Pregnancy exposure to disease-modifying drugs in multiple sclerosis: a prospective study. / Exposición a fármacos modificadores de la enfermedad durante el embarazo en esclerosis múltiple: estudio prospectivo.

INTRODUCTION: In multiple sclerosis (MS), foetal exposure to disease-modifying drugs (DMDs) carries varying degrees of risk. We sought to analyse the clinical and obstetric outcomes of MS patients (MSp) exposed to DMDs during pregnancy. PATIENTS AND METHODS: Observational study. We analysed the clinical-obstetric data of a cohort MSp, who became pregnant between 2007-2017. They were prospectively followed up during pregnancy and postpartum. CONTROL GROUP: healthy pregnant women (HPW) and MSp unexposed to DMDs. RESULTS: Sixty-eight pregnancies in MSp. Fifty-six HPW. Thirteen MSp were exposed to DMDs during pregnancy. Obstetric outcome: 2 (15%) infants had low birth weight, no preterm deliveries. Fifty-five MSp were not exposed to DMDs: 22 (40%) discontinued DMD before pregnancy, 33(60%) naïve. Five infants (9%) had low birth weight and 7 (12%) were preterm. HPW: 56. Low birth weight 6 (11%), preterm delivery 6 (11%). There were no differences in relapse incidence during pregnancy-puerperium between MSp groups. There were no differences in birth weight, gestation time, delivery-caesarean section. We found no special obstetric morbidity in women exposed to DMDs. CONCLUSIONS: There were no significant differences in the clinical and obstetric variables analysed between pregnant women exposed to DMDs, unexposed, and HPW.

Estudio seroepidemiológico para estimar el riesgo de infección congénita por toxoplasma gondii en Guayaquil, Ecuador / Serological and epidemiological screening to estimate congenital toxoplasma gondii infection in Guayaquil, Ecuador

Exámenes serológicos, por Hemaglutinación indirecta (HAI) y Elisa para anticuerpos anti Toxoplasma gondii se practicaron a niños y adolescentes, distribuidos en 4 grupos: 0 < 5 .años, 5 < 10, 10 < 15 y de 15 < 20, para obtener los datos de prevalencia e incidencia quinquenal, así como, por entrevista para identificar factores de riesgo; los datos se analizaron estadísticamente, como variables independientes y correlaciones bivariadas. Se examinaron 578: 285 varones y 292 mujeres, (1 no consignado), promedio de edad 9,7 años. La prevalencia encontrada es 60,2 con descenso de 18 porciento respecto a 1989. Se discuten hipótesis para explicar esta disminución. La incidencia aumenta rápido hasta los 10 años. No se estableció ninguna correlación con los factores de riesgo incluidos, excepto en el contacto con gatos menores de 6 meses (gatitos). El riesgo de transmisión congénita se estima en 18 por diez mil; en consecuencia se esperarían 106 casos anuales, con 69 asintomáticos (65 porciento), y 37 (35 porciento) con síntomas: 17 con daños leves, 11 con graves y 9 mortinatos. Los 28 niños con lesiones manifiestas, más un número no determinado con lesiones tardías de los 69 asintomáticos incorporan una población que causa un impacto económico y social aún no establecido...

Serological testing, by indirect haemagglutination and ELISA was performed in 4 age groups: 0 to <5, 5 to <10, 10 to <15 and 15 to <20 years old, to find prevalence and quinquennial incidence. An interview to assess risk factors was performed. The statistical analysis was performed for independent variables and bivariate correlations to calculate the odds ratio. The total number of observations was 578: 285 male and 292 female (1 not determined) and median age was 9.7. An increase in the prevalence was related to age, reaching 60.2 percent in the group between 15 and 20 years old, when compared to the same age group in 1989 (78.3 percent) showing an 18 percent decrease. Several hypotheses to explain this decrease were proposed. There is a steep increase at the age of 10. The statistical analysis does not demonstrate a direct correlation with any of the risk factors consigned in the interview, with the exception of exposure to young felines (kittens). The risk for acquiring congenital toxoplasmosis was estimated as 1.8 per thousand (18 per ten thousand), hence 106 cases are expected per year, with 69 (65 percent) of them being asymptomatic, and 37 with different degrees of severity: 17 with mild, 11 severe and 9 with death at birth. Each year there would be 28 newborns with evident lesions and additionally an undetermined number of cases with late onset lesions within the initially asymptomatic group (65 percent), with unknown socioeconomic impact...

Seguridad de los medicamentos gastrointestinales en el embarazo / Gastrointestinal drugs safety in pregnancy

Las embarazadas se consideran población de riesgo para el uso de medicamentos. La incidencia de defectos congénitos en la población general es de 2-4%, y menos del 1% es atribuible a medicamentos. El problema es que la mayoría de los medicamentos tienen un riesgo indeterminado, dado las limitaciones de la evidencia durante el embarazo y la lactancia. Los medicamentos de uso gastrointestinal, son fármacos ampliamente utilizados en la población general y también durante el embarazo. Se realiza una revisión sobre la seguridad fetoneonatal de antieméticos, antiácidos, inhibidores de la bomba de protonoes, antagonistas del receptor H2 de histamina y medicamentos utilizados en el tratamiento de la enfermedad inflamatoria intestinal.