Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials

Objective: To assess the effects of vitamin D supplementation during pregnancy on obstetric outcomes and birth variables. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patient(s): Pregnant women and neonates. Intervention(s): PubMed and 5 other research databases were searched through March 2014 for RCTs evaluating vitamin D supplementation calcium/vitamins/ferrous sulfate vs. a control (placebo or active) during pregnancy. Main Outcome Measure(s): Measures were: circulating 25-hydroxyvitamin D [25(OH)D] levels, preeclampsia, gestational diabetes mellitus (GDM), small for gestational age (SGA), low birth weight, preterm birth, birth weight, birth length, cesarean section. Mantel-Haenszel fixed-effects models were used, owing to expected scarcity of outcomes. Effects were reported as relative risks and their 95% confidence intervals (CIs). Result(s): Thirteen RCTs (n ¼ 2,299) were selected. Circulating 25(OH)D levels were significantly higher at term, compared with the control group (mean difference: 66.5 nmol/L, 95% CI 66.2–66.7). Birth weight and birth length were significantly greater for neonates in the vitamin D group; mean difference: 107.6 g (95% CI 59.9–155.3 g) and 0.3 cm (95% CI 0.10–0.41 cm), respectively. Incidence of preeclampsia, GDM, SGA, low birth weight, preterm birth, and cesarean section were not influenced by vitamin D supplementation. Across RCTs, the doses and types of vitamin D supplements, gestational age at first administration, and outcomes were heterogeneous. Conclusion(s): Vitamin D supplementation during pregnancy was associated with increased circulating 25(OH)D levels, birth weight, and birth length, and was not associated with other maternal and neonatal outcomes. Larger, better-designed RCTs evaluating clinically relevant outcomes are necessary to reach a definitive conclusion. (Fertil Steril 2015;-:-–-. 2015 by American Society for Reproductive Medicine.)
Authors: Perez López, Faustino R.; Pasupuleti, Vinay; Mezones Holguin, Edward; Benites Zapata, Vicente A.; Thota, Priyaleela;Deshpande, Abhishek; Hernandez, Adrian V.
Source: Fertility and Sterility

URL: http://hdl.handle.net/10757/347325

Factor analysis of the ‘‘Questionnaire for the evaluationof occupational burnout syndrome’’ in Peruvian medicalstudents

Background: The ‘‘evaluation of occupational burnout syndrome questionnaire’’(‘‘Cuestionario para la evaluación del síndrome de quemarse por el trabajo (CESQT)’’)has been proposed to evaluate this syndrome in different populations. However, there havenot been studies up to date that have tested this questionnaire in Latin-American universitystudents.Aim: To evaluate the dimensional structure of CESQT in medical students from Peru.Methods: This was an observational, analytical and cross-sectional study. The CESQT wasapplied to a sample of 71 medical students in the final year of their degree (also known as‘‘Medical Internship’’) in a Public Hospital in Lima, Peru. An exploratory factor analysis (EFA)was used to identify the dimension structure with best fit to the data. A multivariate linearregression analysis was also performed to determine the relationship between the occupa-tional burnout syndrome, gender, and their current clinical rotation (obstetrics and gynaecology,surgery, paediatrics, and internal medicine).Results: The EFA found that the two dimensions model best explained the data variability (61.8%of the variance). These two factors were called illusion and exhaustion. The linear regressionshowed that gender and the current clinical rotation were not associated to any of the twofactors (P > .05). Illusion was inversely associated with exhaustion, even after fitting it withgender and current clinical rotation (P = .007and = −.33, respectively).
Authors: Cáceres Mejía, Brenda; Roca Quicaño, Ricardo; Torresa, María F.; Pavic Espinoza, Ivana; Mezones Holguin, Edward;Fiestasca, Fabián
Source: Revista de Psiquiatria y Salud Mental (Rev Psiquiatr Salud Ment -Barc)

URL:http://hdl.handle.net/10757/347244 

Bilateral endogenous ophthalmitis due to Candida glabrata after complicated bariatric surgery

Case report: A 43-year-old female presented with decreased visual acuity in the right eye.“Snowball-like” retinal lesions were found in both eyes on examination. Due to a lackof improvement with intravitreal antifungal empirical treatment, vitreous culture wasperformed and Candida glabrata was isolated. The patient then received intravitreal ampho-tericin B, as well as systemic treatment with caspofungin and amphotericin B lipid complex.Discussion: Endogenous fungal endophthalmitis is a sight-threatening condition. There arefew reports of C. glabrata endogenous endophthalmitis. Treatment regimens for Candidaendophthalmitis include combinations of systemic and/or intravitreal antifungals, as wellas vitrectomy.
Authors: Pizango, O.; Tejeda, E.; Buendia, M.; Lujana, S.
Source: Archivos de la Sociedad Española de Oftalmología

URL: http://hdl.handle.net/10757/347088

A community randomised controlled trial evaluating a home-based environmental intervention package of improved stoves, solar water disinfection and kitchen sinks in rural Peru: Rationale, trial design and baseline findings

Introduction: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. Objective: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. Methods: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. Results: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. Conclusions: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12- month follow up period will provide valuable evidence.
Authors: Hartinger, S.M.; Lanata, Claudio F.; Hattendorf, J.; Gil, I.; Verastegui, H.; Ochoa, T.; Mäusezahl, D.
Source: Contemporary Clinical Trials

URL: http://hdl.handle.net/10757/347070

sing predictors of sexual function in mid-aged sexually active women

Objective: To assess predictors of sexual function in mid-aged women. Methods: We analyzed data of 262 healthy sexually active women (40–59 years) who filled out the Female Sexual Functioning Index (FSFI), the Menopause Rating Scale (MRS) and a general questionnaire containing female/partner data. Correlations between these two measures were also analyzed. Results: Significant inverse correlations were found between all FSFI and MRS scores. This was most evident for the MRS urogenital score in relation to FSFI total, pain and lubrication scores. Multiple linear regression analysis determined best model predicting total FSFI index scores that explained a 66% of the variance. In this model, MRS urogenital score was an important predictor of female sexual function (total FSFI scores) with a significant inverse relation. Additionally total FSFI scores displayed a significant positive correlation with female educational level and HT use and an inverse relation with partner age and female parity. Conclusion: Several female/partner factors predicted female sexual function in this mid-aged series. MRS urogenital scores significantly correlated with total FSFI scores.
Authors: Chedraui, Peter; Pérez López, Faustino R.; Mezones Holguin, Edward; San Migue, Glenda; Avila, Carlos
Source: Maturitas

URL: http://hdl.handle.net/10757/347065