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Background: It has been proposed that abnormal modulation of inflammatory response is involved in the physiopathology of idiopathic recurrent spontaneous abortion (iRSA). Factors that may participate in this process include the genetic background such as carrying specific polymorphisms of genes with functional effects., Objective: The objective is to study the association between iRSA and the frequency of intron-2 variable number tandem repeat-polymorphisms of interleukin-1 receptor antagonist gene (IL1RN)., Methods: We conducted a case-control study including 108 women with iRSA and 103 controls. Five allelic variants of IL1RN were determined by polymerase chain reaction (PCR) product length analysis., Results: The most frequent IL1RN allele in this population was IL1RN*1, which was present in 78% of cases and 94% of controls, and allele IL1RN*2, in 45 (20.8%) cases and 12 (5.8%) controls. Allele IL1RN*2 was significantly associated with iRSA (odds ratio = 4.28, 95% confidence interval 2.2-8.4; p = 0.000)., Conclusion: Carrying allele IL1RN*2 had a strong association with iRSA in Mexican women. This polymorphism codifies for a low-function protein, which may allow for increased activity of IL-1 pro-inflammatory axis in iRSA., (Copyright: © 2017 SecretarÍa de Salud.)

Background: In Mexico, the prevalence of caesarean section is 40.9% in the health sector, the techniques used are the traditional Pfannenstiel-Kerr and Kerr-half infraumbilical and little experience with this new technique Misgav-Ladach modified., Objetive: To compare pregnancy outcomes (surgical and fetal extraction time, bleeding, postoperative pain, surgical wound infection, maternal and fetal death) caesarean section techniques modified Misgav-Ladach, Pfannenstiel-Kerr and infraumbilical., Material and Method: Clinical trial in primiparous women with term pregnancy treated at the Medical Unit of High Specialty 23 of the Mexican Social Security Institute, Monterrey, Nuevo Leon, Mexico. Misgav-Ladach caesarean Caesarean modified and Kerr, the latter subdivided into two groups: infraumbilical Pfannenstiel incision and incision half-Kerr two groups patients were randomized., Results: 137 gilts were studied, with term pregnancy and BMI between 19 and 24.9 kg / m2. Caesarean modified Misgav-Ladach 68 patients and 69 classical Kerr (35 Pfannenstiel-Kerr and 34 infraumbilical) was performed. The surgical time in minutes was lower with modified Misgav-Ladach: 27.8 ± 8.0, Pfannenstiel-Kerr recorded 51.7 ± 12.1 and 12.0 ± infraumbilical media48.3 (p = 0.000). The time in seconds fetal extraction was lower in modified Misgav-Ladach: 96.2 ± 68.3, 474.9 ± Pfannenstiel-Kerr 294.1 and 423.2 ± 398.6 infraumbilical (p = 0.000). The trasoperatory milliliters bleeding was lower with modified Misgav-Ladach: 298.5 ± 57.3, 354.3 ± Pfannenstiel-Kerr 98.0 and 355.9 ± 110.6 infraumbilical (p = 0.001). Postoperative pain assessed with the visual analog scale in the first 24 hours was lower with modified Misgav-Ladach: 4.4 ± 1.9, 5.7 ± Pfannenstiel-Kerr and IK 2.1 6.1 ± 2.0 (p = 0.000). The start of the oral route and ambulation Nwas soon comparing modified Misgav-Ladach against Pfannenstiel-Kerr and Kerr-infraumbilical (p = 0.000). The prevalence of fever was 5.9% with modified Misgav-Ladach, 5.9% Pfannenstiel-Kerr and 32.4% withinfraumbilical-Kerr (p = 001). The discharge in hours was modified Misgav-Ladach ± 45.8 to 12.1 h, Pfannenstiel-Kerr 49.3 ± 12.3 h and 58.5 infraumbilical-Kerr ± 21.5 h (p = .000). In this study no maternal or fetal deaths were observed., Conclusion: Surgical time, bleeding, postoperative pain, better postoperative recovery and shorter hospital stays and less infection were significantly lower than with conventional techniques of caesarean Nsection or infraumbilical-Kerr technique.

Background: Ovarian pregnancy (OP) is a low-frequency pathology but with devastating effects on women reproductive health. It is often difficult to distinguish from tubal or abdominal pregnancy. Diagnostic procedures and actual medical approaches to the treatment of OP are still a challenge., Clinical Case: In this paper we present a 21 years old woman, seen at the Hospital as emergency abdominal pain and hypovolemic shock, with a pregnancy of 14 weeks of gestational age. Emergency laparotomy was performed and right salpingo-oophorectomy was made. The findings were massive hemoperitoneum with a live fetus implanted on the surface of the right ovary. H istopathology report fulfilled Spiegelberg's criteria of primary ovarian pregnancy. The association of IUDs and ectopic pregnancy are discussed as well as some basic aspects of trophoblast biology., Conclusion: Ectopic pregnancy is an obstetric problems including poorly understood pathophysiology, clinical diagnostic dilemma and a very poor arsenal of therapeutic options.

Objective: To test the hypothesis that a relative deficiency in L-arginine, the substrate for synthesis of the vasodilatory gas nitric oxide, may be associated with the development of pre-eclampsia in a population at high risk., Design: Randomised, blinded, placebo controlled clinical trial., Setting: Tertiary public hospital in Mexico City., Participants: Pregnant women with a history of a previous pregnancy complicated by pre-eclampsia, or pre-eclampsia in a first degree relative, and deemed to be at increased risk of recurrence of the disease were studied from week 14-32 of gestation and followed until delivery., Interventions: Supplementation with a medical food-bars containing L-arginine plus antioxidant vitamins, antioxidant vitamins alone, or placebo-during pregnancy., Main Outcome Measure: Development of pre-eclampsia/eclampsia., Results: 222 women were allocated to the placebo group, 228 received L-arginine plus antioxidant vitamins, and 222 received antioxidant vitamins alone. Women had 4-8 prenatal visits while receiving the bars. The incidence of pre-eclampsia was reduced significantly (χ(2) = 19.41; P < 0.001) in women randomised to L-arginine plus antioxidant vitamins compared with placebo (absolute risk reduction 0.17 (95% confidence interval 0.12 to 0.21). Antioxidant vitamins alone showed an observed benefit, but this effect was not statistically significant compared with placebo (χ(2) = 3.76; P = 0.052; absolute risk reduction 0.07, 0.005 to 0.15). L-arginine plus antioxidant vitamins compared with antioxidant vitamins alone resulted in a significant effect (P = 0.004; absolute risk reduction 0.09, 0.05 to 0.14)., Conclusions: Supplementation during pregnancy with a medical food containing L-arginine and antioxidant vitamins reduced the incidence of pre-eclampsia in a population at high risk of the condition. Antioxidant vitamins alone did not have a protective effect for prevention of pre-eclampsia. Supplementation with L-arginine plus antioxidant vitamins needs to be evaluated in a low risk population to determine the generalisability of the protective effect, and the relative contributions of L-arginine and antioxidant vitamins to the observed effects of the combined treatment need to be determined. Trial registration Clinical trials NCT00469846.

Objective: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery., Design: Cohorts. REFERENCE FRAME: Instituto Nacional de Perinatología, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa, México., Patients: Four hundred and sixty eight patients attending prenatal control and delivery care., Interventions: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated., Measurements: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study., Results: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001)., Conclusions: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.

Objective: To evaluate the effect of Palomo's surgery on the semen quality from oligospermic infertile men with varicocele., Study Design: Retrolective cohort., Setting: Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa., Patients: 39 oligospermic infertile men with varicocele., Interventions: Palomo's surgery., Measurements: A spermatobioscopy before the Palomo's surgery was performed, and after the surgery two spermatobioscopies in different times of six months., Results: Spermatobioscopy before the surgery: Concentration/mL = 8.8 +/- 4.1 millions, Motility = 19.5 +/- 10.0%, Vitality = 66.2 +/- 14.4%. First spermatobioscopy after surgery: Concentration/mL = 29 3 +/- 18 3 Motility = 41 5 +/- 19 1, Vitality = 74.7 +/- 14.5. Second spermatobioscopy after surgery: Concentration/mL = 14.6 +/- 10.3, Motility = 28.0 +/- 14.8, Vitality = 78.7 +/- 16.8. All differences from the spermatobioscopy before the surgery were significant., Conclusion: Palomo's surgery has a favorable effect on the quality of the semen, with a diminishing trend in concentration and motility in the second semester after the surgery. The pregnancy rate was 15%.

Unlabelled: Even though endometriosis represents a reproductive health problem of the greatest importance due to the fact that it is one of the most common benign gynecological conditions, its aetiology is still unknown. The most accepted hypothesis is the one proposed by John Sampson, suggesting that the endometrial cells and tissues derived from menstrual flow during uterine scaling reach the peritoneum through the tubes by reversed flow and, under the specific conditions of the peritoneal microenvironment, they are able to implant and proliferate in an ectopic manner. Some evidence shows that the number and activation of macrophages are increased in the peritoneal medium of women with endometriosis. It is known that the activation of this cell group leads to a greater synthesis of diverse molecules associated with this condition., Objective: Evaluating the association between the nitric oxide (NO) synthesis induction capacity of the peritoneal fluid, the percentage of cooperative T lymphocytes and NK cells present in the peritoneal medium of women with different stages of endometriosis, as compared to fertile and healthy women. We also tried to find the correlation between the concentration of TNF-alpha identified in the peritoneal fluid of both groups with the NO synthesis induction that was carried out. Material and methods. The study group was formed by women with endometriosis (WEN) from the National Institute of Perinatology, and the control group was formed by patients attending the Family Planning Clinic of the Northeast Regional Unit (Culiacán, Sin.) (HFW). A NO synthesis induction was performed using lymphocytes stimulated with peritoneal fluid from WEN and HFW in order to measure the concentration of cooperative T lymphocytes and NK cells, the TNF-alpha of the peritoneal fluid was also measured., Results: The NO synthesis induction capacity of peritoneal fluid observed with lymphocytes from a culture was greater than the one presented by healthy women., Conclusion: Nitric oxide was recently described as a potent inhibitor of effector cytotoxic activity associated to the immunological response of cooperative T lymphocytes of the TH-1 type promoting cytotoxic activity on different cell strains. Evidence suggests that NO inhibits INF-alpha synthesis, the later being a potent proliferation and cytotoxic activity inducer in NK cells, cytotoxic T lymphocytes, and cooperative T lymphocytes. A role of NO as a regulator of NK cell activity has also been described.

Recurrent spontaneous abortion of unidentified cause or idiopatic is an important problem of reproduction health. In this study, the study has been started of one of the mechanisms that could act in the pathology of human pregnancy. The general hypothesis proposed, is that in the case of patients with recurrent spontaneous abortion of non identified cause (RSA) there are phenomenons in the materno/fetal/placentary means that manifest themselves in harm to the functionality and/or vitality of placentary tissue. The hypothesis was consistent with the finding of massive activation of cellular death in all the cases with RSA studied in this work.

A comparison was made of ultrasonographic diagnosis of fetal nuchal encirclement by the umbilical cord versus the gold standard in pregnant, women at labor. 114 pregnant women at labor were studied. On admission to the labor and delivery room, each patient underwent an abdominal ultrasonographic evaluation for the identification of nuchal encirclement by the umbilical cord and the diagnosis by ultrasound was compared versus direct visualization of the umbilical cord at the moment of delivery or cesarean section (gold standard). Of the 114 patients studied, the prevalence of nuchal cord diagnosed by ultrasound was 20.1%. The diagnostic test had a sensitivity of 80% (CI 95%: 72.66-87.34), specificity of 96% (CI 95%:92.91-99.09), and positive and negative predictive values of 87% and 94% respectively. The accuracy of the test was 92%. Analysis of the discordances by the McNemar's test was not significative between obstetric ultrasound and the gold standard (p = 0.7236). The likelihood ratios were 20 and 0.20 for a positive and a negative results respectively. The ultrasonographic study during labor for diagnosis of nuchal encirclement by the umbilical cord had a high specificity (96%), and this advantage permit it to be utilized like screening test for the identification of high risk pregnancies with nuchal cord.

The objective was to compare the effectiveness and efficacy of prostaglandin E2 (prepidil gel) plus oxitocin with that of intravenous oxitocin in the treatment of delivery induction in patients complicated with fetal death. Fifteen patients received prepidil gel plus oxitocin and 15 patients oxitocin. In the treatment group only one dosage of 0.5 ng in 2 ml of prepidil gel was administered intracervically and simultaneously oxitocin by intravenous infusion, dosage was increased 2 mUI/min every 30 minutes. In the control group only intravenous oxitocin was administered at the same dosage. The mean duration in hours of delivery in the treatment group was 13.1 +/- h and in the control group was 30.9 +/- 9.1 h. There were statistically significant differences between the groups in reduction of delivery duration (p = 0.0007). It is concluded that prostaglandin E2 plus oxitocin provide better short-term outcomes than oxitocine treatment and gave more short periods of labor in patients with fetal death.

Objective: To determine the frequency of malignant neoplasia of the digestive tract in patients seen at the IMSS concentration hospital in Culiacán, Sinaloa, México., Methods: From 32,097 histopathologic studies performed at No. 1 Regional General Hospital Pathology Department in Culiacán, Sinaloa, 406 were identified as digestive tract malignant neoplasia (DTMN); patient's age and gender were analyzed as well as involvement site and histological type. Benign and metastasic neoplasias were excluded., Results: DTMN prevalence: 1.26%; more affected: 60-69 years; male predominance (66%), p < 0.0001. As a whole, 47.2% of the studies reported stomach cancer; colorectal cancer: 17.5%; gall bladder and bile duct cancer; 8.4%; liver cancer: 8.1%; the remainder were located in other sites. DTMN rate by histologic type were similar to other concentration hospitals of the country., Conclusions: DTMN has an outstanding magnitude in IMSS Sinaloa patients if other hospital registrations are considered. There are possible regional factors that may contribute to this behavior.

Unlabelled: The objective was to compare perinatal conditions of newborns and obstetric complications between a group of adolescent mothers and one of adult mothers. It is a retrolective comparative survey, at the General Hospital "Bernardo J. Gastelum" SSA and General Hospital IMSS, Sinaloa, Mexico., Patients: 10634 clinical records of patients in labour at obstetric unit from 1990 to 1994. A randomized sample of 215 adolescent pregnant patients and 215 adult pregnant patients were selected and the following data were analysed regarding to the mother: age, pregnancy outcome and obstetric complications; in regard to the newborn: gender, weight, height, cefalic circumference and Apgar score. The mean adolescent mother's age was 16 years, and 25 in adult mothers; mean adolescent mother newborn birthweight was 3.297 SD 0.414 kg. and in adult mothers was 3.393 SD 0.591 kg. (p = 0.09), adolescent mothers newborns with Apgar score less than 7 at first minute was 20% and 5% for adult mothers newborns. Statistically significant difference was observed (p = 0.02). There were not statistically significant differences between the groups in obstetric outcome and complications, birthweight. It was concluded that pregnancy in adolescence it's not a risk factor for the mother and the newborn.

The present study is a survey to analyze the actual situation of the wounds produced by bibi-guns, concerning the damage produced, kind of surgical procedure, clinical evolution, and some general characteristics of the population on study. During a period of two years from May 1990 to May 1992 at the General Hospital of Culiacan, Sin. Six patients from the Pediatric Surgery Department with a diagnosis of wound produced by bibi-guns were studied. All patients required surgical treatment with general anesthesia. The average age of patients was 5.8 +/- 1.5 years, five male and one female; wounds were produced accidentally in four cases and two in a guns-game. The severity of the injury was evaluated, and in two cases their internal injury laid in danger the life of patient. No deaths occurred.

This is a case of abdominal pregnancy in an 18 year old woman. It has been diagnosed as a 30.4 weeks gestation abdominal pregnancy by clinical antecedents and findings supported by VSG and roentgenography. Conservative management for a period of two weeks with continual fetal monitoring and a series of maternal hemoglobin levels as well as induction of lung fetal maturation, were carried out. Exploratory laparatomy was done at 32.4 weeks of gestation; a living masculine product was found, weighing 1,100 g and Apgar of 8-9. The placenta was situated on the surface of the anterior leaf of the broad ligament, proximal round ligament portion, and proximal tubal portion on the right side. Removal of the placenta was made and right salpingectomy. Evolution was satisfactory of both mother and newborn. Mother was healthy and was discharged from hospital 3 days after. Newborn at 40 days from birth was healthy and weighing 2,000 g. Although most authors recommend surgical treatment for these cases, this case was treated conservatively as we consider the following to be good prognostic factors: age of the patient, general condition, position of placenta, state of fetal membranes, antecedents of partial detachment of placenta during pregnancy.