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OBJECTIVE: To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS: We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS: In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS: Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.
Assuntos
Região de Recursos Limitados , Natimorto , Gravidez , Feminino , Humanos , Natimorto/epidemiologia , América Latina/epidemiologia , Fatores de Risco , EletrônicaRESUMO
BACKGROUND: The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES: To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS: This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS: In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION: Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.
Assuntos
Morte Perinatal , Complicações na Gravidez , Gravidez , Recém-Nascido , Feminino , Humanos , Estudos Transversais , Ressuscitação , Mortalidade Infantil , Mortalidade Materna , Sistemas de Informação , Complicações na Gravidez/epidemiologiaRESUMO
BACKGROUND: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.
Assuntos
Cesárea , Tetranitrato de Pentaeritritol , Gravidez , Recém-Nascido , Feminino , Humanos , América Latina/epidemiologia , Grupos Raciais , Parto , FamíliaRESUMO
Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Cesárea , Tetranitrato de Pentaeritritol , Parto , América Latina/epidemiologiaRESUMO
OBJECTIVE: To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. MATERIALS AND METHODS: A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). RESULTS: During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0-4 versus median: 3; [IQR]: 2-4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750-2,000 mL versus 1,500 mL [IQR]: 1,200-1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). CONCLUSION: Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.
Assuntos
Placenta Acreta , Gravidez , Humanos , Feminino , Placenta Acreta/diagnóstico por imagem , Cesárea , Ultrassonografia Pré-Natal , Estudos Retrospectivos , Diagnóstico Pré-Natal/métodos , PlacentaRESUMO
Abstract Objective To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. Materials and Methods A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). Results During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0-4 versus median: 3; [IQR]: 2-4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750-2,000 mL versus 1,500 mL [IQR]: 1,200-1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). Conclusion Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.
Assuntos
Humanos , Feminino , Gravidez , Placenta Acreta/diagnóstico por imagem , Procedimentos Cirúrgicos Operatórios , Transfusão de Sangue , Ultrassonografia Pré-NatalRESUMO
Mango is the second most commercialized tropical fruit in the world, and Mexico is the major exporter. In terms of mango production, Manila´s variety represents a quarter of the total mangoes production in Mexico. However, the changes that occur on the phenolic compounds during the Manila mango ripening process are unknown. Quantitative analysis of the major phenolic compounds was conducted at different maturity stages, using several spectrophotometric measurements and by high-performance liquid chromatography (HPLC). At the late ripening stage was observed the biggest content in pulp and peel of total phenols (577 and 10547 mg EAG /100 g), flavonoids (95.33 and 537 mg EQ/100 g), and antioxidant capacity by DPPH (25 and 347 mmol TE/100 g). Some bioactive compounds achieve their highest values at optimal consumption ripening. Although they diminish when the fruit reaches a senescence appearance. This is the first study to prove that mangiferin by itself shows a higher correlation in antioxidant capacity compared to other phenolic compounds in mango peel, and this suggest that phenolic compounds may have an important role in the postharvest antioxidant metabolism in Manila mango fruit. On the other hand, the results show that the peel compared to the pulp contains higher amounts of total phenols, flavonoids, gallic acid, mangiferin and antioxidant capacity, so its use as an ingredient in the preparation of functional food products is recommended. More studies are needed to go in-depth in the changes of the content of phytochemicals during the ripening process in the peel and pulp mango, which ones could be caused by the hormones responsible for ripening in the fruit, such as ethylene, and bioavailability of these compounds at different stages of maturation(AU)
El mango es la segunda fruta tropical más comercializada del mundo y México es el principal exportador. En términos de producción de mango, la variedad Manila representa una cuarta parte de la producción total de mangos en México. Sin embargo, se desconocen los cambios que ocurren en los compuestos fenólicos durante el proceso de maduración del mango Manila. El análisis cuantitativo de los principales compuestos fenólicos se realizó en diferentes etapas de madurez, utilizando varias medidas espectrofotométricas y mediante cromatografía líquida de alta resolución (HPLC). En la etapa de madurez tardía se observó el mayor contenido en pulpa y cáscara de fenoles totales (577 y 10547 mg EAG / 100 g), flavonoides (95.33 y 537 mg EQ / 100 g) y capacidad antioxidante por DPPH (25 y 347 mmol TE / 100 g). Algunos compuestos bioactivos alcanzan sus valores más altos en el punto de madurez óptima. Aunque disminuyen cuando el fruto adquiere una apariencia de senescencia. Este es el primer estudio que demuestra que la mangiferina por sí misma presenta una alta correlación con la capacidad antioxidante en comparación con otros compuestos fenólicos de la cáscara de mango, y esto sugiere que los compuestos fenólicos pueden tener un papel importante en el metabolismo antioxidante postcosecha en el mango Manila. Por otro lado, los resultados muestran que la cáscara comparada con la pulpa contiene mayores cantidades de fenoles totales, flavonoides, ácido gálico, mangiferin y capacidad antioxidante por DPPH, por lo que se recomienda su uso como ingrediente en la elaboración de productos alimenticios fucionales. Se necesitan más estudios para profundizar en los cambios del contenido de fitoquímicos durante el proceso de maduración en la cáscara y pulpa del mango, los cuáles podrían ser provocados por las hormonas responsables de la maduración en el fruto, como el etileno, y la biodisponibilidad de estos compuestos en diferentes etapas de maduración(AU)
Assuntos
Mangifera , Polifenóis/análise , Antioxidantes , Compostos Fitoquímicos , FrutasRESUMO
RESUMEN Actualmente es innegable la participación del sistema endocannabinoides (SEC) en la regulación metabólica; ya que su sobre estimulación ha sido relacionada con varias patologías entre las que se encuentran obesidad, diabetes mellitus, retinopatía e hígado graso no alcohólico. Éstas se relacionan mutuamente a través de alteraciones del metabolismo de los lípidos, como lo es una sobre estimulación de la síntesis de ácidos grasos, una disminución en la beta-oxidación, hiperglicemia causada por un aumento de la gluconeogénesis, así como en la glucólisis; procesos en los cuales se ha descrito al SEC como un participante crucial. Por otro lado, algunos compuestos fitoquímicos, tales como la mangiferina (MGF), han probado sus efectos farmacológicos en el metabolismo de lípidos a nivel hepático y en el control glicémico. Hasta el momento se desconoce el efecto de la mangiferina sobre los receptores de endocannabinoides, por lo que esta revisión aborda la regulación a nivel sistémico (órganos y tejidos) y central (sistema nervioso) de la lipogénesis por el SEC y la regulación negativa que tiene la mangiferina sobre éste. Finalmente se sugiere, con base en la información publicada hasta el momento, una relación entre el posible efecto que pueden tener la MGF sobre el SEC.
ABSTRACT Currently, the participation of the endocannabinoid system in metabolic regulation is undeniable; because its hyperactivation has been related to several pathologies such as obesity, diabetes mellitus, retinopathy and non-alcoholic fatty liver, and others. These pathologies are related through alterations in lipid metabolism, e.g. over stimulation of fatty acid synthesis, beta-oxidation decrease, hyperglycemia increase, all these changes are caused by increase in gluconeogenesis, as well as glycolysis, processes in which the SEC has been described as a main character. On the other hand, some phytochemicals such as mangiferin (MGF) have shown their pharmacological effects on lipid metabolism, as well as glycemic control. So far, the effect of mangiferin on cannabinoid receptors is unknown. In this review, we try to demonstrate how mangiferin and these receptors participate in the opposite manner in the adaptation of lipid metabolism in many organs like as liver, tissue adipose and SN (nervous system). In addition, we suggest, based on the published information to until now, a relationship between the MGF´s effect on the SEC.
RESUMO
Las Opuntia spp. son un recurso fitogenético Mexicano de gran valor nutritivo y alto contenido de betalaínas, compuestos conocidos por sus propiedades antioxidantes. Este estudio evaluó las características fisicoquímicas, el contenido de betalaínas y su capacidad antioxidante (CA), así como el perfil sensorial de frutos de O. robusta y O. ficusindica. Esta última presentó mayor acidez y contenido de sólidos solubles (F= 769,2; P= 0,0001), (F= 360,4; P ≤0,0001), que O. robusta. En humedad y contenido de cenizas no hubo diferencias significativas entre ambas especies. La concentración de betalaínas fue superior en Opuntia robusta (F=529,1; P= ≤0,0001) betacianinas (0,114 mg/mL pulpa) y betaxantinas (0,073 mg/ mL de pulpa), en O. ficus-indica (0,023 mg/ mL de pulpa y 0,0198 mg/ mL de pulpa). Se encontraron diferencias significativas en la CA (F=545,9; P ≤0,0001), en O. ficus-indica hasta 195,38 µmol equivalente Trolox/ mL por el método Ácido2, 2´-azino-bis-(3-etilbenzotiazolina)6-sulfónico (ABTS) y 22% de inhibición de radicales libres por el método 2,2 difenil-1-pricrilhidrazilo (DPPH), para O. robusta 165,6 µmol equivalente Trolox/ mL y más del 36% de inhibición de radicales libres. Los resultados mostraron que la CA está directamente relacionada con la concentración de betacianinas y betaxantinas. Ambas variedades de Opuntia exhiben una tendencia a lo dulce y ácido, con aromas, sabores y resabios con notas frutales y vegetales. Estos resultados sugieren que estas especies pueden ser empleadas para la extracción de betalaínas debido a su gran potencial para utilizarse en la industria como fuente de pigmentos naturales con propiedades antioxidantes y agradables características sensoriales(AU)
Opuntia spp. are a Mexican phytogenetic resource with great nutritive value and high betalains (compounds known for their antioxidant properties) content. Our main goal was to evaluate the physicochemical characteristics, betalains concentration and antioxidant capacity (AC), as well as sensory profiles of Opuntia robusta and O. ficus-indica, where the later one showed higher acidity and soluble solids content (F= 769.2; P= 0.0001 and F= 360.4; P ≤0.0001 respectively) than O. robusta. There was no significant difference between the species in terms of humidity and ash content. Betalains concentrations were higher in Opuntia robusta (F=529.1; P= ≤0.0001), while betacyanins (0.114 mg/ mL pulp) and betaxantins (0.073 mg/ mL de pulp) were higher in O. ficus-indica (0.023 mg/ mL pulp and 0.0198 mg/ mL de pulp). Significant differences for AC were found (F=545.9, P ≤0.0001), with O. ficus-indica showing up to 195.38 µmol Trolox equivalent / mL by the method 2,2'-Azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) and 22% of free radicals inhibition by the method 2, 2 diphenyl-1-pricrylhydrazyl (DPPH), while 165.6 µmol Trolox equivalent / mL and more than 36% free radicals inhibition were found for O. robusta. Results showed that the antioxidant capacity is directly related with betacyanins and betaxantines concentration. Both Opuntia varieties exhibit a tendency to sweetness and acidity, with aromas, flavors and scents within fruity and vegetable notes. These results suggest that both species could be used in the extraction of betalains due to their great industrial potential as a source of natural pigments with antioxidant properties and pleasant sensorial characteristics(AU)
Assuntos
Humanos , Masculino , Feminino , Opuntia , Betalaínas/biossíntese , Neoplasias/prevenção & controle , Antioxidantes/fisiologia , Alimentos, Dieta e NutriçãoRESUMO
UNLABELLED: Descriptive sensory analysis combined with a chemical analysis, provided insight regarding sensory significance for a better understanding of berrycactus' flavor. This study was based on the volatile components derived from the gas chromatography-olfactometry (GC-O) analysis. Four different ripening stages were used for the experiments: unripe, red, transition, and over-ripe. Besides red and transition stages were stored in sealed plastic bags for 7 d at 5 °C as an additional treatment in order to establish comparisons with fresh samples. GC-O analysis was performed following OSME (time-intensity) method. Moreover, chemical characterization was achieved through GC-MS analysis, each compound was tentatively identified by comparing its mass spectra with the spectra from the library NIST02, by its aroma notes and Kovats Index. The aroma descriptors found were: caramel, fruity, acetic acid, fresh, citrus, floral, and phenolics. Nine volatile compounds are among the most important in flavor of berrycactus: furfural, 5-methyl-2-furancarboxaldehyde, 2(5H)-furanone, 5-acetoxymethyl-2-furaldehyde, 2-cyclohexen-1-ol, octanoic acid ethyl ester, decanoic acid ethyl ester, octanoic acid, and phenylethyl alcohol. To better reflect the real responses of these compounds, the regression analysis of concentrations to ripening stages were performed. The 2,3-dihydro-3,5-dihydroxy-6-methyl-(4H)-pyran-4-one was found in berrycactus, it has been reported in chemical profile of other berries as a product of heat-induced reactions, however, this compound has no aroma activity. The data suggest that both furanones and esters contribute to the aroma of berrycactus. On the other hand, solid phase microextraction was found to be more useful in detecting esters and acids whereas solvent extraction was more effective in detecting furanones and ketones. PRACTICAL APPLICATION: This information could contribute to setting up favorable processing conditions; in order to retain the best sensory characteristics of berrycactus along with functional properties that would enhance commercialization and exploitation of this fruit and to promote berrycactus cultivation programs.