Julián A. Herrera

Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia.

Objective Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. Methods A case–control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure ≥ 140/90 mmHg and proteinuria ≥ 0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. Results The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n = 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P = 0.01). A similar tendency was observed in controls with periodontal disease (n = 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P = 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P = 0.01). Conclusion These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia.

Calcium plus linoleic acid therapy for pregnancy-induced hypertension

Objective: To determine the effect of dietary supplementation of calcium plus conjugated linoleic acid (calcium–CLA) in reducing the incidence of vascular endothelial dysfunction in pregnant women at high risk of developing pregnancy‐induced hypertension (PIH). Patients and methods: This randomized, double‐blind, placebo‐controlled trial conducted at 4 outpatient clinics in 2 developing countries recruited 48 healthy primigravidas younger than 19 years or older than 35 years who had a family history of pre‐eclampsia and diastolic notch. Twenty‐four participants received daily elemental calcium (600 mg) plus CLA (450 mg) and 24 received placebo from week 18 to 22 of pregnancy until delivery. Results: Calcium–CLA supplementation reduced significantly the incidence of PIH (2 cases [8%] in the study group vs. 10 cases [42%] in the placebo group; relative risk, 0.20; 95% confidence interval, 0.05–0.82; P = .01). Endothelial dysfunction was also significantly reduced after calcium–CLA supplementation (in 18 women [75%] vs. 4 women [17%]; P < .001), compared with the placebo group (in 15 [63%] vs. 9 women [38%]; P = .08). Conclusion: In pregnant women at high risk for PIH, calcium–CLA supplementation decreases the incidence of PIH and improves endothelial function.

Reproductive health risk behavior survey of Colombian high school students.

PURPOSE To establish rates of potentially risky sexual behaviors among Colombian adolescent students. METHODS A total of 230 9th and 11th graders at a Colombian high school (69% of enrolled students) were anonymously surveyed about selected reproductive health behaviors using the Centers for Disease Control and Preventions self-administered Youth Risk Behavior Survey. RESULTS The response rate was >90%. The group was demographically representative of students. Twenty-nine percent of the group had engaged in intercourse (13% of 9th and 43% of 11th graders). Male gender [beta = 0.7873; odds ratio (OR) = 2.09; 95% confidence interval (CI) = 1.57-3.08] and increasing age (beta = 0.3413; OR = 1.41; 95% CI = 1.02-1.93) were each significantly correlated with prior sexual activity. Compared with females, males initiated intercourse at a significantly earlier age (beta = 0.284; p < .001) but did not report significantly more partners (means 2.1 vs. 1.4; chi2 = 1.25; p = .262). Forty-eight percent of respondents used contraception during their last encounter. Sixty-three percent used oral contraceptives or condoms, while the remainder used less effective methods. Contraceptive use did not correlate with gender or age. Age was significantly and positively correlated with use of alcohol prior to sexual activity (B = 1.28; OR = 3.6; 95% CI = 1.49-8.44). CONCLUSIONS Compared with U.S. populations of similar ages, the Colombian group surveyed had fewer sexually active members, reported fewer partners, and used contraception with lower frequency.

Subclinical infection as a cause of inflammation in preeclampsia.

Preeclampsia, a pregnancy-exclusive hypertensive disorder, is the major cause of maternal and perinatal mortality, with a greater importance in developing countries. The role of inflammation in the pathogenesis of preeclampsia has been the object of recent studies by our group. We have described elevated levels of inflammatory markers (tumor necrosis factor alpha, interleukin-6, and C-reactive protein) in preeclamptic patients and demonstrated that Latin-American women present a higher degree of inflammation than women from developed countries. We have results that suggest that chronic subclinical infections and insulin resistance are the most probable causes of the increased inflammation in preeclampsia. Moreover, we showed that early treatment of urinary and vaginal infections decreased the incidence of preeclampsia. We also have evidence that suggests that inflammation leads to endothelial dysfunction, predisposing women to develop preeclampsia. Increased levels of inflammation markers and endothelial dysfunction are found in the early stages of pregnancy in women who later on develop preeclampsia. Appropriate prenatal care programs, including screening and treatment of urinary, vaginal, and periodontal infections in early pregnancy and prevention of factors that predispose to insulin resistance, such as excessive weight gain during pregnancy, may reduce the incidence of preeclampsia in Latin-American women.

Prenatal biopsychosocial risk assessment and low birthweight

A double-blind prospective study was conducted to compare the predictive value of a prenatal biomedical risk scale (PBRS) and a prenatal biopsychosocial risk assessment (PBRAS) with respect to low birthweight. All obstetric patients at seven health centers located in Argentina, Colombia, Honduras, and Uruguay from November 1992 through January 1994 whose initial prenatal visits occurred between the 14th and 28th week of gestation were invited to participate. Information was obtained on 979 mother-infant pairs. High PBRS scores showed sensitivity of 62.1% and specificity of 81.3%, positive predictive value (PPV) of 45.3% and negative predictive value (NPV) of 89.5%, with respect to low birthweight. With the addition of the psychosocial factors (PBRAS), sensitivity of 75.7% and specificity of 76.1%, PPV of 55.1% and NPV of 88.9% were observed. The prospective cohort design of this study provides a strong basis for conclusion that an evaluation of the prenatal biopsychosocial risk (as operationalized by the PBRAS) adjusted for other variables such as length of gestation, neonatal APGAR, perinatal mortality, socioeconomic status, drinking and smoking improves the positive predictive value of the assessment of women who may give birth to newborns with low birthweight (P < 0.01).

Periodontal intervention effects on pregnancy outcomes in women with preeclampsia

Objective: To determine the efficacy of periodontal intervention on pregnancy outcome in mild preeclamptic women. Methods: A sample of 60 pregnant women with mild preeclampsia (blood pressure levels <160/110 mm and proteinuria >300 mg/l in 24 hours urine) from the Hospital Universitario del Valle (Cali, Colombia) was included to the study. Preeclamptic women were randomized in two groups, one with periodontal intervention (PIG, N=28) and another in which the periodontal intervention was practiced after childbirth (NPIG, N=32). Maternal socio-demographic, medical and periodontal data were obtained. PIG included patients in which supragingival and subgingival cleaning within ultrasonic and manual devices were performed after study inclusion. The progression from mild to severe preeclampsia, eclampsia or HELLP syndrome, the number of days of clinical stability and the percentile of birth-weight adjusted for gestational age were evaluated in both groups. Results: Most of the patients (60%) were multigravids. Gestational age at inclusion was 31.8±1.6 weeks. Chronic periodontitis was a frequent finding (61.7%). Social, demographic, medical and periodontal conditions were similar between both groups. Disease progression to severe preeclampsia, eclampsia or HELLP syndrome was also similar (89.2% PIG versus 84.4%, p=0.65) (OR=1.06 IC 95% 0.87-1.29, p=0.65). Days of clinical stability were similar between the groups (median 10 days , range 1-46, PIG versus 12 days, range 1-59, p=0.57) and the percentile of birth weight adjusted with gestational age had no differences between the groups (median percentil 50 range 5-90 PIG versus percentil 55 range 5-95, p=0.73). Conclusion: Periodontal intervention does not seem to harm the health, the severity or alter the frequency on maternal complications in mild preeclampsia subjects.

Effect of periodontal therapy on the subgingival microbiota in preeclamptic patients

INTRODUCTION Few studies have described subgingival microbiota in pregnant women with mild preeclampsia. OBJECTIVE Clinical periodontal and subgingival microbiota changes were identified in pregnant women with mild preeclampsia after periodontal treatment. MATERIALS AND METHODS In a secondary analysis of a randomized clinical trial, 57 preeclamptic women were studied at Hospital Universitario del Valle in Cali, Colombia. Thirty one women were randomized to the periodontal intervention group (subgingival scaling and planing ultrasonic and manual) during pregnancy and 26 to the control group (supragingival prophylaxis). Periodontal clinical parameters and subgingival microbiota were characterized at the time of acceptance into the study and again at postpartum. Eight periodontopathic bacteria and 2 herpesviruses were assessed by polymerase chain reaction. Chi-square, McNemar or Students t tests were used, with a significance level of p≤0.05. RESULTS Both groups were comparable in the clinical and microbiological variables at baseline. Periodontal treatment reduced the average pocket depth in the intervention group from 2.4±0.3 to 2.3±0.2 mm (p<0.001) and in control group 2.6±0.4 to 2.44±0.4 mm, (p<0.001) and bleeding index 16.4±1.5% to 7.9±0.7% in the intervention group(p<0.001) and 17.1±1.8% to 10±0.9% in the control group (p=0.002). The frequency of detection of microorganisms did not differ significantly between groups. CONCLUSION Scaling/root planning and supragingival prophylaxis significantly reduced the probing depth and gingival bleeding index. Periodontal treatment was not more effective than prophylaxis in reducing periodontopathic organisms or herpesvirus.INTRODUCTION Listeria monocytogenes is an intracellular, opportunistic pathogen which can cause severe infections such as meningitis, encephalitis and bacteremia. It can also cause abortions in human beings. Foods are the vehicle for infection of the host. Serotypification has discriminated 13 serotypes: 1/2a,1/2b, 1/2c, 3a, 3b, 3c, 4a, 4ab, 4b, 4c, 4d, 4e, 7. 4b is the cause of the majority of cases of listeriosis in the world. OBJECTIVE The frequency of serotypes of L. monocytogenes was determined in bacteria isolated from foods in Colombia. MATERIALS AND METHODS The study is descriptive and retrospective. Over a 10-year period, 2000-2009, 1,599 isolates were examined. All were confirmed as Listeria monocytogenes and other strains of Listeria, using biochemical tests recommended by the Food and Drug Administration (USA) and API Listeria and serotyped using the Seeliger and Höhne method. RESULTS Of the 1,599 isolates, 1,424 were confirmed as L. monocytogenes. Serotypes identified were: 1/2a, 135 (9.5%); 1/2b, 154 (10.8%); 1/2c, 68 (4.8%); 3a, 4 (0.3%); 3b, 29 (2.0%); 3c, 2 (0.1%); 4a, 44 (3.1%); 4b, 820 (57.6%); 4c, 6 (0.4%); 4d- 4e, 140 (9.8%); 4e, 17 (1.2%); 7, 2 (0.1%); not susceptible of serotypification, three cases, (0.2%). Isolates came mainly from the Capital District of Bogotá, 1,035 (73%); from Antioquia 199 (14%), from Nariño, 109 (8%); from Valle del Cauca 50 (3,5%) and from other provinces 33 (2.3%). CONCLUSION Of the analyzed isolates, 1,424 (89%) belonged to L. monocytogenes, showing a good quality in isolation and identification. Most of these isolates belonged to serotype 4b, 820 (57.6%), a highly virulent serotype. Obligatory surveillance of this microorganism is recommended.