas. Vinte e quatro fêmeas Dorper e mestiças foram alocadas em três grupos e receberam implante intravaginal contendo 0,3g de progesterona (CIDR(r)), 60mg de acetato de medroxiprogesterona (MAP) ou esponjas sem progesterona (CONTROLE) por seis dias. Posteriormente, as ovelhas tratadas com CIDR e MAP receberam 12,5mg de dinoprost e 300 UI de eCG. Amostras do muco vaginal foram coletadas em quatro momentos: antes da inserção do dispositivo, no dia de sua retirada, 24 e 48 horas após. As amostras foram cultivadas e as colônias foram contadas (UFC mL-1) e identificadas. Os resultados obtidos da contagem das UFC mL-1 foram submetidos ao teste do qui-quadrado, com P<0,05 sendo considerado significativo. Antes da inserção do dispositivo, 68,2% das amostras continham Staphylococcus spp., sendo 60,0% delas Staphylococcus aureus. Após a remoção do implante, 100% das ovelhas apresentaram sinais clínicos de vaginite. Entretanto, o grau de infecção local nas ovelhas do grupo CONTROLE foi menor (P>0.05), em comparação com as ovelhas recebendo CIDR e MAP. Durante a ocorrência da vaginite, os isolados predominantes pertenciam ao grupo dos coliformes, principalmente Escherichia coli (72,7%). Tal infecção não foi determinada pelos membros da microbiota vaginal, que estavam presentes antes da inserção dos dispositivos, e a microbiota normal foi reestabelecida entre 24 e 48 horas após sua remoção.

Qualitative and quantitative analysis of bacteria from vaginitis associated with intravaginal implants in ewes following estrus synchronization / Análise qualitativa e quantitativa de bactérias da vaginite associadas com implante intravaginal em ovelhas após sincronização de estro

This study evaluated the presence of vaginitis and the bacterial load associated with different intravaginal implants in ewes. Twenty-four Dorper and crossbred ewes were allocated into three groups and received intravaginal implant containing 0.3g progesterone (CIDR(r)), 60mg MAP or sponges without progesterone (CONTROL) for six days. Then, CIDR and MAP treated-ewes received 12.5mg dinoprost and 300IU eCG. Vaginal mucus samples were collected at four times: before device insertion, at the day of its removal, 24 and 48 hours after. The samples were cultured and the colonies were counted (CFU/mL) and identified. The results obtained from the counting of CFU mL-1 were submitted to Kruskal-Wallis H test, with P 0.05 being considered significant. Before device insertion, 68.2% of the samples yielded Staphylococcus spp. and 60.0% of them were Staphylococcus aureus. After implant removal, 100% of ewes had clinical signs of vaginitis. However, the level of local infection in the CONTROL-ewes was lower (P>0.05) in comparison with MAP and CIDR-treated ewes. During the occurrence of vaginitis, the predominant isolates belonged to the coliform group, mainly Escherichia coli (72.7%). Such infection was not determined by the members of the vaginal microbiota that were present before implant insertion and normal microbiota was restored between 24 to 48 hours after insert removal.(AU)

Este estudo avaliou a presença de vaginite e contagem bacteriana associada ao uso de diferentes dipositivos intravaginais em ovelhas. Vinte e quatro fêmeas Dorper e mestiças foram alocadas em três grupos e receberam implante intravaginal contendo 0,3g de progesterona (CIDR(r)), 60mg de acetato de medroxiprogesterona (MAP) ou esponjas sem progesterona (CONTROLE) por seis dias. Posteriormente, as ovelhas tratadas com CIDR e MAP receberam 12,5mg de dinoprost e 300 UI de eCG. Amostras do muco vaginal foram coletadas em quatro momentos: antes da inserção do dispositivo, no dia de sua retirada, 24 e 48 horas após. As amostras foram cultivadas e as colônias foram contadas (UFC mL-1) e identificadas. Os resultados obtidos da contagem das UFC mL-1 foram submetidos ao teste do qui-quadrado, com P 0,05 sendo considerado significativo. Antes da inserção do dispositivo, 68,2% das amostras continham Staphylococcus spp., sendo 60,0% delas Staphylococcus aureus. Após a remoção do implante, 100% das ovelhas apresentaram sinais clínicos de vaginite. Entretanto, o grau de infecção local nas ovelhas do grupo CONTROLE foi menor (P>0.05), em comparação com as ovelhas recebendo CIDR e MAP. Durante a ocorrência da vaginite, os isolados predominantes pertenciam ao grupo dos coliformes, principalmente Escherichia coli (72,7%). Tal infecção não foi determinada pelos membros da microbiota vaginal, que estavam presentes antes da inserção dos dispositivos, e a microbiota normal foi reestabelecida entre 24 e 48 horas após sua remoção.(AU)

Epidemiología de la infección vaginal en gestantes diabéticas / Epidemiología de la infección vaginal en gestantes diabéticas i: en

Se realizó un estudio descriptivo y transversal de 37 gestantes diabéticas ingresadas en el Servicio de Perinatología del Hospital General "Orlando Pantoja Tamayo" de Contramaestre, provincia de Santiago de Cuba, desde enero hasta diciembre de 2012, con vistas a caracterizarles desde el punto de vista epidemiológico. La información fue procesada con el programa SPSS, versión 11.5 y se utilizó el porcentaje como medida de resumen. Entre los resultados principales predominaron el grupo de 26-30 años (35,1 %), el diagnóstico de infección vaginal a las 28-36 semanas de gestación (48,7 %), la técnica incorrecta para el aseo (67,6 %) y la moniliasis como principal causa de infección (62,2 %). Se impone intensificar estrategias para la prevención de dichas infecciones en las embarazadas con diabetes gestacional.

A descriptive and cross-sectional study of 37 diabetic pregnant women admitted in the Perinatology Service of "Orlando Pantoja Tamayo" General Hospital in Contramaestre, Santiago de Cuba province, was carried out from January to December, 2012, aimed at characterizing them from the epidemiological point of view. The information was processed with the program SPSS, version 11.5 and the percentage was used as summary measure. Among the main results the 26-30 year group (35.1%), the diagnosis of vaginal infection at 28-36 weeks (48.7%), the incorrect technique for the toilet (67.6%) and moniliasis as the main infection cause (62.2%) prevailed. It is imposed to intensify strategies for the prevention of these infections in this populational group.

Algunos factores de riesgo asociados al bajo peso al nacer en el Hospital General "Orlando Pantoja Tamayo" / Some risk factors associated with the low birth weight in "Orlando Pantoja Tamayo" General Hospital i: en

Introducción: cuando un recién nacido tiene un peso inferior a 2500 gramos, independientemente de su edad gestacional, se considera bajo peso. Objetivo: caracterizar algunos factores de riesgo asociados al bajo peso al nacer. Métodos: se realizó un estudio retrospectivo y longitudinal de 242 recién nacidos, atendidos en el Hospital General Docente "Orlando Pantoja Tamayo" de Contramaestre, en la provincia de Santiago de Cuba, desde enero hasta diciembre del 2012. Resultados: prevalecieron los recién nacidos con bajo peso al nacer pertenecientes al área de salud América I (41,3 %), las infecciones vaginales (74,8 %) y el periodo intergenésico menor de 2 años. De los neonatos con esa insuficiencia ponderal, 67,3 % fueron producto de partos pretérmino. Los hábitos tóxicos y la edad materna extrema constituyeron los factores de riesgo predominantes. Conclusiones: el bajo peso constituye un problema de salud que se acrecienta aún más cuando hay desnutrición, debido a la repercusión negativa que tiene para los padres, la familia y la sociedad.

Introduction: when a new born has an weight lower than 2500 grams, independently from its gestacional age, it is considered underweight. Objective: to characterize some risk factors associated with low birth weight. Methods: A retrospective and longitudinal study of 242 newborns, assisted in "Orlando Pantoja Tamayo" Teaching General Hospital from Contramaestre was carried out in Santiago de Cuba province, from January to December, 2012. Results: the underweight newborns who belonged to the health area América I (41.3%), the vaginal infections (74.8%) and the intergenesis period shorter than 2 years prevailed. Of the neonates with that ponderal deficit, 67.3% resulted from preterm childbirths. The toxic habits and the extreme maternal age constituted the predominant risk factors. Conclusions: the low birthweight constitutes a health problem that increases even more when there is malnutrition, due to the negative repercussion that has for the parents, the family and the society.

Factores de riesgo asociados a la infección vaginal por Chlamydia trachomatis / Risk factors associated with vaginal infection caused by Chlamydia trachomatis

Se realizó un estudio de casos y controles, a fin de identificar la posible asociación causal entre algunos factores de riesgo y la ocurrencia de infección vaginal por Chlamydia trachomatis en féminas provenientes de la consulta de Infertilidad del Policlínico Docente "José Martí Pérez" del municipio Santiago de Cuba, desde junio hasta diciembre de 2010. En el estudio se incluyeron 25 casos y se seleccionaron 3 controles por cada uno, mientras que para los cálculos estadísticos se aplicaron la razón de productos cruzados y el intervalo de confianza. Los factores de riesgo asociados a la infección vaginal por esta bacteria fueron: tener historia previa de infección de transmisión sexual y mantener una conducta sexual riesgosa.

A case-control study was carried out in order to identify the potential causative association between some risk factors and the occurrence of vaginal infection caused by Chlamydia trachomatis in females from the Infertility Department of "José Martí Pérez" Teaching Polyclinic in Santiago de Cuba municipality, from June to September 2010. Twenty five cases were included in the study and 3 controls were selected for each, while for the statistical calculations odds ratio and confidence interval were used. History of sexually transmitted infections and risky sexual conduct were the risk factors associated with vaginal infection by this bacterium.

Infecciones del tracto genital y urinario como factores de riesgo para parto pretérmino en adolescentes / Genitourinary infections as risk factors for preterm delivery in teenagers

Objetivo: Determinar las infecciones genitourinarias como factores de riesgo para parto pretérmino en adolescentes. Método: Estudio de casos y controles en las Unidades de Medicina Familiar del IMSS Querétaro, periodo octubre 2010 a octubre 2011. Se incluyeron 35 adolescentes con parto pretérmino y 148 con parto a término, mediante muestreo no aleatorio por cuota; se excluyeron aquellas con preeclampsia, eclampsia u otras enfermedades. Los datos se recolectaron del expediente clínico electrónico. Se estudiaron variables sociodemográficas; antecedentes gineco-obstétricos; tipo de parto (pretérmino y término); e infecciones urinarias y vaginales. La infección de vías urinarias fue diagnosticada mediante urocultivo y/o examen general de orina, con >105 UFC y >10 leucocitos por campo, respectivamente. La infección vaginal se diagnosticó por exudado vaginal con reporte de patógenos y/o por clínica. El análisis se realizó con porcentajes, promedios, chi2, razón de momios (Odds Ratio), prueba de t e intervalo de confianza. Resultados: De las adolescentes con parto pretérmino el 54,3 por ciento presentaron infección de vías urinarias, mientras que solo 33,8 por ciento de estas presentaron parto a término (p=0,02). El 57,1 por ciento de las adolescentes con parto pretérmino presentaron infección vaginal en comparación con 35,1 por ciento de las de parto a término (p=0,01). Conclusión: Las infecciones vaginales y urinarias incrementan dos veces el riesgo de presentar parto pretérmino en adolescentes.

Objective: To determine genitourinary infections as risk factors for preterm delivery in teenagers. Method: Case-control study in the Family Medicine Unit IMSS Querétaro, from October 2010 to October 2011. We included 35 teenagers with preterm delivery and 148 who delivered at term, using non-random sampling, we excluded those with preeclampsia, eclampsia or other diseases. Data were collected from electronic medical record. We studied socio-demographic variables, gyneco-obstetrics antecedents, mode of delivery (preterm and term), and genitourinary infections. Urinary tract infection was diagnosed by urine culture or urinalysis, with > 105 CFU and >10 leukocytes per field, respectively. Vaginal infection was diagnosed by vaginal culture with report of pathogens and / or by clinic. The analysis was performed using percentages, averages, chi-squared test, odds ratio, t-test and confidence intervals. Results: The 54.3 percentof the teenagers with preterm delivery had urinary tract infection, while only 33.8 percent of those with term delivery presented it (p = 0.02). Also 57.1 percent of adolescents with vaginal infection had preterm delivery compared with 35.1 percent of those giving birth at term (p=0.01). Conclusion: Vaginal and urinary infections increase twice the risk of preterm delivery in teenagers.

Infección vaginal en gestantes y su incidencia en indicadores seleccionados del Programa Materno Infantil / Vaginal infection in pregnants and its incidence in indicators selected from Mother Child Program

Introducción: en la atención materno infantil las infecciones se encuentran entre las primeras tres causas de muerte materna, junto a las hemorragias y la hipertensión arterial. Objetivos: describir el cuadro clínico-epidemiológico de las infecciones vaginales y la distribución de gestantes con estas infecciones según indicadores seleccionados del Programa Materno Infantil. Métodos: estudio descriptivo de corte transversal realizado en las gestantes ingresadas en el hogar materno Mariana Grajales Coello del municipio Playa en La Habana durante el trienio 2006-2008. El universo de estudio quedó conformado por 182 gestantes con el diagnóstico de infección vaginal según el protocolo de manejo sindrómico del flujo vaginal. Las variables de estudio fueron edad, momento del diagnóstico, momento del ingreso, tipo de infección vaginal y respuesta al tratamiento e indicadores del Programa Materno Infantil. Para la recolección de la información se utilizó el método observacional documental de historias clínicas. Resultados: se encontró que el 31,31 por ciento de la muestra eran adolescentes, el 40,66 por ciento ingresaron en el segundo y tercer trimestre del embarazo, con moniliasis el 48,35 por ciento y el 12,08 por ciento aportaron niños bajo peso al nacer. Conclusiones: la incidencia de las infecciones vaginales en el hogar materno Mariana Grajales Coello es alta con predominio de moniliasis, infección que en la mayoría de las mujeres evoluciona satisfactoriamente al tratamiento indicado. El bajo peso al nacer es el indicador del Programa Materno infantil más afectado

Introduction: in the mother child care, infections are among the three causes of mother death, together with hemorrhages and high blood pressure. Objectives: to describe the clinical-epidemiological picture of vaginal infections and the pregnants distribution presenting these infections according to the indicators selected from the Mother Child Program. Method: a cross-sectional and descriptive study was conducted in pregnants admitted in the Mariana Grajales Coello maternal home from Playa municipality of La Habana during three years (2006-2008). Sample included 182 pregnants diagnosed with vaginal infection according to the syndrome management protocol of vaginal discharge. Study variables included: age, diagnosis time, admission time, type of vaginal infection and response to treatment and Mother Child Program indicators. For information collection the documentary and observational method from medical records was used. Results: the 31.31 percent of sample were adolescents, the 40.66 percent were admitted during the second and the third trimester of pregnancy, presence of moniliasis in the 48.35 percent and the 12.08 percent gave birth low birth weight children. Conclusions: incidence of vaginal infections in the Mariana Grajales Coello maternal home is high with predominance of moniliasis which in most of women evolve adequately to treatment prescribed. The low birth weight is the more affected indicator of Mother Child Program

Tricomoníase vaginal: o que se passa? / Vaginal trichomoniasis: what is up?

Este estudo faz uma revisão atualizada da prevalência do Trichomonas vaginalis na população geral, bem como sua complexa interação com o hospedeiro e as consequências da infecção não diagnosticada. O Trichomonas vaginalis é um parasita extracelular das mucosas, especialmente a vaginal, que causam descarga vaginal, irritação e inflamação, podendo ser assintomático em quase 1/3 dos casos. Atualmente tem sido pouco encontrado em alguns centros, mas continua como causa importante de vulvovaginites no mundo, mantendo-se com taxas de 10% dos corrimentos vaginais em vários estudos epidemiológicos. É abordada a complexa relação parasita-hospedeiro, em que a resposta imunológica predispõe vaginose bacteriana e infecção pelo HIV, por mobilização das células de defesa (leucócitos, linfócitos T CD4 e macrófagos). As formas de diagnóstico são apontadas para facilitar a compreensão do diagnóstico. Foram apontadas ainda as formas de tratamento e em especial as dificuldades com casos de resistência medicamentosa.

This study is an updated review of Trichomonas vaginalis prevalence in the general population as well as its complex interaction with the host and the consequences of undiagnosed infection. The Trichomonas vaginalis is an extracellular parasite of the mucous membranes, especially the vagina, causing vaginal discharge, irritation and inflammation and may be asymptomatic in nearly one third of cases. Currently, little has been found in some centers, but remains a important cause of vulvovaginitis in the world keeping up with rates of 10% of vaginal discharge in several epidemiological studies. This involves complex host parasite relationship where the immune response predisposes to bacterial vaginosis and HIV infection by mobilizing defense cells (leukocytes, CD4 T lymphocytes and macrophages). The forms of diagnosis are pointed to facilitate understanding of the diagnosis. We also pointed the way to treatment and in particular the difficulties with cases of drug resistance.