Inducción del parto en gestaciones gemelares: estudio comparativo de oxitocina vs dinoprostona / Induction of labour in twin pregnancies: Comparative study of oxytocin vs. dinoprostone

Introducción: En los últimos años el número de gestaciones gemelares que alcanzan el término se ha incrementado. Aunque la vía vaginal ha demostrado ser una alternativa segura frente a la cesárea cuando el primer feto se encuentra en presentación cefálica, la evidencia disponible sobre los métodos de inducción aplicados a este tipo de gestaciones es limitada. Métodos: Estudio observacional retrospectivo realizado en un hospital de tercer nivel. Se incluyeron 44 gestantes gemelares, con edad gestacional superior a 34 semanas y con el primer gemelo en presentación cefálica, que fueron sometidas a inducción del parto. En 17 casos se utilizaron prostaglandinas vaginales (dinoprostona) y en 27, oxitocina intravenosa. La indicación se realizó aleatoriamente según la práctica clínica diaria. Se compararon los resultados de ambos grupos en seguridad y eficacia. Resultados: No se encontraron diferencias significativas en la tasa de cesárea por fracaso de inducción entre la oxitocina y las prostaglandinas (42,9% vs. 57,1%; p=0,3). Tampoco se encontraron diferencias en complicaciones neonatales ni maternas. Dos gestantes presentaron hemorragia obstétrica, única complicación materna descrita, ambas en el grupo de oxitocina. El 100% de las cesáreas realizadas fueron en gestantes con índices Bishop ≤6. Se encontró un mayor riesgo de cesárea en mujeres con IMC>30kg/m2 (p=0,001) e índice de Bishop previo a la inducción ≤6 (RR: 2,06; p=0,005). Conclusiones: Tanto las prostaglandinas vaginales como la oxitocina intravenosa resultan similares en eficacia, seguridad materna y neonatal, cuando se utilizan en gestaciones gemelares. Un índice de Bishop ≤6 y un IMC >30 se asocian con una mayor probabilidad de inducción fallida.

Introduction: In the last few years the number of twin gestations that reach term has increased. Although vaginal delivery route has proven to be a safe alternative to caesarean section when first foetus is in cephalic presentation, available evidence on induction methods applied to this type of pregnancies is limited. Methods: Retrospective observational study conducted in a tertiary hospital. Forty-four pregnant twins, with gestational age greater than 34weeks, and with the first twin in cephalic presentation, who underwent induction of labour, were included. Vaginal prostaglandins (dinoprostone) were used in 17 cases and intravenous oxytocin in 27 cases, indication was randomised according to daily clinical practice. Results of both groups were compared in terms of safety and efficacy. Results: No significant differences were found in the rate of caesarean section due to induction failure between oxytocin and prostaglandins (42.9% vs. 57.1%; P=.3). No differences were found either in terms of neonatal or maternal complications. Two pregnant women presented obstetric haemorrhage, the only maternal complication described, both in oxytocin group. Higher risk of caesarean section was found in women with BMI >30kg/m2 (P=.001) and pre-induction Bishop's index ≤6 (RR: 2.06) (P=.005). Conclusions: Both vaginal prostaglandins and intravenous oxytocin are similar in efficacy, maternal and neonatal safety when used in twin gestations. Bishop's index ≤6 and BMI >30 are associated with higher probability of induction failure.(AU)

Estudio comparativo lesional en judocas de élite / Lessional Comparative Study in Elite Judocas

El Judo es un deporte estático alto y dinánimo bajo, con alto riesgo de colisión corporal y lesional. El objetivo de este trabajo es determinar la incidencia lesional y comparar los distintos factores de riesgo que pudieran estar implicados. Se estudió a un total de 86 judocas del Equipo Nacional de Judo español (ENJE) durante dos períodos olímpicos: Beijing-Río. Se produjeron 2028 lesiones con mayor frecuencia en miembro inferior, sin diferencias significativas por sexo. Se objetivó mayor incidencia lesional cuando el judoca era tori y durante el momento del entrenamiento. No existen trabajos previos que comparen estos parámetros, por lo que este estudio aporta datos que pueden ser utilizados para prevenir los riesgos de lesión en el judo de alta competición. (AU)

Judo is a high static and low dynamic sport, with a high risk of bodily and injury collision. The objective of this work is to determine the incidence of injury and to compare the different risk factors that may be involved. A total of 86 judokas from the Spanish National Judo Team (ENJE) were studied during two Olympic periods: Beijing-Rio. 2028 injuries occurred more frequently in the lower limb, without significant differences by sex. A higher incidence was observed in tori judoka and during training. No existing work has examined these parameters. The present study provides data that can be used to reduce the risk of injury in elite judokas. (AU)

[Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care]. / Atención especializada domiciliaria de patologías médicas desde un hospital universitario terciario urbano. Coordinación entre los servicios médicos del hospital y la Atención Primaria de salud del territorio.

INTRODUCTION: The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. PATIENTS AND METHOD: Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). RESULTS: 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. CONCLUSIONS: The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care.

Atención especializada domiciliaria de patologías médicas desde un hospital universitario terciario urbano. Coordinación entre los servicios médicos del hospital y la Atención Primaria de salud del territorio / Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care

Introducción. Se presenta la experiencia de un hospital universitario terciario urbano en el diseño e implementación de una unidad de hospitalización a domicilio (UHaD) integrada en un Servicio de Medicina Interna y altamente coordinada con los servicios médicos del hospital y la Atención Primaria de salud del entorno hospitalario, que contempla como principales objetivos la promoción de la atención especializada domiciliaria de patologías médicas y la mejora de la coordinación con la Atención Primaria de salud. Pacientes y métodos. Recogida sistemática en todos los pacientes ingresados entre abril 2006 y marzo 2007 en la UHaD de las siguientes variables: edad, sexo, lugar y servicio de procedencia, diagnóstico principal, índice de Barthel y de Charlson, número de visitas al día de enfermería y médicas, destino al alta y equipo médico responsable. El análisis estadístico descriptivo se realizó en abril de 2007. Los resultados se presentan de forma global y diferenciados por equipos (Medicina Interna, Neumología y soporte nutricional). Resultados. Quinientos seis ingresos que correspondían a 390 pacientes con una edad media de 66,5 (18) años, y un 53% mujeres. El índice de Charlson fue de 2 (2,2) y el índice de Barthel de 63,5 (40,4). La estancia media fue de 7,9 (8,2) días. Los principales motivos de ingreso fueron las infecciones y tratamiento antibiótico por vía intravenosa en 153 (30,5%) casos, las agudizaciones de enfermedad pulmonar obstructiva crónica o insuficiencia cardíaca en 107 (21%) casos y la nutrición enteral o parenteral domiciliaria en 102 (20%) casos. Doscientos (39,5%) pacientes al finalizar el ingreso fueron controlados por sus equipos de Atención Primaria, 241 (47,5%) fueron seguidos en consultas del hospital y 45 (9%) retornaron directamente al hospital. Conclusión. La creación de una UHaD para patologías médicas desde el Servicio de Medicina Interna, altamente coordinada con servicios médicos del hospital, especialmente con Urgencias, Neumología y Soporte Nutricional y con la Atención Primaria del entorno hospitalario, facilita la atención especializada domiciliaria de patologías médicas y mejora la coordinación con la Atención Primaria de salud

Introduction. The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. Patients and method. Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). Results. 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. Conclusions. The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care

Secretory leukocyte protease inhibitor and its potential interactions with elastase and cathepsin B in gingival crevicular fluid and saliva from patients with chronic periodontitis.

BACKGROUND AND OBJECTIVE: Elastase is carried into the oral cavity by gingival crevicular fluid (GCF) from periodontal lesions. Our study investigated the regulation of elastase activity by secretory leukocyte protease inhibitor (SLPI) and the possible action of another GCF protease on this protective salivary component. MATERIAL AND METHODS: Whole-mouth saliva (WMS), parotid saliva (PS) and GCF were obtained from 19 patients with periodontitis. The concentrations of active elastase and cathepsin B were determined using peptide substrates. SLPI and alpha1-proteinase inhibitor (alpha1PI) concentrations were determined using enzyme-linked immunosorbent assays (ELISAs). The molecular forms of SLPI were examined by immunoblotting. RESULTS: The molar concentrations of elastase, cathepsin B and alpha1PI were higher in GCF than in WMS and especially PS (p < 0.0002). The GCF SLPI concentrations were also higher than the WMS SLPI concentrations (p < 0.05). All WMS components increased with GCF content, significantly for elastase and SLPI (p < 0.002). In GCF, the concentration of alpha1PI was higher than the concentration of SLPI (p < 0.0002), while there was no significant difference for WMS. SLPI and elastase levels in GCF and WMS were inversely related (p < 0.005). In SLPI immunoblots, PS contained only the intact 14-kDa molecule of SLPI, while WMS also contained an 8-kDa fragment. For WMS there was a positive correlation between SLPI degradation and cathepsin B (p < 0.002). Incubation of WMS alone or of PS with GCF in the presence of cysteine proteinase activators caused SLPI immunoreactivity to shift to 8 kDa. CONCLUSION: For GCF, serum-derived alpha1PI is the major elastase inhibitor, but in WMS SLPI probably reduces activity. The inflamed gingivae can be an additional source of SLPI in the oral cavity, but here the molecule is apparently cleaved by GCF cysteine proteinases, such as cathepsin B.

Distribution of prepubertal and adult goat oocyte cortical granules during meiotic maturation and fertilisation: ultrastructural and cytochemical study.

The aim of this study was evaluate cortical granule (CG) distribution during in vitro maturation (IVM) and fertilisation of prepubertal goat oocytes compared to CG distribution of ovulated and in vitro fertilised oocytes from adult goats. Oocytes from prepubertal goats were recovered from a slaughterhouse and were matured in M199 with hormones and serum for 27 hr. Ovulated oocytes were collected from gonadotrophin treated Murciana goats. Frozen-thawed spermatozoa were selected by centrifugation in percoll gradient and were capacitated in DMH with 20% steer serum for 1 hr. Ovulated and IVM-oocytes were inseminated in DMH medium with steer serum and calcium lactate for 20 hr. Oocytes and presumptive zygotes were stained with FITC-LCA (Lens culinaris agglutinin labelled with fluorescein isothiocyanate) and observed under a confocal laser scanning microscope. Ultrastructure morphology of oocytes and presumptive zygotes were analysed by transmission electron microscopy (TEM). Prepubertal goat oocytes at germinal vesicle stage show a homogeneous CG distribution in the cytoplasm. IVM-oocytes at Metaphase II (MII) and ovulated oocytes presented CGs located in the cortex with the formation of a monolayer beneath to the plasma membrane. At 20 hr postinsemination (hpi), zygotes from IVM-oocytes showed a complete CG exocytosis whereas zygotes from ovulated oocytes presented aggregates of CGs located at the cortical region. Images by TEM detected that CGs were more electrodense and compacts in oocytes from prepubertal than from adult goats.

Selection of prepubertal goat oocytes using the brilliant cresyl blue test.

Brilliant cresyl blue stain allows us to determine the activity of glucose-6-phosphate dehydrogenase (G6PD), an enzyme synthesized in growing oocytes but with decreased activity in oocytes that have finished their growth phase. The objective of this study was to evaluate the utility of the brilliant cresyl blue (BCB) test as an indirect measure of oocyte growth, in order to select competent prepubertal goat oocytes for in vitro embryo production. Oocytes were exposed to BCB diluted in PBS and were classified according to their cytoplasm coloration: oocytes with a blue cytoplasm or grown oocytes (BCB+) and oocytes without a blue cytoplasm or growing oocytes (BCB-). After exposure to different BCB concentrations, we evaluated in vitro maturation (IVM), in vitro fertilization (IVF) and embryo development parameters. We defined matured oocytes as those oocytes that reached the metaphase II (MII) stage after being cultured for 27 h. Oocytes showing two pronuclei at 20 h post-insemination were classified as normally fertilized oocytes. We assessed embryo development 8 days post-insemination and recorded the percentage of total embryos, morale and blastocysts. The mean percentage of BCB+ oocytes was 29.4%. Mean diameter of BCB+ oocytes (136.6+/-6.3 microm) was higher (P < 0.001) than that of BCB- oocytes (125.5+/-10.2 microm). The percentage of BCB+ oocytes reaching the MII stage (81.4%) was higher (P < 0.05) than that of BCB- (52.5%) and control oocytes (72.4%). Normal fertilization rate of BCB+ oocytes was also higher (23.5%) than that of BCB- (8.2%; P < 0.0001) and control oocytes (11.9%; P < 0.05). The percentages of total embryos undergoing development to >8-cell and the morula plus blastocyst stages were higher (P < 0.05) in the group of BCB+ (41.3 and 12.0%, respectively) than in BCB- oocytes (21.3 and 3.6%, respectively). In conclusion, the BCB test is a useful way to select more competent prepubertal goat oocytes for in vitro embryo production.

Effects of the addition of glutathione during maturation on in vitro fertilisation of prepubertal goat oocytes.

Glutathione (gamma-glutamyl-cysteinyl-glycine; GSH) is a ubiquitous intracellular free thiol that improves development of the male pronucleus at fertilisation and has also been implicated in promoting the development of preimplantation embryos. The objective of this study was to evaluate the effects of adding GSH or cysteine to the in vitro maturation medium on intracellular GSH amounts after in vitro maturation and fertilisation of prepubertal goat oocytes. Oocytes were matured in TCM199 medium supplemented with 10% bovine fetal serum, 1 mg/ml 17beta-estradiol, 10 microg/ml o-FSH, 10 microg/ml LH and 50 mg/ml gentamicin. In vitro maturation medium was completed with two independent treatments: GSH at different concentrations (0, 0.25, 0.50 and 1.00 mM) and L-cysteine at different concentrations (0, 150, 300, 600 and 900 microM). After 27 h of culture at 38.5 degrees C in 5% CO2 in air, the nuclear stage was evaluated. Simultaneously, another sample of oocytes was frozen and the intracellular GSH level was evaluated with spectrophotometric methodology. Oocytes were inseminated with fresh semen (2-3 x 10(6) sperm/ml) in TALP medium supplemented with 1 mg/ml hypotaurine. Oocytes were fixed at 20 h post-insemination to evaluate the in vitro fertilisation. Oocytes matured in 1.00 mM GSH-supplemented medium exhibited higher amounts of intracellular GSH (3.23 pmol per oocyte). The percentage of normal fertilisation (17-27%) was similar for the treatment groups. In conclusion, the addition of 1.00 mM GSH to the maturation medium could be a useful method for increasing the intracellular GSH levels of prepubertal goat oocytes. However, this increase was not associated with a higher normal fertilisation rate of prepubertal goat oocytes.

Entrenamiento de las reacciones de equilibrio en el paralítico cerebral adulto / Training of equilibrium reactions in adult cerebral palsy patients

El artículo propone un enfoque sobre el tratamiento fisioterápico de las alteraciones del equilibrio en el paralítico cerebral adulto a partir del entrenamiento de sus reacciones, incluyendo como tales los mecanismos de enderezamiento, las reacciones de equilibrio y las reacciones protectoras. Tras una breve reseña de la neurofisiología y del desarrollo del equilibrio en el niño se realiza una propuesta de valoración en las distintas posturas que servirá como base para la realización del entrenamiento en las reacciones de equilibrio. Dicho entrenamiento se desarrolla en dos fases, una de actividades básicas posturales y otra de desequilibrios en cada posición. Las ideas que se proponen son aplicables a paralíticos cerebrales adultos (AU)