Oxidative stress changes in pregnant patients with and without severe preeclampsia.

BACKGROUND AND AIMS: The etiology of preeclampsia (PE) is unknown and the only treatment is removal of the fetus and placenta. The critical changes of this state include the increase of vascular resistance and hypoperfusion in the uteroplacental microcirculation that predispose to hypoxia and ischemia and, therefore, increased oxidative stress through 8-isoprostane, which is characterized by damage to the placenta and endothelium. We undertook this study to compare oxidative stress in pregnant women with PE. METHODS: A case-control, cross-sectional and comparative study was undertaken. Pregnant women between 28 and 38 weeks of gestation with and without PE were recruited. Venous blood samples were taken for determination of 8-isoprostane. Obstetrical variables were measured and 8-isoprostane by radioimmunoassay. SPSS v.11 for Windows was used for descriptive statistics. Mean ± standard deviation, correlation and χ(2) were used for comparison between groups. RESULTS: We studied 45 patients: 20 with PE (44.6%) and 25 without PE (55.4%). The average for 8-isoprostane in preeclamptic patients was 699.2 ± 38.6 pg/dl and without PE was 113.9 ± 52.4 pg/dL (p <0.01), gestational age 32.1 ± 2.6 and 35.1 ± 1.8 weeks, birth weight 1880 ± 238 g and 2787 ± 312 g, respectively. Apgar at birth was similar in both groups. CONCLUSIONS: We found statistical differences in the 8-isoprostane levels in both groups. There was no correlation in perinatal results in both groups according to 8-isoprostane levels. These results could be the basis for the use of antioxidants in the management of PE to counteract tissue damage.

[Clinical aptitude of residents that attend patients with the cervical intraepithelial neoplasia]. / Aptitud clínica de médicos residentes en la atención de pacientes con neoplasia intraepitelial cervical.

OBJECTIVE: To build, validate and apply an instrument to evaluate the clinical aptitude in intraepitelial cervical neoplasia (ICN) in residents. METHODS: The instrument included four clinical real cases, validated by experts and included 106 items using true, false and don't know answers. A pilot test and the 21 Kuder-Richardson formula were used to estimate consistency. It was applied to residents, in an observational, transversal, comparative and open study, including 11 second year residents, 13 third year residents and 12 fourth year residents. RESULTS: Consistency of 0.88 was obtained; 22% were located in the middle level, 39% were located in the low level and 39% in the very low level. There were no residents in the high or very high level or by chance answer level. The Kruskal-Wallis test showed significant differences among the three groups and with the U test of Mann Whitney there were no differences between groups. CONCLUSIONS: The year of residence did not show differences in the development of clinical aptitude in ICN. Most of the residents were located in the inferior level of clinical aptitude. This study makes evident the need to reframe our educative processes in a qualitative different manner.

[Clinical aptitude of gynecology and obstetrics residents to manage obstetric bleeding]. / Aptitud clínica de médicos residentes en el tratamiento de sangrados de la segunda mitad del embarazo.

OBJECTIVE: to build, validate and apply a test that explores and evaluates the clinical aptitudes of Gynecology and Obstetrics (Ob/Gyn) residents. MATERIAL AND METHODS: the test included five actual clinical cases representing the main obstetric conditions associated with obstetric bleeding. The validation process included rounds with experts and the final version of the test included 100 items in which the answers had the options "true." "false " and "don't know." A pilot study and the 21 Kuder-Richardson formula served to increase the consistency of the test. Then, 33 Ob/Gyn residents (8 of 2nd year; 14 of 3rd year and 11 of 4th year) answered the test. RESULTS: According to the 21 Kuder-Richardson formula the consistency of the test was 0.80; regarding the clinical aptitudes, 18 % of residents scored in the middle level, 66 % in the low level and 15 % in the very low level. No resident scored in the high or very high levels or by chance answers level. The Kruskal-Wallis test did not show statistically significant differences among the three groups and with the U test of Mann-Whitney no differences between groups were observed after comparing 2nd year versus 3rd year; 3rd year versus 4th year, and 2nd year versus 4th year residents. CONCLUSIONS: The years of residence did not show differences to developing clinical aptitudes. Most of the residents were located in the low level of these clinical aptitudes. This study underlined the need to reconsider our educative processes in a qualitative different manner.

[Sacropexy with abdominal fascia in treatment of vaginal prolapse vault of menopausal women]. / Sacropexia con fascia de recto abdominal en el tratamiento del prolapso de la cúpula vaginal.

INTRODUCTION: Vaginal vault prolapsed is a rare complication, with a frequency from 0.2 to 1% after hysterectomy, which is presented due to a bad surgical technique in fixation of the vault suspension elements, as well others factors as the multiparity, menopause, chronic lungs disease, obesity, smoking and weak physical activity. There are many techniques reported to correct this pelvic disease, although the conventional sacropexy has been established for abdominal way, where the diversity of materials of fixation is varied, including natural material as the abdominal fascia and aponeurosis of muscle rectos. OBJECTIVE: This descriptive and clinical study was carried out in a group of patient with vaginal vault prolapsed, with the objective to know the results and experience of this correction with the surgical technique of sacropexy utilizing abdominal fascia. MATERIAL AND METHODS: 32 menopausal patient with mean age of 53.9 years, 5 gestations, as well as index of Quetelet of 26.2, were studied, a following of a year was carried out. In these women the main symptom were the sensation of vaginal strange body and subsequently urinary incontinence of effort. Moreover, considering to all group the mean in presentation of the vaginal vault prolapsed after hysterectomy was of 7.7 years, with surgical time of 129 minutes and bled of 172 milliliters. RESULTS. The 97.5% of the patient returned to its sexual life without difficulties and only one referred dyspareunia. Post-surgical complications were not presented and only a patient presented vault prolapsed again (0.31%). CONCLUSIONS: With this results we can consider that the sacropexy with abdominal fascia is a good technique for the correction of the vaginal vault prolapsed in healthy menopausal women with regular sexual activity and then is a natural material who cause not any.