Valor predictivo del perfil biofísico fetal en gestantes a término en relación con las condiciones neonatales detectadas por el APGAR. Hospital Regional Vicente Corral Moscoso, enero-septiembre 2005

Se justifica el estudio como un aporte importante que permite en base al trabajo en equipo de a profesionales en imágenes, pediatras y obstetras, responsables del binomio madre-hijo, tener un método útil o de exploración peri.natal que ha permitido evaluar una serie de actividades biofísicas que ayudan en la toma de decisiones certeras en la conducción del parto y/o culminación del embarazo, que ayudan a predecir varias complicaciones entre las más importantes el sufrimiento fetal agudo, consecuencia de la hipoxia que muchas de las veces ha terminado en la muerte fetal. Por lo que se hace necesario determinar el valor predictivo de la prueba del Perfil Biofísico Fetal en gestantes a término en relación con las condiciones neonatales valoradas por el Test de Pagar al momento del nacimiento. Conclusiones: en relación a la prueba de perfil biofísico fetal se encontró que la sensibilidad de la prueba es de 62.96, la especificidad de 93.45, el valor predictivo positivo fue del 48.5, el valor predictivo negativo 96.45, los índices de verdaderos positivos de 48.47, de falsos positivos de 51.43, de falsos negativos 3.75y de verdaderos negativos 96.25

El ejercicio físico durante el embarazo : ¿un riesgo para el recién nacido?

Resumen tomado de la publicación

Factores que influyen en la prevalencia de bullyng en estudiantes de los colegios rurales del Cantón Cuenca, Azuay, 2014.

Objetivo: Determinar los factores que influyen en la prevalencia de bullying en estudiantes de los colegios rurales del Cantón Cuenca, Azuay, 2014. Métodos: Estudio descriptivo transversal con participación de 493 estudiantes (283 hombres y 210 mujeres), de 11 a 19 años de edad. La selección de la muestra se realizó por aleatorización simple. Los datos se obtuvieron a través de una encuesta auto-aplicada, los instrumentos utilizados fueron el cuestionario de intimidación escolar CIE-A (Modificado) y el Test del APGAR Familiar. Los datos se procesaron en el programa SPSS 19. Resultados: La prevalencia de bullying en los estudiantes de los colegios rurales del Cantón Cuenca es del 20.0% en mujeres y 17.3% en varones, el acoso fue más evidente en estudiantes de octavos, novenos y decimos de básica superior 21.9%. El tipo de agresión más frecuente es el daño a la propiedad 98.6%. Los factores de riesgo encontrados fueron ambiente escolar desfavorable 71,4%, familiar desfavorable 71.4%, e individual desfavorable 42.2%. Conclusiones: Se encontró una prevalencia importante del bullying en los estudiantes de los colegios rurales del cantón Cuenca y existe asociación significativa del mismo con los factores familiar, escolar e individual desfavorables

Influencia del programa SWEP (Study Water Exercise Pregnant) en los resultados perinatales: protocolo de estudio

Introducción: el entrenamiento mediante ejercicio físico moderado durante el periodo de gestación aporta beneficios tanto a la mujer embarazada como al feto. Los trabajos de investigación consultados vinculan la actividad física con una reducción del número de cesáreas, de partos instrumentados y con un parto más fisiológico. Previene igualmente la ganancia excesiva de peso de la mujer, disminuye el riesgo de diabetes gestacional y de hipertensión arterial. Objetivo: el objetivo de esta investigación es conocer si un programa de ejercicio físico de carácter moderado con el método Study Water Exercise Pregnant (SWEP), realizado en un medio acuático, contribuye a obtener unos resultados más favorables en la etapa perinatal, tanto para la mujer como para el bebé. Material y métodos: el diseño que se llevará a cabo es un ensayo clínico aleatorizado. La muestra estará constituida por 364 gestantes, obtenida de un universo total de 6.579 partos acontecidos en Granada (España) durante el año 2014. Dicha muestra se ha dividido en dos grupos, uno de intervención y otro de control. La actividad se realizará en las instalaciones deportivas acuáticas de la Facultad de Ciencias del Deporte de la Universidad de Granada, que cuentan con dos vasos adecuados a nuestros objetivos, uno polivalente de 25 metros y otro de enseñanza de 12,5 metros. Resultados: el programa de ejercicios diseñado específicamente para el proyecto denominado SWEP, abarca desde la 20 hasta la 37 semana de gestación (SG) y consta de tres sesiones semanales, con una duración de 60 minutos cada una. Las sesiones incluirán tres fases: fase de calentamiento, fase principal en la que el ejercicio se divide en una parte aeróbica y otra de ejercicios de fuerza y resistencia y una final con estiramientos y relajación. Las variables que se van a estudiar son las siguientes: a) maternas: peso, IMC, tensión arterial, test de O'Sullivan, aparición de depresión postparto, nivel de autopercepción de salud, calidad del sueño y esfuerzo percibido durante la actividad física; b) fetales: peso, test de Apgar, perímetro cefálico y SG (semana de gestación al nacimiento); c) periparto: tiempos de dilatación, expulsivo y alumbramiento, tipo de parto, presencia de episiotomía, tipo de alimentación que recibe el RN y tiempo de lactancia materna exclusiva; y d) descriptivas: edad, profesión, nivel de estudios, tipo de ejercicio físico realizado previamente y FO (fórmula obstétrica). Conclusión: con la actividad física acuática moderada, por parte de la embarazada (método SWEP), se pretenden mejorar las variables arriba indicadas.

Asfixia perinatal y proteína S100B

La asfixia perinatal es la principal causa de muerte en la primera semana de vida la nivel mundial, los niños que sufren esta complicación y sobreviven pueden presentar trastornos neurológicos de diferente nivel de compromiso que inciden en su desarrollo personal y social. Las cifras de muerte por este problema de salud han disminuido de manera importante, sin embargo en el reporte de la Organización Mundial de Salud (OPS) del 2010, la asfixia perinatal es causa del 29% de muertes infantiles en los países de América Latina y el Caribe 2. Es necesario conocer además la extensión del daño neurológico que sufren estos niños, con este fin se desarrolló un estudio piloto en el Hospital Universitario Mayor Mederi de Bogotá, en el cual se determinó la concentración de un marcador metabólico de daño cerebral, la proteína S100B en suero de 60 recién nacidos sanos, con el objetivo de analizar la asociación del mismo con el peso al nacer, la edad gestacional y el diagnóstico. Los resultados no mostraron diferencias significativas entre este marcador y las variables analizadas que puede asociarse al pequeño número de pacientes, sin embargo han sentado las bases para el desarrollo de un estudio que incluya varios hospitales de Bogotá y sobre todo la determinación del mismo en recién nacidos con diagnóstico de hipoxia en el período perinatal, lo cual aportará información del grado de la alteración que puedan tener a nivel cerebral y contribuya al mejor manejo evolutivo con la aplicación de medidas de intervención en estadios tempranos de la vida.

Virginia Apgar and string music

Virginia Apgar (1909-1974) is one of the most recognized American doctors, worldwide known by his contribution as the developer of the "Apgar test" a method used for the evaluation of newborns all over the world. She had many interests. She was anesthesiologist, a brilliant teacher and researcher, but she also loved lecture, basketball, fishing, golf, philately, and music. She played violin and cello and she interpreted that instruments in various chamber groups. Being motivated by one of her patients, Carleen Hutchinson, a science and music teacher, she made four instruments, viola, violin, cello, and mezzo violin. Nearly twenty years of her death, on October 24 1994, on the occasion of the annual meeting of the American Academy of Pediatrics and the issue by American Postal Service of a stamp honoring her, some of the preferred Dr. Apgar music pieces where performed with the instruments she made. Her life mixed different activities and let invaluable contributions for humanity.

Adapting The Sniffin' Sticks Olfactory Test To Diagnose Parkinson's Disease In Estonia.

The aim of the study was to develop a culturally adapted translation of the 12-item smell identification test from Sniffin' Sticks (SS-12) for the Estonian population in order to help diagnose Parkinson's disease (PD). A standard translation of the SS-12 was created and 150 healthy Estonians were questioned about the smells used as response options in the test. Unfamiliar smells were replaced by culturally familiar options. The adapted SS-12 was applied to 70 controls in all age groups, and thereafter to 50 PD patients and 50 age- and sex-matched controls. 14 response options from 48 used in the SS-12 were replaced with familiar smells in an adapted version, in which the mean rate of correct response was 87% (range 73-99) compared to 83% with the literal translation (range 50-98). In PD patients, the average adapted SS-12 score (5.4/12) was significantly lower than in controls (average score 8.9/12), p < 0.0001. A multiple linear regression using the score in the SS-12 as the outcome measure showed that diagnosis and age independently influenced the result of the SS-12. A logistic regression using the SS-12 and age as covariates showed that the SS-12 (but not age) correctly classified 79.0% of subjects into the PD and control category, using a cut-off of <7 gave a sensitivity of 76% and specificity of 86% for the diagnosis of PD. The developed SS-12 cultural adaption is appropriate for testing olfaction in Estonia for the purpose of PD diagnosis.

Effects Of Therapeutic Approach On The Neonatal Evolution Of Very Low Birth Weight Infants With Patent Ductus Arteriosus.

To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.

Effect Of Exercise Test On Pulmonary Function Of Obese Adolescents.

to investigate the pulmonary response to exercise of non-morbidly obese adolescents, considering the gender. a prospective cross-sectional study was conducted with 92 adolescents (47 obese and 45 eutrophic), divided in four groups according to obesity and gender. Anthropometric parameters, pulmonary function (spirometry and oxygen saturation [SatO2]), heart rate (HR), blood pressure (BP), respiratory rate (RR), and respiratory muscle strength were measured. Pulmonary function parameters were measured before, during, and after the exercise test. BP and HR were higher in obese individuals during the exercise test (p = 0.0001). SatO2 values decreased during exercise in obese adolescents (p = 0.0001). Obese males had higher levels of maximum inspiratory and expiratory pressures (p = 0.0002) when compared to obese and eutrophic females. Obese males showed lower values of maximum voluntary ventilation, forced vital capacity, and forced expiratory volume in the first second when compared to eutrophic males, before and after exercise (p = 0.0005). Obese females had greater inspiratory capacity compared to eutrophic females (p = 0.0001). Expiratory reserve volume was lower in obese subjects when compared to controls (p ≤ 0,05). obese adolescents presented changes in pulmonary function at rest and these changes remained present during exercise. The spirometric and cardiorespiratory values were different in the four study groups. The present data demonstrated that, in spite of differences in lung growth, the model of fat distribution alters pulmonary function differently in obese female and male adolescents.

The Lea Grating Test In Assessing Detection Grating Acuity In Normal Infants Less Than 4 Months Of Age.

To assess binocular detection grating acuity using the LEA GRATINGS test to establish age-related norms in healthy infants during their first 3 months of life. In this prospective, longitudinal study of healthy infants with clear red reflex at birth, responses to gratings were measured at 1, 2, and 3 months of age using LEA gratings at a distance of 28 cm. The results were recorded as detection grating acuity values, which were arranged in frequency tables and converted to a one-octave scale for statistical analysis. For the repeated measurements, analysis of variance (ANOVA) was used to compare the detection grating acuity results between ages. A total of 133 infants were included. The binocular responses to gratings showed development toward higher mean values and spatial frequencies, ranging from 0.55 ± 0.70 cycles per degree (cpd), or 1.74 ± 0.21 logMAR, in month 1 to 3.11 ± 0.54 cpd, or 0.98 ± 0.16 logMAR, in month 3. Repeated ANOVA indicated differences among grating acuity values in the three age groups. The LEA GRATINGS test allowed assessment of detection grating acuity and its development in a cohort of healthy infants during their first 3 months of life.

The Geometric Curvature Of The Spine Of Runners During Maximal Incremental Effort Test.

This study sought to analyse the behaviour of the average spinal posture using a novel investigative procedure in a maximal incremental effort test performed on a treadmill. Spine motion was collected via stereo-photogrammetric analysis in thirteen amateur athletes. At each time percentage of the gait cycle, the reconstructed spine points were projected onto the sagittal and frontal planes of the trunk. On each plane, a polynomial was fitted to the data, and the two-dimensional geometric curvature along the longitudinal axis of the trunk was calculated to quantify the geometric shape of the spine. The average posture presented at the gait cycle defined the spine Neutral Curve. This method enabled the lateral deviations, lordosis, and kyphosis of the spine to be quantified noninvasively and in detail. The similarity between each two volunteers was a maximum of 19% on the sagittal plane and 13% on the frontal (p<0.01). The data collected in this study can be considered preliminary evidence that there are subject-specific characteristics in spinal curvatures during running. Changes induced by increases in speed were not sufficient for the Neutral Curve to lose its individual characteristics, instead behaving like a postural signature. The data showed the descriptive capability of a new method to analyse spinal postures during locomotion; however, additional studies, and with larger sample sizes, are necessary for extracting more general information from this novel methodology.

Twin-twin Transfusion Syndrome: Neurodevelopmental Screening Test.

Objective To assess the neurodevelopmental functions (cognition, language and motor function) of survivors of twin-twin transfusion syndrome (TTTS). Method Observational cross-sectional study of a total of 67 monochorionic diamniotic twins who underwent fetoscopic laser coagulation (FLC) for treatment of TTTS. The study was conducted at the Center for Investigation in Pediatrics (CIPED), Universidade Estadual de Campinas. Ages ranged from one month and four days to two years four months. Bayley Scales of Infant and Toddler Development Screening Test-III, were used for evaluation. Results Most children reached the competent category and were classified as having appropriate performance. The preterm children scored worse than term infants for gross motor subtest (p = 0.036). Conclusion The majority of children reached the expected development according to their age. Despite the good neurodevelopment, children classified at risk should be monitored for development throughout childhood.

Evaluation of the cytotoxic and genotoxic potential of water from the River Paraíba do Sul, in Brazil, with the Allium cepa L. test

This work investigated the cytotoxic and genotoxic potential of water from the River Paraíba do Sul (Brazil) using Allium cepa roots. An anatomo-morphological parameter (root length), mitotic indices, and frequency of micronuclei were analysed. Eight bulbs were chosen at random for treatment for 24 to 120 hours with the River water collected in the years of 2005 and 2006 from sites in the cities of Tremembé and Aparecida (São Paulo state, Brazil). Daily measurements of the length of the roots grown from each bulb were carried out throughout the experiment. Mitotic index (MI) and frequency of micronuclei (MN) were determined for 2000 cells per root, using 3-5 root tips from other bulbs (7-10). Only in the roots treated with samples of the River water collected in 2005 in Tremembé city was there a decrease in the root length growth compared to the respective control. However, a reduction in MI values was verified for both sites analysed for that year. Considering the data involving root length growth and especially MI values, a cytotoxic potential is suggested for the water of the River Paraíba do Sul at Tremembé and Aparecida, in the year of 2005. On the other hand, since in this year the MN frequency was not affected with the river water treatments, genotoxicity is not assumed for the river water sampled at the aforementioned places.

Comparison between the 1% and 2% ibopamine provocative test in primary open-angle glaucoma patients: sensitivity, specificity and tolerability

PURPOSE: To compare intraocular pressure (IOP) rise in normal individuals and primary open-angle glaucoma patients and the safety and efficacy of ibopamine eye drops in different concentrations as a provocative test for glaucoma. METHODS: Glaucoma patients underwent (same eye) the ibopamine provocative test with two concentrations, 1% and 2%, in a random sequence at least 3 weeks apart, but not more than 3 months. The normal individuals were randomly submitted to one of the concentrations of ibopamine (1% and 2%). The test was considered positive if there was an IOP rise greater than 3 or 4 mmHg at 30 or 45 minutes to test which subset of the test has the best sensitivity (Se)/specificity (Sp). RESULTS: There was no statistically significant difference in any of the IOP measurements, comparing 1% with 2% ibopamine. The IOP was significantly higher at 30 and 45 minutes with both concentrations (p<0.001). The best sensitivity/specificity ratio was achieved with the cutoff point set as greater than 3 mmHg at 45 minutes with 2% ibopamine (area under the ROC curve: 0.864, Se: 84.6%; Sp:73.3%). All patients described a slight burning after ibopamine's instillation. CONCLUSION: 2% ibopamine is recommended as a provocative test for glaucoma. Because both concentrations have similar ability to rise IOP, 1% ibopamine may be used to treat ocular hypotony.

Applying a new version of the Brazilian-Portuguese UPSIT smell test in Brazil

Standardized olfactory tests are now available to quantitatively assess disorders of olfaction. A Brazilian-Portuguese version of the University of Pennsylvania Smell Identification Test (UPSIT) is currently being developed specifically for the Brazilian population. The most recent Brazilian-Portuguese version of the UPSIT (UPSIT-Br2) was administered to 88 Brazilian subjects who had no history of neurological or otorhinolaryngological disease. UPSIT-Br2 scores decreased with age, were lower in men than in women, and were lower in subjects with lower income. The degree to which the poorer performance of subjects with lower socio-economic status reflects lack of familiarity with test items is not known. Although this version of the UPSIT provides a sensitive and useful test of smell function for the Brazilian population, a revision of some test items is needed to achieve comparable norms to those found using the North American UPSIT in the United States.