Early HbA1c Levels as a Predictor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis.

Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks' gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53-2.66; RR 1.38, 95% CI 1.15-1.66; RR 1.40, 95% CI 1.07-1.83; and RR 1.67, 95% CI 1.39-2.0, respectively) was shown, with a moderate-high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications.

Tiempo de espera para el diagnóstico final de BI-RADS 4 y 5 / Waiting time for the final diagnosis of BI-RADS 4 and 5

Resumen Objetivo: Medir el tiempo de espera en otorgar un diagnóstico final a las derechohabientes con BIRADS 4 y 5 de 40 a 69 años, en el Hospital General de Zona, Medicina Familiar No.1 en La Paz, Baja California Sur, México. Material y métodos: Estudio observacional, descriptivo, con la revisión de 36 registros de control de mastografías del área de radiología, con resultados de BI-RADS 4 y 5. Se midieron variables demográficas y los tiempos de espera del proceso desde la solicitud de la mastografía hasta el diagnóstico final. Se realizó estadística descriptiva. Estudio considerado sin riesgo de acuerdo a la Ley General de Salud. Fue autorizado por los comités de ética e investigación de la unidad hospitalaria. Resultados: Se analizaron un total de 36 expedientes de tamizaje en mujeres entre los 40 y los 69 años, con una media de 51.86 + 8.28 años. El promedio de días trascurridos desde la solicitud de la mastografía hasta el diagnóstico final fue 125.05 + 66.23. En el 13.9% de los casos, se logró concluir el proceso diagnóstico en el tiempo normalmente previsto; para el 86.1% restante, se necesitó un tiempo mayor a 30 días para concluir el protocolo diagnóstico. Las causas del tiempo prolongado fueron atribuibles a la demora en la atención en segundo nivel, (consulta de especialidades y área de patología). Conclusiones: Se necesita generar estrategias en todos los pasos del proceso, para asegurar que se cumpla con el tiempo de espera normado en flujograma, tanto en primero como en el segundo nivel de atención; para mejorar el pronóstico de pacientes con cáncer de mama.

Abstract Objective: To measure the waiting time in granting a final diagnosis to the rights holders with BI RADS 4 and 5 from 40 to 69 years old, in the General Hospital of the Zone + Family Medicine No.1 in La Paz, Baja California Sur, Mexico. Material and methods: Observational, descriptive study, with the review of 36 mammography control records from the radiology area, with BI RADS 4 or 5 results. Demographic variables and waiting times for the process were measured from mammography request until the final diagnosis. Descriptive statistics were performed. Study considered without risk according to the General Health Law. It was authorized by the ethics and research committees of the hospital unit. Results: A total of 36 screening files were analyzed in women between 40 and 69 years old, with a mean of 51.86 + 8.28 years. The average number of days elapsed from the request for the mammography to the final diagnosis was 125.05 + 66.23. In 13.9% of the cases, the diagnostic process was concluded in the normal scheduled time; for the remaining 86.1%, it took more than 30 days to complete the diagnostic protocol. The causes of the prolonged time were attributable to the delay in care at the second level (consultation of specialties and pathology area). Conclusions: It is necessary to generate strategies in all the steps of the process, to ensure that the waiting time regulated in the flowchart is complied with, both in the first and second level of care; to improve the prognosis of patients with breast cancer.

[Comparison of the Pap smear with conventional technique versus modified technique]. / Comparación del Papanicolau con técnica convencional frente a técnica modificada.

Background: Despite the fact that the Papanicolaou technique is the most effective method of prevention and detection of cervical cancer, the precision of this tool remains controversial; Because of this, there are medical and scientific efforts to improve the quality of the procedure. Objective: Compare the quality of sampling between the conventional and modified technique. Material and methods: Descriptive and comparative observational study in 150 cervical cytology samples (75 conventional technique samples and 75 in modified technique) in women aged 25 to 64 years. Demographic variables, characteristics of the cervix and quality of the sample were analyzed. Descriptive statistics and association measures were performed. Study with risk greater than the minimum. All participants signed an informed consent. Results: The quality of the sample was satisfactory in 92.0% for the conventional technique vs 89.3% for the modified technique. The main cause of unsatisfactory samples was insufficient cellularity 6.7% in conventional technique vs 12% of the modified technique, with no significant difference between both techniques p = 0.575 (1.37; 0.45-4.1), findings that reject the working hypothesis. Conclusions: There was no significant difference when using both tests, the samples with satisfactory quality were similar between both techniques.

Introducción: a pesar de que la técnica de papanicolaou es el método más eficaz para la prevención y detección del cáncer cervicouterino, la precisión de esta herramienta sigue siendo controversial; debido a esto, existen esfuerzos médicos y científicos para mejorar la calidad del procedimiento. Objetivo: comparar la calidad en la toma de muestra entre la técnica convencional y la modificada. Material y métodos: estudio observacional descriptivo y comparativo en 150 muestras de citología cervical (75 muestras técnica convencional y 75 en técnica modificada) en mujeres de 25 a 64 años. Se analizaron variables demográficas, características del cérvix y calidad de la muestra. Se realizó estadística descriptiva y medidas de asociación. Estudio con riesgo mayor que el mínimo. Todas las participantes firmaron consentimiento informado. Resultados: la calidad de la muestra fue satisfactoria en el 92% para la técnica convencional frente al 89.3% para la técnica modificada. La causa principal de muestras insatisfactorias fue la celularidad insuficiente, la cual se presentó en el 6.7% de las muestras con técnica convencional frente al 12% de la técnica modificada, sin diferencia significativa entre ambas técnicas p = 0.575 (1.37; 0.45-4.1), hallazgos que rechazan la hipótesis de trabajo. Conclusiones: no hubo diferencia significativa al utilizar ambas pruebas, las muestras con calidad satisfactoria fueron similares entre ambas técnicas.

Comparación del Papanicolau con técnica convencional frente a técnica modificada / Comparison of the Pap smear with conventional technique versus modified technique

Introducción: a pesar de que la técnica de papanicolaou es el método más eficaz para la prevención y detección del cáncer cervicouterino, la precisión de esta herramienta sigue siendo controversial; debido a esto, existen esfuerzos médicos y científicos para mejorar la calidad del procedimiento. Objetivo: comparar la calidad en la toma de muestra entre la técnica convencional y la modificada. Material y métodos: estudio observacional descriptivo y comparativo en 150 muestras de citología cervical (75 muestras técnica convencional y 75 en técnica modificada) en mujeres de 25 a 64 años. Se analizaron variables emográficas, características del cérvix y calidad de la muestra. Se realizó estadística descriptiva y medidas de asociación. Estudio con riesgo mayor que el mínimo. Todas las participantes firmaron consentimiento informado. Resultados: la calidad de la muestra fue satisfactoria en el 92% para la técnica convencional frente al 89.3% para la técnica modificada. La causa principal de muestras insatisfactorias fue la celularidad insuficiente, la cual se presentó en el 6.7% de las muestras con técnica convencional frente al 12% de la técnica modificada, sin diferencia significativa entre ambas técnicas p = 0.575 (1.37; 0.45-4.1), hallazgos que rechazan la hipótesis de trabajo. Conclusiones: no hubo diferencia significativa al utilizar ambas pruebas, las muestras con calidad satisfactoria fueron similares entre ambas técnicas.

Background: Despite the fact that the Papanicolaou technique is the most effective method of prevention and detection of cervical cancer, the precision of this tool remains controversial; Because of this, there are medical and scientific efforts to improve the quality of the procedure. Objective: Compare the quality of sampling between the conventional and modified technique. Material and methods: Descriptive and comparative observational study in 150 cervical cytology samples (75 conventional technique samples and 75 in modified technique) in women aged 25 to 64 years. Demographic variables, characteristics of the cervix and quality of the sample were analyzed. Descriptive statistics and association measures were performed. Study with risk greater than the minimum. All participants signed an informed consent. Results: The quality of the sample was satisfactory in 92.0% for the conventional technique vs 89.3% for the modified technique. The main cause of unsatisfactory samples was insufficient cellularity 6.7% in conventional technique vs 12% of the modified technique, with no significant difference between both techniques p = 0.575 (1.37; 0.45-4.1), findings that reject the working hypothesis. Conclusions: There was no significant difference when using both tests, the samples with satisfactory quality were similar between both techniques.