[Inflamatory indexes predictors of complicated acute apendicitis in children]. / Índices inflamatorios predictores de apendicitis aguda complicada en niños.

Background: Appendicitis is the main cause of acute surgical abdomen in pediatrics. Delay in the diagnosis implies serious consequences. Objective: To know the utility of inflammation markers for predicting complicated acute appendicitis (CAA) in children. Material and methods: Analytical cross-sectional retrolective study. We included patients from 3 to 17 years, with and without acute appendicitis (AA), who had complete blood count (CBC). Presurgical CBC, surgical findings and histopathologic results were recorded; group I, CAA; group II, uncomplicated acute appendicitis (UAA); and group III, without AA, with stratified analysis by age group. Results: 377 patients were included, 9 years of age (IQR 5-12.5), group I (n = 94), group II (n = 94) and group III (n = 189). Group I showed elevation in the values of Neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and Systemic immune inflammation (SII) index and lower levels for the Lymphocyte/monocyte ratio (LMR). For AA, in preeschoolers, NLR (sensitivity [S]: 0.85; specificity [E]: 0.98), PLR (S: 0.76; E: 0.85), SII (S: 0.92; E: 0.92) was observed; school children, NLR (S: 0.90; E: 0.96), PLR (S: 0.70: E: 0.86), SII (S: 0.91; E: 0.91); adolescents, NLR (S: 0.85; E: 0.97), PLR (S: 0.26; E: 0.95), SII (S: 0.86; E: 0.86); in CAA, S and E decreased. NLR, PLR, LMR and SII were associated with AA in all ages; PLR and SII in preschoolers, LMR in school children were associated with CAA. Conclusion: NLR, PLR, LMR and SII are predictors of AA in pediatric age, and for AAC, PLR and SII in preschoolers and LMR in school children.

Introducción: la apendicitis es la principal causa de abdomen agudo quirúrgico en pediatría; el retraso en su diagnóstico implica consecuencias graves. Objetivo: conocer la utilidad de los índices inflamatorios para predicción de apendicitis aguda complicada (AAC) en niños. Material y métodos: estudio transversal, analítico, retrolectivo. Incluimos pacientes de 3 a 17 años, con y sin apendicitis aguda (AA), con biometría hemática completa (BHC). Se registró BHC prequirúrgica, hallazgos quirúrgicos y resultado histopatológico; grupo I, AAC; grupo II, apendicitis aguda no complicada (AANC) y grupo III, sin AA; con análisis estratificado por grupo etario. Resultados: se incluyeron 377 pacientes, edad 9 años (RIC 5-12.5), grupo I, 94; grupo II, 94, y grupo III, 189. El grupo I mostró elevación de los índices neutrófilos/linfocitos (INL), plaquetas/linfocitos (IPL) e inmuno/sistémico (IIS) y menor índice linfocitos/monocitos (ILM). Para AA, se observó en preescolares, INL (sensibilidad [S]: 0.85; especificidad [E]: 0.98), IPL (S: 0.76; E: 0.85), IIS (S: 0.92; E: 0.92); escolares, INL (S: 0.90; E: 0.96), IPL (S: 0.70; E: 0.86), IIS (E: 0.91; S: 0.91); adolescentes, INL (S: 0.85; E: 0.97), IPL (S: 0.26; E: 0.95), IIS (S: 0.86; E: 0.86); en AAC, S y E disminuyeron. INL, IPL, ILM e IIS se asociaron con AA en todas las edades; IPL e IIS en preescolares e ILM en escolares se asociaron con AAC. Conclusión: INL, IPL, ILM e IIS son predictores de AA en edad pediátrica, así como, IPL e IIS en preescolares e ILM en escolares lo son de AAC.

[Predictive value of Doppler fluxometry of umbilical and middle cerebral arteries with the perinatal outcomes in fetus with intrauterine growth restriction]. / Valor predictivo de la flujometría Doppler de las arterias umbilical y cerebral media con los resultados perinatales en fetos con restricción del crecimiento intrauterino.

OBJECTIVE: To determine the predictive value of the Doppler fluxometry of the umbilical artery and middle cerebral artery with the perinatal outcome in fetuses with intrauterine growth restriction. MATERIAL AND METHODS: We carried out a cross-sectional study. There were included 220 pregnant women with diagnosis of intrauterine growth restriction. We carried out in these women Doppler fluxometry of umbilical artery and middle cerebral artery. It was followed the perinatal outcome of the newborns. We used student's t test for comparing the fluxometry indexes; and logistic regression analysis to determine its association with the perinatal outcome. An alpha value was set at 0.05. RESULTS: The fluxometry indexes of the umbilical artery were abnormal in all the cases of intrauterine growth restriction. The fluxometry indexes of the middle cerebral artery were abnormal in a small number of fetuses with perinatal complications. In the logistic regression analysis the fluxometry index of the umbilical artery was significant in order to predict bad perinatal outcome, in the other hand, the middle cerebral artery was not significant. The perinatal complications diagnosed were: distress respiratory syndrome (37.2%) necrotizing enterocolitis (6.2%) and sepsis (6.2%). CONCLUSIONS: The Doppler fluxometry of the umbilical artery have better predictive value than the middle cerebral artery for predicting bad perinatal outcome. We recommend the assessment of umbilical artery as first choice in order to determine the well-being in fetuses with intrauterine growth restriction.

[Placental histopathological changes in gestational hypertension]. / Alteraciones histopatológicas placentarias en la hipertensión gestacional.

BACKGROUND: Preeclampsia develops after a partial disorder in the process of placental formation, perhaps due to a deficiency of the trophoblast invasion by its spiral arteries and acute aterosis in its miometrial segments. It has not been reported if these changes also appear in placentas of women with gestational hypertension without proteinuria. OBJECTIVE: To describe histopathological changes in the placenta of patients with hypertensive disorders during pregnancy. MATERIAL AND METHODS: Cross-sectional study carried out in 138 patients divided into three groups: 46 with normotensive pregnancy (A group or control), 46 with gestational hypertension (group B), and 46 with preeclampsia (group C). There were registered sociodemographic and clinical variables; and the histopathological study of the placenta was performed. Mean, standard error and percentages were used. We calculated analysis of variance for comparing groups and linear regression for determining correlation between histopathological changes and blood pressure (it was assigned an alpha value of 0.05). RESULTS: There were more histopathological changes in groups of gestational hypertension and preeclampsia compared with controls (p < 0.01). Most frequent changes in all groups were: sincitial hyperplasia and fibrin deposits around the villi. There was correlation between histopathological changes and blood pressure (r= 0.27, p <0.01). CONCLUSION: There are more histopathological changes in placentas of women with hypertensive disease; number of histopathological changes is correlated with the severity of hypertension.

[Risk factors associated with dystocic delivery]. / Factores de riesgo asociados con el parto distócico.

BACKGROUND: the dystocic delivery is a frequent complication and its perinatal repercussions vary from minor lesions to severe brain damage. It has been reported diverse factors associated with this medical complication. OBJECTIVE: to identify the risk factors with significant association with dystocic delivery. MATERIAL AND METHODS: a case-control study was carried out. There were included 750 patients, divided into 250 women with dystocic deliveries (cases) and 500 women with eutocic deliveries (controls). Demographic and clinical variables were registered. The statistical analysis was performed with percentages, arithmetic media, standard deviation, Student t test, chi2 and logistic regression analysis. An alpha value was set at 0.05. RESULTS: the factors with statistical significance were: advanced age (p < 0.001), major patient's height (p < 0.001), major new born's weight (p = 0.009), lower parity (p < 0.001), and prolonged duration of labor (p = 0.04). Other variables such as number of pregnancies, previous cesarean sections, spontaneous abortions, weight of the patient, weight earned during pregnancy, number of medical appointments during antenatal care, previous dystocic delivery, and premature rupture of the membranes, were not significant. CONCLUSIONS: there are clinical and demographic risk factors associated with dystocic delivery. To identify this risk factors during the antenatal care could diminish the frequency of dystocic deliveries and therefore to avoid the associated maternal-fetal complications.