Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720110003&lang= vol. 139 num. 3 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Prevalence of zinc and copper deficiencies in older subjects living in Metropolitan Santiago</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300001&lng=&nrm=iso&tlng= Background: Older subjects have a high risk of developing zinc and copper deficiencies. Aim: To determine the prevalence of copper and zinc deficiencies in adults aged over 60 years, living in Metropolitan Santiago. Subjects and Methods: Analyses were performed using anonymous serum samplesfrom older subjects living in Santiago, Chile, who participated in the multicenter project SABE. Of the studied subjects, 49.3% had enough left over serum to measure serum zinc and copper concentrations by atomic absorption spectrometry. Results: A total of444 men and 198 women were studied. A positive correlation between serum zinc and copper was found in both women (r = 0.44, p < 0.001) and men (r = 0.48, p < 0.001). There were no differences in serum zinc concentration by sex and age. The prevalence of subnormal serum zinc valúes was 66.9% in women and 66.7% in men. Women had a significantly higher serum copper valúes than men (p < 0.02) and there were no differences by age. Prevalence of subnormal serum copper valúes was higher in women than in men (32.9 and 23.7% respectively, p < 0.05). Women had significantly higher copper I zinc serum ratio than men (p < 0.001). Conclusions: Older people living in Metropolitan Santiago have a high prevalence of copper and zinc deficiencies. <![CDATA[<b>Risk factors for a high carotid intima media thickness among healthy adults</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300002&lng=&nrm=iso&tlng= Background: Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors. Aim: To determine attributable risk factors for a high CIMT among healthy adults. Material ana Methods: A sample of 1270 individuáis (636 males and 634 femóles) aged 44 ±11 years, was studied. Blood pressure, weight, height, lipidprofile and blood glucose were measured in all. CIMT and thepresence of atheroscleroticplaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes. Results: Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and thepresence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57%, respectively. Conclusions: In this sample, the main risk factor for a high CIMT was hypertension. <![CDATA[<b>Cytogenetic and molecular profile of genetic diseases in Puerto Montt main hospital</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300003&lng=&nrm=iso&tlng= Background: Chromosome aberrations (CA) are the main etiology of múltiple congenital malformations, recurrent abortions and intellectual disability (ID) specifically of modérate and severe degree. They accountfor 0.3 to 1% of newborns (NB) and 6 of 10,000 NB have chromosome imbalances with submicroscopic deletions or duplications smaller than 10 MB that are overlooked by conventional cytogenetic studies. Aim: To report the results of cytogenetic and molecular studies performed in patients with a congenital malformation disease or ID with or without dysmorphic features, attended in a regional hospital. Patients and Methods: One hundred and eighty patients, 27 with a clinical diagnosis ofDown syndrome, derivedfor the sus-picion of a genetic disease, were studied. A karyogram was performed in all ofthem and in 30 cases additional molecular studies, such as fluorescence in situ hybridization (FISH) orpolymerase chain reaction (PCR) were carried out. Results: Amongthe 153 patients without Down syndrome, 20 (13%) had a genetic abnormality responsible for the altered phenotype. Sixteen had a chromosome aberration (structural and numerical aberrations in 75 and 25% respectively) andfour had genetic molecular alterations. Additional studies were performed to confirm or better characterize the chromosome aberration in 13 ofthe 30 patients in whom these were requested. Conclusions: Chromosome and specific genetic molecular studies in selected cases help to characterize patients with genetic diseases. The collaboration between academic and health care facilities is crucial. <![CDATA[Association of age with sperm DNA fragmentation]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300004&lng=&nrm=iso&tlng= Background: There is an association between aging ana an increased number ofsperms with alterations in nuclear DNA. Aim: To study the association between age and fragmentation of sperm DNA. Material andMethods: Sixty two volunteers provided semen for analysis. These were separated in a group aged less than forty years and a second group aged more than forty years. Sperm DNA fragmentation was studied by TÚNEL (terminal deoxynucleotidyl transferase-mediated2'-deoxyuridine 5'-triphosphate nick end-labeling) and SCD (sperm chromatin dispersión test) assays. Results: Compared with theiryounger counterparts, patients aged more than 40years had a higher proportion ofsperms with DNA fragmentation by TÚNEL (20 ±1.3 and24 ± 1.9% respectively, p < 0.05) and SCD (22 ± 1.4 and26 ± 1.6% respectively, p < 0.05). The results ofboth assays had a correlation coefficientofO.8. No differences between groups were observed for other seminal parameters. Conclusions: Sperm DNA fragmentation increases with age in males. <![CDATA[<b>Health related quality of life among patients with type 2 diabetes mellitus</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300005&lng=&nrm=iso&tlng= Background: Type 2 diabetes mellitus may affect profoundly the quality oflife of patients. Aim: To assess health related quality oflife among patients with Type 2 Diabetes Mellitus. Material ana Methods: The Diabetes Quality ofLife (DQOL) questionnaire was applied to 296patients with diabetes mellitus aged 63 ± lOyears (201 women) seen in primary health care centers. Results: The concern about the future effects of diabetes was the worst evaluated domain. Women perceived a lower health related quality oflife than men. There was an inverse correlation between age and satisfaction with treatment, concern about vocational, social and future effects of the disease. Conclusions: Type 2 diabetes affects health related quality of life, especially in some specific domains such as perception of the future. <![CDATA[<b>Clinical impact of pandemic influenza A H1N1 in a Chilean regional hospital</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300006&lng=&nrm=iso&tlng= Background: Pandemic flu (H1N1 ) strongly affected southern Chile during2009. Aim: To report the logistic and organizational changes implemented at a regional hospital to face the pandemic. Material and Methods: All patients with flu like disease that were hospitalized, were prospectively enrolled at the Puerto Montt hospital. A nasopharyngeal aspirate was obtained in all for influenza virus A and B direct immunofluorescence and polymerase chain reaction (PCR). All epidemiological and clinical data of patients were recorded. Results: Between May 29 and July 7, 2009, 184 adults were admitted to the hospital and in 117patients aged 41 ± 18 years (56% females ), direct immunofluorescence was positive for influenza. In 67 of these patients PCR did not confirm the disease. These unconfirmed patients had a mean age of 49 ± 19 years (p < 0.01, compared with confirmed cases) and had a lower frequency of fever, rhinorrhea and chills. No significant differences in the incidence of community acquired pneumonia or chest X ray findings were observed between confirmed and unconfirmed cases. Hospital stay was over 15 days in 14% of confirmed cases and 5% of unconfirmed cases (p = 0.03). Fifteen patients, aged 53 ± 18 years, died. Conclusions: Low sensibility of direct immunofluorescence and delay in obtaining PCR confirmation of influenza posed a problem for the management of these patients. <![CDATA[<b>Changes long term prognosis of 17 patients with pulmonary artery hypertension</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300007&lng=&nrm=iso&tlng= Background: Pulmonary artery hypertension (PAH) is a progressive disease with high mortality. Major advances had been made in the treatment of this condition during the last decade. Aim: To characterize the clinical evolution and mortality of a cohort of Chilean patients. Material and Methods: Seventeen patients with PAH diagnosed in the last 10 years in two Chilean hospitals were enrolled. Measurements at diagnosis included hemodynamic variables and 6-minute walk test. The patients were followed clinically for 3 years and the observed mortality was compared with that predicted by the prognostic equation proposed by the historic registry of the National Institutes of Health (NIH). Results: The mean age of patients was 45 years and 80% had an idiopathic PAH. The mean median pulmonary artery pressure was 57 ± 15 mmHg, the cardiac index was 2.4 ± 0.7 l/min/m² and the right atrial pressure was 12 ± 8 mmHg. The 6-minute walk distance was 348 ± 98 m. All patients received anticoagulants. Eighty two percent received ambrisentan, 12% received bosentan, 29% received iloprost and 24% sildenafil. At the end of follow-up only 3 patients had died, with an observed survival rate of88, 82 and 82% at 1, 2 and 3 years, respectively. In contrast, the survival calculated according to the predictive formula of the NIH was 67, 56 and 45%, respectively. Among surviving patients, an improvement in exercise capacity was observed after one year (p < 0.05). Conclusions: The observed survival rate was significantly better than that estimated according to historical data. Furthermore, therapy was associated with an improvement in functional capacity after one year. This prognostic improvement is consistent with data of other contemporary registries published after the NIH Registry. <![CDATA[<b>Hypovitaminosis</b><b> D in pediatric patients on renal replacement therapy</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300008&lng=&nrm=iso&tlng= Background: Hypovitaminosis D has a high prevalence among patients with chronic kidney disease (CKD). Aim: To determine the prevalence of 25 hydroxy vitamin D (25(OH) D) insufficiency and deficiency in pediatric patients on dialysis and kidney transplantation. Material and Methods: Serum calcium and phosphorus, parathormone (PTH), alkaline phosphatases and 25 (OH)D were measured in 13 children on hemodialysis (HD), 18 on peritoneal dialysis (PD) and 53 that received an allograft (Tx), aged 9.8 ± 4.6 years (51% females). Results: Fifty four percent of patients had height Z score less than -1.88. Patients on HD had the lowest values. The average time of replacement therapy was 2.9 ± 2.8 years. Mean 25(OH)D levels in all was 18.7 ± 10.7ng/ml (HD: 21 ± 16.8, PD: 18.9 ± 8.5, Tx: 18.1 ± 9.72 ng/ml). Eighty eight percent of patients had levels below 30 ng/ml. Mean of serum calcium was 9.5 ± 0.64 mg/dl, serum phosphorus 5.03 ± 1.02 mg/dl, calcium-phosphorus product 48 ± 11.8 mg/dl and alkaline phosphatases 300.5 ± 171.3 IU/L. Average PTH values in dialyzed and Tx patients were 724.6 ± 640.5 and 107.7 ± 56.2 pg/ml, respectively (p < 0.001). A positive correlation between 25 (OH) D and calcium levels among PD patients was observed (r = 0.490, p = 0.04). Conclusions: Hypovitaminosis D is highly prevalent among children on renal substitution therapy, regardless of the type of therapy used and the stage of renal failure. <![CDATA[<b>Validation of the University of Southern California Repeatable Episodic Memory Test</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300009&lng=&nrm=iso&tlng= Background: Memory is affected differently with the passage of time; specifically, episodic memory presents a clear decline. There is a relationship of this memory impairment and degenerative and psychiatric diseases. Aim: To determine the reliability and validity of the University of Southern California Repeatable Episodic Memory Test (USC-REMT) in a sample of Chilean adults. Material and Methods: The instrument was administered to 178 subjects living in the Metropolitan Region of Santiago. The sessions were individual, during the morning, lasting approximately 15 minutes. Results: The ANOVA indicates that subjects over 61 years old had lower scores in the test than their younger counterparts. There was an inverse correlation between age and success in "Free recall" (r =- 0.570), "Recognition indicating yes-no" (r = -0.412) and "forced-choice recognition" (r =- 0.371). Regression analysis showed that age explained 32.1 % "free recall" variance. The three components were grouped into a single factor. Conclusions: The USC-REMT meets the criteria for validity and reliability to be applied for clinical and research purposes. <![CDATA[<b>Tako-Tsubo syndrome</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300010&lng=&nrm=iso&tlng= Tako-Tsubo syndrome resembles an acute myocardial infarction in symptoms, laboratory parameters and electrocardiographic changes. However, angiography does not show evidence of coronary occlusion, and typically an apical ballooning ofthe ventricle in systole is observed. We report a 78-year-old woman with no coronary risks factors, admitted to the emergency room due to acute chestpain and an electrocardiogram compatible with an acute coronary syndrome with ST elevation. Serum troponin and creatin-kinase (MB fraction) were elevated. An emergency coronary angiography did not show a coronary occlusion. Due to the apical ballooning observed in the left ventriculography, aprobable diagnosis of Tako-Tsubo was proposed. The patient had a favorable evolution. A treadmill test, echocardiogram and myocardial perfusión SPECT, performed one month later, disclosed no abnormalities. <![CDATA[<b>Trans-esophageal echocardiography in non-cardiac surgery</b>: <b>Report of four illustrating cases</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300011&lng=&nrm=iso&tlng= Transesophageal echocardiography can assess ventricular filling ana contraction ana detect motility disturbances secondary to ischemia. In non-cardiac surgery it can be extremely helpful to monitor complexpatients. We report a 69-year-old mole subjected to a hepatic lobectomy, a 59-year-old mole with hepatorenal syndrome, a 52-year-old femóle subjected to a gastric bypass, and a 54-year-old mole subjected to a thyroidectomy. In these four cases, left ventricular motility and preload were evaluated with transesophageal echocardiography, and itwas ofgreat aid in decision-making during anesthesia. <![CDATA[Acquired hemophilia a treated with rituximab. Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300012&lng=&nrm=iso&tlng= We report a 54-year-old male presenting with a history or recurrent nose bleeds and ecchymoses. The coagulation study showed a prolongedpartial thromboplastin time, a factor VIII of 8% and a high inhibitor titer (193 Bethesda units). A diagnosis of acquired hemophilia A was reached. The patient was initially treated with cyclophosphamide for seven months without response. Therefore rituximab in doses of 375 mglm²Iweek for four weeks was started. After starting treatment, the patient had a hematoma in the psoas muscle with a concomitantfactor VIII ofless than 5%, thatwas treated with local measures. Thereafter, aprogressive reduction in inhibitor titers was observed, until its disappearance atfive months of treatment. Factor VIII levéis normalized and the patient has not experienced abnormal bleeding episodes. The patient remains in remission after 67 months offollow up. Rituximab, a chimeric monoclonal antibody against theprotein CD 20 is an effective treatment in acquired hemophilia A. <![CDATA[<b>Olfactory sensory perception</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300013&lng=&nrm=iso&tlng= The five senses have had a fundamental importance for survival and socialization of human beings. From an evolutionary point of view the sense of smell is the oldest. This sense has a strong representation within the genome, allowing the existence of many types of receptors that allow us to capture multiple volatile odor producing molecules, sending electrical signals to higher centers to report the outside world. Several cortical areas are activated in the brain, which are interconnected to form an extensive and complex neural network, linking for example, areas involved with memory and emotions, thus giving this sense of perceptual richness. While the concept of fl avor is largely related to the sense of taste, smell provides the necessary integration with the rest of the senses and higher functions. Fully understanding the sense of smell is relevant to health professionals. Knowing the characteristics of the receptors, the transduction processes and convergence of information in the higher centers involved, we can properly detect olfactory disorders in our patients. <![CDATA[<b>Vasoplegic</b><b> syndrome and its treatment with vasopressin during cardiac surgery with cardiopulmonary bypass</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300014&lng=&nrm=iso&tlng= Cardiac surgery with cardiopulmonary bypass is associated with systemic inflammatory response. In some cases this clinical condition is characterized by severe hypotension due to low systemic vascular resistance during and after cardiopulmonary bypass. Afew ofthese cases do not respond to volume or catecholamines. This condition is known as vasoplegic syndrome. Its etiology is notfully understood today and carries associated morbidity and mortality In this syndrome, vasopressin levéis are reduced, as in septic and hypovolemic shock. Supplementary vasopressin improves blood pressure and might be considered as an alternative treatment. Severa! reports have shown benefits when used alone or in combination with catecholamines. However, further studies are necessary to find the most appropriate use ofthe drug for vasoplegic syndrome. <![CDATA[<b>Treatment and prevention of cáncer treatment related oral mucositis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300015&lng=&nrm=iso&tlng= One ofthe most common and troublesome complications ofmodern intensive anticancer treatments is oral mucositis. The purpose ofthis review is to summarize current evidente and clinical guidelines regarding its prevention and therapy. The use of keratinocyte growth factor-1, supplementary glutamine and other recently developed treatment modalities are discussed. The injury ofthe oral mucosa caused by antineoplastic agents promotes the local expression of múltiple pro-inflammatory and pro-apoptotic molecules and eventually leads to the development of ulcers. Such lesions predispose patients to several infectious and nutritional complications. Also, they lead to modification of treatment schedules, potentially affecting overall prognosis. Local cryotherapy with ice chips and phototherapy with low energy láser may be useful as preventive measures. Mouthwashes with allopurinol and phototherapy with low energy láser can be used as treatment. In radiotherapy, special radiation administration techniques should be used to minimize mucosal injury. Pain control should always be optimized, with the use ofpatient controlled analgesia and topical use of morphine. Supplemental glutamine should not be used outside of research protocols. Lastly, thorough attention should bepaid to general care and hygiene measures. <![CDATA[<b>Mechanical ventilation in patients with acute brain injury</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300016&lng=&nrm=iso&tlng= In about20% of patients admitted to an Intensive Care Unit (ICU) the indica-tion of mechanical ventilation (MV) is a neurological disease. These patients have a prolonged MV stay and high mortality. The appropriate use of MV in patients with acute brain injury (ABI) is critica! considering that MV by itself is oble to induce or worsen an underlying lung injury. Patients with ABI have a higher risk to develop pulmonary complications. During endotracheal intubation the activation of airway reflexes should beprevented, because they may increase intracranialpressure. Tracheostomy is indicated to improve airway management and it is performed in about 33% of these patients. Indications for MV are loss of spontaneous respira-tory effort, changes in lung compliance, gas exchange impairment and ventilatory failure due to muscle fatigue or neuromuscular junction dysfunction. During MV, hypoxemia should be avoided. The pC0(2) level has a critica! role in cerebral blood flow regulation; therefore a normal pCO must be maintained in order to guarantee an optimal cerebral blood flow. Despite that, hypocapnia has been used in patients with increased intracranial pressure, at the present it is not recommended. Its use should be limited to the emergency management of intracranial hypertension, while the underlying cause is beingtreated. Non-conventional ventilatory modes asprone position ventilation, high-frequency oscillatory ventilation and extracorporeal C02 removal can be used in patients with ABI. All ofthem have specific risks and should be employed cautiously This paper reviews upper airway management and MV in patients with acute brain injury. <![CDATA[<b>Masters of Internal Medicine, in Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300017&lng=&nrm=iso&tlng= In about20% of patients admitted to an Intensive Care Unit (ICU) the indica-tion of mechanical ventilation (MV) is a neurological disease. These patients have a prolonged MV stay and high mortality. The appropriate use of MV in patients with acute brain injury (ABI) is critica! considering that MV by itself is oble to induce or worsen an underlying lung injury. Patients with ABI have a higher risk to develop pulmonary complications. During endotracheal intubation the activation of airway reflexes should beprevented, because they may increase intracranialpressure. Tracheostomy is indicated to improve airway management and it is performed in about 33% of these patients. Indications for MV are loss of spontaneous respira-tory effort, changes in lung compliance, gas exchange impairment and ventilatory failure due to muscle fatigue or neuromuscular junction dysfunction. During MV, hypoxemia should be avoided. The pC0(2) level has a critica! role in cerebral blood flow regulation; therefore a normal pCO must be maintained in order to guarantee an optimal cerebral blood flow. Despite that, hypocapnia has been used in patients with increased intracranial pressure, at the present it is not recommended. Its use should be limited to the emergency management of intracranial hypertension, while the underlying cause is beingtreated. Non-conventional ventilatory modes asprone position ventilation, high-frequency oscillatory ventilation and extracorporeal C02 removal can be used in patients with ABI. All ofthem have specific risks and should be employed cautiously This paper reviews upper airway management and MV in patients with acute brain injury. <![CDATA[<b>Jonathan Swift's scientific contribution on his "Gulliver's Travels"</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300018&lng=&nrm=iso&tlng= Jonathan Swift is one of the most celebrated satirist writers in literature. His well-known "Gulliver's Travels", apartfrom being a serious human being criticism, contains many interesting ana unrecognized comments about medical and other scientific facts. Swift made what seems to be thefirst account of a dementing illness in the elderly; his description fits well with what we now know as Alzheimer's disease. He also described a condition now called synaesthesia, a very interestingphenomenon that may contribute to creativity. In thispaper, we review aspects ofhis Ufe and reveal these amazing descriptions as samples of Swift's extraordinary power of observation. <![CDATA[<b>Human pregnancy, a biological paradigm of tolerance and adaptation</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300019&lng=&nrm=iso&tlng= This review analyses the changes in immunological tolerance, and the systemic and local hemodynamic changes observed along human pregnancy. To underscore the conceptual importance of tolerance and adaptation the background isprovided by the two main advocates ofthese ideas: Gandhi and Darwin. The cognate factors that determine immunological tolerance (IT), systemic (SA) and local adaptation (LA) are múltiple; IT = desensitisation to paternal antigens, absence of HLA-A, roles of HLA-G, natural killer cells and their receptors; SA = decreased vascular resistance, plasma volume expansión, increased cardiac output and plasma renin activity; LA = prostacyclin, nitric oxide, kallikrein-kinin system, vasodilator arm of the renin angiotensin system, vascular endothelial growth factor (VEGF). A possible role of vasodilators in the crucial process of trophoblast invasión and uterine artery transformation is supported. The relevance ofan adequate adaptation to pregnancy is highlighted not only by the intragestational complications derivedfrom a defective process, such as intrauterine growth restriction, preterm birth, and preeclampsia -its foremost expression- but also by the long term cardiovascular complications ofthe mother and her offspring. <![CDATA[<b><i>Training in Neuropsychiatry</i></b>: <b><i>A National need?</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000300020&lng=&nrm=iso&tlng= This review analyses the changes in immunological tolerance, and the systemic and local hemodynamic changes observed along human pregnancy. To underscore the conceptual importance of tolerance and adaptation the background isprovided by the two main advocates ofthese ideas: Gandhi and Darwin. The cognate factors that determine immunological tolerance (IT), systemic (SA) and local adaptation (LA) are múltiple; IT = desensitisation to paternal antigens, absence of HLA-A, roles of HLA-G, natural killer cells and their receptors; SA = decreased vascular resistance, plasma volume expansión, increased cardiac output and plasma renin activity; LA = prostacyclin, nitric oxide, kallikrein-kinin system, vasodilator arm of the renin angiotensin system, vascular endothelial growth factor (VEGF). A possible role of vasodilators in the crucial process of trophoblast invasión and uterine artery transformation is supported. The relevance ofan adequate adaptation to pregnancy is highlighted not only by the intragestational complications derivedfrom a defective process, such as intrauterine growth restriction, preterm birth, and preeclampsia -its foremost expression- but also by the long term cardiovascular complications ofthe mother and her offspring.