ABSTRACT Introduction Obstructive azoospermia occurs when there is a blockage in the male reproductive tract, leading to a complete absence of sperm in the ejaculate. It constitutes around 40% of all cases of azoospermia (1, 2). Blockages in the male reproductive tract can arise from either congenital or acquired factors, affecting various segments such as the epididymis, vas deferens, and ejaculatory ducts (3). Examples of congenital causes encompass conditions like congenital bilateral absence of the vas deferens and unexplained epididymal blockages (4). Acquired instances of obstructive azoospermia may result from factors like vasectomy, infections, trauma, or unintentional injuries caused by medical procedures (5). This complex condition affecting male fertility, presents two main treatment options: microsurgical reconstruction and surgical extraction of sperm followed by in vitro fertilization (IVF). Microsurgical reconstruction proves to be the most cost-effective option for treating obstructive azoospermia when compared with assisted reproductive techniques (6, 7). However, success rates of reconstruction defined by patency are as high as 99% for vasovasostomy (VV) but decline to around 65% if vasoepididymostomy (VE) is required (8, 9). Thus, continued refinement in technique is necessary in order to attempt to improve patency for patients undergoing VE. In this video, we show a comprehensive demonstration of microsurgical VE, highlighting the innovative epididymal occlusion stitch. The goal of this innovative surgical technique is to improve outcomes for VE. Materials and Methods The patient is a 39-year-old male diagnosed with obstructive azoospermia who presents for surgical reconstruction via VE. His partner is a 37-years-old female with regular menstrual cycles. The comprehensive clinical data encompasses a range of factors, including FSH levels, results from semen analysis, and outcomes from testicular sperm aspiration. This thorough exploration aims to provide a thorough understanding of our innovative surgical technique and its application in addressing complex cases of obstructive azoospermia. Results The procedure was started on the right, the vas deferens was identified and transected. The abdominal side of the vas was intubated and a vasogram performed, there was no obstruction. There was no fluid visible from the testicular side of the vas for analysis, thus we proceeded with VE. Upon inspection of the epididymis dilated tubules were identified. After selecting a tubule for VE, two 10-0 nylon sutures were placed, and it was incised. Upon inspection of the fluid motile sperm was identified. After VE, we performed a novel epididymal occlusion stitch technique. This was completed distal to the anastomosis by placing a 7-0 prolene through the tunica of the epididymis from the medial to lateral side. This stitch was then tightened down with the goal to largely occlude the epididymis so that sperm will preferentially travel through the anastomosis. The steps were then repeated on the left. At 3-month follow up, the patient had no change in testicular size as compared with preoperative size (18cc), he had no testicular or incisional discomfort, and on semen analysis he had presence of motile sperm. After 3 months post-surgery, the patient had motile sperm seen on semen analysis. Discussion The introduction of a novel epididymal occlusion stitch demonstrates a targeted strategy to enhance the success of microscopic VE. Encouragingly, a 3-month post-surgery follow-up reveals the presence of motile sperm, reinforcing the potential efficacy of our approach. This is promising given the historical lower patency, delayed time to patency, and higher delayed failure rates that patients who require VE experience (10). In total, 40% of all azoospermia cases can be attributed to obstruction. The conventional treatments for obstructive azoospermia involve microsurgical reconstruction and surgical sperm retrieval followed by IVF. While microsurgical reconstruction has proven to be economically viable, the quest for enhanced success rates has led to the exploration of innovative techniques. Historically, the evolution of VV and VE procedures, initially performed in the early 20th century, laid the foundation for contemporary microsurgical approaches (11). Notably, the microscopic VV demonstrated significant improvements in patency rates and natural pregnancy likelihood, as evidenced by the seminal Vasovastomy Study Group study in 1991 (8). In contemporary literature, success rates particularly for VE remain unchanged for the past three decades since the original published success rates by the Vasectomy Reversal Study Group (12). VE is associated with a longer time to patency as well with patients taking 2.8 to 6.6 months to have sperm return to ejaculate as compared to 1.7 to 4.3 months for those undergoing VV. Additionally, of those patients who successfully have sperm return to the ejaculate after VE up to 50% will have delayed failure compared to 12% for those undergoing VV who are patent. Finally, of those who experience delayed failure after undergoing VE it usually occurs earlier with studies reporting as early as 6 months post-operatively (20). Given the lack of improvement and significantly worsened outcomes with VE further surgical refinement is a constant goal for surgeons performing this procedure. Conclusion: In conclusion, this video is both a demonstration and a call to action for commitment to surgical innovation. We aim to raise the bar in VE success rates, ultimately bringing tangible benefits to patients and contributing to the ongoing evolution of reproductive medicine. The novel epididymal occlusion stitch emerges as a beacon of progress, promising not only enhanced safety but also potential reductions in patency time. Surgical excellence and methodological refinement, as exemplified in this video, lay the foundation for a future where male reproductive surgery continues to break new ground. 40 1, 1 (1 2. 2 . 2) 3. (3) 4. 4 (4) vasectomy infections trauma 5. 5 (5) fertility options IVF (IVF) costeffective cost effective 6, (6 7. 7 7) However 99 (VV 65 (VE 8, 8 (8 9. 9 9) Thus 39yearold yearold 39 year old 37yearsold yearsold 37 years cycles levels aspiration right transected obstruction 100 10 0 10- placed incised 70 7- left 3month month 18cc, 18cc cc , (18cc) discomfort postsurgery, postsurgery post surgery, Encouragingly followup approach 10. (10) total viable Historically th century 11. 11 (11) Notably likelihood 199 8. (8) literature 12. 12 (12) 28 66 6. 17 1. 43 Additionally 50 patent Finally postoperatively operatively 20. 20 (20) Conclusion conclusion innovation medicine progress ground ( (3 (4 (5 (IVF (18cc (10 (11 19 (12 (20 (2

Resumen El embarazo ectópico se considera un problema de salud pública a nivel mundial, se hizo una investigación con el objetivo de establecer los fundamentos acerca del embarazo ectópico y las políticas de salud que se requieren para su mitigación. Esta revisión bibliográfica integrativa incluyó diversos textos, artículos, materiales impresos y digitales relacionados con el embarazo ectópico, consultando además en las bases de datos y directorios: SciELO, LILACS, Latindex, Medline; el proceso se realizó mediante el uso de palabras clave en español, quedando seleccionados 18 artículos publicados entre 1990 y 2023. Desde un enfoque histórico social del embarazo ectópico, se determinó que de la toma de decisiones clínicas oportunas, depende el diagnóstico temprano de esa patología; así como de la identificación de factores de riesgo y la actuación pertinente en consecuencia.

Abstract Ectopic pregnancy is considered a public health problem worldwide. This research aimed to establish the foundations of ectopic pregnancy and the health policies required for its mitigation. This bibliographic review included various texts, articles, printed and digital materials related to ectopic pregnancy, consulting databases and directories such as SciELO, LILACS, Latindex, and Medline; through the use of keywords in Spanish, 18 articles published between 1990 and 2023 were selected. Based on a social-historical approach to ectopic pregnancy, it was determined that timely clinical decision-making depends on the early diagnosis of this pathology, the identification of risk factors, and the relevant action accordingly.

Abstract Primary hyperparathyroidism (PHPT) is characterized by elevated levels of calcium and parathyroid hormone (PTH). However, the interpretation of diagnostic tests, such as serum calcium and PTH levels, is complex in pregnant women. The aim of this report is to present a case of PHTP in a pregnant adolescent, with a special emphasis on an uncommon complication, as well as diagnostic and treatment strategies. A 17-year-old pregnant female presented with hyper emesis gravidarum and neurological symptoms, leading to the diagnosis of cerebral venous thrombosis. Further investigations revealed hypercalcemia and persistently elevated PTH levels, consistent with PHPT. After local ization studies, the patient underwent an emergency parathyroidectomy with a diagnosis of parathyroid ad enoma. During follow-up, intrauterine growth restric tion and severe preeclampsia developed, necessitating an emergency cesarean section. Both the mother and neonate had favorable outcomes. PHPT is an infrequent condition in the pregnant population, and its diagnosis can be challenging due to the overlap of symptoms with normal physiological changes during pregnancy. The occurrence of uncom mon complications, such as thrombotic phenomena, highlights the need for a comprehensive approach to ensure early detection and management. In most cases, parathyroidectomy is the treatment of choice.

Resumen El hiperparatiroidismo primario (HPTP) se caracteriza por niveles elevados de calcio y hormona paratiroidea (PTH). Sin embargo, la interpretación de pruebas diag nósticas, como los niveles de calcio sérico y PTH, es compleja en mujeres embarazadas. El objetivo de este re porte es presentar un caso de HPTP en una adolescente embarazada, con especial hincapié en una complicación infrecuente, así como en las estrategias diagnósticas y de tratamiento. Una mujer embarazada de 17 años presentó hiperé mesis gravídica y síntomas neurológicos, lo que llevó al diagnóstico de trombosis venosa cerebral. Posterio res investigaciones revelaron hipercalcemia y niveles persistentemente elevados de PTH, consistentes con HPTP. Tras la realización de estudios de localización, la paciente fue sometida a una paratiroidectomía de emergencia con diagnóstico de adenoma de paratiroi des. Durante el seguimiento, se desarrolló restricción del crecimiento intrauterino y preeclampsia grave, lo que resultó en la necesidad de realizar una cesárea de emergencia. Tanto la madre como el neonato evolucio naron favorablemente. El HPTP es una condición infrecuente en la población embarazada y su diagnóstico puede ser desafiante por la superposición de síntomas con los cambios fisiológicos normales del embarazo. La aparición de complicaciones infrecuentes, como fenómenos trombóticos, resalta la necesidad de un abordaje integral para garantizar la detección y el manejo temprano. En la mayoría de los casos, la paratiroidectomía es el tratamiento de elección.

ABSTRACT Introduction: Cardiovascular diseases represent an important cause of morbidity and mortality during pregnancy, cardiomyopathy is notable as a syndrome of heart failure. Objective: To characterize patients with peripartum cardiomyopathy according to clinical and epidemiological variables of interest for the investigation. Methods: A descriptive and cross-sectional study of 18 patients with diagnosis of peripartum cardiomyopathy was carried out. They were assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from October, 2015 to December, 2022. Results: In the series there was a prevalence of patients over 35 years (32.6 average age), besides African descendant (50.0 %), chronic hypertension (44.4 %) and multiparity (8.9 %) as risk factors and the left ventricle failure as clinical manifestation. The ejection fraction of this ventricle was regularly diminished and the pharmacological treatment response was satisfactory in all the sample. Conclusions: Peripartum cardiomyopathy is of low incidence in this center; however, due to its seriousness, the early diagnosis and the specialized staff intervention are necessary to avoid complications.

RESUMEN Introducción: Las enfermedades cardiovasculares representan una causa importante de morbilidad y mortalidad durante la gestación, entre las que se destaca la miocardiopatía, que cursa como un síndrome de insuficiencia cardíaca. Objetivo: Caracterizar a pacientes con miocardiopatía periparto según variables clínicas y epidemiológicas de interés para la investigación. Métodos: Se realizó un estudio descriptivo y transversal de las 18 pacientes con diagnóstico de miocardiopatía periparto, asistidas en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba en el período comprendido desde octubre de 2015 hasta diciembre de 2022. Resultados: En la serie predominaron las pacientes mayores de 35 años de edad (edad promedio de 32,6 años), además de la descendencia africana (50,0 %), la hipertensión arterial crónica (44,4 %) y la multiparidad (8,9 %) como factores de riesgo y la insuficiencia del ventrículo izquierdo como manifestación clínica. La fracción de eyección de dicho ventrículo estuvo regularmente disminuida y la respuesta al tratamiento farmacológico fue satisfactoria en el total de la muestra. Conclusiones: La miocardiopatía en el periparto es de baja incidencia en este centro; sin embargo, por la gravedad que representa, se impone el diagnóstico temprano y la intervención del personal especializado para evitar complicaciones.

Abstract: Worldwide, there is an alert due to the increase in the seroprevalence of hepatitis B virus (HBV). This can cause up to 3.5% of chronic diseases, of which 40% present secondary complications and/ or early death. Objective: To determine the seroprevalence of HBV in pregnant women at the time of delivery. Patients and Method: Observational, descriptive, cross-sectional study with cross-association between 2018 and 2019 at the Hospital Carlos Van Buren (HCVB), in Valparaiso, Chile. All pregnant women admitted for delivery care or with an immediate newborn who had HBV surface antigen study were included. Data were collected from the pregnant woman (age, nationality, education level, parity, type of delivery, and peripartum HIV-syphilis serology) and the newborn (gestational age, weight, and APGAR score). Inferential and multivariate analysis was performed using the Stata software. Results: 1,355 pregnant women were analyzed. 87.7% were Chilean, 5.5% Haitian, 4.2% Venezuelan, and 2.6% were of other nationalities. 0.3% were positive for HBV. The prevalence of HBV in Chileans was 0.08% and in Haitians 4%. Haitian nationality was at higher risk of HBV (OR = 83) vs. Chilean nationality (p = 0.0001). None presented coinfection with HIV and/or syphilis. Conclusions: HBV seroprevalence in HCVB pregnant women was 0.3%, similar to that described in the general population in Chile. There was no coinfection with other sexually transmitted diseases. The only predictor of HBV infection was Haitian nationality.

Resumen: Existe una alerta a nivel mundial por el aumento de la seroprevalencia del virus hepatitis B (VHB), el que puede ocasionar hasta un 3,5% de enfermedad crónica, de los cuales un 40% presenta complicaciones secundarias y/o muerte anticipada. Objetivo: Determinar la seroprevalencia de VHB de gestantes al momento del parto. Pacientes y Método: Estudio observacional descriptivo de corte transversal con asociación cruzada entre los años 2018 y 2019, en el Hospital Carlos Van Buren (HCVB), Valparaíso, Chile. Se incluyeron todas las gestantes que ingresaron para la atención del parto o con recién nacido inmediato que tenían el resultado del antígeno de superficie de VHB. Se recopilaron datos de la gestante (edad, nacionalidad, escolaridad, paridad, tipo de parto y serología VIH-sífilis periparto) y del recién nacido (edad gestacional, peso y APGAR). Se aplico análisis inferencial y multivariado con Stata. Resultados: Se analizaron 1.355 gestantes. Un 87,7% de nacionalidad chilena, 5,5% haitianas, 4,2% venezolanas y 2,6% de otras nacionalidades. El 0,3% resultaron positivas para VHB. La prevalencia de VHB en chilenas fue 0,08% y en haitianas 4%. La nacionalidad haitiana resultó de mayor riesgo de VHB (OR = 83) versus la nacionalidad chilena (p = 0,0001). Ninguna presentó coinfección con VIH y/o Sífilis. Conclusiones: La seroprevalencia de VHB en gestantes del HCVB fue de 0.3%, similar a la población general en Chile. No existió coinfección con otras enfermedades de transmisión sexual. El único factor predictor de infección por VHB fue la nacionalidad haitiana.

RESUMEN Introducción: El herpes connatal es una entidad infrecuente asociada a elevada morbimortalidad. La probabilidad de transmisión al recién nacido va de 5% al 85%. El diagnóstico se dificulta por falta de clínica, serología no confiable y por la no disponibilidad de PCR en los servicios públicos de países en vías de desarrollo. La IgM en gestantes podría ser utilizada como un marcador de sospecha para evaluar al neonato. Objetivo: Caracterizar a los recién nacidos, hijos de gestantes con IgM positiva para HVS 1-2 y la frecuencia de encefalitis en los infantes. Materiales y métodos : Estudio observacional, descriptivo, prospectivo, realizado de mayo de 2020 a octubre de 2021. Se incluyeron recién nacidos (RN) de madres con IgM positiva para Herpes Virus Simplex (HVS) a partir de la segunda mitad del embarazo. En el RN se realizó serología IgG e IgM, y además, PCR- RT para HVS 1-2 en sangre y/o LCR, excluyéndose los nacidos en otras maternidades y/o sin datos de serología materna. Resultados: 36 pacientes. Edad materna 28 años (DS + 4), 5% con antecedentes de HVS, 61% cesárea. 36% prematuros, 13% RCIU. Síntomas agudos en el RN 22%. De ellos, 19% plaquetopenia, 44% alteración de GOT. 63% PCR HVS en sangre y 44% en LCR. Se encontró hemorragia, hidrocefalia, leucomalacia en 27%. No se encontró diferencias en la expresión clínica por tipo de parto. Conclusiones: Los RN hijos de gestantes con IgM positiva para VHS desde la segunda mitad del embarazo o periparto, presentaron infección por VHS determinada por PCR en sangre o LCR, independiente de la vía del parto. El diagnóstico serológico en embarazadas permite la pesquisa, diagnóstico y tratamiento temprano del RN.

ABSTRACT Introduction: neonatal herpes is a rare entity associated with high morbidity and mortality. The probability of transmission to the newborn ranges from 5% to 85%. The diagnosis is difficult due to the lack of clinical signs, unreliable serology and the non-availability of PCR in public services in developing countries. IgM in pregnant women could be used as a suspected marker to evaluate the neonate. Objective: To characterize newborn children of pregnant women with positive IgM for HSV 1-2 and the prevalence of encephalitis in infants. Materials and methods: Observational, descriptive, prospective study, carried out from May 2020 to October 2021. Newborns (NB) of mothers with positive IgM for Herpes Virus Simplex (HSV) from the second half of pregnancy were included. In newborns, IgG and IgM were performed, and in addition, PCR-RT for HSV 1-2 in blood and/or CSF, excluding those born in other hospitales and/or without maternal serology data. Results: We included 36 patients. Maternal age was 28 years (DS + 4), 5% with a history of HSV. 61% were delivered via cesarean section, 36% were premature, 13% had IUGR. 22% of the newborns had acute symptoms. 19% had thrombocytopenia, 44% had GOT alteration. 63% were PCR positive for HSV in serum and 44% were CSF-positive. Hemorrhage, hydrocephalus and leukomalacia were found in 27%. No differences were found in clinical expression by type of delivery. Conclusions: Newborns born to pregnant women with positive IgM for HSV from the second half of pregnancy or peripartum, presented HSV infection as determined by PCR in blood or CSF, regardless of the route of delivery. Serological diagnosis in pregnant women allows early screening, diagnosis and treatment of the NB.

Resumo Introdução: O síndroma de Bardet-Biedl (SBB) é uma doença multissistémica rara, de transmissão predominantemente autossómica recessiva, genética e clinicamente heterogénea. A sua prevalência na Europa varia entre 1:125.000 e 1:175.000, afetando de igual modo ambos os sexos. Este síndroma define-se por obesidade, polidactilia, anomalias genitourinárias, distrofia retiniana e dificuldades cognitivas, que se associam de forma variável e pode incluir um amplo espectro de outras manifestações menos prevalentes. O diagnóstico da SBB é clínico, sendo confirmado por análise molecular, o que permite o aconselhamento genético dos restantes membros da família e a realização do diagnóstico pré-natal. Atualmente não existe tratamento curativo, mas o diagnóstico precoce é importante para orientar o acompanhamento multidisciplinar. O médico de família, pela sua proximidade com o doente e seguimento longitudinal, poderá identificar sinais de alarme relativos ao diagnóstico e à identificação de complicações da doença, além de poder ajudar a mitigar impactos psicossociais deletérios. Descrição do caso: Utente do sexo masculino, quatro anos de idade, raça caucasiana, natural de Lisboa, primeiro filho de uma fratria de três. A gravidez foi vigiada pelo seu médico de família, tendo, por alterações na ecografia morfológica - rins poliquísticos e polidactilia - iniciado seguimento na consulta de genética médica, onde se estabeleceu o diagnóstico de SBB tipo 4. Nasceu por parto eutócico de uma gestação de termo sem outras intercorrências. Foi referenciado às consultas de pediatria, genética, nefrologia, oftalmologia, otorrinolaringologia, cirurgia pediátrica plástica e cardiologia pediátrica. Com cerca de um ano de idade foi-lhe diagnosticada miopia. Aos três anos foi submetido a desarticulação de dedos supranumerários. Presentemente mantém vigilância na consulta de saúde infantil da USF e acompanhamento nutricional, apresentando progressão estaturo-ponderal adequada. Comentário: O objetivo deste trabalho é relatar um caso de SBB e identificar o papel do médico de família na sinalização e acompanhamento da criança com doença genética rara.

Abstract Introduction: Bardet-Biedl syndrome (BBS) is a rare multisystem disorder, predominantly of autosomal recessive transmission, with genetic and clinical heterogeneity. Prevalence in Europe varies from 1:125,000 to 1:175,000, equally affecting both sexes. BBS is defined by a variable combination of obesity, polydactyly, genitourinary anomalies, retinal dystrophy, cognitive impairment, and other less prevalent manifestations. The diagnosis of BBS is clinical, confirmed by molecular analysis. This allows for genetic counseling of families and the possibility of prenatal diagnosis. Currently, there is no curative treatment for BBS, being early diagnosis is important to plan a multidisciplinary follow-up. Family physicians, owing to their closeness with the patient and longitudinal follow-up, may identify red flags leading both to early diagnosis and early detection of complications, and to detect and mitigate any psychosocial mishaps. Case description: Male, Caucasian, four years old, born in Lisbon, first of three children. The pregnancy was initially followed by the general practitioner. Due to changes in the routine morphological ultrasound - polycystic kidneys and polydactyly - a referral was made to a consultation of medical genetics, where the genetic study was carried out to establish the diagnosis of BBS type 4. He was born by eutocic delivery, at the end of a full-term gestation, without complications. He was referred to consultations in pediatrics, genetics, nephrology, ophthalmology, otorhinolaryngology, pediatric plastic surgery, and pediatric cardiology. At about one year of age, he was diagnosed with myopia. At the age of three, he underwent the first disarticulation of the supernumerary fingers and toes. The child keeps follow-up at the USF consultation and nutritional monitoring, so far showing adequate height-weight progression. Comment: The objective of this case report is to describe a case of BBS and to identify the role of the family physician in the referral and follow-up of a child with a rare genetic disorder.

ABSTRACT Gallstone ileus-induced intestinal obstruction is a rare but significant condition that occurs when a gallstone becomes lodged in the gastrointestinal tract. Major risk factors for gallstone ileus-induced intestinal obstruction include older age, female sex, diabetes, history of gallbladder disease such as gallstones, as well as previous gallbladder-related surgical procedures such as cholecystectomy. Pregnancy is also a known risk factor for gallstone disease. We present the case of a 38-year-old patient with a history of three cesarean sections and no apparent comorbidities. Prior to her visit to the emergency department, the patient experienced moderate colicky abdominal pain in the lower abdomen for two days. The physical examination revealed diffuse abdominal tenderness, predominantly in the right iliac fossa, along with signs of irritation of the peritoneum. Laboratory tests showed a leukocyte count of 11,490 cells/µl and neutrophilia of 85.6 %. Following an exploratory laparotomy, the suspected diagnosis of gallstone ileus was confirmed. An enterolithotomy was performed, and the patient experienced good post-surgical progress. In conclusion, it is important to consider gallstone ileus-induced intestinal obstruction among patients with relevant symptoms and medical history. This case report highlights the importance of considering gallstone ileus-induced intestinal obstruction among patients with gastrointestinal symptoms and a history of pregnancy. Early diagnosis and intervention are crucial to prevent serious complications.

RESUMEN La obstrucción intestinal inducida por íleo biliar es una condición rara pero significativa que se produce cuando una piedra en la vesícula se aloja en el tracto gastrointestinal. Entre los principales factores de riesgo para la obstrucción intestinal inducida por íleo biliar se encuentran la edad avanzada, el sexo femenino, la diabetes, los antecedentes de enfermedad biliar como cálculos biliares, así como procedimientos quirúrgicos previos relacionados con la vesícula biliar, como la colecistectomía. También el embarazo es un factor de riesgo conocido para la enfermedad de los cálculos biliares. En este artículo, se presenta el caso de una paciente de 38 años con antecedentes de tres cesáreas previas y sin comorbilidades aparentes. Antes de acudir al departamento de emergencias, la paciente experimentó dolor abdominal con cólico moderado en la parte inferior del abdomen durante dos días. El examen físico reveló sensibilidad abdominal difusa, predominantemente en la fosa ilíaca derecha, junto con signos de irritación peritoneal. Los análisis de laboratorio mostraron un recuento de leucocitos de 11 490 células/μl y una neutrofilia del 85,6 %. Después de una laparotomía exploratoria, se confirmó el diagnóstico sospechado de íleo biliar por cálculo. Se realizó una enterolitotomía y la paciente mostró un progreso posoperatorio favorable. En conclusión, es importante considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas relevantes y antecedentes médicos. Este reporte de caso subraya la importancia de considerar la obstrucción intestinal inducida por íleo biliar en pacientes con síntomas gastrointestinales y antecedentes de embarazo. El diagnóstico temprano y la intervención son cruciales para prevenir complicaciones graves.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the prevalence of early neonatal sepsis in pregnant women with a positive culture for group B beta-hemolytic Streptococcus in a middle-income city in Southeastern Brazil. METHODS: A retrospective cohort study was conducted, involving singleton low- and high-risk pregnancies in whom group B beta-hemolytic Streptococcus cultures were evaluated between 35 and 37 weeks of gestation using vaginal and anal swabs. A specific medium (Todd-Hewitt) was used for culturing. The pregnant women were divided into two groups based on positive (n==201) and negative (n==420) cultures for group B beta-hemolytic Streptococcus. RESULTS: The maternal colonization rate by group B beta-hemolytic Streptococcus was 32.3%. The prevalence of early neonatal sepsis was 1.0% (2/201) among patients with a positive group B beta-hemolytic Streptococcus culture and 1.9% (8/420) among patients with a negative culture. Among the patients who underwent adequate prophylaxis, crystalline penicillin G was used in 51.9% (54/104), followed by cefazolin in 43.3% (45/104), ampicillin in 3.8% (4/104), and clindamycin in 1.0% (1/104). A model that included prematurity (p==0.001) proved to be an independent risk predictor of early neonatal sepsis [χ2 (1)==15.0, odds ratio: 16.9, 95% confidence interval: 4.7–61.6, p<0.001, Nagelkerke R2==0.157]. CONCLUSION: The prevalence of a positive culture for group B beta-hemolytic Streptococcus was high. However, the prevalence of early neonatal sepsis was low in pregnant women with both positive and negative group B beta-hemolytic Streptococcus cultures and in pregnant women with a positive culture who underwent both adequate and inadequate antibiotic prophylaxis. Prematurity proved to be an independent predictor of early neonatal sepsis, considering the entire study population.

Abstract: Worldwide, there is an alert due to the increase in the seroprevalence of hepatitis B virus (HBV). This can cause up to 3.5% of chronic diseases, of which 40% present secondary complications and/ or early death. Objective: To determine the seroprevalence of HBV in pregnant women at the time of delivery. Patients and Method: Observational, descriptive, cross-sectional study with cross-association between 2018 and 2019 at the Hospital Carlos Van Buren (HCVB), in Valparaiso, Chile. All pregnant women admitted for delivery care or with an immediate newborn who had HBV surface antigen study were included. Data were collected from the pregnant woman (age, nationality, education level, parity, type of delivery, and peripartum HIV-syphilis serology) and the newborn (gestational age, weight, and APGAR score). Inferential and multivariate analysis was performed using the Stata software. Results: 1,355 pregnant women were analyzed. 87.7% were Chilean, 5.5% Haitian, 4.2% Venezuelan, and 2.6% were of other nationalities. 0.3% were positive for HBV. The prevalence of HBV in Chileans was 0.08% and in Haitians 4%. Haitian nationality was at higher risk of HBV (OR = 83) vs. Chilean nationality (p = 0.0001). None presented coinfection with HIV and/or syphilis. Conclusions: HBV seroprevalence in HCVB pregnant women was 0.3%, similar to that described in the general population in Chile. There was no coinfection with other sexually transmitted diseases. The only predictor of HBV infection was Haitian nationality.

Resumen: Existe una alerta a nivel mundial por el aumento de la seroprevalencia del virus hepatitis B (VHB), el que puede ocasionar hasta un 3,5% de enfermedad crónica, de los cuales un 40% presenta complicaciones secundarias y/o muerte anticipada. Objetivo: Determinar la seroprevalencia de VHB de gestantes al momento del parto. Pacientes y Método: Estudio observacional descriptivo de corte transversal con asociación cruzada entre los años 2018 y 2019, en el Hospital Carlos Van Buren (HCVB), Valparaíso, Chile. Se incluyeron todas las gestantes que ingresaron para la atención del parto o con recién nacido inmediato que tenían el resultado del antígeno de superficie de VHB. Se recopilaron datos de la gestante (edad, nacionalidad, escolaridad, paridad, tipo de parto y serología VIH-sífilis periparto) y del recién nacido (edad gestacional, peso y APGAR). Se aplico análisis inferencial y multivariado con Stata. Resultados: Se analizaron 1.355 gestantes. Un 87,7% de nacionalidad chilena, 5,5% haitianas, 4,2% venezolanas y 2,6% de otras nacionalidades. El 0,3% resultaron positivas para VHB. La prevalencia de VHB en chilenas fue 0,08% y en haitianas 4%. La nacionalidad haitiana resultó de mayor riesgo de VHB (OR = 83) versus la nacionalidad chilena (p = 0,0001). Ninguna presentó coinfección con VIH y/o Sífilis. Conclusiones: La seroprevalencia de VHB en gestantes del HCVB fue de 0.3%, similar a la población general en Chile. No existió coinfección con otras enfermedades de transmisión sexual. El único factor predictor de infección por VHB fue la nacionalidad haitiana.

Abstract OBJECTIVE: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. MATERIALS AND METHODS: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. RESULTS: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. CONCLUSION: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.

Resumen OBJETIVO: Describir las características de la población afectada y los retrasos que contribuyeron a la mortalidad materna, secundaria a los trastornos hipertensivos del embarazo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo efectuado con base en la vigilancia epidemiológica de casos centinela de muertes maternas tempranas de mujeres residentes en Antioquia, Colombia, durante el embarazo, el parto y los 42 días siguientes a éste ocurridas en el periodo 2012-2020. Se creó una base de datos en Microsoft Access 2007 (Microsoft, Redmond, WA, USA) y los datos se analizaron en Microsoft Excel y SPSS versión 22. RESULTADOS: Se registraron 266 muertes maternas, de las que 38 fueron secundarias a trastornos hipertensivos del embarazo. La eclampsia fue causa de 15 fallecimientos; 12 por síndrome HELLP, 9 por hemorragia intracerebral y 2 por desprendimiento prematuro de placenta y coagulación intravascular diseminada. En 13 de los 38 casos no hubo una pauta adecuada del sulfato de magnesio, 19 no recibieron tratamiento antihipertensivo, que estaba indicado y 17 no tuvieron un control antihipertensivo adecuado. CONCLUSIÓN: La atención prenatal es una oportunidad decisiva para la detección, prevención y estratificación del riesgo. Todos los centros de atención obstétrica deben estar preparados para gestionar urgencias asociadas con los trastornos hipertensivos del embarazo. Los desenlaces mejoran con la aplicación de protocolos de emergencia estandarizados, organizados y la participación de equipos multidisciplinarios que garanticen una atención de calidad y un efecto positivo en la morbilidad y mortalidad materna susceptible de prevención.

ABSTRACT BACKGROUND: Exclusive breastfeeding is recommended for the first six months, and mother’s age impact early weaning. Educational support and relevant information can increase breastfeeding rates. OBJECTIVE: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. DESIGN AND SETTING: A prospective cohort study involving primiparous adolescents who gave birth at the Woman’s Hospital (CAISM), Universidade Estadual de Campinas, Brazil. METHODS: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman’s Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student’s t-test, Mann–Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. RESULTS: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. CONCLUSION: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period. BACKGROUND mother s weaning rates OBJECTIVE maintenance intention SETTING Womans Woman CAISM, CAISM , (CAISM) Campinas Brazil METHODS care (WH (PC stay Students Student ttest, ttest t test t-test MannWhitney Mann Whitney chisquared chi squared Logbinomial Log binomial intervals RESULTS 13 5 7 P 0.005 0005 0 005 0.04 004 04 0.02 002 02 0.01. 001 0.01 . 01 0.01) Notably CONCLUSION period (CAISM 1 0.00 000 00 0.0 0.

Abstract In the current study, we aimed to assess the expression levels of two circulating microRNAs (miRNA) (oar-miR-485-5p and oar-miR-493-5p) in the ovine plasma during the peri-implantation. After mating, we collected the plasma samples from a total of 8 ewes on day 22 of pregnancy (P22; n = 4) and day 22 of the estrous cycle (C22; n=4). We used mature miRNA sequences for oar-miR-485-5p and oar-miR-493-5p out of one hundred fifty, which were retrieved from our microarray results of previous study. We showed that the miRNA expression of oar-miR-485-5p and oar-miR-493-5p were upregulated in P22 (P<0.05) when compared to C22. Those two miRNAs targeted 311 target genes in the peri-implantation period of pregnancy. Furthermore, we revealed 151 GO/pathway terms in biological process (BP) and 25 GO/pathway terms in molecular function (MF), while we demonstrated 13 GO/pathway terms in cellular component (CC). We revealed three hub genes as interleukin 2 (IL2), interleukin 18 (IL18), and C-X-C Motif Chemokine Ligand 10 (CXCL10). In conclusion, both miR-485-5p and oar-miR-493-5p have the potential to be a biomarker to understand peri-implantation of the ovine pregnancy in the aspect of pregnancy-reflected changes in maternal plasma. study (miRNA oarmiR4855p oarmiRp oar miR 485 5p p oarmiR4935p 493 periimplantation. periimplantation peri implantation. implantation mating P (P22 4 C22 C (C22 n=4. n4 n=4 . n=4) fifty P2 P<0.05 P005 0 05 (P<0.05 31 Furthermore 15 GOpathway GO pathway BP (BP MF, MF , (MF) 1 CC. CC (CC) IL2, IL2 IL (IL2) IL18, IL18 (IL18) CXC X CXCL10. CXCL10 CXCL (CXCL10) conclusion miR4855p miRp pregnancyreflected reflected oarmiR 48 49 (P2 C2 (C2 n= P<0.0 P00 (P<0.0 3 (MF (CC (IL2 IL1 (IL18 CXCL1 (CXCL10 (P (C P<0. P0 (P<0. (IL (IL1 (CXCL1 P<0 (P<0 (CXCL P< (P<

Abstract Aim miR-141-5p expression in patients with Early Spontaneous Abortion (ESA) and its correlation with hormone levels during pregnancy were investigated. Methods A total of 70 pregnant women with ESA were selected as the research group, and 70 normal pregnant women who chose abortion for non-medical reasons were selected as the Con group. Serum β-HCG, Progesterone (P), and Estrogen (E2) were detected by enzyme-linked immunosorbent assay. Differentially expressed miRNAs were screened by miRNA microarray analysis. miR-141-5p expression was detected by RT-qPCR, and its correlation with serum β-HCG, P, and E2 levels was analyzed. The diagnostic value of miR-141-5p for ESA was evaluated by the ROC curve. Results Serum β-HCG, P, and E2 were decreased and serum miR-141-5p was increased in patients with ESA. Pearson correlation analysis showed that serum β-HCG, P, and E2 levels were negatively correlated with miR-141-5p expression levels. ROC curve showed that miR-141-5p had a diagnostic value for ESA. Conclusions miR-141-5p is related to hormone levels during pregnancy and is expected to become a new candidate diagnostic marker for ESA. miR1415p miRp miR 141 5p p (ESA investigated 7 group nonmedical non medical βHCG, βHCG β HCG, HCG β-HCG P , (P) E (E2 enzymelinked enzyme linked assay RTqPCR, RTqPCR RT qPCR, qPCR RT-qPCR analyzed 14 (P (E 1

Abstract We hypothesized that the hCG modulates the expression of IFNT-pathway and ISGs in bovine endometrium during early pregnancy. The aim of the current study is to evaluate the effect of hCG on IFNT-pathway signals and ISGs expression in endometrial cells. For this, 29 non-lactating cross-bread cows were used in the study and submitted to a 9-day fixed-time artificial insemination (FTAI) protocol. The day of the AI was considered Day 0 (D0), and five days (D5) after the FTAI, the cows were allocated into two groups: Control and hCG group, when a hCG group received a single dose of 2.500UI of hCG. On day 18 after FTAI (D18) cows were slaughtered and endometrial tissue samples were collected. There was no difference between the embryo recovery rate of the cows in C compared to the hCG. The hCG group increased the accessory corpus luteum formation rate. The hCG resulted in greater serum progesterone concentration in the hCG group compared to the C on Day 14. Only the expression of IFNAR2 and STAT1 were upregulated on pregnant cows of the hCG group compared to the C group. The pathway genes (JAK1, STAT2, and IRF9) were not regulated. The mRNA abundance of ISG15, MX1, MX2, and OAS1 was upregulated in pregnant cows for hCG group, compared to C group. The results show that the administration of hCG, 5 days after AI, in addition to increasing the serum progesterone, modulates the expression of IFNT-pathway and ISGs on bovine endometrium on Day 18 of pregnancy. IFNTpathway IFNT pregnancy cells this 2 nonlactating non lactating crossbread cross bread 9day 9 fixedtime fixed time (FTAI protocol D0, D0 D , (D0) D5 (D5 groups 2500UI UI 500UI 1 D18 (D18 collected 14 IFNAR STAT JAK1, JAK1 JAK (JAK1 STAT2 IRF9 IRF regulated ISG15 ISG MX1 MX MX2 OAS (D0 (D D1 (D1 (JAK ISG1